The introduction of continuous subcutaneous insulin infusion in clinical care has led to more optimal glycemic and quality-of-life outcomes, compared with multiple daily injections (MDI). Despite this, some insulin pump users revert back to MDI. The aim of this review was to include the most recent rates of insulin pump discontinuation among people with type 1 diabetes and to identify reasons for and factors associated with discontinuation. A systematic literature search was conducted using the Embase.com, MEDLINE (via OVID), PsycINFO, and CINAHL databases. Titles and abstracts of eligible publications were screened, and baseline characteristics of the included studies were extracted, as were variables in the context of insulin pump use. Data were synthesized into themes: indications for insulin pump initiation, persons with type 1 diabetes (PWD)-reported reasons for, and factors associated with insulin pump discontinuation. A total of 826 eligible publications were identified and 67 were included. Discontinuation percentages ranged from 0% to 30% (median 7%). The most frequently mentioned reasons for discontinuation were wear-related issues (e.g., device attached to the body, interference with daily activities, discomfort, affected body image). Related factors included hemoglobin A1c (HbA1c) (17%), issues with following treatment recommendations (14%), age (11%), gender (9%), side effects (7%), and comorbidity- and complication-related factors (6%). Despite many developments in insulin pump technology, discontinuation rates and PWD-reported reasons for and factors associated with insulin pump discontinuation in more recent studies were comparable to earlier reviews/meta-analyses. Continuation of insulin pump treatment depends on a knowledgeable and willing health care provider (HCP) team and a close match with PWDs' wishes and needs.
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References
1.
CumminsE, RoyleP, SnaithA, et al.Clinical effectiveness and cost-effectiveness of continuous subcutaneous insulin infusion for diabetes: Systematic review and economic evaluation. Health Technol Assess, 2010; 14(11):1–208.
2.
MeneghiniL, Sparrow-BodenmillerJ. Practical aspects and considerations when switching between continuous subcutaneous insulin infusion and multiple daily injections. Diabetes Technol Ther, 2010; 12(Suppl. 1):S109–S114.
3.
JamesS, PerryL, LoweJ, et al.Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry. Pediatr Diabetes, 2022; 23(6):736–741.
4.
RosnerB, Roman-UrrestarazuA. Health-related quality of life in paediatric patients with Type 1 diabetes mellitus using insulin infusion systems. A systematic review and meta-analysis. PLoS One, 2019; 14(6):e0217655.
5.
Mortality in type 1 diabetes in the DCCT/EDIC versus the general population. Diabetes Care, 2016; 39(8):1378–1383.
6.
SteineckI, CederholmJ, EliassonB, et al.Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: Observational study. BMJ (Clin Res Ed), 2015; 350:h3234.
7.
CooperA, KanumilliN, HillJ, et al.Language matters. Addressing the use of language in the care of people with diabetes: Position statement of the English Advisory Group. Diabetic Med, 2018; 35(12):1630–1634.
8.
SpeightJ, ConnJ, DunningT, et al.Diabetes Australia position statement. A new language for diabetes: Improving communications with and about people with diabetes. Diabetes Res Clin Pract, 2012; 97(3):425–431.
9.
PriggeR, McKnightJA, WildSH, et al.International comparison of glycaemic control in people with type 1 diabetes: An update and extension. Diabetic Med, 2022; 39(5):e14766.
10.
PerryL, JamesS, SteinbeckK, et al.Young people with type 1 diabetes mellitus: Attitudes, perceptions, and experiences of diabetes management and continuous subcutaneous insulin infusion therapy. J Eval Clin Pract, 2017; 23:554–561.
11.
FosterNC, BeckRW, MillerKM, et al.State of type 1 diabetes management and outcomes from the T1D exchange in 2016–2018. Diabetes Technol Ther, 2019; 21(2):66–72.
12.
Cardona-HernandezR, SchwandtA, AlkandariH, et al.Glycemic outcome associated with insulin pump and glucose sensor use in children and adolescents with type 1 diabetes. Data from the international pediatric registry SWEET. Diabetes Care, 2021; 44(5):1176–1184.
13.
SaiyedM, HasnaniD, AlonsoGT, et al.Worldwide differences in childhood type 1 diabetes: The SWEET experience. Pediatr Diabetes, 2021; 22(2):207–214.
