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Insulin pump use in children with type 1 diabetes : an exploration of families' experiencesAllan, Lesley Anne January 2013 (has links)
Introduction: The management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes. Method: Data were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the Pump’. Children’s data is presented separately within a journal article format. Discussion: Findings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control. Conclusion: This research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.
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The artificial pancreas in children and adolescents with type 1 diabetes : bringing closed-loop homeTauschmann, Martin January 2019 (has links)
Type 1 diabetes is one of the most common chronic conditions in childhood and adolescence. Despite ongoing development of more physiological insulin preparations, recent advancements in insulin pump technology and more accurate blood glucose monitoring, in clinical practice it remains challenging to achieve normoglycaemia whilst reducing the risk of hypoglycaemia, particularly in young people with type 1 diabetes. Closed-loop insulin delivery (the artificial pancreas) is an emerging technology gradually progressing from bench to clinical practice. Closed-loop systems combine glucose sensing with computer-based algorithm informed insulin delivery to provide real-time glucose-responsive insulin administration. The key objective of my thesis is to evaluate the safety, efficacy and utility of closed-loop insulin delivery in children and adolescents with type 1 diabetes outside of the research facility setting. Results of five clinical trials are presented in the main chapters of this thesis. In a mechanistic study, the impact of glucose sensor operation duration on efficacy of overnight closed-loop was investigated comparing closed-loop performance on day 1 of sensor insertion to day 3 to 4 of sensor. Twelve adolescents with type 1 diabetes attended the research facility for two overnight visits. The sequence of the interventions was random. Despite differences in sensor accuracy, overnight CL glucose control informed by sensor glucose on day 1 or day 3-4 after sensor insertion was comparable. The model predictive controller appears to mitigate against sensor inaccuracies. In home settings, overnight closed-loop application was evaluated over three months in 25 children and adolescents with type 1 diabetes aged six to 18 years. The study was conducted at three centres in the UK and adopted a randomised cross-over design. Compared to sensor-augmented pump therapy, overnight home use of closed-loop increased the proportion of time sensor glucose was in target, and reduced mean glucose and hypoglycaemia. Two randomised crossover studies evaluated the safety and efficacy of day-and-night hybrid closed-loop insulin delivery in young people with type 1 diabetes aged 10 to 18 years over seven days, and 21 days, respectively. A total of 24 subjects were enrolled in this single centre trial. Free-living home use of day-and-night closed-loop in suboptimally controlled adolescents with type 1 diabetes was safe, and improved glucose control without increasing the risk of hypoglycaemia. Finally, closed-loop technology was assessed in five very young children (aged one to seven years) with type 1 diabetes in a two-period, crossover study. Closed-loop was used during both 3-week intervention periods, either with standard strength insulin (U100), or with diluted insulin (U20). The order of intervention was random. Free-living home use of day-and-night hybrid closed-loop in very young children with type 1 diabetes was feasible and safe. Glucose control was comparable during both intervention periods. Thus, use of diluted insulin during closed-loop insulin delivery might not be of additional benefit in this population. In conclusion, studies conducted as part of my thesis demonstrate that use of hybrid closed-loop insulin delivery systems in children and adolescents aged one to 18 years in free daily living without remote monitoring or supervision is feasible, safe and effective. My work supports the progression of this technology from research to mainstream clinical practice.
