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Schütz A, Rami-Merhar B, Schütz-Fuhrmann I, Blauensteiner N, Baumann P, Pöttler T, Mader JK. Retrospective Comparison of Commercially Available Automated Insulin Delivery With Open-Source Automated Insulin Delivery Systems in Type 1 Diabetes. J Diabetes Sci Technol 2024:19322968241230106. [PMID: 38366626 DOI: 10.1177/19322968241230106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
BACKGROUND Automated insulin delivery (AID) systems have shown to improve glycemic control in a range of populations and settings. At the start of this study, only one commercial AID system had entered the Austrian market (MiniMed 670G, Medtronic). However, there is an ever-growing community of people living with type 1 diabetes (PWT1D) using open-source (OS) AID systems. MATERIALS AND METHODS A total of 144 PWT1D who used either the MiniMed 670G (670G) or OS-AID systems routinely for a period of at least three to a maximum of six months, between February 18, 2020 and January 15, 2023, were retrospectively analyzed (116 670G aged from 2.6 to 71.8 years and 28 OS-AID aged from 3.4 to 53.5 years). The goal is to evaluate and compare the quality of glycemic control of commercially available AID and OS-AID systems and to present all data by an in-depth descriptive analysis of the population. No statistical tests were performed. RESULTS The PWT1D using OS-AID systems spent more time in range (TIR)70-180 mg/dL (81.7% vs 73.9%), less time above range (TAR)181-250 mg/dL (11.1% vs 19.6%), less TAR>250 mg/dL (2.5% vs 4.3%), and more time below range (TBR)54-69 mg/dL (2.2% vs 1.7%) than PWT1D using the 670G system. The TBR<54 mg/dL was comparable in both groups (0.3% vs 0.4%). In the OS-AID group, median glucose level and glycated hemoglobin (HbA1c) were lower than in the 670G system group (130 vs 150 mg/dL; 6.2% vs 7.0%). CONCLUSION In conclusion, both groups were able to achieve satisfactory glycemic outcomes independent of age, gender, and diabetes duration. However, the PWT1D using OS-AID systems attained an even better glycemic control with no clinical safety concerns.
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Affiliation(s)
- Anna Schütz
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Ingrid Schütz-Fuhrmann
- Karl Landsteiner Institute, Endocrinology and Nephrology, Vienna, Austria
- Department of Endocrinology and Nephrology, Clinic Hietzing, Vienna Health Care Group, Vienna, Austria
| | - Nicole Blauensteiner
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Petra Baumann
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Tina Pöttler
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Do QD, Hásková A, Radovnická L, Konečná J, Horová E, Parkin CG, Grunberger G, Prázný M, Šoupal J. Comparison of Control-IQ and open-source AndroidAPS automated insulin delivery systems in adults with type 1 diabetes: The CODIAC study. Diabetes Obes Metab 2024; 26:78-84. [PMID: 37743832 DOI: 10.1111/dom.15289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Revised: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 09/26/2023]
Abstract
AIM To compare open-source AndroidAPS (AAPS) and commercially available Control-IQ (CIQ) automated insulin delivery (AID) systems in a prospective, open-label, single-arm clinical trial. METHODS Adults with type 1 diabetes who had been using AAPS by their own decision entered the first 3-month AAPS phase then were switched to CIQ for 3 months. The results of this treatment were compared with those after the 3-month AAPS phase. The primary endpoint was the change in time in range (% TIR; 70-80 mg/dL). RESULTS Twenty-five people with diabetes (mean age 34.32 ± 11.07 years; HbA1c 6.4% ± 3%) participated in this study. CIQ was comparable with AAPS in achieving TIR (85.72% ± 7.64% vs. 84.24% ± 8.46%; P = .12). Similarly, there were no differences in percentage time above range (> 180 and > 250 mg/dL), mean sensor glucose (130.3 ± 13.9 vs. 128.3 ± 16.9 mg/dL; P = .21) or HbA1c (6.3% ± 2.1% vs. 6.4% ± 3.1%; P = .59). Percentage time below range (< 70 and < 54 mg/dL) was significantly lower using CIQ than AAPS. Even although participants were mostly satisfied with CIQ (63.6% mostly agreed, 9.1% strongly agreed), they did not plan to switch to CIQ. CONCLUSIONS The CODIAC study is the first prospective study investigating the switch between open-source and commercially available AID systems. CIQ and AAPS were comparable in achieving TIR. However, hypoglycaemia was significantly lower with CIQ.
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Affiliation(s)
- Quoc Dat Do
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Aneta Hásková
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Lucie Radovnická
- 1st Faculty of Medicine Charles University, Prague, Czech Republic
- Department of Internal Medicine, Masaryk Hospital, Ústí nad Labem, Czech Republic
| | - Judita Konečná
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Eva Horová
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | | | | | - Martin Prázný
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
| | - Jan Šoupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine Charles University, Prague, Czech Republic
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Schipp J, Hendrieckx C, Braune K, Knoll C, O'Donnell S, Ballhausen H, Cleal B, Wäldchen M, Lewis DM, Gajewska KA, Skinner TC, Speight J. Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes. J Med Internet Res 2023; 25:e44002. [PMID: 38096018 PMCID: PMC10755653 DOI: 10.2196/44002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 06/10/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emerging research suggests that open-source automated insulin delivery (AID) may reduce diabetes burden and improve sleep quality and quality of life (QoL). However, the evidence is mostly qualitative or uses unvalidated, study-specific, single items. Validated person-reported outcome measures (PROMs) have demonstrated the benefits of other diabetes technologies. The relative lack of research investigating open-source AID using PROMs has been considered a missed opportunity. OBJECTIVE This study aimed to examine the psychosocial outcomes of adults with type 1 diabetes using and not using open-source AID systems using a comprehensive set of validated PROMs in a real-world, multinational, cross-sectional study. METHODS Adults with type 1 diabetes completed 8 validated measures of general emotional well-being (5-item World Health Organization Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), diabetes-specific QoL (modified DAWN Impact of Diabetes Profile), diabetes-specific positive well-being (4-item subscale of the 28-item Well-Being Questionnaire), diabetes treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire), diabetes distress (20-item Problem Areas in Diabetes scale), fear of hypoglycemia (short form of the Hypoglycemia Fear Survey II), and a measure of the impact of COVID-19 on QoL. Independent groups 2-tailed t tests and Mann-Whitney U tests compared PROM scores between adults with type 1 diabetes using and not using open-source AID. An analysis of covariance was used to adjust for potentially confounding variables, including all sociodemographic and clinical characteristics that differed by use of open-source AID. RESULTS In total, 592 participants were eligible (attempting at least 1 questionnaire), including 451 using open-source AID (mean age 43, SD 13 years; n=189, 41.9% women) and 141 nonusers (mean age 40, SD 13 years; n=90, 63.8% women). Adults using open-source AID reported significantly better general emotional well-being and subjective sleep quality, as well as better diabetes-specific QoL, positive well-being, and treatment satisfaction. They also reported significantly less diabetes distress, fear of hypoglycemia, and perceived less impact of the COVID-19 pandemic on their QoL. All were medium-to-large effects (Cohen d=0.5-1.5). The differences between groups remained significant after adjusting for sociodemographic and clinical characteristics. CONCLUSIONS Adults with type 1 diabetes using open-source AID report significantly better psychosocial outcomes than those not using these systems, after adjusting for sociodemographic and clinical characteristics. Using validated, quantitative measures, this real-world study corroborates the beneficial psychosocial outcomes described previously in qualitative studies or using unvalidated study-specific items.
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Affiliation(s)
- Jasmine Schipp
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- Section for Health Services Research, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
| | - Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Christine Knoll
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
| | - Shane O'Donnell
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | - Hanne Ballhausen
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Dedoc Labs GmbH, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
| | - Mandy Wäldchen
- School of Sociology & School of Medicine, University College Dublin, Dublin, Ireland
| | | | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Timothy C Skinner
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Carlton, Australia
- School of Psychology, Deakin University, Burwood, Australia
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Raimond LH, O'Donnell S, Bøggild-Damkvist T, Filges T, Lomborg K. Open-source automated insulin delivery systems and formal healthcare: A qualitative study of challenges in the interaction between service-users with type 1 diabetes and healthcare professionals. Chronic Illn 2023; 19:836-847. [PMID: 36437583 DOI: 10.1177/17423953221142341] [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: 11/29/2022]
Abstract
OBJECTIVES To explore the challenges that open-source automated insulin delivery systems pose to the encounter between service-users and healthcare professionals and how these challenges might be addressed in the future. METHODS Five adult service-users and six healthcare professionals participated in semi-structured interviews. A six-step thematic analysis was conducted, the focus being on challenges and needs for improvement of the interactions. RESULTS The analysis revealed three overarching challenges and wishes: (1) Lack of exchange of experiences. Service-users are reticent about disclosing their use of the systems to healthcare professionals. (2) Unclear ethical responsibility. Service-users are aware of their responsibility and guidelines can help to alleviate healthcare professional's legal responsibility; however, ambiguities around ethical responsibility for healthcare professionals remain an impediment to meaningful clinical interactions. (3) Unresolved individual and mutual expectations. Service-users expect better access to technology and focus on psychosocial aspects. In contrast, healthcare professionals fear the burden associated with the rising technical expectations. CONCLUSION Transparency and openness towards open-source systems need to be part of service-user and healthcare professionals interaction. Requirements for future care include improved knowledge about the systems, an openminded approach towards user-driven initiatives among healthcare professionals, and a focus on psychosocial aspects in the interaction.
