This new investigation from the United Kingdom evaluated health care professionals’ (HCP) perceptions and implementation of practices that focus on open-source automated insulin delivery (OS-AID).
Results of a survey conducted in the United Kingdom from February through April 2019 revealed that although health care professionals (HCPs) are aware of the benefits of open-source automated insulin delivery (OS-AID) for children and adults with type 1 diabetes, and would support patients who choose to use it, few are confident in both their overall knowledge of the technology and their awareness of its regulations and do not discuss the potential treatment option as a result.
Findings were published recently in Diabetes Therapy, and they also revealed 43% of HCPs surveyed have concerns OS-AID use may introduce risk of adverse outcomes if put “in the wrong hands.” Their survey was distributed through the Association of British Clinical Diabetologists Diabetes Technology Network UK and the Association of Children’s Diabetes Clinicians (ACDC). Questions could be answered on a Likert scale of 1 to 5, yes/no manner, or via multiple choice, which contained an option to write in their own answer.
“OS-AID systems have previously been described in detail in other papers and their uptake by the diabetes community has grown steadily over the past few years. [However,] they remain unapproved at present,” the study authors wrote. “Given the complexities of the issues around OS-AID systems from clinical, regulatory, and ethical viewpoints, the aim of this work was to establish the prevailing opinions and perceptions of HCPs and their approaches to users of these systems in everyday practice.”
Of the 317 responses received, few responded that they were “extremely confident” in being able to adequately describe how to set up an OS-AID (8.8%). On the contrary, a majority (73.5%) were “somewhat confident” or less, as indicated by a score of 3 or more on the Likert scale. Just 5 of the “extremely confident” respondents were from practices that had 5 or more patients already using an OS-AID.
Similar trends were seen when considering the risks and benefits, respectively, of OS-AID systems: Most—77.9% and 81.4%—were “somewhat confident” or less at being able to adequately address these with their patients. Just 3.7% and 5.3%, respectively, chose “extremely confident.”
Consultants were shown to be the most confident (P < .001) at being able to discuss OS-AID systems, compared with diabetes specialists, with regard to the system as a whole, risks, and benefits.
Total insulin pump and OS-AID users in a service also were likely factors in level of comfort. Pairwise comparisons demonstrated that respondents at practices with fewer than 2 OS-AID users had less confidence compared with respondents at practices with 2 to 5 or 6 to 10 users. Respondents at pump centers with 0 to 100 users had less confidence that those at centers with more than 500 insulin pump users.
Close to 91% chose a multiple-choice answer for their attitudes toward OS-AID systems and their current practice, with the majority again saying they were uncomfortable providing ongoing support (59.0%). Just 5% felt “extremely comfortable.” Most (91%) also noted they were uncomfortable even initiating discussions about OS-AID systems, with common reasons being because they were still unapproved (67%), had limited knowledge (63%), had concern for their professional reputations (31.8%), and did not want to invalidate a National Health Service–provided pump warranty (28%).
Despite the above numbers, 94% said they would still provide ongoing care; among those who said they were not able to provide care, their principal reason was feeling unable to advise on system management. Further, 96.5% expressed a belief that HCPs should learn more about OS-AID and 95.9% said they wanted to learn more themselves.
Crabtree TSJ, Choudhary P, Lumb A, et al. Association of British Clinical Diabetologists, Diabetes Technology Network UK and Association of Children’s Diabetes Clinicians survey of UK healthcare professional attitudes towards open-source automated insulin delivery systems. Diabetes Ther. 2022;13(2):341-353. doi:10.1007/s13300-022-01203-5