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What Training, Support, and Resourcing Do Health Professionals Need to Support People Using a Closed-Loop System? A Qualitative Interview Study with Health Professionals Involved in the Closed Loop from Onset in Type 1 Diabetes (CLOuD) Trial.

Accepted version
Peer-reviewed

Type

Article

Change log

Authors

Kimbell, Barbara 
Rankin, David 
Ashcroft, Nicole L 
Varghese, Lidiya 
Allen, Janet M 

Abstract

Background: We explored health professionals' views about the training, support, and resourcing needed to support people using closed-loop technology in routine clinical care to help inform the development of formal guidance. Methods: Interviews were conducted with health professionals (n = 22) delivering the Closed Loop from Onset in Type 1 Diabetes (CLOuD) trial after they had ≥6 months' experience of supporting participants using a closed-loop system. Data were analyzed descriptively. Results: Interviewees described how, compared with other insulin regimens, teaching and supporting individuals to use a closed-loop system could be initially more time-consuming. However, they also noted that after an initial adjustment period, users had less need for initiating contact with the clinical team compared with people using pumps or multiple daily injections. Interviewees highlighted how a lessened need for ad hoc clinical input could result in new challenges; specifically, they had fewer opportunities to reinforce users' diabetes knowledge and skills and detect potential psychosocial problems. They also observed heightened anxiety among some parents due to the constant availability of data and unrealistic expectations about the system's capabilities. Interviewees noted that all local diabetes teams should be empowered to deliver closed-loop system care, but stressed that health professionals supporting closed-loop users in routine care will need comprehensive technology training and standardized clinical guidance. Conclusion: These findings constitute an important starting point for the development of formal guidance to support the rollout of closed-loop technology. Our recommendations, if actioned, will help limit the potential additional burden of introducing closed-loop systems in routine clinical care and help inform appropriate user education and support.

Description

Keywords

Closed-loop system, Health professional, Qualitative Study, Training, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Health Personnel, Humans, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Qualitative Research

Journal Title

Diabetes Technol Ther

Conference Name

Journal ISSN

1520-9156
1557-8593

Volume Title

22

Publisher

Mary Ann Liebert Inc

Rights

All rights reserved
Sponsorship
Department of Health (via National Institute for Health Research (NIHR)) (EME 14/23/09)
Wellcome Trust (100574/B/12/Z)
Helmsley Charitable Trust (#2016PG-T1D045)
Cambridge University Hospitals NHS Foundation Trust (CUH) (146281)
Wellcome Trust (100574/Z/12/Z)
NIHR Evaluation Trials and Studies Coordinating Centre (14/23/09)
NIHR Wellcome Trust Strategic Award (100574/Z/12/Z)