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Affiliation(s)
- Linda H Raimond
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Type1 - Diabetes Think Tank, Copenhagen, Denmark
| | | | | | - Tine Filges
- Type1 - Diabetes Think Tank, Copenhagen, Denmark
| | - Kirsten Lomborg
- Steno Diabetes Center Copenhagen, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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5
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Cooper D, Reinhold B, Shahid A, Lewis DM. Glucose Variability Analysis in Two Large-Scale and Real-World Data Sets of Open-Source Automated Insulin Delivery Systems. J Diabetes Sci Technol 2023:19322968231198871. [PMID: 37750308 DOI: 10.1177/19322968231198871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/27/2023]
Abstract
BACKGROUND Open-source automated insulin delivery (OS-AID) systems combine commercially available insulin pumps and continuous glucose monitors with open-source algorithms to automate insulin dosing for people with insulin-requiring diabetes. Two data sets (OPEN and the OpenAPS Data Commons) contain anonymized OS-AID user data. METHODS We assessed glycemic variability (GV) outcomes in the OPEN data set and characterized it alongside a comparison to the n = 122 version of the OpenAPS Data Commons. Glucose data are analyzed using an unsupervised machine learning algorithm for clustering, and GV metrics are quantified using statistical tests for distribution comparison. Demographic data are also analyzed quantitatively. RESULTS The n = 75 OPEN data set contains 36 827 days worth of data. Mean TIR is 82.08% (TOR < 70: 3.66%; TOR > 180: 14.3%). LBGI (P < .05) differs by gender whereas HBGI distributions are similar (P > .05). GV metrics (except TOR < 70, LBGI) show a statistically significant difference (P < .05) between data sets. CONCLUSIONS Both the OPEN and OpenAPS Data Commons data sets show TOR < 70, TIR, and TOR > 180 within recommended goals, adding additional evidence of real-world efficacy of OS-AID. Future research should evaluate in more detail potential data set differences and relationships between individual patterns of user behaviors and GV outcomes.
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Affiliation(s)
- Drew Cooper
- Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Arsalan Shahid
- CeADAR, Ireland's Centre for Applied AI, University College Dublin, Dublin, Ireland
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Lei M, Lin B, Ling P, Liu Z, Yang D, Deng H, Yang X, Lv J, Xu W, Yan J. Efficacy and safety of Android artificial pancreas system use at home among adults with type 1 diabetes mellitus in China: protocol of a 26-week, free-living, randomised, open-label, two-arm, two-phase, crossover trial. BMJ Open 2023; 13:e073263. [PMID: 37558445 PMCID: PMC10414065 DOI: 10.1136/bmjopen-2023-073263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 07/28/2023] [Indexed: 08/11/2023] Open
Abstract
INTRODUCTION Do-it-yourself artificial pancreas system (DIY APS) is built using commercially available insulin pump, continuous glucose monitoring (CGM) and an open-source algorithm. Compared with commercial products, DIY systems are affordable, allow personalised settings and provide updated algorithms, making them a more promising therapy for most patients with type 1 diabetes mellitus (T1DM). Many small and self-reported observational studies have found that their real-world use was associated with potential metabolic and psychological benefits. However, rigorous-designed studies are urgently needed to confirm its efficacy and safety. METHODS AND ANALYSIS In this 26-week randomised, open-label, two-arm, two-phase, crossover trial, participants aged 18-75 years, with T1DM and glycated haemoglobin (HbA1c) 7-11%, will use AndroidAPS during one 12-week period and sensor-augmented pump during another 12-week period. This study will recruit at least 24 randomised participants. AndroidAPS consists of three components: (1) real-time CGM; (2) insulin pump; (3) AndroidAPS algorithm implemented in Android smartphone. The primary endpoint is time in range (3.9-10.0 mmol/L) derived from CGM. The main secondary endpoints include percentage of sensor glucose values below, within and above target range; mean sensor glucose value; measures of glycaemic variability and centralised HbA1c. Safety endpoints mainly include the frequency of hypoglycaemia events, diabetic ketoacidosis and other serious adverse events. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of the Third Affiliated Hospital of Sun Yat-sen University. There will be verbal and written information regarding the trial given to each participant. The study will be disseminated through peer-reviewed publications and conference presentations. OVERALL STATUS Recruiting. STUDY START 11 February 2023. PRIMARY COMPLETION 31 July 2024. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT05726461).
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Affiliation(s)
- Mengyun Lei
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Beisi Lin
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Ping Ling
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Zhigu Liu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Daizhi Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xubin Yang
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jing Lv
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, Guangdong Provincial Key Laboratory of Diabetology, Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
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Dahlberg M, Lek M, Malmqvist Castillo M, Bylund A, Hasson H, Riggare S, Reinius M, Wannheden C. Objectives and outcomes of patient-driven innovations published in peer-reviewed journals: a qualitative analysis of publications included in a scoping review. BMJ Open 2023; 13:e071363. [PMID: 37263703 PMCID: PMC10255190 DOI: 10.1136/bmjopen-2022-071363] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVES The aim of this study was to gain a deeper understanding of the objectives and outcomes of patient-driven innovations that have been published in the scientific literature, focusing on (A) the unmet needs that patient-driven innovations address and (B) the outcomes for patients and healthcare that have been reported. METHODS We performed an inductive qualitative content analysis of scientific publications that were included in a scoping review of patient-driven innovations, previously published by our research group. The review was limited to English language publications in peer-reviewed journals, published in the years 2008-2020. RESULTS In total, 83 publications covering 21 patient-driven innovations were included in the analysis. Most of the innovations were developed for use on an individual or community level without healthcare involvement. We created three categories of unmet needs that were addressed by these innovations: access to self-care support tools, open sharing of information and knowledge, and patient agency in self-care and healthcare decisions. Eighteen (22%) publications reported outcomes of patient-driven innovations. We created two categories of outcomes: impact on self-care, and impact on peer interaction and healthcare collaboration. CONCLUSIONS The patient-driven innovations illustrated a diversity of innovative approaches to facilitate patients' and informal caregivers' daily lives, interactions with peers and collaborations with healthcare. As our findings indicate, patients and informal caregivers are central stakeholders in driving healthcare development and research forward to meet the needs that matter to patients and informal caregivers. However, only few studies reported on outcomes of patient-driven innovations. To support wider implementation, more evaluation studies are needed, as well as research into regulatory approval processes, dissemination and governance of patient-driven innovations.
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Affiliation(s)
- Marie Dahlberg
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Madelen Lek
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Moa Malmqvist Castillo
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Ami Bylund
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholms Lans Landsting, Stockholm, Sweden
| | - Sara Riggare
- Participatory eHealth and Health Data, Department of Women's and Children's Health, Uppsala Universitet, Uppsala, Sweden
| | - Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
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Salzmann-Erikson M, Eriksson H. A Mapping Review of Netnography in Nursing. QUALITATIVE HEALTH RESEARCH 2023:10497323231173794. [PMID: 37192601 PMCID: PMC10387728 DOI: 10.1177/10497323231173794] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
People use the Web to seek health-related information and to discuss health issues with peers. Netnography, a qualitative research methodology, has gained the attention of researchers interested in people's health and health issues. However, no previous reviews have accounted for how netnography is used in nursing research. The purpose of this mapping review was to generate a map of netnographic research in nursing. The search was conducted in PubMed, Academic Search Elite, the Cumulative Index to Nursing and Allied Health Literature, Medline, PsycINFO, Scopus, and Web of Science. Data were extracted from 53 original articles. The results show an increasing trend in published netnographies over time; 34% of the total sample was published in 2021. Of the total, 28% originated from Sweden, and 81% had used a covert approach. In studies in which the researchers used more participatory designs, the time spent on online forums ranged between 4 weeks and 20 months. Informed consent is found to be an issue in netnographic studies. We discuss the fact that nursing researchers have used netnography to address a wide range of research topics of concern and interest, from self-care support in an online forum for older adults to nursing students' perspectives on effective pedagogy. In line with the digital transformation in society in general, we discuss the fact that netnography as a research methodology offers great opportunities for nurse researchers to monitor new spaces and places that presuppose online methodological knowledge.
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Affiliation(s)
- Martin Salzmann-Erikson
- Faculty of Health and Occupational Studies, Department of Caring Sciences, University of Gävle, Gävle, Sweden
| | - Henrik Eriksson
- Department of Health Sciences, University West, Trollhättan, Sweden
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Speight J, Choudhary P, Wilmot EG, Hendrieckx C, Forde H, Cheung WY, Crabtree T, Millar B, Traviss-Turner G, Hill A, Ajjan RA. Impact of glycaemic technologies on quality of life and related outcomes in adults with type 1 diabetes: A narrative review. Diabet Med 2023; 40:e14944. [PMID: 36004676 DOI: 10.1111/dme.14944] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 08/18/2022] [Indexed: 12/24/2022]
Abstract
AIMS To explore the association between the use of glycaemic technologies and person-reported outcomes (PROs) in adults with type 1 diabetes (T1D). METHODS We included T1D and technology publications reporting on PROs since 2014. Only randomised controlled trials and cohort studies that used validated PRO measures (PROMs) were considered. RESULTS T1D studies reported on a broad range of validated PROMs, mainly as secondary outcome measures. Most studies examined continuous glucose monitoring (CGM), intermittently scanned CGM (isCGM), and the role of continuous subcutaneous insulin infusion (CSII), including sensor-augmented CSII and closed loop systems. Generally, studies demonstrated a positive impact of technology on hypoglycaemia-specific and diabetes-specific PROs, including reduced fear of hypoglycaemia and diabetes distress, and greater satisfaction with diabetes treatment. In contrast, generic PROMs (including measures of health/functional status, emotional well-being, depressive symptoms, and sleep quality) were less likely to demonstrate improvements associated with the use of glycaemic technologies. Several studies showed contradictory findings, which may relate to study design, population and length of follow-up. Differences in PRO findings were apparent between randomised controlled trials and cohort studies, which may be due to different populations studied and/or disparity between trial and real-world conditions. CONCLUSIONS PROs are usually assessed as secondary outcomes in glycaemic technology studies. Hypoglycaemia-specific and diabetes-specific, but not generic, PROs show the benefits of glycaemic technologies, and deserve a more central role in future studies as well as routine clinical care.
