The Do-It-Yourself Artificial Pancreas: A Comprehensive Review

The new artificial pancreas system includes a body-attached blood glucose sensor that tracks glucose levels, a worn insulin infusion pump that communicates with the sensor, and features new software that integrates the two systems. The artificial pancreas is purportedly revolutionary because of its closed-loop design, which means that the machine can give insulin without direct patient intervention. It can read a blood sugar and administer insulin based on an algorithm. But, the hardware for the corporate artificial pancreas is expensive and its software code is closed-access. Yet, well-educated, tech-savvy diabetics have been fashioning their own fully automated do-it-yourself (DIY) artificial pancreases for years, relying on small-scale manufacturing, open-source software, and inventive repurposing of corporate hardware. In this chapter, we trace the corporate and DIY artificial pancreases as they grapple with issues of design and accessibility in a content where not everyone can become a diabetic cyborg. The corporate artificial pancreas offers the cyborg low levels of agency and no ownership and control over his or her own data; it also requires access to health insurance in order to procure and use the technology. The DIY artificial pancreas offers patients a more robust of agency but also requires high levels of intellectual capital to hack the devices and make the system work safely. We argue that efforts to increase agency, radically democratize biotechnology, and expand information ownership in the DIY movement are characterized by ideologies and social inequalities that also define corporate pathways.

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Safety and effectiveness of Do‐It‐Yourself Artificial Pancreas System (DIYAPS) compared with continuous subcutaneous insulin infusions (CSII) in combination with Free Style Libre (FSL) in people with Type 1 diabetes

Diabetic Medicine ◽

10.1111/dme.14793 ◽

2022 ◽

Author(s):

R Patel ◽

TSJ Crabtree ◽

N Taylor ◽

L Langeland ◽

T Gazis ◽

...

Keyword(s):

Type 1 Diabetes ◽

Artificial Pancreas ◽

Subcutaneous Insulin ◽

Do It Yourself

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Do-It-Yourself Open Artificial Pancreas System in Children and Adolescents with Type 1 Diabetes Mellitus: Real-World Data

Diabetes & Metabolism Journal ◽

10.4093/dmj.2021.0011 ◽

2021 ◽

Author(s):

Min Sun Choi ◽

Seunghyun Lee ◽

Jiwon Kim ◽

Gyuri Kim ◽

Sung Min Park ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Real World ◽

Artificial Pancreas ◽

Real World Data ◽

World Data ◽

Do It Yourself

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The Do-It-Yourself Artificial Pancreas

Pediatric Annals ◽

10.3928/19382359-20210622-02 ◽

2021 ◽

Vol 50 (7) ◽

Author(s):

Walter Palmer ◽

Siri Atma W. Greeley ◽

Rochelle Naylor

Keyword(s):

Artificial Pancreas ◽

Do It Yourself

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Use of a do-it-yourself artificial pancreas system is associated with better glucose management and higher quality of life among adults with type 1 diabetes

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820950146 ◽

2020 ◽

Vol 11 ◽

pp. 204201882095014

Author(s):

Zekai Wu ◽

Sihui Luo ◽

Xueying Zheng ◽

Yan Bi ◽

Wen Xu ◽

...

Keyword(s):

Quality Of Life ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Artificial Pancreas ◽

Pump Therapy ◽

Quality Of Life Scale ◽

Do It Yourself ◽

Glucose Management

Background: Previous studies show that the use of do-it-yourself artificial pancreas system (DIYAPS) may be associated with better glycemic control characterized by improved estimated hemoglobin A1c (eHbA1c) and time in range among adults with type 1 diabetes (T1D). However, few studies have demonstrated the changes in laboratory-measured HbA1c, which is a more accepted index for glycemic control, after using a DIYAPS. Methods: This is a retrospective before-after study approaching patients who reported self-use of AndroidAPS. The main inclusion criteria included: T1D; aged ⩾18 years; having complete record of ⩾3 months of continuous AndroidAPS use; with laboratory-measured HbA1c and quality of life scale data before and after 3 months of AndroidAPS use; and not pregnant. The primary outcome was the change in HbA1c between baseline and 3 months after initiation of AndroidAPS use. Results: Overall, 15 patients (10 females) were included; the median age was 32.2 years (range: 19.2–69.4), median diabetes duration was 9.7 years (range: 1.8–23.7) and median baseline HbA1c was 7.3% (range: 6.4–10.1). The 3 months of AndroidAPS use was associated with substantial reductions in HbA1c [6.79% (SD: 1.29) versus 7.63% (SD: 1.06), p = 0.002] and glycemic variability when compared with sensor-augmented pump therapy. A lower level of fear of hypoglycemia [22.13 points (SD: 6.87) versus 26.27 points (SD: 5.82), p = 0.010] was also observed after using AndroidAPS. Conclusions: The 3 months of AndroidAPS use was associated with significant improvements in glucose management and quality of life among adults with T1D.

