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Nanayakkara N, Sharifi A, Burren D, Elghattis Y, Jayarathna DK, Cohen N. Hybrid Closed Loop Using a Do-It-Yourself Artificial Pancreas System in Adults With Type 1 Diabetes. J Diabetes Sci Technol 2024; 18:889-896. [PMID: 36788715 PMCID: PMC11307222 DOI: 10.1177/19322968231153882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
OBJECTIVE There is increasing use of open-source artificial pancreas systems (APS) in the management of Type 1 diabetes. Our aim was to assess the safety and efficacy of the automated insulin delivery system AndroidAPS (AAPS), compared with stand-alone pump therapy in people with type 1 diabetes. The primary outcome was the difference in the percentage of time in range (TIR, 70-180 mg/dL). Secondary aims included mean sensor glucose value and percent continuous glucose monitor (CGM) time below range (TBR, <70 mg/dL). RESEARCH DESIGN AND METHODS This open-label single-center randomized crossover study (ANZCTR, Australian New Zealand clinical trial registry, ANZCTR-ACTRN12620001191987) comprised 20 participants with type 1 diabetes on established pump therapy, assigned to either stand-alone insulin pump therapy or the open-source AAPS hybrid closed-loop system for four weeks, with crossover to the alternate arm for the following four weeks. The CGM outcome parameters were measured by seven-day CGM at baseline and the final week of each four-week study arm. RESULTS Twenty participants were recruited (60% women), aged 45.8 ± 15.9 years, with mean diabetes duration of 23.9 ± 13.2 years, baseline glycated hemoglobin (HbA1c) 7.5% ± 0.5% (58 ± 6 mmol/mol) and mean TIR 62.3% ± 12.9%. The change in TIR from baseline for AAPS compared with stand-alone pump therapy was 18.6% (11.4-25.9), (P < .001), TIR 76.6% ± 11.7%, 58.0% ± 15.6%, for AAPS and stand-alone pump, respectively. Time glucose <54 mg/dL was not increased (mean = -2.0%, P = .191). No serious adverse events or episodes of severe hypoglycemia were recorded. CONCLUSIONS This clinical trial of the open-source AAPS hybrid closed-loop system performed in an at-home setting demonstrated comparable safety to stand-alone pump therapy. The glycemic outcomes of AAPS were superior with improved TIR, and there was no significant difference in TBR compared with stand-alone pump therapy.
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Affiliation(s)
- Natalie Nanayakkara
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Amin Sharifi
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Department of Endocrinology and Diabetes, Eastern Health, Box Hill, VIC, Australia
| | - David Burren
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Yasser Elghattis
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Dulari K Jayarathna
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Neale Cohen
- Department of Diabetes Clinical Research, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Public Health and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, VIC, Australia
- School of Pharmacy, The University of Queensland, Brisbane, QLD, Australia
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Mewes D, Wäldchen M, Knoll C, Raile K, Braune K. Variability of Glycemic Outcomes and Insulin Requirements Throughout the Menstrual Cycle: A Qualitative Study on Women With Type 1 Diabetes Using an Open-Source Automated Insulin Delivery System. J Diabetes Sci Technol 2023; 17:1304-1316. [PMID: 35254146 PMCID: PMC10563528 DOI: 10.1177/19322968221080199] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND The impact of hormone dynamics throughout the menstrual cycle on insulin sensitivity represents a currently under-researched area. Despite therapeutic and technological advances, self-managing insulin therapy remains challenging for women with type 1 diabetes (T1D). METHODS To investigate perceived changes in glycemic levels and insulin requirements throughout the menstrual cycle and different phases of life, we performed semi-structured interviews with 12 women with T1D who are using personalized open-source automated insulin delivery (AID) systems. Transcripts were analyzed using thematic analysis with an inductive, hypothesis-generating approach. RESULTS Participants reported significant differences between the follicular phase, ovulation, and luteal phase of the menstrual cycle and also during puberty, pregnancy, and menopause. All participants reported increased comfort and safety since using AID, but were still required to manually adjust their therapy according to their cycle. A lack of information and awareness and limited guidance by health care providers were frequently mentioned. Although individual adjustment strategies exist, achieving optimum outcomes was still perceived as challenging. CONCLUSIONS This study highlights that scientific evidence, therapeutic options, and professional guidance on female health-related aspects in T1D are insufficient to date. Further efforts are required to better inform people with T1D, as well as for health care professionals, researchers, medical device manufacturers, and regulatory bodies to better address female health needs in therapeutic advances.