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Affiliation(s)
- Jane Speight
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Emma G Wilmot
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Geelong, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Hannah Forde
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Wai Yee Cheung
- Diabetes Research Unit Cymru, Swansea University Medical School, Swansea, UK
| | - Thomas Crabtree
- Department of Diabetes, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Bekki Millar
- Diabetes Research Steering Group, Diabetes UK, London, UK
| | | | - Andrew Hill
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Ramzi A Ajjan
- Leeds Institute of Cardiovascular and Metabolic Medicine, the LIGHT Laboratories, University of Leeds, Leeds, UK
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10
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Wexler A. Mapping the Landscape of Do-it-Yourself Medicine. CITIZEN SCIENCE : THEORY AND PRACTICE 2022; 7:38. [PMID: 36632334 PMCID: PMC9830450 DOI: 10.5334/cstp.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
The practice of medicine is typically conceptualized as remaining within the boundaries of a hospital or clinic. However, in recent years, patients have been able to gain access to information about medical research as it is ongoing. As a result, there has been a rise in do-it-yourself (DIY) medicine, where individuals treat themselves for medical conditions outside of clinical settings, often mimicking experimental therapies that remain inaccessible to the wider public. For example, in DIY brain stimulation, individuals suffering from depression build at-home electrical headsets using nine-volt batteries, mimicking an experimental neuroscience technique used in scientific laboratories. In DIY fecal transplantation, those with intestinal disorders like C. Difficile and inflammatory bowel disease transplant stool from donors into themselves with the aid of blenders and enemas. In the open Artificial Pancreas System movement, diabetes patients hacked together an artificial pancreas system from their glucose monitors and insulin pumps, years before such a system was approved by the United States Food and Drug Administration (US FDA). To date, scholarship on DIY medicine has largely been relegated to specific medical domains (e.g., neurology, gastroenterology, infectious disease). In this paper, however, I recognize DIY medicine as a cross-cutting phenomenon that has emerged independently across medical domains but shares common features. I map the varieties of DIY medicine across these domains and suggest that four key factors lead to their creation, growth, and uptake. In doing so, this essay sheds light on an understudied area of biomedical citizen science that is likely to grow substantially in the coming decades.
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Affiliation(s)
- Anna Wexler
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Drive, Philadelphia, PA 19104, US
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11
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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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12
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Grant AD, Lewis DM, Kriegsfeld LJ. Multi-Timescale Rhythmicity of Blood Glucose and Insulin Delivery Reveals Key Advantages of Hybrid Closed Loop Therapy. J Diabetes Sci Technol 2022; 16:912-920. [PMID: 33719596 PMCID: PMC9264430 DOI: 10.1177/1932296821994825] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Blood glucose and insulin exhibit coordinated daily and hourly rhythms in people without diabetes (nonT1D). Although the presence and stability of these rhythms are associated with euglycemia, it is unknown if they (1) are preserved in individuals with type 1 diabetes (T1D) and (2) vary by therapy type. In particular, Hybrid Closed Loop (HCL) systems improve glycemia in T1D compared to Sensor Augmented Pump (SAP) therapies, but the extent to which either recapitulates coupled glucose and insulin rhythmicity is not well described. In HCL systems, more rapid modulation of glucose via automated insulin delivery may result in greater rhythmic coordination and euglycemia. Such precision may not be possible in SAP systems. We hypothesized that HCL users would exhibit fewer hyperglycemic event, superior rhythmicity, and coordination relative to SAP users. METHODS Wavelet and coherence analyses were used to compare glucose and insulin delivery rate (IDR) within-day and daily rhythms, and their coordination, in 3 datasets: HCL (n = 150), SAP (n = 89), and nonT1D glucose (n = 16). RESULTS Glycemia, correlation between normalized glucose and IDR, daily coherence of glucose and IDR, and amplitude of glucose oscillations differed significantly between SAP and HCL users. Daily glucose rhythms differed significantly between SAP, but not HCL, users and nonT1D individuals. CONCLUSIONS SAP use is associated with greater hyperglycemia, higher amplitude glucose fluctuations, and a less stably coordinated rhythmic phenotype compared to HCL use. Improvements in glucose and IDR rhythmicity may contribute to the overall effectiveness of HCL systems.
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Affiliation(s)
- Azure D. Grant
- The Helen Wills Neuroscience
Institute, University of California, Berkeley, CA, USA
| | | | - Lance J. Kriegsfeld
- The Helen Wills Neuroscience
Institute, University of California, Berkeley, CA, USA
- Department of Psychology,
University of California, Berkeley, CA, USA
- Department of Integrative Biology,
University of California, Berkeley, CA, USA
- Graduate Group in Endocrinology,
University of California, Berkeley, CA, USA
- Lance J. Kriegsfeld, PhD, Department
of Psychology, Integrative Biology, Graduate Group in Endocrinology
and The Helen Wills Neuroscience Institute, University of California,
2121 Berkeley Way, Mail Code 1650, Berkeley, CA 94720, USA.
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13
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McLarney M, Litchman ML, Greenwood D, Drincic A. Navigating Diabetes Online Communities in Clinical Practice. J Diabetes Sci Technol 2022; 16:874-886. [PMID: 35125019 PMCID: PMC9264440 DOI: 10.1177/19322968211069409] [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: 11/15/2022]
Abstract
OBJECTIVE This purpose of this study was to conduct a rapid review and environmental scan of diabetes online communities (DOCs) to highlight the clinical impact of DOC engagement and provide guidance to health care providers for navigating and prescribing DOCs. METHODS This two-phase review included a rapid review of clinical outcomes and an assessment of DOC content. We conducted a literature search for studies evaluating DOC use and glucometric (glycated hemoglobin [A1C], time-in-range, hypoglycemia), behavioral, and psychosocial outcomes. The environmental scan of current DOC sites established key features, including available platforms, target population, content areas, and reach. RESULTS Twelve papers were included-eight reported DOC use within a context of do-it-yourself (DIY) noncommercial, opensource hybrid closed loop systems community and four were non-DYI related. In latter, all studies were cross-sectional, describing patient-reported outcomes. Two studies reported A1C lowering with DOC use, two DOC use was associated with high self-efficacy, one showed association with higher self-care levels, and one showed higher quality of life scores when compared with population norms. All DIY studies showed improvement in glucometrics after initiation of sensor augmented pump technology with DOC support. Of 54 DOC sites reviewed in the environmental scan, 29 were included. Diabetes online community sites were heterogenous in social media platform and type of diabetes targeted. CONCLUSION Diabetes online communities have the potential to improve clinical, behavioral, and psychosocial outcomes. Randomized control trials and/or longitudinal prospective studies evaluating outcomes are needed to further examine the potential benefits of DOC use. Diabetes online communities are diverse and span a variety of social media platforms, providing clinicians opportunities to individualize recommendations for DOC use.
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Affiliation(s)
- Meghan McLarney
- Department of Internal Medicine,
Diabetes and Endocrinology Center, University of Nebraska Medical Center, Omaha, NE,
USA
| | | | - Deborah Greenwood
- School of Nursing, UT Health San
Antonio, San Antonio, TX, USA
- Deborah Greenwood Consulting, Granite
Bay, CA, USA
| | - Andjela Drincic
- Department of Internal Medicine,
Diabetes and Endocrinology Center, University of Nebraska Medical Center, Omaha, NE,
USA
- Division of Diabetes, Endocrinology and
Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
- Andjela Drincic, MD, FACP, Department of
Internal Medicine, Diabetes and Endocrinology Center, University of Nebraska
Medical Center, 984120 Nebraska Medical Center, Omaha, NE 68198-4120, USA.
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14
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Morrison AE, Chong K, Lai V, Farnsworth K, Senior PA, Lam A. Improved Glycemia and Quality of Life Among Loop users – Analysis of Real-World Data from a Single Centre (Preprint). JMIR Diabetes 2022; 7:e40326. [DOI: 10.2196/40326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 08/17/2022] [Accepted: 09/01/2022] [Indexed: 11/13/2022] Open
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15
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Patel R, Crabtree TSJ, Taylor N, Langeland L, Gazis AT, Mendis B, Wilmot EG, Idris I. 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. Diabet Med 2022; 39:e14793. [PMID: 35034388 DOI: 10.1111/dme.14793] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 01/12/2022] [Indexed: 11/29/2022]
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 HbA1c , 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 follow-up duration of 1.4 (IQR 0.8-2.1) and 1.3 (IQR 0.7-1.8) years, respectively, were included. HbA1c 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 HbA1c 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.
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Affiliation(s)
- Rachel Patel
- School of Medicine, University of Nottingham, Nottingham, UK
| | - Thomas S J Crabtree
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Nicola Taylor
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
| | - Linn Langeland
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
| | - Anastasios Tasso Gazis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, UK
| | - Buddhike Mendis
- Department of Diabetes and Endocrinology, Queens Medical Centre, Nottingham University Hospital, Nottingham, UK
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- Division of Graduate Entry Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Iskandar Idris
- Department of Diabetes & Endocrinology, Royal Derby Hospital, University Hospitals of Derby & Burton NHS Trust, Derby, UK
- MRC-Versus Arthritis Centre for Musculoskeletal Ageing Research, University of Nottingham, Nottingham, UK
- NIHR, Nottingham BRC, University of Nottingham, Nottingham, UK
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16
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Lewis DM. Errors of commission or omission: The net risk safety analysis conversation we should be having around automated insulin delivery systems. Diabet Med 2022; 39:e14687. [PMID: 34510544 DOI: 10.1111/dme.14687] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/02/2021] [Accepted: 08/07/2021] [Indexed: 12/18/2022]
Abstract
The question of safety often arises when discussing automated insulin delivery systems, but discussion of safety is often anchored on a comparison to the risk to a person without diabetes, overlooking the risks of living with insulin-requiring diabetes. We should use a net risk safety perspective for evaluating diabetes technology that takes into account the ongoing risks of insulin management for people living with diabetes.