14.
GerhardssonP, SchwandtA, WitschM, et al.The SWEET project 10-year benchmarking in 19 countries worldwide is associated with improved HbA1c and increased use of diabetes technology in youth with type 1 diabetes. Diabetes Technol Ther, 2021; 23(7):491–499.
15.
SchifferdeckerE, SchmidtK, BoehmBO, et al.Long-term compliance of intensified insulin therapy. Diabetes Res Clin Pract, 1994; 23(1):17–23.
16.
Weissberg-BenchellJ, Antisdel-LomaglioJ, SeshadriR. Insulin pump therapy: A meta-analysis. Diabetes Care, 2003; 26(4):1079–1087.
17.
ShulmanR, PalmertMR, DanemanD. Insulin pump therapy in youths with Type 1 diabetes: Uptake and outcomes in the ‘real world’. Diabetes Manag, 2012; 2(2):119–138.
18.
de VriesL, GrushkaY, LebenthalY, et al.Factors associated with increased risk of insulin pump discontinuation in pediatric patients with type 1 diabetes. Pediatr Diabetes, 2011; 12(5):506–512.
19.
HoferSE, HeidtmannB, RaileK, et al.Discontinuation of insulin pump treatment in children, adolescents, and young adults. A multicenter analysis based on the DPV database in Germany and Austria. Pediatr Diabetes, 2010; 11(2):116–121.
20.
KostevK, RockelT, RosenbauerJ, et al.Risk factors for discontinuation of insulin pump therapy in pediatric and young adult patients. Primary Care Diabetes, 2014; 8(4):346–351.
21.
LombardoF, ScaramuzzaAE, IafuscoD. Failure of glycated hemoglobin drop after continuous subcutaneous insulin infusion initiation may indicate patients who discontinue: A 4-year follow-up study in children and adolescents with type 1 diabetes. Acta Diabetol, 2012; 49(Suppl. 1):S99–S105.
22.
WongJC, BoyleC, DiMeglioLA, et al.Evaluation of pump discontinuation and associated factors in the T1D exchange clinic registry. J Diabetes Sci Technol, 2017; 11(2):224–232.
23.
PeetersMAC, de HaanHG, BalRA, et al.Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. Patient Educ Counsel, 2022; 105(6):1510–1517.
24.
ValenzuelaJM, SmithLB, StaffordJM, et al.Shared decision-making among caregivers and health care providers of youth with type 1 diabetes. J Clin Psychol Med Settings, 2014; 21(3):234–243.
25.
StatsToDo. Available from: https://www.statstodo.com/CombineMeansSDs_Pgm.php [Last accessed: February 10, 2020].
26.
AbdulrasoulM, MousaM, AlSanaaH, et al.Continuous subcutaneous insulin therapy in very young children with type 1 diabetes: Efficacy and safety. Pediatr Diabetes, 2015; 21:110.
27.
AhernJA, BolandEA, DoaneR, et al.Insulin pump therapy in pediatrics: A therapeutic alternative to safely lower HbA1c levels across all age groups. Pediatr Diabetes, 2002; 3(1):10–15.
28.
Alfonso Ross TerresJ, JabbourAD, FreemanMA. Trends in the treatment of type 1 diabetes with CSII vs MDI: A Canadian retrospective observational study. Diabetologia, 2012; 1:S422.
29.
AuzanneauM, KargesB, NeuA, et al.Use of insulin pump therapy is associated with reduced hospital-days in the long-term: A real-world study of 48,756 pediatric patients with type 1 diabetes. Eur J Pediatr, 2021; 180(2):10.
30.
BabarGS, AliO, PartonEA, et al.Factors associated with adherence to continuous subcutaneous insulin infusion in pediatric diabetes. Diabetes Technol Ther, 2009; 11(3):131–137.
31.
BaconS, McCarthyA, Costa-PozzaA, et al.The effectiveness and safety of continuous subcutaneous insulin infusion in a large adult cohort over a 10 year period. Irish J Med Sci, 2014; 1:S450–S451.
32.
Beato-ViboraP, Lazaro-MartinL, QuirosC, et al.Efficacy of sensor-augmented insulin pump with predictive low glucose suspension: A multicentre clinical experience in adults and children in Spain. Diabetologia, 2017; 60 (1Supplement 1):S319.
