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There is a pressing need for new treatment regimens that offer enable improved glycaemic control and reduced diabetes self-management burdens. Closed-loop systems, or artificial pancreas systems, represent one of the most promising avenues in this regard. Closed-loop systems connect wearable continuous glucose monitor (CGM) sensors to smartphone- or tablet-mounted algorithms, which process and model CGM data to deliver precise and frequently updated doses of fast-acting insulin (and glucagon in dual-hormone systems) to users via wearable pumps. Recent studies have demonstrated that closed-loop systems offer significant benefit in terms of improved glycaemic control. However, less attention has been paid to their psychosocial impact on users of closed-loop systems. This article reviews recent research on psychosocial aspects of closed-loop usage in light of preceding research on user experience of currently available technologies such as insulin pumps and CGM sensors. The small but growing body of research in this field reports generally positive user experience and a number of experienced benefits including reassurance and reduced anxiety, improved sleep and confidence, and ‘time off’ from diabetes demands. However, these benefits are counterbalanced by a number of important challenges, ranging from variable levels of trust to concerns about physical bulk, technical glitches, and difficulties incorporating closed-loop systems into everyday life. Future research should explore psychosocial aspects of closed-loop usage in more diverse groups and with regard to clinicians as well as users in order to ensure that the clinical benefits of closed-loop systems are realised at scale in routine medical care.

Background: In the UK, the closure of ‘long-stay’ hospitals was accompanied by the development of community teams (CTs) to support people with intellectual disabilities (IDs) to live in community settings. The self-reported experiences of staff working in such teams has been neglected. Methods: Focusing on a single county-wide service, comprising five multi-disciplinary and inter-agency CTs, we measured perceptions among the health care and care management team members of (i) their personal well-being (Maslach Burnout Inventory (MBI) Maslach and Jackson, 1981); (ii) the functioning of their team (Team Climate Inventory (TCI) Anderson and West, 1994) and (iii) organisational commitment to quality and culture (the Quality Implementation Improvement Survey – II (QIIS-II, Shortell et al., 1995, 2000). Results: Almost three-quarters of the questionnaires were returned (73/101; 72%). The scores of health care and care managers were very similar: the MBI scores of more than half the respondents were ‘of concern’; (ii) similarly, almost four in ten respondents’ scores on the Vision scale were ‘of concern’; (iii) the perceived commitment to quality (QIIS-II Part 2) was uncertain; and (iv) the organisational culture (QIIS-II, Part 1) was viewed as primarily hierarchical. Discussion: The perceived absence of a vision for the service, combined with a dominant culture viewed by its members as strongly focussed on bureaucracy and process, potentially compromises the ability of these CTs to respond proactively to the needs of people with IDs. Given the challenges that changes in legislation, policy, and practice that have taken place since CTs were established, it would be timely to revisit their role and purpose.