Efficacy, safety, and user experience of DIY or open-source artificial pancreas systems: a systematic review
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REVIEW ARTICLE
Efficacy, safety, and user experience of DIY or open‑source artificial pancreas systems: a systematic review N. A. M. Asarani1 · A. N. Reynolds2 · M. Elbalshy1 · M. Burnside3 · M. de Bock3 · D. M. Lewis4 · B. J. Wheeler1 Received: 26 August 2020 / Accepted: 14 October 2020 © Springer-Verlag Italia S.r.l., part of Springer Nature 2020
Abstract The do-it-yourself artificial pancreas system (DIYAPS) is a patient-driven initiative with the potential to revolutionise diabetes management, automating insulin delivery with existing pumps and CGM combined with open-source algorithms. Given the considerable interest in this topic within the diabetes community, we have conducted a systematic review of DIYAPS efficacy, safety, and user experience. Following recognised procedures and reporting standards, we identified 10 eligible publications of 730 participants within the peer-reviewed literature. Overall, studies reported improvements in time in range, HbA1c (glycated haemoglobin), reduced hypoglycaemia, and improved quality of life with DIYAPS use. While results were positive, the identified studies were small, and the majority were observational and at high risk of bias. Further research including well-designed randomised trials comparing DIYAPS with appropriate comparators is recommended. Keywords Artificial pancreas · Open-source · Do-it-yourself · Glucose sensing technology
Introduction Diabetes technology has greatly advanced in recent decades, with insulin pumps (continuous subcutaneous insulin infusion; CSII) and continuous glucose monitoring (CGM) now seen as usual care in many clinical settings. With the uptake in use of these devices, improvements in glycaemic control and reduced occurrence of complications such as Managed by Massimo Porta. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00592-020-01623-4) contains supplementary material, which is available to authorized users.
hypoglycaemia and diabetic ketoacidosis have followed, as have improvements in quality of life [1, 2]. The arrival of artificial pancreas systems (APS) or hybrid-closed loop systems that combine CSII with CGM is a natural progression in the technology, with further potential to improve patient outcomes. With the use of computer-controlled algorithms to automate insulin delivery, these systems more closely mimic physiological insulin action, reduce glucose variability, and improve glycaemic control [3, 4]. The first commercially available hybrid-closed loop system received FDA approval in September 2016 [5]. However, this first system, and now one other with FDA approval [6], are yet to be made available worldwide, and this speed
* B. J. Wheeler [email protected]
D. M. Lewis [email protected]
N. A. M. Asarani [email protected]
1
Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin 9054, New Zealand
2
Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 5
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