33.
Beato-VíboraP, Chico-BallesterosA, GiménezM, et al.A national survey on the efficacy and safety of continuous subcutaneous insulin infusion in patients with type 1 diabetes in Spain. Diabetes Res Clin Pract, 2018; 137:56–63.
34.
Beato-VíboraPI, Gamero-GallegoF, Lázaro-MartínL, et al.Prospective analysis of the impact of commercialised hybrid closed-loop system on glycaemic control, glycaemic variability and patient-related outcomes in children and adults: A focus on superiority over predictive low glucose suspend technology. Diabetes Technol Ther, 2020; 22:912–919.
35.
BiesterT, DanneT, BollowE, et al.Reduced rate of acute complications with tubeless insulin pump use-data from 2,640 patients in the German/Austrian DPV registry. Diabetes, 2018; 67(Suppl. 1):A453.
36.
BinderE, LangeO, EdlingerM, et al.Frequency of dermatological side effects of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes. Exp Clin Endocrinol Diabetes, 2015; 123(4):260–264.
37.
BinekA, Rembierz-KnollA, PolańskaJ, et al.Reasons for the discontinuation of therapy of personal insulin pump in children with type 1 diabetes. Pediatr Endocrinol Diabetes Metab, 2016; 21(2):65–69.
38.
ConlonT, SomersE, CostiganC, et al.Factors influencing discontinuation of continuous subcutaneous insulin infusion (CSII), in children with type 1 diabetes: A population based cohort study. Pediatr Diabetes, 2017; 18(Suppl. 25):130.
39.
CzerniawskaA, CzerniawskaE, SzadkowskaA, et al.Dermatological complications of continuous subcutaneous insulin infusion in young adults with type 1 diabetes mellitus. Diabetes Technol Ther, 2015; 1:A67.
40.
Evans-CheungTC, CampbellF, YongJ, et al.HbA(1c) values and hospital admissions in children and adolescents receiving continuous subcutaneous insulin infusion therapy. Diabetic Med, 2019; 36(1):88–95.
41.
FouldsLR, BoucherA, HamiltonK, et al.Reversion to injected insulin from CSII and the “pump probation” process at the Royal Children's Hospital (RCH) Melbourne, Australia. Pediatr Diabetes, 2011; 15:92.
42.
HayesM, FrearsonS, KellerC, et al.A hermeneutic phenomenological study of why adults with type 1 diabetes choose to discontinue CSII. Eur Diabetes Nurs, 2011; 8(1):12–16.
43.
HottaY, KawamuraT, HashimuraK, et al.Our experience of using sensor augmented pump. In: International Journal of Pediatric Endocrinology Conference: 9th Biennial Scientific Meeting of the Asia Pacific Paediatric Endocrine Society, APPES and the 50th Annual Meeting of the Japanese Society for Pediatric Endocrinology, JSPE Japan. 2017 (pagination).
44.
JarvelaA, MetsoS, HannulaP, et al.Real world experience of long-term glycaemic control with insulin pump among adults with type 1 diabetes. Diabetes Technol Ther, 2018; 20(Suppl. 1):A126.
45.
KaragianniP, SampanisC, KatsoulisC, et al.Continuous subcutaneous insulin infusion versus multiple daily injections. Hippokratia, 2009; 13(2):93–96.
46.
KaufmanFR, HalvorsonM, CarpenterS, et al.Pump therapy for children: Weighing the risks and benefits. View 2: Insulin pump therapy in young children with diabetes. Diabetes Spectr, 2001; 14(2):84–89.
47.
KilmartinGM, WilkinsonJ, KilmartinJF, et al.Improved therapeutic outcomes in an Australian rural diabetes centre undertaking CSII. Diabetes Technol Ther, 2013; 1:A44.
48.
LaptevDN, PeterkovaVA, DedovII. Frequency and reasons for CSII discontinuation in children and young patients with T1DM. Diabetes Technol Ther, 2018; 20(Suppl. 1):A126.
49.
Lou FrancesGM, Jimenez OlmosA, Adan LancetaV, et al.Our experience with sensor-augmented-pump therapy for children. Pediatr Diabetes, 2016; 17(Suppl. 24):53.
