Short-term investment for long-term gains
HYPOGLYCEMIA
While interviewees emphasized that wider rollout of HCL would require an initial investment of time and effort to train up staff to support technology use, most expressed optimism that, in the long-term, their workloads could lessen. As several explained, after optimizing settings, improvements in glycemic management when using the HCL could result in women requiring less support in the later stages of pregnancy: “if women are getting [more] time in range… through the technology doing it, we're probably going to have less input into micromanaging them” (HP-007). Others observed that women using HCL experienced fewer episodes of hypoglycemia, hence, “later support is hopefully less burdensome, if indeed there are fewer hypos and fewer overnight hypos” (HP-012).Furthermore, healthcare professionals described how it was “a lot less onerous” (HP-004) to support women using HCL, because the automated regulation of basal insulin rates meant their focus was “almost all-around mealtime boluses and I don't have to think about the basal” (HP-006):
“if we could put the type 1's on the automatic pump, that would do at least some of the work for us… It's the CGM data that's the issue, looking at the CGM data. And that's why closed-loop is good because you're only looking at … the post meal bit. Whereas when you're looking at the CGM data for open loop and MDI you have to look at everything.” (HP-009)Indeed, some speculated that, after making initial adjustments to settings/insulin-to-carbohydrate ratios, women using HCL might need less frequent or intensive glycemic reviews, although there would still be a need for someone to “eyeball the data” (HP-010). To this end, interviewees highlighted the potential value of using a system (similar to the CamAPS FX reports), which provided summary glycemic metrics for HCL users at each site/clinic. As interviewees explained, color-coded data enabled them to “interpret… a mountain of data within like five minutes” (HP-008) and quickly establish:
“what I need to know, across a clinic or a population base level. So it'll instantly highlight women who are above or below target, anyone who's having a ton of alarms, anything that's kind of out of the ordinary.” (HP-014)As several further noted, using these kinds of reports had enabled them to “triage” individuals and identify who required support (