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Affiliation(s)
- Darius Mewes
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Mandy Wäldchen
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Christine Knoll
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- School of Sociology, University College Dublin, Dublin, Ireland
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Klemens Raile
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Katarina Braune
- Department of Pediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
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Kesavadev J, Basanth A, Krishnan G, Shankar A, Sanal G, Jothydev S. Real-World User and Clinician Perspective and Experience with MiniMed™ 780G Advanced Hybrid Closed Loop System. Diabetes Ther 2023:10.1007/s13300-023-01427-z. [PMID: 37278948 PMCID: PMC10299959 DOI: 10.1007/s13300-023-01427-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023] Open
Abstract
INTRODUCTION The advanced hybrid closed loop (AHCL) MiniMed™ 780G system changes basal insulin delivery every 5 min and auto bolus in response to sensor glucose values. We assessed the performance of the AHCL system in real-world settings for individuals with type 1 diabetes (T1DM) as well as user and clinician perspectives and satisfaction. METHODS We held two peer group discussions: one having adults with T1DM/parents of children and adolescents with T1DM to understand their experiences with the AHCL system and another with healthcare providers (HCPs). Responses from the discussions were analyzed and categorized into themes by two independent researchers, with any inconsistencies resolved by consensus. We also analyzed data from the system uploaded to CareLink personal software. Glycemic outcomes, including time in range (TIR), time below range (TBR), time above range (TAR), mean sensor glucose (SG) levels, glucose management indicator (GMI), sensor use, and percentage of time spent in AHCL, were determined. RESULTS The peer group discussions revealed numerous key themes and issues for each group, such as the significance of setting reasonable expectations, carbohydrate counting and bolus dosing, technical difficulties, and overall user experience. The users (n = 25; T1DM; 17 female; age 13.8 ± 7.49 years; A1C 6.54 ± 0.45%; duration of diabetes 6 ± 6.78 years) were very satisfied with the system. Most users experienced consistent blood glucose values with very few hypoglycemic episodes. However, there were a few limitations reported, such as hyperglycemic episodes caused by inaccuracies in carb counting, issues with sensor connectivity, and cannula blockages or kinking for those using insulin Fiasp. Users achieved a mean GMI of 6.4 ± 0.26%, TIR of 83.0 ± 8.12%, TBR (54-70 mg/dL) of 2.0 ± 0.81%, TBR* (< 54 mg/dL) of 0%. All of the users achieved a TIR of > 70%. CONCLUSION The use of the AHCL system in T1DM resulted in robust glycemic control, minimizing hypoglycemia. Providing training to both users and HCPs can help them use the system effectively.
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India.
