Positive and negative psychosocial outcomes for individuals using diabetes technology occur. In hybrid closed-loop (HCL) systems, most studies were short-term with limited real-world application. We conducted a 12-month observational real-world study of youth and young adults with type 1 diabetes (T1D) using the Medtronic 670G HCL system for routine T1D care.
HCL use data, glycemic outcomes, and indicators of fear of hypoglycemia [FOH; Hypoglycemia Fear Survey (HFS)] and distress [Problem Areas in Diabetes (PAID)] were collected at baseline and every 3 months for one year. Associations between changes in FOH and distress and demographic and clinical measures were examined.
Ninety youth and young adults (mean 14.5yrs, range 2-25yrs, mean HbA1c 8.7±1.7%) participated. At 6 months, HbA1c was significantly higher in participants who scored above the median change in HFS-behavior score (9.7±2.0% vs 8.5±1.1%, p=0.018) and in those whose HFS-behavior scores increased compared to those whose scores decreased (9.7±2.0% vs 8.5±1.2%, p=0.037). At 12 months, increasing distress was associated with increasing time in auto mode (p=0.039). There were no other associations between FOH and distress, and time in auto mode, time in range, time hypoglycemic, T1D duration, age, or previous technology use.
Behavioral manifestation of FOH is associated with worse HbA1c in youth and young adults with T1D. More diabetes distress after one year was associated with more time in auto mode, but not increased time in range. This association may be related to the high amount of user involvement necessary to maintain auto mode.