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Crabtree TSJ, Choudhary P, Lumb A, Hammond P, McLay A, Campbell F, Ng SM, Wilmot EG, Hussain S. Association of British Clinical Diabetologists, Diabetes Technology Network UK and Association of Children's Diabetes Clinicians Survey of UK Healthcare Professional Attitudes Towards Open-Source Automated Insulin Delivery Systems. Diabetes Ther 2022; 13:341-353. [PMID: 35099784 PMCID: PMC8873338 DOI: 10.1007/s13300-022-01203-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/12/2022] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Automated insulin delivery (AID) systems can enable improved glycaemic outcomes with reduced mental burden. Open-source AID (OS-AID) systems overcome some of the developmental and access barriers enabling a wider use of these systems. Limited data are available on healthcare professional (HCP) opinions and current practice regarding these systems. The aim of this survey was to gain insight into HCP perceptions and practices around OS-AID. METHODS This survey was developed collaboratively with OS-AID users and distributed to adult and children's teams, using an online survey tool. Results were received between February and April 2019. Responses were assessed using simple descriptive statistics with analyses stratified by respondent characteristics. RESULTS 317 responses were obtained from a range of HCPs in both adult and paediatric services. Key results include: HCP perception of OS-AID as "risky in the wrong hands" (43%); 91% felt uncomfortable initiating discussions around OS-AID because of lack of regulation (67%) and/or their own lack of knowledge (63%). Half of HCPs (47%) reported that they would choose OS-AID if they themselves had type 1 diabetes. CONCLUSIONS HCPs are generally supportive of OS-AID users but many feel uncomfortable with the technicalities of the systems given the lack of approval. Knowledge around the use of these systems was limited. Re-assessment of HCP perceptions should be performed in the future given the evolving landscape of diabetes technology, recent consensus statements and emerging ethical and legal perspectives.
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Affiliation(s)
- Thomas S J Crabtree
- Division of Graduate Entry Medicine & Health Sciences, University of Nottingham, Nottingham, UK
| | - Pratik Choudhary
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford, UK
| | - Peter Hammond
- Department of Diabetes, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - A McLay
- DIY APS Community, Derby, UK
| | - Fiona Campbell
- Paediatric Diabetes Department, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Sze M Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Ormskirk, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Emma G Wilmot
- Department of Diabetes & Endocrinology, University Hospitals of Derby & Burton NHS Trust, Derby, UK.
- Division of Graduate Entry Medicine & Health Sciences, University of Nottingham, Nottingham, UK.
| | - Sufyan Hussain
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK.
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospital NHS Trust, London, UK.
- Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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18
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Reinius M, Mazzocato P, Riggare S, Bylund A, Jansson H, Øvretveit J, Savage C, Wannheden C, Hasson H. Patient-driven innovations reported in peer-reviewed journals: a scoping review. BMJ Open 2022; 12:e053735. [PMID: 35074818 PMCID: PMC8788234 DOI: 10.1136/bmjopen-2021-053735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 12/03/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Awareness of patients' innovative capabilities is increasing, but there is limited knowledge regarding the extent and nature of patient-driven innovations in the peer-reviewed literature. OBJECTIVES The objective of the review was to answer the question: what is the nature and extent of patient-driven innovations published in peer-reviewed scientific journals? ELIGIBILITY CRITERIA We used a broad definition of innovation to allow for a comprehensive review of different types of innovations and a narrow definition of 'patient driven' to focus on the role of patients and/or family caregivers. The search was limited to years 2008-2020. SOURCES OF EVIDENCE Four electronic databases (Medline (Ovid), Web of Science Core Collection, PsycINFO (Ovid) and Cinahl (Ebsco)) were searched in December 2020 for publications describing patient-driven innovations and complemented with snowball strategies. CHARTING METHODS Data from the included articles were extracted and categorised inductively. RESULTS A total of 96 articles on 20 patient-driven innovations were included. The number of publications increased over time, with 69% of the articles published between 2016 and 2020. Author affiliations were exclusively in high income countries with 56% of first authors in North America and 36% in European countries. Among the 20 innovations reported, 'Do-It-Yourself Artificial Pancreas System' and the online health network 'PatientsLikeMe', were the subject of half of the articles. CONCLUSIONS Peer-reviewed publications on patient-driven innovations are increasing and we see an important opportunity for researchers and clinicians to support patient innovators' research while being mindful of taking over the work of the innovators themselves.
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Affiliation(s)
- Maria Reinius
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Pamela Mazzocato
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Sara Riggare
- Department of Women's and Children's Health, Healthcare Sciences and E-Health, Uppsala University, Uppsala, Sweden
| | - Ami Bylund
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Hanna Jansson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - John Øvretveit
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Department of Research Development and Education, Region Stockholm, Stockholm, Sweden
| | - Carl Savage
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Carolina Wannheden
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
| | - Henna Hasson
- Department of Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, Stockholm, Sweden
- Unit for Implementation and Evaluation, Center for Epidemiology and Community Medicine, Region Stockholm, Stockholm, Sweden
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Schmitzer J, Strobel C, Blechschmidt R, Tappe A, Peuscher H. Efficient Closed Loop Simulation of Do-It-Yourself Artificial Pancreas Systems. J Diabetes Sci Technol 2022; 16:61-69. [PMID: 34328030 PMCID: PMC8721541 DOI: 10.1177/19322968211032249] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
BACKGROUND Numerical simulations, also referred to as in silico trials, are nowadays the first step toward approval of new artificial pancreas (AP) systems. One suitable tool to run such simulations is the UVA/Padova Type 1 Diabetes Metabolic Simulator (T1DMS). It was used by Toffanin et al. to provide data about safety and efficacy of AndroidAPS, one of the most wide-spread do-it-yourself AP systems. However, the setup suffered from slow simulation speed. The objective of this work is to speed up simulation by implementing the algorithm directly in MATLAB®/Simulink®. METHOD Firstly, AndroidAPS is re-implemented in MATLAB® and verified. Then, the function is incorporated into T1DMS. To evaluate the new setup, a scenario covering 2 days in real time is run for 30 virtual patients. The results are compared to those presented in the literature. RESULTS Unit tests and integration tests proved the equivalence of the new implementation and the original AndroidAPS code. Simulation of the scenario required approximately 15 minutes, corresponding to a speed-up factor of roughly 1000 with respect to real time. The results closely resemble those presented by Toffanin et al. Discrepancies were to be expected because a different virtual population was considered. Also, some parameters could not be extracted from and harmonized with the original setup. CONCLUSIONS The new implementation facilitates extensive in silico trials of AndroidAPS due to the significant reduction of runtime. This provides a cheap and fast means to test new versions of the algorithm before they are shared with the community.
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Affiliation(s)
- Jana Schmitzer
- Institute for Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Ulm, Germany
| | - Carolin Strobel
- Institute for Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Ulm, Germany
| | - Ronald Blechschmidt
- Institute for Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Ulm, Germany
| | - Adrian Tappe
- AndroidAPS.org, Software Development, Linz, Austria
| | - Heiko Peuscher
- Institute for Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Ulm, Germany
- Heiko Peuscher, Dr.-Ing., Institute for Medical Engineering and Mechatronics, Ulm University of Applied Sciences, Albert-Einstein-Allee 55, Ulm, 89081, Germany.
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Shepard JA, Breton M, Nimri R, Roberts JTF, Street T, Klonoff D, Barnard-Kelly K. User and Healthcare Professional Perspectives on Do-It-Yourself Artificial Pancreas Systems: A Need for Guidelines. J Diabetes Sci Technol 2022; 16:224-227. [PMID: 33000636 PMCID: PMC8875047 DOI: 10.1177/1932296820957728] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A growing number of individuals with type 1 diabetes are choosing to use "do-it-yourself" artificial pancreas systems (DIY APS) to support their diabetes self-management. Observational and self-report data of glycemic benefits of DIY APS are promising; however, without rigorous clinical trials or regulation from governing bodies, liability and user safety continue to be central concerns for stakeholders. Despite DIY APS having been used for several years now, there are no guidelines to assist users and healthcare professionals in addressing DIY APS use in routine clinical care. This commentary reports key stakeholders' perspectives presented at the annual Advanced Technologies and Treatments in Diabetes conference in February 2020. Important considerations to inform the development of clinical care guidelines are also presented to generate further debate.
