Rollout of closed-loop technology to pregnant women with type 1 diabetes: Healthcare professionals' views about potential challenges and solutions

Rankin, David, Hart, Ruth, Kimbell, Barbara, Barnard-Kelly, Katharine, Brackenridge, Anna, Byrne, Caroline, Collett, Corinne, Dover, Anna R., Hartnell, Sara, Hunt, Katharine F., Lee, Tara T. M. ORCID:, Lindsay, Robert S., McCance, David R., McKelvey, Alastair, Rayman, Gerry, Reynolds, Rebecca M., Scott, Eleanor M., White, Sara L., Hovorka, Roman, Murphy, Helen R. and Lawton, Julia (2023) Rollout of closed-loop technology to pregnant women with type 1 diabetes: Healthcare professionals' views about potential challenges and solutions. Diabetes Technology & Therapeutics, 25 (4). pp. 260-269. ISSN 1520-9156

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Aims: To explore healthcare professionals' views about the training and support needed to rollout closed-loop technology to pregnant women with type 1 diabetes. Methods: We interviewed (n = 19) healthcare professionals who supported pregnant women using CamAPS FX closed-loop during the Automated insulin Delivery Amongst Pregnant women with Type 1 diabetes (AiDAPT) trial. Data were analyzed descriptively. An online workshop involving (n = 15) trial team members was used to inform recommendations. Ethics approvals were obtained in conjunction with those for the wider trial. Results: Interviewees expressed enthusiasm for a national rollout of closed-loop, but anticipated various challenges, some specific to use during pregnancy. These included variations in insulin pump and continuous glucose monitoring expertise and difficulties embedding and retaining key skills, due to the relatively small numbers of pregnant women using closed-loop. Inexperienced staff also highlighted difficulties interpreting data downloads. To support rollout, interviewees recommended providing expert initial advice training, delivered by device manufacturers together with online training resources and specific checklists for different systems. They also highlighted a need for 24 h technical support, especially when supporting technology naive women after first transitioning onto closed-loop in early pregnancy. They further recommended providing case-based meetings and mentorship for inexperienced colleagues, including support interpreting data downloads. Interviewees were optimistic that if healthcare professionals received training and support, their long-term workloads could be reduced because closed-loop lessened women's need for glycemic management input, especially in later pregnancy. Conclusions: Interviewees identified challenges and opportunities to rolling-out closed-loop and provided practical suggestions to upskill inexperienced staff supporting pregnant women using closed-loop. A key priority will be to determine how best to develop mentorship services to support inexperienced staff delivering closed-loop.

Item Type: Article
Additional Information: Funding Information: This project (NIHR 16/35/01) is funded by the Efficacy and Mechanism Evaluation (EME) Programme, an MRC and NIHR partnership. Additional support for the artificial pancreas work has been provided by the National Institute for Health Research Cambridge Biomedical Research Centre, JDRF, and Wellcome Strategic Award (100574/Z/12/Z). Dexcom supplied discounted continuous glucose monitoring devices. For the purpose of open access, the author has applied aC C-BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled Keywords: closed-loop system,continuous glucose monitoring,healthcare professional,pregnancy,qualitative research,type 1 diabetes,medical laboratory technology,endocrinology,endocrinology, diabetes and metabolism,sdg 3 - good health and well-being ,/dk/atira/pure/subjectarea/asjc/3600/3607
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Norwich Clinical Trials Unit
Faculty of Medicine and Health Sciences > Research Groups > Cardiovascular and Metabolic Health
Faculty of Medicine and Health Sciences > Research Centres > Metabolic Health
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Depositing User: LivePure Connector
Date Deposited: 14 May 2024 09:32
Last Modified: 20 May 2024 08:30
DOI: 10.1089/dia.2022.0479


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