Women's and Partners' Experiences With a Closed-loop Insulin Delivery System to Manage Type 1 Diabetes in the Postpartum Period

Maira Quintanilha; Jennifer M Yamamoto; Breanne Aylward; Denice S Feig; Patricia Lemieux; Helen R Murphy; Ronald J Sigal; Josephine Ho; Heidi Virtanen; Susan Crawford; Lois E Donovan; Rhonda C Bell

doi:10.1016/j.jcjd.2024.08.005

Women's and Partners' Experiences With a Closed-loop Insulin Delivery System to Manage Type 1 Diabetes in the Postpartum Period

Can J Diabetes. 2024 Sep 3:S1499-2671(24)00176-X. doi: 10.1016/j.jcjd.2024.08.005. Online ahead of print.

Authors

Affiliations

¹ Division of Human Nutrition, Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.
² Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada; Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.
³ School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
⁴ Department of Medicine University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario, Canada; Sinai Health System, Mount Sinai Hospital, Toronto, Ontario, Canada.
⁵ Department of Medicine, University Laval, Québec City, Québec, Canada.
⁶ Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
⁷ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada; Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁸ Department of Pediatrics, Endocrinology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
⁹ Alberta Perinatal Health Program, Alberta Health Services, Calgary, Alberta, Canada.
¹⁰ Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada. Electronic address: [email protected].
¹¹ Li Ka Shing Centre for Health Research Innovation, Division of Human Nutrition, Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.

PMID: 39236999
DOI: 10.1016/j.jcjd.2024.08.005

Abstract

Objectives: Closed-loop insulin delivery has the potential to offer women with type 1 diabetes a break from intense diabetes self-care efforts postpartum. Our aim in this study was to explore the views and opinions of hybrid closed-loop users and their partners in the first 24 weeks postpartum.

Methods: This qualitative study was embedded in a controlled study of women with type 1 diabetes randomized to closed-loop insulin delivery (MiniMed™ 670G or 770G) or sensor-augmented pump use for 1 to 11 weeks 6 days postpartum, with all on closed-loop delivery from 12 to 24 weeks postpartum. Semistructured interviews were conducted with 16 study participants and their partners at 12 and 24 weeks postpartum. Thematic analyses were used to examine participants' and partners' experiences.

Results: Participants' positive perceptions of closed-loop use related to reduced hypoglycemia, in contrast to previous experiences with nonautomated insulin delivery. These perceptions were balanced against frustrations with the system, allowing blood glucose levels to be higher than desired. Closed-loop use did not influence infant feeding choice, but infant feeding and care impacted participants' diabetes management. Partners expressed uncertainty about the closed loop taking away control from participants who were highly skilled with diabetes self-management.

Conclusions: Participants reported that closed-loop insulin delivery resulted in less time spent in hypoglycemia when compared with the previously used nonautomated delivery. Yet, participants desired a greater understanding of the workings of the closed-loop algorithm. Our study provides potential users with realistic expectations about the experience with the MiniMed 670G or 770G closed-loop system in the postpartum period.

Keywords: administration automatisée d'insuline; artificial pancreas; automated insulin delivery; diabète de type 1; hybrid closed-loop therapy; pancréas artificiel; post-partum; postpartum; qualitative research; recherche qualitative; thérapie hybride en boucle fermée; type 1 diabetes.