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“Going Rogue”

Digital Culture & Society ◽

10.14361/dcs-2018-0208 ◽

2018 ◽

Vol 4 (2) ◽

pp. 137-156

Author(s):

Samantha D. Gottlieb ◽

Jonathan Cluck

Keyword(s):

Open Source ◽

Treatment Guidelines ◽

Artificial Pancreas ◽

Medical Model ◽

Glucose Monitoring ◽

Diabetes Research ◽

Medical Surveillance ◽

Patient Centered ◽

Do It Yourself ◽

Medical Category

Abstract This paper explores our collaborative STS and anthropological project with type 1 diabetes (T1D) hardware “hacking” communities, whose work focuses on reverse-engineering and extracting data from medical devices such as insulin pumps and continuous glucose monitoring systems (CGMS) to create do-it-yourself artificial pancreas systems (APS). Rather than using these devices within their prescriptive and prescribed purposes (surveillance and treatment monitoring), these “hackers” repurpose, reinterpret, and redirect of the possibilities of medical surveillance data in order to reshape their own treatment. Through “deliberate non-compliance” (Scibilia 2017) with cliniciandeveloped treatment guidelines, T1D device hackers deliberatively engage with clinicians’ conceptions and formulations of what constitutes “good treatment” and empower themselves in discussions about the effectiveness of treatment guidelines. Their non-compliance is, however, neither negligence, as implied by the medical category of patients who fail to comply with clinical orders, nor ignorance, but a productive and creative response to their embodied expertise, living with a chronic and potentially deadly condition. Our interlocutors’ explicit connections with the free and open source software principles suggests the formation of a “recursive public” (Kelty 2008) in diabetes research and care practices, from a patient-centered “medical model” to a diverse and divergent patient-led model. The philosophical and ethical underpinnings of the open source and collaborative strategies these patients draw upon radically reshape the principles that drive the commercial health industry and government regulatory structures.

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Survey about do-it-yourself closed loop systems in the treatment of diabetes in Germany

PLoS ONE ◽

10.1371/journal.pone.0243465 ◽

2020 ◽

Vol 15 (12) ◽

pp. e0243465

Author(s):

Anna Laura Herzog ◽

Jonas Busch ◽

Christoph Wanner ◽

Holger K. von Jouanne-Diedrich

Keyword(s):

Blood Glucose ◽

Glucose Control ◽

Closed Loop ◽

Artificial Pancreas ◽

Direct Interaction ◽

Loop System ◽

Closed Loop System ◽

Glucose Levels ◽

Blood Glucose Levels ◽

Do It Yourself

Continuous glucose monitoring (CGM) improves treatment with lower blood glucose levels and less patient effort. In combination with continuous insulin application, glycemic control improves and hypoglycemic episodes should decrease. Direct feedback of CGM to continuous subcutaneous insulin application, using an algorithm is called a closed-loop (CL) artificial pancreas system. Commercial devices stop insulin application by predicting hypoglycemic blood glucose levels through direct interaction between the sensor and pump. The prediction is usually made for about 30 minutes and insulin delivery is restarted at the previous level if a rise in blood glucose is predicted within the next 30 minutes (hybrid closed loop system, HCL this is known as a predictive low glucose suspend system (PLGS)). In a fully CL system, sensor and pump communicate permanently with each other. Hybrid closed-loop (HCL) systems, which require the user to estimate the meal size and provide a meal insulin basis, are commercially available in Germany at the moment. These systems result in fewer hyperglycemic and hypoglycemic episodes with improved glucose control. Open source initiatives have provided support by building do-it-yourself CL (DIYCL) devices for automated insulin application since 2014, and are used by a tech-savvy subgroup of patients. The first commercial hybrid CL system has been available in Germany since September 2019. We surveyed 1054 patients to determine which devices are currently used, which features would be in demand by potential users, and the benefits of DIYCL systems. 9.7% of these used a DIYCL system, while 50% would most likely trust these systems but more than 85% of the patients would use a commercial closed loop system, if available. The DIYCL users had a better glucose control regarding their time in range (TIR) and glycated hemoglobin (HbA1c).

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Evolution of Do-It-Yourself Remote Monitoring Technology for Type 1 Diabetes

Journal of Diabetes Science and Technology ◽

10.1177/1932296819895537 ◽

2020 ◽

Vol 14 (5) ◽

pp. 854-859

Author(s):

Michelle Ng ◽

Emily Borst ◽

Ashley Garrity ◽

Emily Hirschfeld ◽

Joyce Lee

Keyword(s):

Type 1 Diabetes ◽

Open Source ◽

Remote Monitoring ◽

Diabetes Management ◽

Rapid Development ◽

Artificial Pancreas ◽

Commercial Space ◽

Technology Innovations ◽

Do It Yourself

Background: The Nightscout Project is a leading example of patient-designed, do-it-yourself (DIY), open-source technology innovations to support type 1 diabetes management. We are unaware of studies that have described the evolution of patient-driven innovations from the Nightscout Project to date. Methods: We identified patient-driven, DIY innovations from posts and comments in the “CGM in the Cloud” private Facebook group as well as data from Twitter, GitHub, and the Nightscout website. For each innovation, we described its intent or its unaddressed need as well as the associated features and improvements. We conducted a thematic analysis to identify overarching patterns among the innovations, features, and improvements, and compared the timeline of innovations in the DIY space with the timing of similar innovations in the commercial space. Results: We identified and categorized innovations in Nightscout with the most commonly appearing themes of: visualization improvements, equipment improvements, and user experience improvements. Other emerging themes included: Care Portal support, safety, remote monitoring, decision support, international support, artificial pancreas, pushover notifications, and open-source collaboration. Conclusions: This rapid development of patient-designed DIY innovations driven by unmet needs in the type 1 diabetes community reflects a revolutionary, bottom–up approach to medical innovation. Nightscout users accessed features earlier than if they had waited for commercial products, and they also personalized their tools and devices, empowering them to become the experts of their own care.

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