Partner Perspectives on Closed Loop Systems

  • Esti Iturralde, PhD Stanford University School of Medicine
  • Molly L. Tanenbaum, PhD Stanford University School of Medicine
  • Diana Naranjo, PhD Stanford University School of Medicine
  • Korey K. Hood, PhD Stanford University School of Medicine


Objective: Closed loop automated insulin delivery systems have the potential to transform diabetes management. Partners and relationships will be increasingly affected by these innovations. We examine current understanding of the partner’s role in type 1 diabetes (T1D) management and technology, and provide an example of how to elicit partners’ perspectives in technology research.

Research Design and Methods: We conducted a literature review and a small focus group with the partners of participants enrolled in a 5-day hybrid closed loop (HCL) clinical trial. Couples’ questionnaire ratings of diabetes-related distress and hypoglycemia concerns were described.

Results: Partners play an integral and often helpful role in managing diabetes. They also report significant diabetes-related distress and fear of hypoglycemia, which have implications for relationships. Closed loop systems offer potential benefits such as hypoglycemia prevention and partners’ online access to glucose data (“remote monitoring”). However, disruptive alerts, technical glitches, maintenance tasks, device size, and other drawbacks may strain partners and relationships. A partner focus group elicited several novel themes. Partners gained valuable insights about T1D from remote monitoring and identified hypoglycemia prevention as a major benefit. For all partners, hypoglycemia worries decreased during system use. However, partners also cited vicarious frustrations with the system, concerns about remote monitoring disrupting couple communication, and needs for technology-specific partner education.

Conclusion: Closed loop systems stand to affect partners and relationships. As researchers continue to design closed loop systems and devise their integration into standard clinical care, it will be vital to assess partner perspectives to increase satisfaction and success with this technology.

Author Biographies

Esti Iturralde, PhD, Stanford University School of Medicine

Esti Iturralde, PhD, is a psychology postdoctoral fellow at the Stanford University School of Medicine in the Department of Pediatrics. She is a clinical psychologist and researcher trained in evidence-based behavioral treatments for children, families, and adults. Her research interests include mechanisms that affect adjustment and adherence among people with type 1 diabetes, and the role of close relationships in health behavior.

Molly L. Tanenbaum, PhD, Stanford University School of Medicine

Molly L. Tanenbaum, PhD, is a postdoctoral psychology fellow at Stanford University School of Medicine in the Department of Pediatrics. Her training is in clinical psychology and health psychology. As a clinician, she is trained to work with people with diabetes throughout the lifespan. As a researcher, she has focused broadly on diabetes self-management and diabetes-related distress in adults with type 1 and type 2 diabetes, and more recently, she has focused on human factors related to diabetes device uptake and use.

Diana Naranjo, PhD, Stanford University School of Medicine

Diana M. Naranjo, PhD, is an Assistant Professor of Psychiatry at Stanford School of Medicine. As a trained pediatric and adult psychologist working in behavioral medicine, Dr. Naranjo focuses on the psychosocial needs of patients and families with diabetes. She is a licensed clinical psychologist and a part of both the diabetes care team and cystic fibrosis care team at Lucile Packard Children’s Hospital. Together with the team, she aims to understand barriers and facilitators to care, work toward an integrative mental health screening program, understand what developmental demands are important as adolescent's transition to adulthood, and how to best provide services that engage youth and their families. Furthermore, as a Latino-American and fluent in Spanish, much of her clinical work focuses on bridging the health-care gap for underserved ethnic minority patients with type 1 diabetes.  

Korey K. Hood, PhD, Stanford University School of Medicine

Korey K. Hood, PhD, works closely with people with diabetes in clinical, research, and advocacy settings. Dr. Hood is a clinical psychologist and researcher at Stanford University, where he is Professor of Pediatrics and Psychiatry & Behavioral Sciences. At Stanford, he directs NIH- and foundation-funded research projects and provides clinical care aimed at promoting health and quality of life outcomes. Much of this work focuses on increasing the uptake of diabetes devices and technologies and promoting the optimal use of current and future closed loop systems. Dr. Hood works closely with Drs. Buckingham and Maahs at Stanford and coordinates many of the “Human Factors” assessments conducted in closed loop trials. He is the past chair of the Behavioral Medicine and Psychology Interest Group of the American Diabetes Association (ADA), is on editorial boards for Diabetes Care and Pediatric Diabetes, and assists with programming for JDRF and Children With Diabetes events. In addition to publishing over 85 scientific articles, Dr. Hood is the author of Type 1 Teens: A Guide to Managing Your Life with Diabetes and co-author of ADA’sTeens With Diabetes: A Clinician’s Guide.

Original Research Articles