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Randomized Controlled Trial
. 2025 Mar;42(3):e15448.
doi: 10.1111/dme.15448. Epub 2024 Nov 25.

Parental perspectives following the implementation of advanced hybrid closed-loop therapy in children and adolescents with type 1 diabetes and elevated glycaemia

Sin-Ting Tiffany Lai  1 , Sara E Styles  2 , Alisa Boucsein  1 , Yongwen Zhou  1   3 , Venus Michaels  1 , Craig Jefferies  4   5 , Esko Wilshire  6   7 , Martin I De Bock  8   9 , Benjamin J Wheeler  1   10
Affiliations
Randomized Controlled Trial

Parental perspectives following the implementation of advanced hybrid closed-loop therapy in children and adolescents with type 1 diabetes and elevated glycaemia

Sin-Ting Tiffany Lai et al. Diabet Med. 2025 Mar.

Abstract

Aims: To identify from a parental perspective facilitators and barriers of effective implementation of advanced hybrid closed-loop (AHCL) therapy in children and adolescents with type 1 diabetes (T1D) with elevated glycaemia.

Methods: Semi-structured interviews were conducted with parents of participants while in a post-trial extension phase of the CO-PILOT randomized controlled trial. The Capability, Opportunity, Motivation, Behaviour Model and Theoretical Domain Framework informed the interviews and framework analysis.

Results: Eleven parents of 9 children and adolescents were interviewed. The median age of their children and adolescents was 14.2 years (IQR 13.3-14.7) with median HbA1c 78 mmol/mol (IQR 75-86) (9.3% IQR 9-10) before starting AHCL. Facilitators of implementing AHCL therapy included the following: (1) knowledge acquired from training, (2) establishing routines and action plans, (3) remote glucose monitoring, (4) achievement of glycaemic goals through automation, (5) children/adolescents' capability to use AHCL independently, (6) improved outcomes incentivized continued AHCL, (7) optimism about sustained improvements and (8) social support from healthcare providers, school staff, peers and parents. Barriers to AHCL implementation included the following: (1) challenges with device usability, (2) need for technical support, (3) forgotten knowledge and skills, (4) non-adherence to best practices, (5) negative social influences, (6) physical and psychosocial burden and (7) negative emotions.

Conclusions: This study provides comprehensive insights into parental perspectives of influences on implementing AHCL therapy in children and adolescents with elevated glycaemia. As parents remain key partners in diabetes care, these findings inform successful implementation of AHCL and development of future diabetes technology.

Keywords: advanced hybrid closed loop; artificial pancreas; automated insulin delivery; children and adolescent; parents; type 1 diabetes.

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Conflict of interest statement

The diabetes technology used in this study was provided by Medtronic, in addition to partial financial support for some aspects of staffing related to the original randomized controlled trial. Authors, BJW and MIdB, have received past speaker honoraria and compensation for travel costs from Medtronic.

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