Background and Aims

In March 2017, after being a T1D for 34 years, I built the Loop app. Life on Loop has completely changed my life, marking significant improvements in diabetes care. In this paper, I wish to consider the philosophical and practical realities of life on Loop, drawing on my own experiences.

Methods

As an internationally published writer, the notion of “returning to the patient narrative”, as advocated by philosopher Havi Carel, is appealing. With this in mind, I set out to write a “Diabetes Diary”. For the past year, I have been writing about what it means to live as a T1D in 2019 on Loop. In my paper I will highlight and summarize results of this diary, a literary memoir project at the core of my PhD dissertation at University of Alberta.

Results

My journey has been, in many ways, a mediation and encounter with the uncanny. Borrowing from Heideigger’s concept of “unhomelikeness-in-the-world” (1996), my experience of the ‘unheimlisch’ is both a response to technological changes presented by the Loop phenomena, as well as a symptom of the day-to-day illness experience.

Conclusions

I hope this paper will open conversations into how medical professionals approach T1Ds. In listening to the diabetic’s story, it opens the possibility of a broader empathy, what Havi Carel calls “the second-person perspective”. Loop also challenges our very belief in a life-story. For as I grow into my own flesh, medical technology grows into my diabetic body, and with it, the question: Where does my body begin and end?

Background and Aims

The aim was to evaluate the outcomes of hybrid closed-loop system in children and adults with type 1 diabetes.

Methods

Patients consecutively starting hybrid closed-loop system (MiniMed-670G) were evaluated in a prospective longitudinal design (baseline, 3-months, 6-months). HbA1c, time in range (TIR) 70-180mg/dl, time >180mg/dl, >250mg/dl, <70mg/dl and <54mg/dl in 2-week downloads were recorded. Glycaemic variability measures were calculated. Adolescents and adults completed a set of questionnaires (Gold and Clarke scores, Hypoglycemia Fear Survey [HFS], Diabetes Quality of Life [DQoL], Diabetes Treatment Satisfaction [DTS], Diabetes Distress Scale [DDS], Pittsburgh Sleep Quality Index [PSQI]).

Results

58 patients were included, age: 28±15 years (7-63), <18 years-old: 38% (n=22), 59% (n=34) females, diabetes duration: 15±9 years, previous treatment: sensor-augmented pump with predictive low glucose suspend (SAP-PLGS): 60% (n=35) (median time: 3.2 years [1.7-3.7]), pump+SMBG: 19% (n=11), MDI+SMBG: 12% (n=7), MDI+CGM: 9% (n=5).

At 3 months, number of auto-mode exits: 4±2/patient-week (0.6±0.3/patient-day), time in auto-mode: 85±17%, alarms: 8.5±3.7/day. Improvement in TIR was not different in children compared to adults, previous pump or CGM users compared to non-users. Baseline HbA1c and baseline TIR were predictors of improvement in TIR. In patients with baseline high hypoglycaemia risk (n=29), time in hypoglycaemia range was significantly reduced. At 6 months (n=21), HbA1c and TIR 70-180 mg/dl improved compared to baseline (HbA1c: 6.9±0.4% vs 7.3±0.7%, p=0.003, TIR: 73±8% vs 64±11%, p<0.001). Discontinuation rate was 3% (n=2).

Conclusions

Real-world use of hybrid closed-loop systems improves glycaemic control, reduces glycaemic variability and ameliorates diabetes burden in children and adults with type 1 diabetes.