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

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Stewart, ZA 
Barnard, K 
Murphy, HR 


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, eight participants felt less worry about overnight hypoglycaemia and that diabetes 'did not run their lives'; however, five reported that closed-loop increased time thinking about diabetes, and three 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.



Adolescent, Adult, Biosensing Techniques, Blood Glucose, Blood Glucose Self-Monitoring, Cross-Over Studies, Diabetes Mellitus, Type 1, Female, Humans, Insulin, Insulin Infusion Systems, Middle Aged, Patient Satisfaction, Pregnancy, Pregnancy in Diabetics, Surveys and Questionnaires, Young Adult

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Diabet Med

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Cambridge University Hospitals NHS Foundation Trust (CUH) (BRC 2012-2017)
Wellcome Trust (100574/Z/12/Z)
TCC (None)
Diabetes UK (None)