New research from the ACBRD looked into how hybrid closed-loop affects well-being, distress, and fear of hypos
By Alison Robinson and Jennifer Halliday
Hybrid closed-loop is medical device which helps people to manage their type 1 diabetes. It combines an insulin pump and continuous glucose monitor. It measures the wearer’s glucose levels and adjusts the amount of insulin they receive accordingly.
There has been lots of research into the safety and effectiveness of diabetes technologies. For example, hybrid closed-loop helps people keep their glucose levels in range. And they alert the person, via an alarm, if their glucose levels get too high or low. This helps to keep them safe. But there is very little research about the psychological effects of hybrid closed-loop.
Our research aimed to find out how hybrid closed-loop affects people’s psychological health and well-being. The paper was led by ACBRD researcher Jennifer Halliday.
Who took part in the study?
The 120 adults with type 1 diabetes who took part in this study were part of a 6-month trial testing the effectiveness of hybrid closed-loop. During the study they visited diabetes clinics in Melbourne, Adelaide, Sydney, Hobart, or Perth, at least 12 times. The clinic visits involved diabetes education, medical reviews, and data collection (surveys, HbA1c, heart checks, and sleep diaries).
Participants were randomly put into one of two groups. Half kept using their usual diabetes treatment (insulin injections or pump, without continuous glucose monitoring). The other half used a hybrid closed-loop (Medtronic 670g).
What did the study measure?
The people who took part filled-in psychological surveys at the start, middle (3-month follow-up) and end (6-month follow-up) of the study. The surveys included person-reported outcome measures (questions about the person with diabetes’ experiences or perspectives) about:
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- Diabetes positive well-being,
- Diabetes distress,
- Diabetes quality of life,
- Fear of hypoglycaemia (low glucose level, also called a ‘hypo’),
- Awareness of hypo symptoms,
- Diabetes treatment satisfaction.
What did the results show?
By the end of the six months, people who used hybrid closed-loop had:
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- Higher diabetes positive well-being. E.g. They felt more positive about diabetes and able to cope better with diabetes challenges.
- Lower diabetes distress. E.g. Diabetes felt like less of a problem, emotionally.
- Lower fear of hypos. E.g. They were less worried about having a hypo.
- Fewer glucose levels which they viewed to be ‘too high’.
Hybrid closed-loop did not improve:
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- Diabetes quality of life. E.g. How diabetes affected their lives, such as their physical health, relationships, work/study, emotions, and finances.
- Awareness of hypo symptoms. E.g. The extent to which they felt the onset of hypos.
- Glucose levels which they viewed to be ‘too low’.
- Diabetes treatment satisfaction. E.g. How convenient, flexible, and effective they felt their diabetes treatment was.
What does this mean?
This study helps us to better understand how diabetes technology affects people’s psychological health. The results show hybrid closed-loop can support improved well-being. Yet, what is a good fit for one person’s diabetes management may not be a good fit for another. People with diabetes should be able to choose glucose monitoring and insulin delivery methods that best suits their needs.
Reference
Halliday JA, Russell-Green S, Lam B, Trawley S, McAuley SA, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Holmes-Walker DJ et al. Six months of hybrid closed-loop therapy improves diabetes-specific positive well-being, and reduces diabetes distress and fear of hypoglycemia: secondary analysis of a randomized controlled trial. BMJ Open Diabetes Research & Care. 2024 22;12(6):e004428.
Read more
Want to know more about what adults with type 1 diabetes say about how hybrid closed-loop affects their daily life? Check out this blog.
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