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Emotional Improvement Seen Among T1D Patients Using CLC Systems


The authors of this study evaluated outcomes among children aged 7 to 16 years, all living with type 1 diabetes (T1D), who attended a 3-day virtual education camp that focused on their use of a closed-loop control (CLC) system for insulin delivery.

Following initiation of a closed-loop control system for insulin delivery and attendance at a 3-day virtual education camp (vEC) from November 6 to 8, 2020, positive and mixed emotions improved among 43 children living with type 1 diabetes (T1D), according to new study findings in Acta Diabetologica.

“While no study has evaluated the effects of technology on emotions during or after an educational camp, the psychological impact of technology on children and adolescents with T1D and their parents has been evaluated. Indeed, insulin pumps led to improvements in diabetes-specific emotional distress,” the authors wrote.

To make it easier for the children (53.5% female) to describe their emotions, because they often have difficulty doing so, the authors noted that during interviews with the children, a psychologist asked them to pick 1 of 3 primary colors to correspond with their feelings. These interviews took place after each day of the camp. There were 6 months of follow-up, with emotional evaluations carried out at 3 junctures: before the vEC, at the end of the vEC, and after 6 months. The 43 children received care at 19 Italian pediatric diabetes centers. Their emotions were evaluated using Plutchik’s Wheel of Emotions and the Geneva Emotion Wheel.

For the primary outcome of changes in emotions at the end of the vEC and 6 months later, the authors saw these results:

  • Before the vEC, joy (75.9%), serenity (65.5%), satisfaction (27.6%), fear (27.6%), amazement (24.1%), indifference (17.2%), and anger (17.3%) predominated
  • Right after the vEC:
    • Joy, serenity, and amazement were up to 76.9%, 76.9%, and 26.9%, respectively
    • Fear, indifference, and anger dropped to 11.5%, 7.7%, and 3.8%, respectively—but the authors deemed these findings insignificant
  • At 6 months, significant drops of 24.1% and 6.9%, respectively, were seen in amazement and sadness
  • Overall positive emotions grew from 38% at baseline to 67% right after the vEC and 65% at the 6-month mark
  • Overall mixed emotions dropped from 61% at baseline to 32% right after the vEC and 15% at the 6-month mark

None of the findings, the authors noted, indicated the children mostly felt negative emotions before or after the vEC.

Time spent in the target range of 70 to 80 mg/dL after 6 months was the authors’ secondary outcome, and this jumped from a median (interquartile range) 64% (54%-72%) to 75% (70%-82%) following attendance at the vEC. There were no reported instances of severe hypoglycemia or diabetic ketoacidosis. Time spent below the target range (< 54 mg/dL or 54-70 mg/dL) was low at baseline and remained there for the study’s duration. However, less time was spent above the target range. For 180 to 250 mg/dL, the time spent in that range dropped from 26% (20%-28%) at baseline to 18% (13%-22%) after 6 months, and for glucose levels above 250 mg/dL, the time dropped from 8% (4%-15%) to 3% (2%-6%).

The authors noted that their findings were limited by the lack of a control group.

“The negative feelings reported before the vEC may well have been linked to the anxiety that precedes the start of a new experience, and the positive emotions may be due to the positive effect of sharing experiences and best practices in the vEC,” the authors concluded. “However, the positive effect persisted for 6 months, suggesting a more fundamental effect of the vEC beyond the experience alone.”

They added that the time they gave the children in the study to process their emotions underscores the significance of their results because “giving the right space to the emotional experiences of children involved probably allowed them to access the fullness of the proposed experience.”


Rabbone I, Savastio S, Pigniatiello, et al. Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed‑loop control system after attending a virtual educational camp. Acta Diabetol. 2022;59(6):837-842. doi:10.1007/s00592-022-01878-z

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