914-P: Veteran Experiences with Hybrid Closed-Loop (HCL) Insulin Delivery Systems in Type 1 Diabetes (T1D)

While HCL systems are increasingly recommended, data regarding veteran experiences are limited. We performed semi-structured interviews to characterize veteran experiences with HCL systems at the VA Ann Arbor Healthcare System. We used qualitative description methodology to elicit participant experiences with HCL and identify factors that could improve practice. Semi-structured interviews were conducted with veterans with T1D using an HCL device for at least 6 months. The interview guide was developed based on a modified Theory of Planned Behavior, examining the domains of attitudes/knowledge, network support, and perceived behavioral control. Inductive thematic analysis of interview transcripts was performed to understand factors that contribute to the overall HCL experience. Nine HCL users (mean age 68 years, mean A1c 7.4%, mean diabetes duration 30 years, 78% Medtronic HCL users, 22% Tandem HCL users) were interviewed. Participants reported that HCL systems ease self-management burden, increase lifestyle flexibility, and enhance the perception of safety. However, challenges in alarm fatigue exist. Participants were satisfied with their outpatient multidisciplinary network support but noted significant gaps in inpatient support for HCL use. Lastly, participants reported an improved sense of confidence in diabetes management using HCL systems. Key facilitators for successful HCL use were a desire to stay healthy for their spouse and to avoid long-term diabetes complications. Our findings confirm that HCL systems improve self-management and enhance safety in veterans as well, similar with prior reports in non-veterans with T1D. Veterans felt supported in using these systems as outpatients though challenges remain for HCL systems in the inpatient setting. Future studies should focus on improving network support for inpatient use of these devices.