Closed loop systems in type 1 diabetes

Waugh, Norman; Adler, Amanda I; Craigie, I; Omer, Timothy

doi:10.1136/bmj.k1613

Cited by 6 publications

(5 citation statements)

References 6 publications

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“…Marshall et al 28 United Kingdom Commentary Patient physician perspective of three cases highlighting benefits of using DIY APS and utilizing this approach in pregnancy, care of a child, and surgery Patton 29 Australia Case Report User's experience from one year of DIY APS Crabtree et al 8 United Kingdom Review DIY APS: Principles, outcomes, and ethics de Bock 30 Australia Editorial DIY APS dilemmas facing healthcare professionals Waugh et al 7 United Kingdom Editorial Need for DIY APS research Barnard et al 31 International Commentary DIY APS overview and dilemmas Lewis 13 United States Viewpoint DIY history, pros and cons, impact Lee et al 32 United States Viewpoint Nightscout overview and regulatory dilemmas Lewis et al 33 United States Letter to the Editor Setting expectations for successful artificial pancreas/hybrid closed loop/automated insulin delivery adoption Lewis et al 27 United States Letter to the Editor Real-world use of open source artificial pancreas systems Lewis 34 United in their approach to DIY APS, despite the strong real-world data showing the benefits of using such systems.…”

Section: Country Literature Type Focusmentioning

confidence: 99%

“…Following the early development of low and predictive low glucose basal insulin suspension sensor augmented insulin pump systems, more recent algorithms for subcutaneous insulin dosing have been developed that allow insulin dosing in an automated fashion via insulin pumps in response to changes in glucose detected by sensors. [6][7][8][9] In this review, we detail the emerging evidence for DIY APS. While these systems are currently unregulated and not medically approved, their real-world use highlights potential metabolic and psychological benefits.…”

Section: Introductionmentioning

confidence: 99%

“…The following is an Accepted Manuscript which has been made available as an Open access version. The final copy-edited and typeset article is available from: have been developed that allow insulin dosing in an automated fashion via insulin pumps in response to changes in glucose detected by sensors [6][7][8][9].…”

Section: Introductionmentioning

confidence: 99%

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Do-It-Yourself Artificial Pancreas Systems: A Review of the Emerging Evidence and Insights for Healthcare Professionals

Jennings

Hussain

2019

J Diabetes Sci Technol

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Application of artificial pancreas systems in type 1 diabetes (T1D) represents a change in approach to managing complex glucose and insulin dynamics using automated features with higher levels of safety, precision, and reliability than those afforded by manual adjustments. To date, limited commercial systems and more widely used open-source, hybrid closed loop, Do-It-Yourself Artificial Pancreas Systems (DIY APS) have been used in nontrial real-world management of T1D. The aims of this article are twofold. First, itsynthesizes the emerging literature on DIY APS and identifies a range of evidence including research, reviews, commentaries, and opinion pieces written by DIY APS users, healthcare professionals (HCPs), and researchers. It summarizes the emerging clinical evidence for DIY APS and provide insight into how the DIY APS movement began, has been disseminated throughout diabetes online communities, and is reshaping self-management of T1D in real-world settings. Second, the article provides commentaries that explore implications of DIY APS to healthcare practice. DIY APS are radically changing T1D management. Automating the process of frequently analyzing glucose readings and appropriately titrating insulin delivery is liberating people with T1D (PWD) from some of the demands of intensive management. Within this super-specialized area of T1D management, the expertise of DIY APS users has outstripped that of many HCPs. While educational, ethical, and legal constraints need to be resolved, HCPs still need to stay abreast of this rapidly developing area. Further research is needed to inform policy and practice relating to DIY APS. Meanwhile, HCPs continue to learn from PWD’s real-world experiences of building and using DIY APS to improve metabolic and psychological outcomes.

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Section: Country Literature Type Focusmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Do-It-Yourself Artificial Pancreas Systems: A Review of the Emerging Evidence and Insights for Healthcare Professionals

Jennings

Hussain

2019

J Diabetes Sci Technol

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“…These systems are not able to increase insulin infusion in response to elevated serum glucose, but reduce hypoglycemic episodes without causing rebound hyperglycemia [12]. The patient's intervention is still required with self-monitoring of blood glucose levels twice daily for calibration and by considering nutritional intake [13].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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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“…The greatest benefits of the AP are the reduced burden of diabetes management during the day, and improved overnight control of glucose levels thanks to reduced glycaemic variability, improved time in target range and reduced risk of nocturnal hypoglycaemia 26–28. Although AP users with type 1 diabetes will still need to self-manage their illness, a closed -loop system with data acted on by the users could reduce the burden 29…”

Section: Introductionmentioning

confidence: 99%

Information and communication technology enabling partnership in person-centred diabetes management: building a theoretical framework from an inductive case study in The Netherlands

et al. 2019

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ObjectivesThe aim of this paper is to construct a theoretical framework for information and communication technology (ICT)-enabled partnership towards diabetes management.DesignWe conducted an inductive case study and held interviews on the development and use of an artificial pancreas (AP) system for diabetes management.SettingThe study was carried out in the Netherlands with users of an AP system.ParticipantsWe interviewed six patients with type 1 diabetes, five healthcare professionals (two medical specialists and three diabetes nurses), and one policy advisor from the Ministry of Health, Welfare and Sport.ResultsWe built a new theoretical framework for ICT-enabled person-centred diabetes management, covering the central themes of self-managing the disease, shared analysing of (medical) data and experiencing the partnership. We found that ICT yielded new activities of data sharing and a new role for data professionals in the provision of care as well as contributed to carefree living thanks to the semiautomated management enabled by the device. Our data suggested that to enable the partnership through ICT, organisational adjustments need to be made such as the development of new ICT services and a viable financial model to support these services.ConclusionThe management of diabetes through ICT requires an adjustment of the partnership between persons with the chronic condition and the healthcare professional(s) in such a way that the potential for self-managing the condition by analysing the newly available (medical) data (from the AP system) together leads to an experience of partnership between patients and healthcare professionals.

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Closed loop systems in type 1 diabetes

Abstract: A promising development, now patients and policy makers need much better evidence

Cited by 6 publications

References 6 publications

Do-It-Yourself Artificial Pancreas Systems: A Review of the Emerging Evidence and Insights for Healthcare Professionals

Do-It-Yourself Artificial Pancreas Systems: A Review of the Emerging Evidence and Insights for Healthcare Professionals

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

Information and communication technology enabling partnership in person-centred diabetes management: building a theoretical framework from an inductive case study in The Netherlands

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