背景:混合闭环(HCL)胰岛素泵基于来自连续葡萄糖监测器的输入来调节胰岛素输送。FDA批准了几种系统,并在范围内改善了时间,血红蛋白A1c减少,降低低血糖发生率。主要糖尿病指南在使用HCL系统方面的建议强度不同。总的来说,关于影响HCL泵临床决策的因素的信息有限,尤其是内分泌学临床医生。
目的:研究目的是描述知识和态度,网络支持,以及中西部一个退伍军人事务(VA)医疗保健系统中内分泌临床医生对HCL胰岛素输送系统的自我效能。
方法:按照描述性方法,这项定性研究使用了半结构化访谈和归纳主题分析。所有的内分泌学家,内分泌学研究员,中西部一个VA医疗保健系统的内分泌和代谢科的护士被邀请参加一对一的电话采访。主题分析探讨了临床医生对HCL胰岛素泵系统的看法。
结果:参与者(n=11)在VA和大学医疗保健系统内分泌学诊所有经验。从他们的经验来看,确定了4个主题,涉及胰岛素泵候选人的评估和评估,规定挑战,HCL泵的临床益处,和临床医生的总体信心。
结论:研究结果表明,临床医生认为HCL系统具有显著的血糖益处,但并不适合所有患者,尤其是那些有认知障碍的人。HCL泵启动是一个多步骤的过程,需要一个跨学科的医疗保健临床医生团队来确保患者和泵的成功。此外,HCL系统提高了临床医生对整体糖尿病管理的信心。
BACKGROUND: Hybrid closed loop (HCL) insulin pumps adjust insulin delivery based on input from a continuous glucose monitor. Several systems are FDA approved and associated with improved time in range, reduction in hemoglobin A1c, and decreased incidence of hypoglycemia. Major diabetes guidelines differ in their strength of recommendations regarding the use of HCL systems. Overall, limited information about the factors that influence HCL pump clinical decision-making is available, especially among endocrinology clinicians.
OBJECTIVE: The study objective is to describe the knowledge and attitudes, network support, and self-efficacy regarding HCL insulin delivery systems among endocrinology clinicians in one Veterans Affairs (VA) Healthcare System in the Midwest.
METHODS: Following a descriptive approach, this qualitative study used semistructured interviews and inductive thematic analysis. All endocrinologists, endocrinology fellows, and nurses in the endocrinology and metabolism department at one VA Healthcare System in the Midwest were invited to participate in one-on-one phone interviews. Thematic analysis explored clinician perspectives on HCL insulin pump systems.
RESULTS: Participants (n=11) had experience within VA and university health care system endocrinology clinics. From their experiences, 4 themes were identified involving the evaluation and assessment of insulin pump candidates, prescribing challenges, clinical benefits of HCL pumps, and overall clinician confidence.
CONCLUSIONS: Findings suggest that clinicians believe HCL systems have significant glycemic benefits but are not appropriate for all patients, especially those with cognitive impairment. HCL pump initiation is a multi-step process requiring an interdisciplinary team of health care clinicians to ensure patient and pump success. Furthermore, HCL systems improve clinician confidence in overall diabetes management.