{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T19:47:14Z","timestamp":1789674434960,"version":"4.0.1"},"reference-count":36,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Diabetes Technology &amp; Therapeutics"],"published-print":{"date-parts":[[2026,4,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Bihormonal fully closed loop (FCL; \u201cartificial pancreas\u201d) reactively manages glucose levels by adjusting insulin or glucagon delivery based on sensor readings. Previous quantitative research has demonstrated FCL group-level efficacy in terms of glycemic and person-reported outcomes. Less is known about specific user experiences and the impact on different life domains.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims:<\/jats:title>\n                    <jats:p>To qualitatively examine motives and user experiences related to this bihormonal FCL system among adults with type 1 diabetes in a real-world setting. This included (a) reasons for considering FCL use, (b) positive or negative impact of FCL, (c) the process of adjusting to the system, and (d) the perceived benefit\u2013burden trade-off.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      After close of a 12-month single-arm trial (FREE 1), a subsample was interviewed (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      = 12). Eight ongoing users were selected based on change patterns in the quantitative trial data. Four people who discontinued the system were selected based on duration of FCL use and discontinuation reasons. Data were analyzed using thematic and narrative analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Participants voiced a combination of personal and altruistic considerations in the decision to start FCL. While there was a variety in individual impact, benefits (improved glycemic outcomes, feeling more like a person without diabetes) mostly outweighed burdens (e.g., hassles related to glucagon replacement, multiple components, alarms). FCL was a positive life changer for ongoing users, despite continued effort required for technology management. Finding a working relation with the system was challenging and took time, with participants reporting different coping strategies. Discontinuation reasons presented early, with an accumulation of negative experiences leading up to the decision to stop.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>FCL users experience improvements mostly in glycemic and often also person-reported outcomes, with continuation of use depending on reconcilability of technology hassles. To facilitate FCL adoption and long-term use, expectation management and continued support from the manufacturer and trained diabetes care teams seem key.<\/jats:p>\n                    <jats:p>\n                      <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" orientation=\"portrait\" position=\"float\" xlink:href=\"10.1177_15209156251383522-fig1.tif\"\/>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/15209156251383522","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T13:11:12Z","timestamp":1759842672000},"page":"360-373","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":5,"title":["User Experiences of a Bihormonal Fully Closed-Loop System Among Adults with Type 1 Diabetes in a Real-World Setting: A Qualitative Analysis"],"prefix":"10.1177","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8772-740X","authenticated-orcid":false,"given":"Giesje","family":"Nefs","sequence":"first","affiliation":[{"name":"Department of Medical Psychology, Radboud University Medical Center, Nijmegen, the Netherlands."},{"name":"Diabeter, Center for Focused Diabetes Care and Research, Rotterdam, the Netherlands."},{"name":"Department of Medical and Clinical Psychology, CoRPS \u2013 Center of Research on Psychological Disorders and Somatic Diseases, Tilburg University, Tilburg, the Netherlands."},{"name":"Diabeter Centrum Amsterdam, Amsterdam, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Theodorus J.P.","family":"Jansen","sequence":"additional","affiliation":[{"name":"Inreda Diabetic, Goor, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michel","family":"Klaassen","sequence":"additional","affiliation":[{"name":"Inreda Diabetic, Goor, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lyan B.","family":"Vlaskamp","sequence":"additional","affiliation":[{"name":"Inreda Diabetic, Goor, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattijs","family":"Out","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Medisch Spectrum Twente, Enschede, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gozewijn D.","family":"Laverman","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, ZGT Hospital, Almelo and Hengelo, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas J.J.W.","family":"Schouwenberg","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin N.","family":"Gerding","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Deventer Hospital, Deventer, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra H.","family":"Mulder","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Slingeland Hospital, Doetinchem, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mechteld A.R.","family":"Vermeulen","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, CWZ, Nijmegen, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeroen P.H.","family":"van Wijk","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Gelderse Vallei, Ede, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank J.","family":"Snoek","sequence":"additional","affiliation":[{"name":"Department of Medical Psychology, Amsterdam UMC, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helga","family":"Blauw","sequence":"additional","affiliation":[{"name":"Inreda Diabetic, Goor, the Netherlands."},{"name":"Medical School Twente, Medisch Spectrum Twente, Enschede, the Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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