| | - Anjana Basanth
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Arun Shankar
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Geethu Sanal
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
| | - Sunitha Jothydev
- Jothydev's Diabetes Research Center, JDC Junction, Mudavanmugal, Trivandrum, Kerala, 695032, India
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O'Donnell S, Cooper D, Chen Y, Ballhausen H, Lewis DM, Froment T, Anna Gajewska K, Tappe A, Skinner T, Cleal B, Braune K. Barriers to uptake of Open-Source automated insulin delivery Systems: Analysis of socioeconomic factors and perceived challenges of adults with type 1 diabetes from the OPEN survey. Diabetes Res Clin Pract 2023; 197:110235. [PMID: 36581143 DOI: 10.1016/j.diabres.2022.110235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 12/27/2022]
Abstract
AIMS Social and technical trends are empowering people with diabetes to co-create or self-develop medical devices and treatments to address their unmet healthcare needs, for example, open-source automated insulin delivery (AID) systems. This study aims to investigate the perceived barriers towards adoption and maintaining of open-source AID systems. METHODS This is a multinational study based on a cross-sectional, retrospective web-based survey of non-users of open-source AID. Participants (n = 129) with type 1 diabetes from 31 countries were recruited online to elicit their perceived barriers towards building and maintaining of an open-source AID system. RESULTS Sourcing the necessary components, lack of confidence in one's own technology knowledge and skills, perceived time and energy required to build a system, and fear of losing healthcare provider support appear to be major barriers towards the uptake of open-source AID. CONCLUSIONS This study identified a range of structural and individual-level barriers to uptake of open-source AID. Some of these individual-level barriers may be overcome over time through the peer support of the DIY online community as well as greater acceptance of open-source innovation among healthcare professionals. The findings have important implications for understanding the possible wider diffusion of open-source diabetes technology solutions in the future.
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Affiliation(s)
- Shane O'Donnell
- University College Dublin, School of Sociology, Belfield, Ireland; University of Copenhagen, Department of Psychology, Copenhagen, Denmark.
| | - Drew Cooper
- Charité - Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany; Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | - Yanbing Chen
- University College Dublin, Michael Smurfit Graduate Business School, Dublin, Ireland.
| | - Hanne Ballhausen
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany; #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany.
| | | | - Timothée Froment
- University College Dublin, School of Sociology, Belfield, Ireland.
| | | | | | - Timothy Skinner
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia; Department of Psychology, University of Copenhagen, Copenhagen Denmark; La Trobe University, Bendigo, Australia.
| | - Bryan Cleal
- Steno Diabetes Center Copenhagen, Herlev, Denmark.
| | - Katarina Braune
- Charité - Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany; Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Berlin, Germany.
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Morrison AE, Chong K, Senior PA, Lam A. A scoping review of Do-It-Yourself Automated Insulin Delivery system (DIY AID) use in people with type 1 diabetes. PLoS One 2022; 17:e0271096. [PMID: 35951597 PMCID: PMC9371307 DOI: 10.1371/journal.pone.0271096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 06/23/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction User designed Automated Insulin Delivery systems (AID), termed Do-It-Yourself (DIY) AID include; AndroidAPS, OpenAPS and Loop. These unregulated systems provide challenges for healthcare providers worldwide, with potential legal and ethical barriers to supporting their use. We performed a scoping review of the currently available literature surrounding DIY AID systems, specifically to highlight the evidence available to facilitate healthcare providers to support persons with diabetes who may benefit from DIY AID. Methods Studies relating to DIY AID systems were searched in Embase, Medline, Web of Science, Scopus, Proquest and Cochrane library until 31st December 2021. Publications were screened through title and abstract to identify study type and AID system type described. A thematic synthesis methodology was used for analysis of studies of DIY AID use due to the heterogeneity in study designs (case reports, qualitative, cross-sectional and cohort studies), with similarity in outcome themes. Results Following implementation of the search strategy, 38 relevant full texts were identified; comprising 12 case reports, 9 qualitative studies and 17 cohort studies, and data was also available from 24 relevant conference abstracts. No randomized studies were identified. Common themes were identified in the outcomes across the studies; glycemic variability, safety, quality of life, healthcare provider attitudes and social media. Conclusion There is extensive real-world data, but a lack of randomized control trial evidence supporting DIY AID system use, due to the user-driven, unregulated nature of these systems. Healthcare providers report a lack of understanding surrounding, and confidence in supporting, DIY AID despite impressive observational and user self-reported improvements in glycemic variability, without any reported safety compromises.