50.
McMahonSK, AireyFL, MarangouDA, et al.Insulin pump therapy in children and adolescents: Improvements in key parameters of diabetes management including quality of life. Diabetic Med, 2005; 22(1):92–96.
51.
MesserLH, TanenbaumML, CookPF, et al.Cost, hassle, and on-body experience: Barriers to diabetes device use in adolescents and potential intervention targets. Diabetes Technol Ther, 2020; 22(10):760–767.
52.
MesserLH, BergetC, VigersT, et al.Real world hybrid closed-loop discontinuation: Predictors and perceptions of youth discontinuing the 670G system in the first 6 months. Pediatr Diabetes, 2020; 21(2):319–327.
53.
MinhasH, WilliamsonS, FindlayC, et al.Reasons for insulin pump discontinuation. Pediatr Diabetes, 2016; 17(Suppl. 24):136.
54.
Moreno-FernandezJ, GomezFJ, PinésP, et al.Continuous subcutaneous insulin infusion in adult type 1 diabetes mellitus patients: Results from a public health system. Diabetes Technol Ther, 2019; 21(8):440–447.
55.
MousaM, Al-MahdiM, Al-SanaaH, et al.A comparison of continuous subcutaneous insulin infusion vs. multiple daily insulin injection in children with type i diabetes in Kuwait: Glycemic control, insulin requirement, and BMI. Oman Med J, 2015; 30(5):336–343.
56.
O'ConnellMA, CameronFJ. ‘It's not for me’-patterns of glycaemia in youth who discontinue CSII. Pediatr Diabetes, 2011; 15:132–133.
57.
OmarD, AlsanaeH, Al KhawariM, et al.An audit of clinical practice in a single centre in Kuwait: Management of children on continuous subcutaneous insulin infusion and cardiovascular risk factors screening. Open Cardiovasc Med J, 2017; 11:19–27.
58.
Perez-NievesM, GareyC, FanL, et al.Insulin pump therapy-patient and provider perceptions. Diabetes, 2018; 67(Suppl. 1):A255–A256.
59.
PlotnickLP, ClarkLM, BrancatiFL, et al.Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. Diabetes Care, 2003; 26(4):1142–1146.
60.
PrinzN, BächleC, BeckerM, et al.Insulin pumps in type 1 diabetes with mental disorders: Real-life clinical data indicate discrepancies to recommendations. Diabetes Technol Ther, 2016; 18(1):34–38.
61.
PytkaE, BarnesR, BossyA, et al.Differences in long-term metabolic control and BMI in children with type 1 diabetes on insulin pumps stratified by age and sex. Canadian J Diabetes, 2009; 33(3):261.
62.
QuirósC, ViñalsC, GiménezM, et al.Assessment of the effectiveness of long-term insulin pump therapy using a combined goal of HbA(1c) decrease and absence of severe hypoglycemia. Endocrinol Diabetes Nutr, 2019; 66(9):534–539.
63.
RabboneI, MinutoN, ScaramuzzaA, et al.Pump breakdown or malfunctions in a large cohort of Italian children and adolescents with type 1 diabetes using insulin pump therapy. Diabetes Technol Ther, 2015; 1:A9–A10.
64.
RachmielM, Levy-ShragaY, GruberN, et al.Comparing insulin pump devices in real life: The AWeSoMe study group prospective experience. Diabetes Technol Ther, 2019; 21(3):138–145.
65.
RaileK, NoelleV, LandgrafR, et al.Weight in adolescents with type 1 diabetes mellitus during continuous subcutaneous insulin infusion (CSII) therapy. J Pediatr Endocrinol Metab, 2002; 15(5):607–612.
66.
RigoRS, LevinLE, BelsitoDV, et al.Cutaneous reactions to continuous glucose monitoring and continuous subcutaneous insulin infusion devices in type 1 diabetes mellitus. J Diabetes Sci Technol, 2020:1932296820918894.
67.
RonsinO, Jannot-LamotteMF, VagueP, et al.Factors related to CSII compliance. Diabetes Metab, 2005; 31(1):90–95.
68.
RudolphJW, HirschIB. Assessment of therapy with continuous subcutaneous insulin infusion in an academic diabetes clinic. Endocr Pract, 2002; 8(6):401–405.
