Experiences of closed-loop insulin delivery among pregnant women with Type 1 diabetes

C. Farrington, Z. A. Stewart, K. Barnard, R. Hovorka, H. R. Murphy

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Abstract

Aims: To explore the experiences of pregnant women with Type 1 diabetes, and the relationships between perceptions of glucose control, attitudes to technology and glycaemic responses with regard to closed-loop insulin delivery.

Methods: We recruited 16 pregnant women with Type 1 diabetes [mean ± sd age 34.1 ± 4.6 years, duration of diabetes 23.6 ± 7.2 years, baseline HbA1c 51±5 mmol/mol (6.8 ± 0.6%)] to a randomized crossover trial of sensor-augmented pump therapy vs automated closed-loop therapy. Questionnaires (Diabetes Technology Questionnaire, Hypoglycaemia Fear Survey) were completed before and after each intervention, with qualitative interviews at baseline and follow-up.

Results: Women described the benefits and burdens of closed-loop systems during pregnancy. Feelings of improved glucose control, excitement and empowerment were counterbalanced by concerns about device visibility, obsessive data checking and diminished attentiveness to hyper- and hypoglycaemia symptoms. Responding to questionnaires, 80% of participants felt less worry about overnight hypoglycaemia and that diabetes ‘did not run their lives’; however, 45% reported that closed-loop increased time thinking about diabetes, and 33% felt it made sleep and preventing hyperglycaemia more problematic. Women slightly overestimated their glycaemic response to closed-loop therapy. Most became more positive in their technology attitudes throughout pregnancy. Women with more positive technology attitudes had higher degrees of overestimation, and poorer levels of glycaemic control.

Conclusions: Women displayed complex psychosocial responses to closed-loop therapy in pregnancy. Perceptions of glycaemic response may diverge from biomedical data.
Original languageEnglish
Pages (from-to)1461–1469
Number of pages9
JournalDiabetic Medicine
Volume34
Issue number10
Early online date20 Jun 2017
DOIs
Publication statusPublished - Oct 2017

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