The Psychosocial Outcomes of Advanced Hybrid Closed-Loop System in Children and Adolescents with Type 1 Diabetes
Authors: Jalilova Arzu , Pilan Birsen Şentürk , Demir Günay , Özbaran Burcu , Balkı Hanife Gul , Arslan Emrullah , Köse Sezen Gökcen , Özen Samim , Darcan Şükran , Gökşen Damla 
Published: February 2024

Objective: The study was carried out to determine the psychosocial outcomes of Advanced Hybrid Closed-Loop (AHCL) systems in children and adolescents with Type 1 Diabetes (T1D).
Research design&Method: The study population consisted of 60 children and adolescents with T1D.Standard clinical procedures, including both glycemic indicators, e.g., sensor-measured time within the 70–180 mg/dL range and glycated hemoglobin (HbA1c) levels, and psychosocial metrics were used for data collection. The psychosocial metrics included the Pediatric Quality of Life Inventory (PedsQL) 3.0 Diabetes Module for both children (8-12 years) and parents; the Quality of Life for Youth scale for adolescents (13-18 years); the Strengths and Difficulties Questionnaire (SDQ); the Hypoglycemia Fear Survey for Children(HFS-C); the Revised Child Anxiety and Depression Scale (R-CADS); and AHCLS-specific DTSEQ satisfaction and expectation survey. These metrics were evaluated at the baseline and after six months of AHCL use.
Results: Of the 60 children and adolescents with T1D for whom the AHCL system was utilized, 41 patients, 23 female and 18 male, completed the surveys. The mean age of the 41 children and adolescents that constituted the study sample was 12.5 ± 3.2 (min. 6.7, max. 18) years. The time spent within the target glycemic range, i.e., time-in-range (TIR), improved from 76.9 ± 9% at the baseline to 80.4 ± 5% after six months of AHCL system use(p=0.034). Additionally, HbA1c levels reduced from 7.1% ± 0.7% at the baseline to 6.8% ± 0.8% after six months of AHCL system use(P=0.031). The most notable decline in HbA1c was observed in participants with higher baseline HbA1c levels. All patients’ HFS-C and AHCL system-specific DTSEQ satisfaction and expectation survey scores were within the normal range at the baseline and remained unchanged during the follow-up period. No significant difference was found in the R-CADS scores of children and adolescents between baseline and after six months of AHCL system use. However, there was a significant decrease in the R-CADS scores of children and adolescents administered by their parents. Patients’ PedsQL scores were high both at the baseline and after six months of AHCL system use. The evaluation of children and adolescents with SDQ revealed high overall difficulty scores at the baseline. On the other hand, no significant improvement was achieved in SDQ scores after six months of AHCL system use compared to baseline.
Conclusions: This is the first study to investigate in detail the psychosocial outcomes of AHCL system use in T1D patients and their parents. Although state-of-the-art technologies such as AHCL provide patients with more flexibility in their daily lives and information about glucose fluctuations, the AHCL resulted in a TIR above the recommended target range without a change in QOL, HFS-C, SDQ, and R-CADS scores. The scores obtained from the R-CADS conducted by the parents of their children indicated that the use of pumps caused a psychological improvement in the long term, with a significant decrease in the R-CADS scores of the children and adolescents with T1D. Further studies are needed to elucidate the reasons for AHCL discontinuation and determine intervention strategies.