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The Do-It-Yourself Artificial Pancreas: A Comprehensive Review.
Jothydev Kesavadev1, Seshadhri Srinivasan2, Banshi Saboo3
1Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India. jothydev@gmail.com.
Summary
Patients with type 1 diabetes are developing their own artificial pancreas systems (DIYAPS) to improve glycemic control. While showing promise, these unregulated systems face challenges with safety, regulation, and acceptance by healthcare professionals.
Area of Science:
- Diabetes Technology
- Artificial Pancreas Systems
- Patient-Driven Innovation
Background:
- Significant advancements in diabetes technology (DT) aim to improve management for patients with diabetes (PWD).
- However, many PWD face challenges with type 1 diabetes management due to limited access to innovative DT, driven by slow commercialization, high costs, and lack of peer support.
- This has led to the #WeAreNotWaiting movement, where tech-savvy individuals develop do-it-yourself artificial pancreas systems (DIYAPS).
Purpose of the Study:
- To provide a comprehensive overview of DIYAPS, including their origin, existing literature, advantages, and disadvantages.
- To inform industry leaders, clinicians, and PWD about the potential and challenges of DIYAPS.
- To highlight the need for a multi-agency approach to evaluate risks and responsibilities associated with DIYAPS.
Main Methods:
- Review of existing literature and observational studies on DIYAPS.
- Analysis of anecdotal evidence and real-world patient experiences.
- Exploration of online platforms (GitHub, CGM in the Cloud, Twitter) used for sharing DIYAPS technologies and user experiences.
Main Results:
- DIYAPS integrate continuous glucose monitoring (CGM), insulin pumps, and smartphone technology with open-source algorithms for automated insulin delivery (AID).
- Studies and patient reports indicate significant improvements in time in range (TIR), time in hypoglycemia (TIHypo), HbA1c levels, and quality of life (QoL) with DIYAPS.
- Unregulated DIYAPS face significant concerns from healthcare professionals, regulatory bodies, and manufacturers regarding safety, off-label use, and lack of standardized data.
Conclusions:
- DIYAPS represent a patient-driven innovation addressing access gaps in diabetes technology, demonstrating potential for improved glycemic control and QoL.
- Significant barriers remain, including regulatory hurdles, safety concerns, ethical and legal issues, and lack of insurance coverage.
- A collaborative, multi-agency approach is crucial to assess risks, establish guidelines, and potentially integrate DIYAPS into mainstream diabetes care.
