998-P: Alerts from an Ideal Artificial Pancreas (AP) System: Preferences of Young Persons with Type 1 Diabetes (T1D) and Parents
Authors: ROETHKE LINDSAY , COMMISSARIAT PERSIS V. , FINNEGAN JENNIFER L. , VOLKENING LISA K. , BUTLER DEBORAH A. , DASSAU EYAL , WEINZIMER STUART A. , LAFFEL LORI M. 
Published: June 2020

Aim: Current automated insulin delivery systems utilize insulin pumps and CGMs, both of which impose multiple alerts/alarms upon users. Patients and parents must respond to such notifications in order to effectively manage glucose levels. We interviewed children, teens, and young adults with T1D and parents of youth with T1D to explore preferences for alerting features of an ideal AP system.
Methods: Semi-structured interviews were conducted with 39 youth, ages 10-25 years with T1D duration ≥1 year, and 28 parents at 2 diabetes centers. Interview transcripts were coded and underwent content analysis. Youth (72% female, 82% white) were (M±SD) age 17.0±4.7 years, with T1D duration 9.4±4.9 years, and A1c 8.4±1.1%; 79% used an insulin pump and 82% used a CGM. Of parents, 96% parents were mothers and 89% were white.
Results: Youth and parents both endorsed a desire for the following 5 alerting features: 1) personalized sounds and volumes for different treatment situations (e.g., low vs. high glucose levels, insulin delivery issues), 2) custom schedules and glucose thresholds to account for different activities or times of day/night, 3) pleasant sounds to avoid negative emotional reactions, 4) flexible share settings (e.g., which alerts followers receive), and 5) consistent and personalized overnight alerts. Some youth wanted the option to turn off alerts completely. Parents wanted certainty that they would receive share alerts and suggested adding more share options (e.g., confirmation of insulin coverage for food or correction dose for high glucose), stating that such notifications may lessen their emotional distress and worry for their child’s safety.
Conclusions: Youth and parents emphasized need for customizable alerts and control over alert settings to reduce physical and emotional burdens of diabetes care. AP designs that provide comprehensive, customizable alert options are essential to reduce care burden for youth with T1D and their parents.

Disclosure
L. Roethke: None. P.V. Commissariat: None. J.L. Finnegan: None. L.K. Volkening: None. D.A. Butler: None. E. Dassau: Consultant; Self; Eli Lilly and Company. Research Support; Self; Dexcom, Inc., DreaMed Diabetes, Tandem Diabetes Care, Xeris Pharmaceuticals, Inc. Speaker’s Bureau; Self; Roche Diabetes Care. Other Relationship; Self; Dexcom, Inc., Insulet Corporation, Roche Diabetes Care. S.A. Weinzimer: Consultant; Spouse/Partner; Tandem Diabetes Care. Consultant; Self; Zealand Pharma A/S. Speaker’s Bureau; Self; Insulet Corporation. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.

Funding
National Institutes of Health (P30DK036836, DP3DK113511, DP3DK104057, K12DK094721, T32DK007260)