69.
SahaME, HuupponeT, MikaelK, et al.Continuous subcutaneous insulin infusion in the treatment of children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab, 2002; 15(7):1005–1010.
70.
SasT, De JongC, De VriesM, et al.Discontinuation of pump use in children and adolescents with type 1 diabetes (T1D). Diabetes Technol Ther, 2019; 21(Suppl. 1):A125.
71.
ScheuingN, BadenhoopK, BorkensteinM, et al.Why is insulin pump treatment rarely used in adolescents and young adults with cystic fibrosis-related diabetes?. Pediatr Diabetes, 2015; 16(1):10–15.
72.
ScheuingN, BachleC, BeckerM, et al.Mental disorder and type 1 diabetes: Initiation and discontinuation of CSII in pediatric and young adult patients with ADHD, depression, eating disorder, needle phobia, anxiety or obsessive-compulsive disorder or psychosis. A German/Austrian DPV analysis. Pediatr Diabetes, 2014; 19:44.
73.
SchoberE, RamiB. Dermatological side effects and complications of continuous subcutaneous insulin infusion in preschool-age and school-age children. Pediatr Diabetes, 2009; 10(3):198–201.
74.
SeereinerS, NeeserK, WeberC, et al.Attitudes towards insulin pump therapy among adolescents and young people. Diabetes Technol Ther, 2010; 12(1):89–94.
75.
ShahV, BoyleC, GargS, et al.Human factors associated with insulin pump and continuous glucose monitor discontinuation among adults with type 1 diabetes. Diabetes Technol Ther, 2016; 1:A18.
76.
ShulmanR, StukelTA, MillerFA,. Insulin pump use and discontinuation in children and teens: A population-based cohort study in Ontario, Canada. Pediatr Diabetes, 2017; 18(1):33–44.
77.
SulliN, ShashajB. Long-term benefits of continuous subcutaneous insulin infusion in children with Type 1 diabetes: A 4-year follow-up. Diabetic Med, 2006; 23(8):900–906.
78.
SulmontV, SouchonPF, Gouillard-DarnaudC, et al.Metabolic control in children with diabetes mellitus who are younger than 6 years at diagnosis: Continuous subcutaneous insulin infusion as a first line treatment?. J Pediatr, 2010; 157(1):103–107.
79.
SumnikZ, HlavkaZ, VolnaK, et al.Diabetes control did not worsen after insulin pump discontinuation in non-compliant adolescents with type 1 diabetes. Pediatr Diabetes, 2012; 17:116.
80.
TanenbaumML, HanesSJ, MillerKM, et al.Diabetes device use in adults with type 1 diabetes: Barriers to uptake and potential intervention targets. Diabetes Care, 2017; 40(2):181–187.
81.
ThomakosP, KepaptsoglouO, TaraouneI, et al.Pump users and insulin infusion sets during financial crisis: A matter of consideration?. Diabetes Technol Ther, 2015; 1:A69.
82.
van DijkPR, LogtenbergSJ, GroenierKH, et al.Fifteen-year follow-up of quality of life in type 1 diabetes mellitus. World J Diabetes, 2014; 5(4):569–576.
83.
Van WalleghemN, HoilettT, MarksS. An evaluation of the Manitoba pediatric insulin pump program. Pediatr Diabetes, 2014; 19:101.
84.
WilliSM, PlantonJ, EgedeL, et al.Benefits of continuous subcutaneous insulin infusion in children with type 1 diabetes. J Pediatr, 2003; 143(6):796–801.
85.
WongJC, DolanLM, YangTT,. Insulin pump use and glycemic control in adolescents with type 1 diabetes: Predictors of change in method of insulin delivery across two years. Pediatr Diabetes, 2015; 16(8):592–599.
86.
WoodJR, MorelandEC, VolkeningLK, et al.Durability of insulin pump use in pediatric patients with type 1 diabetes. Diabetes Care, 2006; 29(11):2355–2360.
87.
XatzipsaltiM, MentesidouL, KourtiA, et al.How frequent are the dermatological and technicalproblems of continuous subcutaneous insulininfusion (CSII) and continuous glucosemonitoring (CGM). Pediatr Diabetes, 2016; 17 (Suppl. 24):50.
88.
