Impact of Closed-Loop Insulin Delivery System in the Management of Type 1 Diabetes

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Abstract
According to the CDC (2012), 13,000 youths are diagnosed with type 1 Diabetes every year. Type 1 Diabetes is an autoimmune disease in which the pancreas fails to secrete insulin. If not well managed, this condition can be fatal. Children and adolescents are of a particular concern because they are still in a psychosocial developmental stage that does not promote favorable behaviors towards the proper management of the disease. This paper is a review of the literature on closed-loop insulin delivery systems to evaluate whether they are better for the management of type 1 Diabetes than open-loop continuous insulin delivery systems. The databases searched were CINAHL and MEDLINE EBSCO using the following keywords: Closed-loop insulin delivery system, closed-loop insulin, and type 1 Diabetes. Out of 20 research papers reviewed, 5 were used for this review paper. The 5 research papers were published between the years of 2006 and 2010. The overall result showed that the closed-loop delivery systems were feasible in maintaining tight glycemic control in children and adolescents. While these studies highlighted the benefits of the closed-loop system, they were not specific to the adaptation of adolescents to the technology and their adherence to diabetic treatments. This subject is particularly important to nursing practice because nurses are the primary educators in the healthcare environment. By staying abreast of the evidence based practice of new technologies, nurses are able to properly care for their parents and increase their quality of life.

Introduction
According to the Centers for Disease Control and Prevention (CDC, 2012), 13,000 youths are diagnosed with type 1 Diabetes Mellitus (DM) every year. It is an autoimmune disease in which the pancreas loses its ability to manufacture and secrete insulin. It is sometimes referred to as juvenile diabetes due to the fact that it tends to occur in children and young adults. Unlike Type 2 DM, the only treatment for Type 1 DM is insulin administration. Patients diagnosed with type 1DM have to quickly adhere to regular balanced dietary regimens and maintain a tight glycemic control in order to avoid the complications of the disease. The major complications are hypoglycemia and hyperglycemia. Hypoglycemia is low blood sugar and occurs when too much insulin is administered or the patient fails to adhere to regular meals. This usually leads to fatigue and decreased level of consciousness which can escalate to fainting and seizures. Hyperglycemia occurs when not enough insulin is provided or too many carbohydrates are consumed at once. If not dealt with immediately, hyperglycemia can lead to macro and micro vascular damage and diabetic keto-acidosis, which are all life threatening conditions.

The use of lancets and glucometers has been the most common method of monitoring blood sugar and maintaining glycemic control. This can be rather challenging when it comes to the management of diabetes in children and adolescents, considering their psychosocial and cognitive stages. School age children have greater peer influence and they feel the need to win approval from others by performing something valued by society (McLeod, 2008). Adolescents are defining their identity and are becoming more independent (McLeod, 2008). Children are therefore prone to having self-esteem issues as they can perceive themselves different from their peers. Adolescents can become rebellious and would want to do things their own way. In addition, the routine of pricking fingers 3 to 4 times a day and having to follow a regular balanced meal can be frustrating for both patients and their caregivers. The insulin treatment also requires good time management skills to avoid missing doses of insulin or missing out on meals, skills that are not very well mastered by this age group. Because this process can cause a lot of frustration, it usually leads to noncompliance and non-adherence to their...
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