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Affiliation(s)
- Jaclyn A. Shepard
- Department of Psychiatry & Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
- Jaclyn A. Shepard, PsyD, University of Virginia School of Medicine, Department of Psychiatry & Neurobehavioral Sciences, P.O. Box 800223, Charlottesville, VA 22908, USA.
| | - Marc Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA
| | - Revital Nimri
- The Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children’s Medical Center of Israel, Petah Tikva, Israel
| | | | | | - David Klonoff
- Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
| | - Katharine Barnard-Kelly
- BHR Limited, Fareham, Hampshire, UK
- Faculty of Health & Social Science, Bournemouth University, Dorset, UK
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Braune K, Lal RA, Petruželková L, Scheiner G, Winterdijk P, Schmidt S, Raimond L, Hood KK, Riddell MC, Skinner TC, Raile K, Hussain S. Open-source automated insulin delivery: international consensus statement and practical guidance for health-care professionals. Lancet Diabetes Endocrinol 2022; 10:58-74. [PMID: 34785000 PMCID: PMC8720075 DOI: 10.1016/s2213-8587(21)00267-9] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 01/15/2023]
Abstract
Open-source automated insulin delivery systems, commonly referred to as do-it-yourself automated insulin delivery systems, are examples of user-driven innovations that were co-created and supported by an online community who were directly affected by diabetes. Their uptake continues to increase globally, with current estimates suggesting several thousand active users worldwide. Real-world user-driven evidence is growing and provides insights into safety and effectiveness of these systems. The aim of this consensus statement is two-fold. Firstly, it provides a review of the current evidence, description of the technologies, and discusses the ethics and legal considerations for these systems from an international perspective. Secondly, it provides a much-needed international health-care consensus supporting the implementation of open-source systems in clinical settings, with detailed clinical guidance. This consensus also provides important recommendations for key stakeholders that are involved in diabetes technologies, including developers, regulators, and industry, and provides medico-legal and ethical support for patient-driven, open-source innovations.
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Affiliation(s)
- Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany; Institute of Medical Informatics, Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health, Berlin, Germany
| | - Rayhan A Lal
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA.
| | - Lenka Petruželková
- Department of Pediatrics, University Hospital Motol, Prague, Czech Republic
| | | | - Per Winterdijk
- Diabeter, Center for Pediatric and Adult Diabetes Care and Research, Rotterdam, Netherlands
| | | | | | - Korey K Hood
- Stanford Diabetes Research Center, Stanford University School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Timothy C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark; La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Sufyan Hussain
- Department of Diabetes and Endocrinology, Guy's and St Thomas' Hospital NHS Trust, London, UK; Department of Diabetes, King's College London, London, UK; Institute of Diabetes, Endocrinology and Obesity, King's Health Partners, London, UK.
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22
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Moon SJ, Jung I, Park CY. Current Advances of Artificial Pancreas Systems: A Comprehensive Review of the Clinical Evidence. Diabetes Metab J 2021; 45:813-839. [PMID: 34847641 PMCID: PMC8640161 DOI: 10.4093/dmj.2021.0177] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 10/24/2021] [Indexed: 12/19/2022] Open
Abstract
Since Banting and Best isolated insulin in the 1920s, dramatic progress has been made in the treatment of type 1 diabetes mellitus (T1DM). However, dose titration and timely injection to maintain optimal glycemic control are often challenging for T1DM patients and their families because they require frequent blood glucose checks. In recent years, technological advances in insulin pumps and continuous glucose monitoring systems have created paradigm shifts in T1DM care that are being extended to develop artificial pancreas systems (APSs). Numerous studies that demonstrate the superiority of glycemic control offered by APSs over those offered by conventional treatment are still being published, and rapid commercialization and use in actual practice have already begun. Given this rapid development, keeping up with the latest knowledge in an organized way is confusing for both patients and medical staff. Herein, we explore the history, clinical evidence, and current state of APSs, focusing on various development groups and the commercialization status. We also discuss APS development in groups outside the usual T1DM patients and the administration of adjunct agents, such as amylin analogues, in APSs.
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Affiliation(s)
- Sun Joon Moon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inha Jung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Cheol-Young Park
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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23
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March CA, Oyetoro R, Adams J, Rodriguez H, Albanese-O'Neill A. School Nurse Perspectives on Do-It-Yourself Automated Pancreas Systems in the School Setting. Diabetes Technol Ther 2021; 23:705-709. [PMID: 33900843 DOI: 10.1089/dia.2021.0042] [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: 11/13/2022]
Abstract
Do-it-yourself (DIY) artificial pancreas systems (APSs) are gaining popularity among children with type 1 diabetes. Little is known about how school systems provide care for children who use DIY APSs, and available guidance for schools is limited. This study explored school staff perspectives on DIY APSs through a national survey of school nurses about their current practices, beliefs, and attitudes toward DIY APSs. Although one-quarter (23%) of school nurses reported experience with DIY APSs in school, nearly half (46%) had no prior knowledge of this new technology. The majority (82%) reported that children should be allowed to use DIY APSs in school, although there was less consensus about school nurse responsibilities with these devices. Qualitative responses added context regarding potential barriers, including the need for more informed guidelines and training and fears of liability. Future development of school guidelines for DIY APSs is necessary and should incorporate stakeholder perspectives.
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Affiliation(s)
- Christine A March
- Division of Pediatric Endocrinology and Diabetes, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca Oyetoro
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Janey Adams
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Henry Rodriguez
- USF Diabetes and Endocrinology Center, University of South Florida, Tampa, Florida, USA
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24
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Guerrón AD, Davis GM, Pasquel FJ. Advances in Pharmacotherapeutics, Metabolic Surgery, and Technology for Diabetes. Endocrinol Metab Clin North Am 2021; 50:457-474. [PMID: 34399956 DOI: 10.1016/j.ecl.2021.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Remarkable advances in diabetes management have occurred since the discovery of insulin 100 years ago. Advances across a therapeutic spectrum, including pharmacotherapy, metabolic surgery, and diabetes technology, offer superior treatment options for diabetes management. New medication classes (glucagon-like peptide-1 receptor analogs and SGLT-2 inhibitors) have demonstrated cardiorenal benefits beyond glycemic control in type 2 diabetes mellitus, while evolving metabolic surgical interventions also help patients achieve diabetes remission. The use of artificial pancreas systems has shown consistent improvement in glycemic control in type 1 diabetes mellitus. It is time for policy changes to expand access to such advantageous therapies.
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Affiliation(s)
- Alfredo Daniel Guerrón
- Division of Metabolic and Bariatric Surgery, Duke University, 407 Crutchfield Street, Durham, NC 27704, USA
| | - Georgia M Davis
- Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr Drive SE, GA 30030, USA
| | - Francisco J Pasquel
- Division of Endocrinology, Emory University School of Medicine, 69 Jesse Hill Jr Drive SE, GA 30030, USA.
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25
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Schipp J, Skinner T, Holloway E, Scibilia R, Langstrup H, Speight J, Hendrieckx C. How Adults with Type 1 Diabetes Are Navigating the Challenges of Open-Source Artificial Pancreas Systems: A Qualitative Study. Diabetes Technol Ther 2021; 23:546-554. [PMID: 33720767 DOI: 10.1089/dia.2020.0652] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Objective: An emerging group of people with type 1 diabetes are building and using their own artificial pancreas systems (APS). Currently, these "user-led," open-source systems are not endorsed by regulatory bodies. People face multiple challenges when building and using open-source APS (e.g., lacking required technical knowledge, difficulties sourcing hardware). We explored the experiences of adults with type 1 diabetes using open-source APS to understand how they are navigating these challenges. Research Design and Methods: We conducted semistructured telephone interviews (October 2018 to January 2019) with Australian adults about their experiences using an open-source APS. Interviews were recorded, transcribed, and analyzed thematically. Results: Participants included 23 adults with type 1 diabetes, aged 25-64 years, 10 (43%) women, with 1-34 months of experience of open-source APS. Participants used four key strategies to navigate challenges: (1) peer support, (2) self-sufficiency, (3) risk management, and (4) trade-offs. Participants relied on peer support and self-sufficiency to fill perceived gaps in professional and industry support. They felt that using an open-source solution was no riskier than previous management and demonstrated a conscious weighing-up of risks. Overall, participants felt that the experienced benefits for their physical health and quality of life outweighed the challenges and potential risks. Conclusions: Adults with type 1 diabetes are applying several interweaving psychosocial and practical strategies to navigate the challenges of building and using open-source APS. The findings highlight the importance of health professionals' showing support and understanding for those choosing to use an open-source APS.
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Affiliation(s)
- Jasmine Schipp
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Edith Holloway
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Renza Scibilia
- Diabetes Australia, Type 1 Diabetes and Communities, Canberra, Australia
| | - Henriette Langstrup
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jane Speight
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
| | - Christel Hendrieckx
- School of Psychology, Deakin University, Burwood, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia
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26
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Abstract
A growing number of people with diabetes are turning to self-built systems to dose and deliver insulin. These do-it-yourself artificial pancreas systems (DIY-APS) use commercially available insulin pumps and continuous glucose monitors and add an algorithm that independently modulates insulin dosing. Frustrated by the pace of diabetes technology development, a group of patients and diabetes advocates developed this technology without formal safety studies and without approval by the US Food and Drug Administration (FDA). Loop, OpenAPS, and AndroidAPS are the three available platforms, and patients worldwide are choosing them over other options. Patients generally report positive outcomes, but in May 2019, the FDA publicly warned against the use of such systems. Endocrinology providers are, therefore, faced with a difficult decision of whether to support patients interested in using a DIY-APS. This article describes the current state of DIY-APS, regulatory considerations, and our recommendations for endocrinology providers regarding this technology. [Pediatr Ann. 2021;50(7):e304-e307.].
