Safety and effectiveness of do‐it‐yourself artificial pancreas system compared with continuous subcutaneous insulin infusions in combination with free style libre in people with type 1 diabetes

Abstract

Aims:The use of do-it-yourself artificial pancreas systems (DIYAPS) among people with type 1 diabetes is increasing. At present, it is unclear how DIYAPS compares with other technologies such as FreeStyle Libre (FSL) and continuous subcutaneous insulin infusion (CSII).The aim of this analysis is to compare safety, effectiveness and quality-of-life outcomes of DIYAPS use with the addition of FSL to CSII.Method: Data from two large UK hospitals were extracted from the Association of British Clinical Diabetologists (ABCD) DIYAPS and FSL audits. Outcomes included HbA 1c , glucose TBR (time-below-range), TIR (time-in-range), Diabetes Distress Score (DDS), and Gold hypoglycaemia score. Any adverse events were noted. Changes at follow-up were assessed using paired t-tests and ANOVA in Stata; TIR/TBR at follow-up assessed using unpaired t-tests; chi-square tests assessed the change in frequency of health utilisation (e.g. hospital admissions). Results: DIYAPS (n = 35) and FSL+CSII (n = 149) users, with median followup duration of 1.4 (IQR 0.8-2.1) and 1.3 (IQR 0.7-1.8) years, respectively, were included. HbA 1c with DIYAPS use changed by −10 mmol/mol [0.9%] (p < 0.001, 95% CI 5, 14 [0.5, 1.3%]) significantly lower (p < 0.001) than in the FSL+CSII group −3 mmol/mol [0.25%] (p < 0.001, 95% CI 1, 4 [0.1, 0.4%]). TIR was higher and TBR was lower in the DIYAPS group. Adverse events were rare in both groups and no significant differences were observed in the frequency of healthcare utilisation. Conclusion:DIYAPS use was associated with a lower HbA 1c levels, higher TIR and lower TBR compared with FSL+CSII. There was no significant increase in adverse events, although this should be interpreted cautiously given the low numbers of users. Full results from the ABCD DIYAPS audit are awaited.How to cite this article: Patel R, Crabtree TSJ, Taylor N, et al. Safety and effectiveness of do-ityourself artificial pancreas system compared with continuous subcutaneous insulin infusions in combination with free style libre in people with type 1 diabetes.

Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes

“…Evidence of similar benefits has also been derived from qualitative studies, including content analysis of data shared through Twitter (subsequently rebranded X), which also demonstrated reduced diabetes burden [16,17]. A total of 2 small studies (N=35 and N=15) using validated PROMs have demonstrated benefits for diabetes distress [14] and fear of hypoglycemia [18]. Recently, a larger cohort study (N=239) found significant improvements, from baseline to 6 months of open-source AID use, in diabetes distress, sleep quality, fear of hypoglycemia, and hypoglycemia confidence [19].…”

“…In contrast to commercial systems, there has been relatively little research into the psychosocial outcomes of those using open-source AID systems. Early surveys showed benefits for sleep and QoL but were limited by the use of study-specific (unvalidated) survey questions [12,14,15]. Evidence of similar benefits has also been derived from qualitative studies, including content analysis of data shared through Twitter (subsequently rebranded X), which also demonstrated reduced diabetes burden [16,17].…”

#We are not waiting - DIY APS Do-It-Yourself Artificial Pancreas Systems: The story so far

“…10,11 In addition to these findings, others have compared DIY APS to commercial systems, often with favourable glucose outcomes (despite often lower HbA1c and higher time-in-range at baseline) and reassuring safety data. [12][13][14] It is difficult to draw conclusions from observational data but with the systems being actively used in the real world there were limited other means to understand them better in the current cohort of users. That being said, AndroidAPS has recently been put through a randomised controlled trial.…”

Barriers to Uptake of Open-Source Automated Insulin Delivery Systems: Analysis of Socioeconomic Factors and Perceived Challenges of Caregivers of Children and Adolescents With Type 1 Diabetes From the OPEN Survey

“…Previous studies have shown that open-source AID systems have the potential to improve clinical outcomes in users of several age groups (e.g. better HbA1c-level and time in range (TIR)) (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Moreover, they reduce the individual burden of living with diabetes, such as improving quality of life and sleep quality (14,(24)(25)(26)(27)(28).…”