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Affiliation(s)
- Amy E. Morrison
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- * E-mail:
| | - Kimberley Chong
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Peter A. Senior
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, University of Alberta, Edmonton, AB, Canada
| | - Anna Lam
- Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, Edmonton, AB, Canada
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Huhndt A, Chen Y, O’Donnell S, Cooper D, Ballhausen H, Gajewska KA, Froment T, Wäldchen M, Lewis DM, Raile K, Skinner TC, Braune K. 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. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:876511. [PMID: 36992765 PMCID: PMC10012142 DOI: 10.3389/fcdhc.2022.876511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/04/2022] [Indexed: 01/15/2023]
Abstract
BackgroundAs a treatment option for people living with diabetes, automated insulin delivery (AID) systems are becoming increasingly popular. The #WeAreNotWaiting community plays a crucial role in the provision and distribution of open-source AID technology. However, while a large percentage of children were early adopters of open-source AID, there are regional differences in adoption, which has prompted an investigation into the barriers perceived by caregivers of children with diabetes to creating open-source systems.MethodsThis is a retrospective, cross-sectional and multinational study conducted with caregivers of children and adolescents with diabetes, distributed across the online #WeAreNotWaiting online peer-support groups. Participants—specifically caregivers of children not using AID—responded to a web-based questionnaire concerning their perceived barriers to building and maintaining an open-source AID system.Results56 caregivers of children with diabetes, who were not using open-source AID at the time of data collection responded to the questionnaire. Respondents indicated that their major perceived barriers to building an open-source AID system were their limited technical skills (50%), a lack of support by medical professionals (39%), and therefore the concern with not being able to maintain an AID system (43%). However, barriers relating to confidence in open-source technologies/unapproved products and fear of digital technology taking control of diabetes were not perceived as significant enough to prevent non-users from initiating the use of an open-source AID system.ConclusionsThe results of this study elucidate some of the perceived barriers to uptake of open-source AID experienced by caregivers of children with diabetes. Reducing these barriers may improve the uptake of open-source AID technology for children and adolescents with diabetes. With the continuous development and wider dissemination of educational resources and guidance—for both aspiring users and their healthcare professionals—the adoption of open-source AID systems could be improved.
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Affiliation(s)
- Antonia Huhndt
- Department of Paediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Yanbing Chen
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Ireland
| | - Shane O’Donnell
- School of Sociology, University College Dublin, Belfield, Ireland
| | - Drew Cooper
- Department of Paediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Hanne Ballhausen
- Department of Paediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany
| | - Katarzyna A. Gajewska
- #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany
- Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Timothée Froment
- #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany
| | - Mandy Wäldchen
- School of Sociology, University College Dublin, Belfield, Ireland
| | | | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Timothy C. Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia
- La Trobe University, Bendigo, Australia
| | - Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité—Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Institute of Medical Informatics, Charité—Universitätsmedizin Berlin, Berlin, Germany
- *Correspondence: Katarina Braune,
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Kesavadev J, Krishnan G, Mohan V. Digital health and diabetes: experience from India. Ther Adv Endocrinol Metab 2021; 12:20420188211054676. [PMID: 34820114 PMCID: PMC8606976 DOI: 10.1177/20420188211054676] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 10/04/2021] [Indexed: 11/15/2022] Open
Abstract
The digitization of healthcare and its usage in the delivery of healthcare have experienced exponential growth across the world in recent times. India's fast-growing diabetes population has been exerting immense pressure on the country's healthcare infrastructure. Various innovative and evolving technologies are converging to impact the trajectory of digital health in diabetes. The diabetes community has been adopting various technologies such as connected glucose meters, continuous glucose monitoring systems, continuous subcutaneous insulin infusion, closed-loop systems, digitalization of health data, and diabetes-related apps for the prevention and management of the condition. India has provided some excellent examples in exploiting the potential of digital transformation in revamping the diabetes ecosystem. Yet, there are still various hurdles in technology development, healthcare delivery, as well as concerns related to data privacy, digital divide, policies by the government, role of stakeholders, attitude, and absorption by healthcare professionals, and hospitals. This article provides an overview of the digital diabetes technologies currently practiced in India and recommends the need for strong technology adaptation and policy interventions for an ideal roadmap of digitalization of diabetes care in the Indian milieu.
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