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27
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Braune K, Gajewska KA, Thieffry A, Lewis DM, Froment T, O'Donnell S, Speight J, Hendrieckx C, Schipp J, Skinner T, Langstrup H, Tappe A, Raile K, Cleal B. Why #WeAreNotWaiting-Motivations and Self-Reported Outcomes Among Users of Open-source Automated Insulin Delivery Systems: Multinational Survey. J Med Internet Res 2021; 23:e25409. [PMID: 34096874 PMCID: PMC8218212 DOI: 10.2196/25409] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/19/2020] [Accepted: 03/16/2021] [Indexed: 12/19/2022] Open
Abstract
Background Automated insulin delivery (AID) systems have been shown to be safe and effective in reducing hyperglycemia and hypoglycemia but are not universally available, accessible, or affordable. Therefore, user-driven open-source AID systems are becoming increasingly popular. Objective This study aims to investigate the motivations for which people with diabetes (types 1, 2, and other) or their caregivers decide to build and use a personalized open-source AID. Methods A cross-sectional web-based survey was conducted to assess personal motivations and associated self-reported clinical outcomes. Results Of 897 participants from 35 countries, 80.5% (722) were adults with diabetes and 19.5% (175) were caregivers of children with diabetes. Primary motivations to commence open-source AID included improving glycemic outcomes (476/509 adults, 93.5%, and 95/100 caregivers, 95%), reducing acute (443/508 adults, 87.2%, and 96/100 caregivers, 96%) and long-term (421/505 adults, 83.3%, and 91/100 caregivers, 91%) complication risk, interacting less frequently with diabetes technology (413/509 adults, 81.1%; 86/100 caregivers, 86%), improving their or child’s sleep quality (364/508 adults, 71.6%, and 80/100 caregivers, 80%), increasing their or child’s life expectancy (381/507 adults, 75.1%, and 84/100 caregivers, 84%), lack of commercially available AID systems (359/507 adults, 70.8%, and 79/99 caregivers, 80%), and unachieved therapy goals with available therapy options (348/509 adults, 68.4%, and 69/100 caregivers, 69%). Improving their own sleep quality was an almost universal motivator for caregivers (94/100, 94%). Significant improvements, independent of age and gender, were observed in self-reported glycated hemoglobin (HbA1c), 7.14% (SD 1.13%; 54.5 mmol/mol, SD 12.4) to 6.24% (SD 0.64%; 44.7 mmol/mol, SD 7.0; P<.001), and time in range (62.96%, SD 16.18%, to 80.34%, SD 9.41%; P<.001). Conclusions These results highlight the unmet needs of people with diabetes, provide new insights into the evolving phenomenon of open-source AID technology, and indicate improved clinical outcomes. This study may inform health care professionals and policy makers about the opportunities provided by open-source AID systems. International Registered Report Identifier (IRRID) RR2-10.2196/15368
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Affiliation(s)
- Katarina Braune
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Katarzyna Anna Gajewska
- #dedoc° Diabetes Online Community, Berlin, Germany.,Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Axel Thieffry
- Novo Nordisk Center for Biosustainability, Technical University of Denmark, Copenhagen, Denmark
| | | | | | - Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Jane Speight
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Christel Hendrieckx
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,School of Psychology, Faculty of Health, Deakin University, Geelong, Australia
| | - Jasmine Schipp
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Timothy Skinner
- The Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia.,Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Langstrup
- Department of Public Health, Section for Health Services Research, University of Copenhagen, Copenhagen, Denmark
| | | | - Klemens Raile
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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28
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Petruzelkova L, Jiranova P, Soupal J, Kozak M, Plachy L, Neuman V, Pruhova S, Obermannova B, Kolouskova S, Sumnik Z. Pre-school and school-aged children benefit from the switch from a sensor-augmented pump to an AndroidAPS hybrid closed loop: A retrospective analysis. Pediatr Diabetes 2021; 22:594-604. [PMID: 33576551 DOI: 10.1111/pedi.13190] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/18/2020] [Accepted: 01/29/2021] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVE Data on closed loop systems in young children with type 1 diabetes (T1D) are limited. We tested the efficacy and safety of an open-source, do-it-yourself automated insulin delivery system AndroidAPS in preschool and school-aged children. RESEARCH DESIGN AND METHODS This retrospective study analyzed diabetes control in 18 preschool (3-7 years) and 18 school-aged children (8-14 years) with T1D who switched from a sensor-augmented pump (SAP) to AndroidAPS. We compared the CGM parameters and HbA1c levels 3 months before and 6 months after the initiation of AndroidAPS therapy and evaluated frequency of severe adverse events during AndroidAPS use, the most frequent reasons for its interruption, and the experience and psychosocial benefits of AndroidAPS use. RESULTS General glycemic control was significantly improved after the switch from SAP to AndroidAPS. Time in range (TIR) increased in both preschool (70.8%-78.6%, p = 0.004) and school-aged children (77.2%-82.9%, p < 0.001), whereas HbA1c levels decreased (preschool children 53.8-48.5 mmol/mol, p < 0.001; school-aged children 52.6-45.1 mmol/mol, p = 0.001). Time spent in range of 3.0-3.8 mmol/L increased slightly in school children (2.6%-3.8%, p = 0.040), but not in preschool children (3.0%-3.0%, p = 0.913). Time spent at <3 mmol/L remained unchanged in both preschool (0.95%-0.67%, p = 0.432) and school-aged children (0.8%-0.8%, p = 1.000). No episodes of severe hypoglycemia or DKA and significant improvement of quality of life were reported by AndroidAPS users. CONCLUSIONS AndroidAPS seems effective for T1D control both in preschool and school-age children but further validation by prospective studies is necessary.
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Affiliation(s)
- Lenka Petruzelkova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavlina Jiranova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jan Soupal
- 3rd Department of Internal Medicine, 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Milos Kozak
- IT division, CLOSED LOOP Systems, Prague, Czech Republic
| | - Lukas Plachy
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Vit Neuman
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stepanka Pruhova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Barbora Obermannova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Stanislava Kolouskova
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Zdenek Sumnik
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
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29
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Asarani NAM, Reynolds AN, Elbalshy M, Burnside M, de Bock M, Lewis DM, Wheeler BJ. Efficacy, safety, and user experience of DIY or open-source artificial pancreas systems: a systematic review. Acta Diabetol 2021; 58:539-547. [PMID: 33128136 DOI: 10.1007/s00592-020-01623-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/14/2020] [Indexed: 02/07/2023]
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.
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Affiliation(s)
- N A M Asarani
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - A N Reynolds
- Department of Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M Elbalshy
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand
| | - M Burnside
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - M de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | | | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin, 9054, New Zealand.
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30
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Gawrecki A, Zozulinska-Ziolkiewicz D, Michalak MA, Adamska A, Michalak M, Frackowiak U, Flotynska J, Pietrzak M, Czapla S, Gehr B, Araszkiewicz A. Safety and glycemic outcomes of do-it-yourself AndroidAPS hybrid closed-loop system in adults with type 1 diabetes. PLoS One 2021; 16:e0248965. [PMID: 33819289 PMCID: PMC8021167 DOI: 10.1371/journal.pone.0248965] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 03/04/2021] [Indexed: 12/12/2022] Open
Abstract
Background The aim of the study was to assess the safety and glycemic outcomes with the use of a Do-It-Yourself (DIY) Hybrid Closed-Loop (HCL) system based on the AndroidAPS application in type 1 diabetes (T1D). Methods Single-center clinical trial, with 3-week run-in and 12-week study period. DIY HCL system consisted of the Dana Diabecare RS insulin pump, Dexcom G5 continuous glucose monitoring system and AndroidAPS application. Primary outcome was safety: incidences of severe hypoglycemia, diabetic ketoacidosis, time spent in glycemia <54 mg/dl. Secondary endpoints included percentage of time in range (TIR) 70–180 mg/dl, time below 70 mg/dl, HbA1c, insulin requirements, and body weight. Results In total 12 subjects (5 men, 7 women) were enrolled, mean age 31.3±6.7, 95%CI(27.7–34.9) years, mean diabetes duration 16.1±5.7, 95%CI(13.0–19.2) years. No episodes of severe hypoglycemia or ketoacidosis were observed. Percentage of time spent in glycemia below 54mg/dl was not increased. Average sensor glycemia was lower in the study period than baseline (141.1 ± 8.4, 95%CI(136.3–145.9) vs. 153.3 ± 17.9, 95%CI(143.2–163.4), mg/dl p<0.001). TIR 70–180 mg/dl was improved by 11.3%, 95%CI(2.8%-19.8%) (from 68.0 ± 12.7 to 79.3 ± 6.4%, p<0.001), without increasing hypoglycemia time. The HbA1c level decreased by -0.5%, 95%CI(-0.9%–-0.1%) (from 6.8 ± 0.5 to 6.3 ± 0.4%, p<0.001). Additionally, in the last 4 weeks of the study period participants significantly improved and showed TIR 70–180 mg/dl 82.1 ± 5.6%, 95%CI(78.9–85.3), time <54 mg/dl 0.30 (0.20–0.55)%, median 95%CI(0.1–0.7) and <70 mg/dl 1.90 (1.10–3.05)%, median 95%CI(0.7–3.2). The insulin requirement and body weight did not change in the study. Conclusions The study revealed safety of the Do-It-Yourself HCL system AndroidAPS in adults with T1D, limited to well-controlled, highly selected and closely monitored patients. The use of AndroidAPS significantly improved HbA1c, time in range and average sensor glycemia without increasing hypoglycemia. As both patients and their medical team are gaining experience using the system over time, they improve glycemic control. Trial registration German Clinical Trials Register: no. DRKS00015439; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015439.
