Closed Loop Experiences

July 27, 2021

Closed loop insulin delivery systems are becoming more accessible to people living with diabetes (PWD). They come in different forms, but have a few key pieces in common: an insulin delivery method (usually a pump), a continuous glucose monitor (CGM), and a software algorithm that uses the data from the CGM to drive insulin delivery.

All closed loop systems have the goal of improving health outcomes for people with diabetes, including the improvement of quality of life. Diabetes is a constant day-to-day burden that requires a lot of time and energy to manage. Having a system that drives itself with less input from the user can help decrease that burden.

Since diabetes is such an individualized condition, there is a need to have a variety of treatment options available for PWD, and that includes closed loop system options. There are also a variety of barriers to access and implement these technologies.

In 2017, researchers at Stanford University and the Jaeb Center for Health Research surveyed 1,503 adults with diabetes and found that 47% felt the “hassle of wearing devices” was a major barrier, and 35% did not like having devices on their body.1 Young adults aged 18-25 years old that participated in the study were least likely to use an insulin pump or CGM.1

In data published this past July, researchers from hospitals and clinics across the United Kingdom published data on adolescents’ experiences using a closed loop system that involved a smartphone app which housed the algorithm for the system.2 The participants in the study had worn the system for at least six months and reported these benefits of the system:2

  • Less burden
  • Components were easier to carry/wear
  • The app made it easier to discreetly manage blood sugars in public
  • They liked the customizable alarms
  • Some had issues with using the phone at school
  • Many stated they checked their blood sugars more often on the phone because they were using it for other things already
  • Some said it caused them to forget diabetes related tasks

The algorithm that was used for this study had two options that are unique to the system: “Boost” and “Ease-off” to help increase or decrease blood sugars.2 Many of the adolescents felt that this system was much easier than having to calculate changes in their doses.2 Continuing to evaluate the user experience with closed loop systems will help ensure the systems are something that people will continue to use, and therefore improve outcomes.

If researchers only look at what devices do to blood glucose levels in a study and don’t acknowledge the emotional or physical burden of wearing a device, they’re missing an integral piece in the puzzle of improving diabetes self-management. Thankfully, there are people committed to reducing barriers to technology and continue to assess the human factors of the closed loop devices.

Cheers to these researchers who are committed not only to our blood sugars, but to making our lives better all around!

  1. Diabetes Device Use in Adults with Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets
  2. Adolescents’ Experiences of Using a Smartphone Application Hosting a Closed-loop Algorithm to Manage Type 1 Diabetes in Everyday Life: Qualitative Study

Written and clinically reviewed by Marissa Town, RN, BSN, CDCES