Using a Do-It-Yourself Artificial Pancreas: Perspectives from Patients and Diabetes Providers

Background: A growing number of people with diabetes are choosing to adopt do-it-yourself artificial pancreas system (DIYAPS) despite a lack of approval from the US Food and Drug Administration. We describe patients’ experiences using DIYAPS, and patient and diabetes providers’ perspectives on the use of such technology. Methods: We distributed surveys to patients and diabetes providers to assess each group’s perspectives on the use of DIYAPS. The patient survey also assessed glycemic control and impact on sleep. The patient survey was distributed in February 2019 via Facebook and Twitter ( n = 101). The provider survey was distributed via the American Association of Diabetes Educators’ e-mail newsletter in April 2019 and the Pediatric Endocrine Society membership e-mail list in May 2019 ( n = 152). Results: Patients overwhelmingly described improvements in glycemic control and sleep quality: 94% reported improvement in time in range, and 64% reported improvement in all five areas assessed. Eighty-nine percent of patients described DIYAPS as “Safe” or “Very Safe,” compared to only 27% of providers. Most felt encouraged by their diabetes provider to continue using DIYAPS, but few described providers as knowledgeable regarding its use. Providers cited a lack of experience with such systems and an inability to troubleshoot them as their most significant challenges. Conclusions: Despite evidence that DIYAPS usage is increasing, our surveys suggest that patients’ adoption of this technology and trust in it is outpacing that of diabetes providers. Providers must be aware of this growing population of patients and familiarize themselves with DIYAPS to support patients using this technology.

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Diabeloop DBLG1 Closed-Loop System Enables Patients With Type 1 Diabetes to Significantly Improve Their Glycemic Control in Real-Life Situations Without Serious Adverse Events: 6-Month Follow-up

10.2337/figshare.13583129 ◽

2021 ◽

Author(s):

Coralie Amadou ◽

Sylvia Franc ◽

Pierre-Yves Benhamou ◽

Sandrine Lablanche ◽

Erik Huneker ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Adverse Events ◽

Closed Loop ◽

Artificial Pancreas ◽

Real Life ◽

Serious Adverse Events ◽

Life Conditions ◽

Time In Range

OBJECTIVE To analyze safety and efficacy of the DBLG1 hybrid closed-loop artificial pancreas system in patients with Type 1 Diabetes in real life conditions. METHODS Following a one-week run-in period with usual pump, 25 patients were provided with the commercial DBLG1 system. We present the results of Time-in-Range and HbA1c over a 6-month period. RESULTS The mean (SD;range) age of patients was 43 years (13.8; 25-72). At baseline, mean HbA1c and TIR 70-180mg/dL were respectively 7.9% (0.93; 5.6- 8.5) [63mmol/mol (10; 38-69)] and 53% (16.4;21-85). One patient stopped using the system after 2 months. At 6-month, mean HbA1c decreased to 7.1% [54mmol/mol] (p<0.001) and TIR 70-180mg/dL increased to 69.7% (p<0.0001). TIR<70mg/dL decreased from 2.4 to 1.3% (p=0.03). TIR<54mg/dL decreased from 0.32 to 0.24% (p=0.42). No serious adverse event was reported during the study. CONCLUSION The DBLG1 System confirms its ability to significantly improve glycemic control in real life conditions, without serious adverse events.

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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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Diabeloop DBLG1 Closed-Loop System Enables Patients With Type 1 Diabetes to Significantly Improve Their Glycemic Control in Real-Life Situations Without Serious Adverse Events: 6-Month Follow-up

10.2337/figshare.13583129.v1 ◽

2021 ◽

Author(s):

Coralie Amadou ◽

Sylvia Franc ◽

Pierre-Yves Benhamou ◽

Sandrine Lablanche ◽

Erik Huneker ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Adverse Events ◽

Closed Loop ◽

Artificial Pancreas ◽

Real Life ◽

Serious Adverse Events ◽

Life Conditions ◽

Time In Range

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An In Silico Head-to-Head Comparison of the Do-It-Yourself Artificial Pancreas Loop and Bio-Inspired Artificial Pancreas Control Algorithms

Journal of Diabetes Science and Technology ◽

10.1177/19322968211060074 ◽

2021 ◽

pp. 193229682110600

Author(s):

