Affiliation:
1. Department of Psychology The Cairnmillar Institute Melbourne Victoria Australia
2. Department of Medicine The University of Melbourne Melbourne Victoria Australia
3. Department of Endocrinology and Diabetes St Vincent's Hospital Melbourne Melbourne Victoria Australia
4. Department of Diabetes and Endocrinology Royal Melbourne Hospital Melbourne Victoria Australia
5. Australian Centre for Accelerating Diabetes Innovations The University of Melbourne Melbourne Victoria Australia
Abstract
AbstractAimsFirst‐generation closed‐loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real‐world lived experience of older adults using closed‐loop therapy outside a trial environment.MethodsSemi‐structured interviews were conducted with older adults who were pre‐existing insulin pump users and previously completed the OldeR Adult Closed‐Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation.ResultsTwenty‐eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608–694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed‐loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed‐loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring‐associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some.ConclusionsAlmost 2 years after completing a closed‐loop clinical trial, closed‐loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real‐world successful use of diabetes technology. Identifying age‐related barriers, and solutions, to diabetes technology use among older adults is warranted.
Funder
Diabetes Australia
Juvenile Diabetes Research Foundation United States of America
Subject
Endocrinology,Endocrinology, Diabetes and Metabolism,Internal Medicine