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Sensorstyrd pumpterapi : En studie om effekt på glykerat hemoglobin vid Diabetes Mellitus typ 1Isberg, Anna January 2016 (has links)
Introduktion Diabetes Mellitus typ 1 är en autoimmun sjukdom som så småningom leder till total insulinbrist vilket är livshotande. Insulinbristsjukdomen är kronisk och är i Sverige en av de vanligaste folksjukdomarna. I världen insjuknar i dagsläget flest antal i Sverige och Finland. Vad gäller behandling vid Diabetes Mellitus typ 1 får alla patienter i dagsläget insulininjektioner antingen via insulinpenna eller via insulinpump. Glukosnivån i blodet bör mätas kontinuerligt för att kunna optimera behandlingsterapin. En annan typ av behandlingsterapi vid Diabetes Mellitus typ 1 är SAP (Sensor- augmented pump). Denna metod innebär att insulinpumpsbehandling kombineras med kontinuerlig glukosmätning (continuous glucose monitoring, CGM).Att mäta glykerat hemoglobin (HbA1c) har blivit en viktig del för att följa samt utvärdera hur behandlingen av Diabetes Mellitus fungerar. Ett lågt HbA1c ger en minskad risk för komplikationer och är ett tydligt mål i behandlingen samtidigt som risken för hypoglykemi måste tas i anspråk. Syfte Syftet med denna litteraturstudie är att undersöka om HbA1c-värden kan förbättras hos patienter med Diabetes Mellitus typ 1 vid användning av SAP-behandlingsterapi jämfört med CSII-behandlingsterapi (continuous subcutaneous insulin infusion) kombinerat med SMBG (self monitoring of blood glucose) och MDI-behandlingsterapi (multiple daily injections) kombinerat med SMBG. Syftet är även att undersöka om det finns något samband mellan användningsfrekvens av CGM-sensorer och förbättrat HbA1c-värde. Metod Denna litteraturstudie baseras på åtta stycken artiklar som hittades via databasen PubMed. Resultat och diskussion Resultatet, av de utvalda originalstudierna, visar att SAP-behandlingsterapi har en bättre effekt på optimering av HbA1c-värden, hos patienter med Diabetes Mellitus typ 1, om det jämförs med MDI-behandlingsterapi kombinerat med SMBG. Om förbättringen beror på SAP-terapibehandlingen eller om CSII och CGM separat hade gett effekten är svårt att avgöra. Däremot ses ingen signifikant skillnad, i resultatet i de originalstudier som valts ut, av denna effekt vid jämförelse av SAP-behandlingsterapi mot CSII kombinerat med SMBG. Ytterligare studier med ett större antal deltagare behövs som underlag för att kunna avläsa detta. Vad gäller relationen mellan frekvens av CGM-sensoranvändning och förändring i HbA1c-värden finns både studier som stödjer och studier som förkastar. Vid ett eventuellt byte av behandlingsterapi bör hänsyn tas till andra aspekter än surrogatmåttet HbA1c. Slutsats Resultatet av denna litteraturstudie visar att SAP-behandlingsterapi i vissa fall kan reducera HbA1c-värden i jämförelse med andra metoder. En del resultat stödjer även sambandet mellan ökad användningsfrekvens av CGM-sensorer och reducering av HbA1c-värden. Det måste tas hänsyn till andra parametrar vid eventuellt byte av behandlingsterapi. Det är av stor vikt att patienterna känner sig tillfreds med sin behandlingsterapi då det kan bibehålla motivationen till att optimera sina HbA1c-värden.
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Insulin Pump Use and Type 1 Diabetes: Connecting Bodies, Identities, and TechnologiesStephen K Horrocks (8934626) 16 June 2020 (has links)
<p>Since the late 1970s, biomedical researchers have heavily invested in the development of portable insulin pumps that allow people with Type 1 Diabetes (T1D) to carry several days-worth of insulin to be injected on an as-needed basis. That means fewer needles and syringes, making regular insulin injections less time consuming and troublesome. As insulin pump use has become more widespread over the past twenty years among people with T1D, the social and cultural effects of using these medical devices on their everyday experiences have become both increasingly apparent for individuals yet consistently absent from social and cultural studies of the disease.</p><p><br></p><p>In this dissertation, I explore the technological, medical, and cultural networks of insulin pump treatment to identify the role(s) these biomedicalized treatment acts play in the structuring of people, their bodies, and the cultural values constructed around various medical technologies. As I will show, insulin pump treatment alters people’s bodies and identities as devices become integrated as co-productive actors within patient-users’ biological and social systems. By analyzing personal interviews and digital media produced by people with T1D alongside archival materials, this study identifies compulsory patterns in the practices, structures, and narratives related to insulin pump use to center chapters around the productive (and sometimes stifling) relationship between people, bodies, technologies, and American culture.</p><p><br></p><p>By analyzing the layered and intersecting sites of insulin pump treatment together, this project reveals how medical technologies, health identities, bodies, and cultures are co-constructed and co-defined in ways that bind them together—mutually constitutive, medically compelled, cultural and social. New bodies and new systems, I argue, come with new (in)visibilities, and while this new technologically-produced legibility of the body provides unprecedented management of the symptoms and side-effects of the disease, it also brings with it unforeseen social consequences that require changes to people’s everyday lives and practices. </p>
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