Ryan Armiger ◽

Monika Reddy ◽

Nick S. Oliver ◽

Pantelis Georgiou ◽

Pau Herrero

Keyword(s):

Glycemic Control ◽

In Silico ◽

Control Algorithm ◽

Artificial Pancreas ◽

Target Range ◽

Loop Control ◽

Percentage Time ◽

Do It Yourself ◽

Lower Variability ◽

Baseline Algorithm

Background: User-developed automated insulin delivery systems, also referred to as do-it-yourself artificial pancreas systems (DIY APS), are in use by people living with type 1 diabetes. In this work, we evaluate, in silico, the DIY APS Loop control algorithm and compare it head-to-head with the bio-inspired artificial pancreas (BiAP) controller for which clinical data are available. Methods: The Python version of the Loop control algorithm called PyLoopKit was employed for evaluation purposes. A Python-MATLAB interface was created to integrate PyLoopKit with the UVa-Padova simulator. Two configurations of BiAP (non-adaptive and adaptive) were evaluated. In addition, the Tandem Basal-IQ predictive low-glucose suspend was used as a baseline algorithm. Two scenarios with different levels of variability were used to challenge the algorithms on the adult (n = 10) and adolescent (n = 10) virtual cohorts of the simulator. Results: Both BiAP and Loop improve, or maintain, glycemic control when compared with Basal-IQ. Under the scenario with lower variability, BiAP and Loop perform relatively similarly. However, BiAP, and in particular its adaptive configuration, outperformed Loop in the scenario with higher variability by increasing the percentage time in glucose target range 70-180 mg/dL (BiAP-Adaptive vs Loop vs Basal-IQ) (adults: 89.9% ± 3.2%* vs 79.5% ± 5.3%* vs 67.9% ± 8.3%; adolescents: 74.6 ± 9.5%* vs 53.0% ± 7.7% vs 55.4% ± 12.0%, where * indicates the significance of P < .05 calculated in sequential order) while maintaining the percentage time below range (adults: 0.89% ± 0.37% vs 1.72% ± 1.26% vs 3.41 ± 1.92%; adolescents: 2.87% ± 2.77% vs 4.90% ± 1.92% vs 4.17% ± 2.74%). Conclusions: Both Loop and BiAP algorithms are safe and improve glycemic control when compared, in silico, with Basal-IQ. However, BiAP appears significantly more robust to real-world challenges by outperforming Loop and Basal-IQ in the more challenging scenario.

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Human-in-the-Loop Insulin Dosing

Journal of Diabetes Science and Technology ◽

10.1177/1932296819891177 ◽

2019 ◽

pp. 193229681989117 ◽

Cited By ~ 2

Author(s):

B. Wayne Bequette

Keyword(s):

User Interface ◽

Interface Design ◽

Closed Loop ◽

Artificial Pancreas ◽

Human In The Loop ◽

The Us ◽

Loop Detection ◽

Do It Yourself ◽

Late Stages ◽

System Movement

The last ten years of efforts in developing automated insulin dosing systems have led to one hybrid closed-loop device in the US market with more in the late stages of development. Much of the focus has been on algorithms, including closed-loop, detection of sensor and pump faults, and safety. There has been less discussion in the open literature about user interface design and related options. This article provides perspectives on automated insulin delivery (AID) system design by analyzing commonly used devices, such as bicycles and car entertainment systems. The recent Boeing 737 Max 8 disasters are used to highlight related challenges with AID systems. The role that system engineers can play in the do it yourself artificial pancreas system movement is also discussed. The human-in-the-loop remains by far the most important “component” of any AID system.

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The Artificial Pancreas in Cyborg Bodies

The Oxford Handbook of the Sociology of Body and Embodiment ◽

10.1093/oxfordhb/9780190842475.013.31 ◽

2020 ◽

pp. 412-430

Author(s):

Anthony Ryan Hatch ◽

Julia T. Gordon ◽

Sonya R. Sternlieb

Keyword(s):

Glucose Sensor ◽

Social Inequalities ◽

Infusion Pump ◽

Artificial Pancreas ◽

Small Scale ◽

Glucose Levels ◽

Loop Design ◽

Access To Health ◽

Do It Yourself ◽

And Control

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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