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Affiliation(s)
- Andrzej Gawrecki
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | | | | | - Anna Adamska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Michal Michalak
- Department of Computer Sciences and Statistics, Poznan University of Medical Sciences, Poznan, Poland
| | - Urszula Frackowiak
- Department of Diabetology and Internal Medicine, Raszeja Hospital, Poznan, Poland
| | - Justyna Flotynska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - Monika Pietrzak
- Department of Diabetology and Internal Medicine, Raszeja Hospital, Poznan, Poland
| | | | - Bernhard Gehr
- Zentrum für Diabetes und Stoffwechselerkrankungen, m&i Fachklinik, Bad Heilbrunn, Germany
| | - Aleksandra Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
- * E-mail:
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31
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Abstract
Background: Optional features of continuous glucose monitoring (CGM) systems empower patients and caregivers to understand and manage diabetes in new ways. We examined associations between use of optional features, demographics, and glycemic outcomes. Methods: Retrospective cohort studies were performed with data from US-based users of the G6 CGM System (Dexcom, Inc.). For all cohorts, data included sensor glucose values (SGVs). In separate cohorts, use of alert features (for hyperglycemia, existing hypoglycemia, and impending hypoglycemia), remote data sharing feature (Share), software for retrospective pattern analysis (CLARITY), "virtual assistant" feature that announces the current SGV and trend in response to a spoken request were assessed. Descriptive statistics were used to summarize feature set utilization patterns and relate them to glycemic outcomes. Results: Most individual features were consistently adopted by high proportions of G6 users. Threshold SGVs chosen for activating hyperglycemia and hypoglycemia alerts varied with age and were higher among the youngest and oldest patients. Use of the Share feature was more common among young patients and those with type 1 diabetes. Individuals who used more of the alert and notification features had more favorable glycemic outcomes, including time in range (TIR), than those who used fewer. More extensive engagement with CLARITY notifications was associated with higher TIR. Frequent use of the virtual assistant feature was associated with higher TIR and lower mean SGV. Conclusions: Optional features of the G6 CGM system are acceptable to and appear to benefit patients who use them. Different levels of engagement suggest that demographics and personal circumstances play a role in how patients and caregivers use CGM features to help manage diabetes.
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Affiliation(s)
- Halis Kaan Akturk
- Barbara Davis Center for Diabetes, University of Colorado, Aurora, Colorado, USA
- Address correspondence to: H. Kaan Akturk, MD, Barbara Davis Center for Diabetes, University of Colorado, 1775 Aurora Ct, Aurora, CO 80045, USA
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32
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Do-It-Yourself Artificial Pancreas System Use in Pregnant Women With Type 1 Diabetes in a Real-World Setting: 2 Case Reports. Can J Diabetes 2021; 45:804-808.e2. [PMID: 33648862 DOI: 10.1016/j.jcjd.2021.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/06/2021] [Accepted: 01/10/2021] [Indexed: 12/12/2022]
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33
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Heile M, Hollstegge B, Broxterman L, Cai A, Close K. Automated Insulin Delivery: Easy Enough to Use in Primary Care? Clin Diabetes 2020; 38:474-485. [PMID: 33384472 PMCID: PMC7755048 DOI: 10.2337/cd20-0050] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
There are three automated insulin delivery devices on the U.S. market, two of which are currently approved by the U.S. Food and Drug Administration. These systems have already made a significant impact for the people who use them in improving diabetes outcomes, including glycemic control and hypoglycemia prevention. This article aims to help primary care and endocrinology providers better understand the components, differences, limitations, and potential fit of these systems into clinical practice.
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Affiliation(s)
- Michael Heile
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
| | - Betty Hollstegge
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
| | - Laura Broxterman
- TriHealth Physician Partners–Family Medicine and Diabetology, Cincinnati, OH
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34
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Heinemann L, Lange K. "Do It Yourself" (DIY)-Automated Insulin Delivery (AID) Systems: Current Status From a German Point of View. J Diabetes Sci Technol 2020; 14:1028-1034. [PMID: 31875681 PMCID: PMC7645134 DOI: 10.1177/1932296819889641] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A group of dedicated people with a high affinity for technology and good understanding of how to treat their type 1 diabetes have developed systems that enable automated insulin delivery (AID). These persons build these AID systems only for themselves (do it yourself [DIY]) and the quality of glucose control achieved with DIY AID systems is impressively good. This overview presents the current status of this development from a German point of view. A high degree of efforts is required to start and maintain this type of therapy and the user must always remain aware of what she/he is doing in everyday life. One main obstacle is liability, because the medicinal products used by persons with diabetes for DIY AID systems are not approved for this indication. They must be regarded as experimental systems. As long as persons with diabetes build and use these systems for themselves and not for other people, they act at their own risk. If a person with diabetes expresses interest in such a system or is already using it, the diabetologist should inform him about the improper use of the medical devices and about the associated risks. The physician should document this information accordingly.
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Affiliation(s)
- Lutz Heinemann
- Science Consulting in Diabetes GmbH, Neuss, Germany
- Lutz Heinemann, PhD, Science Consulting in Diabetes GmbH, Geulenstr. 50, Neuss 41462, Germany.
| | - Karin Lange
- Hannover Medical School, Dept. Medical Psychology, Hannover, Germany
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Murray JA, Clayton MF, Litchman ML. Health Care Provider Knowledge and Perceptions of FDA-Approved and Do-It-Yourself Automated Insulin Delivery. J Diabetes Sci Technol 2020; 14:1017-1021. [PMID: 31876176 PMCID: PMC7645143 DOI: 10.1177/1932296819895567] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Automated insulin delivery (AID) technology may reduce variability in blood glucose, resulting in lower risk for hypoglycemia and associated complications, and by extension improve quality of life. While clinical trials, research, and patient experience have consistently demonstrated the value of AID, this technology is still inaccessible to many patients. Patient-driven innovation has resulted in alternative do-it-yourself (DIY) solutions to available off-the-shelf AID devices. METHOD This two-phase cross-sectional observational study addressed health care provider (HCP) perceptions of AID as well as the perceived need for, development of, and evaluation of an AID fact sheet comparing the most commonly used Federal Drug Administration approved AID and DIY AID devices. RESULTS Negative attitudes toward the use of DIY AID were low. The majority of HCPs saw their lack of knowledge about how DIY AID work to be the greatest barrier to answering patient questions about what is available (74.4%). Additionally, the majority of HCPs (64.5%) indicated they were either "likely" or "very likely" to use the fact sheet when answering patient questions about AID options. CONCLUSION Increased awareness and utilization of AID technology offer hope to further reduce the burden of diabetes, but there is a need to bridge the knowledge gap about DIY AID. A fact sheet provides a way to facilitate discussions of this emerging technology between HCPs and patients. Next steps could investigate additional ways to put needed information in the hands of HCPs.
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Affiliation(s)
- James A. Murray
- University of Utah College of Nursing, Salt Lake City, UT, USA
- James A. Murray, DNP, FNP-C, University of Utah College of Nursing, 10 2000 East Salt Lake City, UT 84112, USA.
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Litchman ML, Walker HR, Fitzgerald C, Gomez Hoyos M, Lewis D, Gee PM. Patient-Driven Diabetes Technologies: Sentiment and Personas of the #WeAreNotWaiting and #OpenAPS Movements. J Diabetes Sci Technol 2020; 14:990-999. [PMID: 32627587 PMCID: PMC7645133 DOI: 10.1177/1932296820932928] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with diabetes have developed innovative do-it-yourself (DIY) methods for adapting existing medical devices to better fit individual needs. METHOD A multiple method study used Symplur Analytics to analyze aggregated Twitter data of #WeAreNotWaiting and #OpenAPS tweets between 2014 and 2017 to examine DIY patient-led innovation. Conversation sentiment was examined between diabetes stakeholders to determine changes over time. Two hundred of the most shared photos were analyzed to understand visual representations of DIY patient-led innovations. Finally, discourse analysis was used to identify the personas who engage in DIY patient-led diabetes technologies activities and conversations on Twitter. RESULTS A total of 7886 participants who generated 46 578 tweets were included. Sentiment analysis showed that 82%-85% of interactions around DIY patient-led innovation was positive among patient/caregiver and physician groups. Through photo analysis, five content themes emerged: (1) disseminating media and conference coverage, (2) showcasing devices, (3) celebrating connections, (4) providing instructions, and (5) celebrating accomplishments. Six personas emerged across the overlapping userbase: (1) fearless leaders, (2) loopers living it up, (3) parents on a mission, (4) the tech titans, (5) movement supporters, and (6) healthcare provider advocates. Personas had varying goals and behaviors within the community. CONCLUSIONS #WeAreNotWaiting and #OpenAPS on Twitter reveal a fast-moving patient-led movement focused on DIY patient innovation that is further mobilized by an expanding and diverse userbase. Further research is indicated to bring technology savvy persons with diabetes into conversation with healthcare providers and researchers alike.
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Affiliation(s)
- Michelle L. Litchman
- College of Nursing, University of Utah, Salt Lake City, USA
- Michelle L. Litchman, PhD, FNP-BC, FAANP, College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT 84112, USA.
| | | | | | | | | | - Perry M. Gee
- Intermountain Healthcare, Salt Lake City, UT, USA
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Shaw D, Crabtree TSJ, Hammond P, McLay A, Wilmot EG. The DIY artificial pancreas system: an ethical dilemma for doctors. Diabet Med 2020; 37:1951-1953. [PMID: 32043649 DOI: 10.1111/dme.14270] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2020] [Indexed: 01/03/2023]
Affiliation(s)
- D Shaw
- Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
- Care and Public Health Research Institute, Maastricht University, Maastricht, The Netherlands
| | - T S J Crabtree
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - P Hammond
- Harrogate and District Foundation Trust, Harrogate, UK
| | | | - E G Wilmot
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Division of Medical Sciences and Graduate Entry Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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Greenwood DA, Ross TA, Reifsnider E. Applying a Solution-Focused Approach to Life With Diabetes: Insights Gleaned via Twitter. DIABETES EDUCATOR 2020; 46:485-494. [PMID: 32674724 DOI: 10.1177/0145721720941415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this study was to explore responses of people with diabetes (PWD) when exposed to a solution-focused brief therapy (SFBT) approach. This approach focuses on solutions rather than the problems and what is desired in life rather than what will not occur. METHODS Ten SFBT questions were presented for discussion during 1 hour of a Twitter chat on November 14, 2018, during a World Diabetes Day multiple-hour chat. Verbatim transcripts of Twitter data were downloaded from Symplur Signals LLC. Thirty-two participants from 4 countries created 358 tweets, 118 retweets, and 1.5 million impressions. A qualitative content analysis was then completed. RESULTS Five themes emerged regarding the desired future state: more living life, laughter and humor, self-compassion, resilience, and support. There was an overwhelming sense of burden associated with diabetes yet a global feeling of hope, acceptance, and being "capable" to manage diabetes. CONCLUSION Employing SFBT, asking future-directed questions with a focus on solutions and the desired state, generated impactful insights around life with diabetes. Diabetes care and education specialists can incorporate SFBT as a tool to focus diabetes care, education, and support in partnership with PWD. Use of SFBT in diabetes demonstrates potential to strengthen resilience and confidence needed to manage this challenging condition.