HanaireH. External insulin pump treatment in the day-to-day management of diabetes: Benefits and future prospectives. Diabetes Metab, 2011; 37(Suppl. 4):S40–S47.
89.
BarnardKD, WysockiT, ThabitH, et al.Psychosocial aspects of closed- and open-loop insulin delivery: Closing the loop in adults with Type 1 diabetes in the home setting. Diabetic Med, 2015; 32(5):601–608.
90.
BarnardK, WysockiT, UllyV, et al.Closing the loop in adults, children and adolescents with suboptimally controlled type 1 diabetes under free living conditions: A psychosocial substudy. J Diabetes Sci Technol, 2017; 11(6):1080–1088.
91.
FarringtonC, StewartZA, BarnardK, et al.Experiences of closed-loop insulin delivery among pregnant women with Type 1 diabetes. Diabetic Med, 2017; 34(10):1461–1469.
92.
HicksD. Why is the UK lagging behind in the pump usage stakes?. J Diabetes Nurs, 2008; 12(3):4.
93.
AlcoladoJ, BaileyK, CuthbertS, et al. CSII therapy: The Cardiff experience. Suppl Diabetes Primary Care, 2008;10(2).
94.
FranklinV. Influences on technology use and efficacy in type 1 diabetes. J Diabetes Sci Technol, 2016; 10(3):647–655.
95.
MesserLH. Why expectations will determine the future of artificial pancreas. Diabetes Technol Ther, 2018; 20(S2):S265–S268.
96.
RitholzMD, SmaldoneA, LeeJ, et al.Perceptions of psychosocial factors and the insulin pump. Diabetes Care, 2007; 30(3):549–554.
97.
BansalS, MarwaA, KasturiK, et al.Improving paediatric residents' knowledge and perspectives regarding the insulin pump using a novel educational workshop. Postgrad Med J, 2018; 94(1108):87–91.
98.
LawtonJ, KimbellB, RankinD, et al.Health professionals' views about who would benefit from using a closed-loop system: A qualitative study. Diabetic Med, 2020; 37(6):1030–1037.
99.
LawtonJ, KirkhamJ, RankinD, et al.Who gains clinical benefit from using insulin pump therapy? A qualitative study of the perceptions and views of health professionals involved in the Relative Effectiveness of Pumps over MDI and Structured Education (REPOSE) trial. Diabetic Med, 2016; 33(2):243–251.
100.
LenhardMJ. A new look at patient selection criteria for continuous subcutaneous insulin infusion (CSII). Diabetes Res Clin Pract, 2006; 74:S140–S143.
101.
BergetC, MesserLH, VigersT, et al.Six months of hybrid closed loop in the real-world: An evaluation of children and young adults using the 670G system. Pediatr Diabetes, 2020; 21(2):310–318.
102.
ShulmanR, MillerFA, StukelTA, et al.Pediatric insulin pump therapy: Reflecting on the first 10 years of a universal funding program in Ontario. Healthc Q (Toronto, Ont), 2017; 19(4):6–9.
103.
PickupJC, Ford HollowayM, SamsiK. Real-time continuous glucose monitoring in type 1 diabetes: A qualitative framework analysis of patient narratives. Diabetes Care, 2015; 38(4):544–550.
104.
GarmoA, Hörnsten Å, LeksellJ. ‘The pump was a saviour for me.'Patients' experiences of insulin pump therapy. Diabetic Med, 2013; 30(6):717–723.
105.
PetersC, Viner. R, Hindmarsh P. The impact of race and socioeconomic factors on paediatric diabetes. EClinicalMedicine, 2021; 42:101186.
106.
RassartJ, LuyckxK, MoonsP, et al.Personality and self-esteem in emerging adults with Type 1 diabetes. J Psychosom Res, 2014; 76(2):139–145.
107.
CemerogluAP, StoneR, KleisL, et al.Use of a real-time continuous glucose monitoring system in children and young adults on insulin pump therapy: Patients' and caregivers' perception of benefit. Pediatr Diabetes, 2010; 11(3):182–187.
108.
ShepardJA, Gonder-FrederickL, VajdaK, et al.Patient perspectives on personalized glucose advisory systems for type 1 diabetes management. Diabetes Technol Ther, 2012; 14(10):858–861.
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