Aim: Patient expectations for an ideal AP system demand creative and attractive solutions in order to maintain engagement and positively impact glucose levels in young persons with T1D. To explore pediatric opinions on optimizing glycemic benefits of AP systems, we interviewed children, teens, and young adults with T1D experienced with diabetes technologies.
Methods: Semi-structured interviews were conducted at two diabetes centers in 39 youth with T1D, ages 10-25 years and T1D duration for ≥1 year. Interview transcripts were coded and reviewed using thematic analysis. Participants (72% female, 82% white) had mean±SD age of 17.0±4.7 years, T1D duration 9.4±4.9 years, and A1c 8.4±1.1%; 79% were pump-treated and 82% were CGM users.
Results: Participants most often suggested an ideal system would improve glucose and A1c by: 1) recognizing and managing glucose trends related to food and exercise; 2) adjusting insulin doses for glucose variations and/or incorporating a mitigation for hypoglycemia (glucagon, glucose, etc.); and 3) providing conveniences to maintain engagement (easy to use, smaller sites/devices, better adhesives, longer-lasting infusion sets/sites, remote monitoring from an app, mobile phone, etc.). While most participants preferred a fully automated system, many preferred to continue manual meal-time bolusing in order to avoid any limits on carbohydrate intake. Other aspects of an ideal system included adjustments for alcohol, auto-insertions, automatic upgrades, increased battery life, personalized algorithms, and the ability to override the system due to concerns about trust.
Conclusion: Stakeholders should be encouraged that young persons with T1D recognize potential glycemic benefits of AP systems, even without full automation. Understanding and incorporating the features preferred by young persons with T1D into the designs of AP systems will be necessary to maximize uptake and maintain durable AP use.
P.V. Commissariat: None. L. Roethke: None. J.L. Finnegan: None. L.K. Volkening: None. D.E. McGill: None. E. Dassau: Consultant; Self; Eli Lilly and Company, Insulet Corporation. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Ltd., Insulet Corporation, Roche Diabetes Care, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker's Bureau; Self; Roche Diabetes Care. Other Relationship; Self; ModAGC. S.A. Weinzimer: Consultant; Self; Eli Lilly and Company, Sanofi. Consultant; Spouse/Partner; Tandem Diabetes Care. Consultant; Self; Zealand Pharma A/S. Speaker's Bureau; Self; Insulet Corporation, Medtronic MiniMed, Inc., Tandem Diabetes Care. Stock/Shareholder; Self; InsuLine Medical Ltd. L.M. Laffel: Advisory Panel; Self; Lilly Diabetes, Novo Nordisk A/S, Roche Diabetes Care, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Janssen Pharmaceuticals, Inc., UpToDate.
National Institutes of Health (DP3DK113511, DP3DK104057, T32DK007260, P30DK036836, K12DK094721)