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Affiliation(s)
- Deborah A Greenwood
- Deborah Greenwood Consulting, Granite Bay, California.,Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Tami A Ross
- Lexington-Fayette County Health Department, Lexington, Kentucky
| | - Elizabeth Reifsnider
- Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
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Ahmed SH, Gallo S. Looping with Do-It-Yourself Artificial Pancreas Systems During Ramadan Fasting in Type 1 Diabetes Mellitus: Perspectives of a User and a Physician. Diabetes Ther 2020; 11:1-11. [PMID: 32922559 PMCID: PMC7480212 DOI: 10.1007/s13300-020-00901-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Indexed: 11/28/2022] Open
Abstract
Hybrid closed-loop automated insulin delivery systems have helped type 1 diabetes (T1D) users close the loop between glucose monitoring and insulin delivery, a very important step in efforts to simulate the glucose-responsive insulin secretory function of a healthy pancreas. Do-It-Yourself Artificial Pancreas Systems (DIY APS) are a form of hybrid closed-loop system that use open-source algorithms, which govern the delivery of insulin in response to interstitial glucose and other variables that are personalized to an individual. The flexibility and customization afforded by these systems make them amenable for use in different worldly circumstances, one of which is fasting during the annual occurrence of Ramadan for observant Muslims. Here, we present the views of a DIY APS user who was able to fast successfully on most days of Ramadan after adopting this system, and the overview of a physician on these systems, with a focus on fasting during Ramadan with T1D.
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Affiliation(s)
- Syed Haris Ahmed
- Department of Endocrinology and Metabolic Medicine, Countess of Chester Hospital NHS Foundation Trust, Chester, UK
- School of Medicine, University of Liverpool, Liverpool, UK
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Ng M, Borst E, Garrity A, Hirschfeld E, Lee J. Evolution of Do-It-Yourself Remote Monitoring Technology for Type 1 Diabetes. J Diabetes Sci Technol 2020; 14:854-859. [PMID: 31893941 PMCID: PMC7753857 DOI: 10.1177/1932296819895537] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Nightscout Project is a leading example of patient-designed, do-it-yourself (DIY), open-source technology innovations to support type 1 diabetes management. We are unaware of studies that have described the evolution of patient-driven innovations from the Nightscout Project to date. METHODS We identified patient-driven, DIY innovations from posts and comments in the "CGM in the Cloud" private Facebook group as well as data from Twitter, GitHub, and the Nightscout website. For each innovation, we described its intent or its unaddressed need as well as the associated features and improvements. We conducted a thematic analysis to identify overarching patterns among the innovations, features, and improvements, and compared the timeline of innovations in the DIY space with the timing of similar innovations in the commercial space. RESULTS We identified and categorized innovations in Nightscout with the most commonly appearing themes of: visualization improvements, equipment improvements, and user experience improvements. Other emerging themes included: Care Portal support, safety, remote monitoring, decision support, international support, artificial pancreas, pushover notifications, and open-source collaboration. CONCLUSIONS This rapid development of patient-designed DIY innovations driven by unmet needs in the type 1 diabetes community reflects a revolutionary, bottom-up approach to medical innovation. Nightscout users accessed features earlier than if they had waited for commercial products, and they also personalized their tools and devices, empowering them to become the experts of their own care.
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Affiliation(s)
- Michelle Ng
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Emily Borst
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Joyce Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
- Joyce Lee, MD, MPH, Pediatric Endocrinology and Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, 300 North Ingalls Building, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
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Do-It-Yourself (DIY) Artificial Pancreas Systems for Type 1 Diabetes: Perspectives of Two Adult Users, Parent of a User and Healthcare Professionals. Adv Ther 2020; 37:3929-3941. [PMID: 32696329 PMCID: PMC7444403 DOI: 10.1007/s12325-020-01431-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Indexed: 12/02/2022]
Abstract
The artificial pancreas system or an automated insulin dosing system has been the ‘holy grail’ for patients with type 1 diabetes and their caregivers who have over the years wanted to ‘close the loop’ between monitoring of glucose and delivery of insulin. The launch of the Medtronic MiniMed 670G system in 2017 and the subsequent release of the Tandem t:slim with Control-IQ system, the DANA RS pump compatible-CamAPS FX app and the more recent announcement of the Medtronic MiniMed 780G system have come as answers to their prayers. However, in the time taken to develop and launch these commercial systems, creative and ebullient parents of young patients with type 1 diabetes, along with other patients, technologists and healthcare professionals have developed mathematical models as software solutions to determine insulin delivery that in conjunction with compatible hardware have helped ‘close the loop’. Under an umbrella movement #WeAreNotWaiting, they have, as a community, refined and disseminated technologies that are open source and ubiquitously available as do-it-yourself (DIY) closed-loop systems or DIY artificial pancreas systems (APS). There are presently three systems—OpenAPS, AndroidAPS and Loop. We present perspectives of two patients, parent of a patient, and their healthcare providers; the users spanning an age spectrum most likely to use this technology—a child, an adolescent in transitional care and a 31-yr old adult patient, highlighting how looping has helped them self-manage diabetes within the routine of their lives and the challenges they faced.
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Schütz-Fuhrmann I, Schütz AK, Eichner M, Mader JK. Two Subsequent Pregnancies in a Woman With Type 1 Diabetes: Artificial Pancreas Was a Gamechanger. J Diabetes Sci Technol 2020; 14:972-973. [PMID: 32059616 PMCID: PMC7753854 DOI: 10.1177/1932296820906219] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Anna K. Schütz
- Endocrinology and Nephrology, Karl Landsteiner Institute, Vienna, Austria
| | - Marlies Eichner
- Department of Endocrinology and Nephrology, City Hospital Hietzing, Vienna, Austria
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Austria
- Julia K. Mader, MD, Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Auenbruggerplatz 15, Graz 8036, Austria.
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Jennings P, Hussain S. Do-It-Yourself Artificial Pancreas Systems: A Review of the Emerging Evidence and Insights for Healthcare Professionals. J Diabetes Sci Technol 2020; 14:868-877. [PMID: 31847570 PMCID: PMC7753866 DOI: 10.1177/1932296819894296] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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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Affiliation(s)
- Peter Jennings
- Nottingham Trent University, UK
- University Hospitals of Derby and Burton
NHS Foundation Trust, UK
| | - Sufyan Hussain
- Department of Diabetes and
Endocrinology, Guy’s and St Thomas’ Hospital NHS Trust, London, UK
- Department of Diabetes, Faculty of Life
Sciences and Medicine, Kings College London, UK
- Sufyan Hussain, MA, MB BChir, MRCP, PhD,
Department of Diabetes and Endocrinology, St Thomas’ Hospital, Guy’s and St
Thomas NHS Trust, 3rd Floor Lambeth Wing, Westminster Bridge Road, London SE1
7EH, UK. ; twitter:
@sugarydoc
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Palmer W, Greeley SAW, Letourneau-Freiberg LR, Naylor RN. Using a Do-It-Yourself Artificial Pancreas: Perspectives from Patients and Diabetes Providers. J Diabetes Sci Technol 2020; 14:860-867. [PMID: 32680447 PMCID: PMC7753849 DOI: 10.1177/1932296820942258] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND A growing number of people with diabetes are choosing to adopt do-it-yourself artificial pancreas system (DIYAPS) despite a lack of approval from the US Food and Drug Administration.We describe patients' experiences using DIYAPS, and patient and diabetes providers' perspectives on the use of such technology. METHODS We distributed surveys to patients and diabetes providers to assess each group's perspectives on the use of DIYAPS. The patient survey also assessed glycemic control and impact on sleep. The patient survey was distributed in February 2019 via Facebook and Twitter (n = 101). The provider survey was distributed via the American Association of Diabetes Educators' e-mail newsletter in April 2019 and the Pediatric Endocrine Society membership e-mail list in May 2019 (n = 152). RESULTS Patients overwhelmingly described improvements in glycemic control and sleep quality: 94% reported improvement in time in range, and 64% reported improvement in all five areas assessed. Eighty-nine percent of patients described DIYAPS as "Safe" or "Very Safe," compared to only 27% of providers. Most felt encouraged by their diabetes provider to continue using DIYAPS, but few described providers as knowledgeable regarding its use. Providers cited a lack of experience with such systems and an inability to troubleshoot them as their most significant challenges. CONCLUSIONS Despite evidence that DIYAPS usage is increasing, our surveys suggest that patients' adoption of this technology and trust in it is outpacing that of diabetes providers. Providers must be aware of this growing population of patients and familiarize themselves with DIYAPS to support patients using this technology.
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Affiliation(s)
- Walter Palmer
- University of Chicago, Pediatric Residency Training Program, Chicago, IL, USA
- Walter Palmer, MD, University of Chicago Medicine, Pediatric Medical Education Office, 5721 South Maryland Ave. MC8016, Chicago, IL 60637, USA.
| | - Siri Atma W. Greeley
- University of Chicago, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Chicago, IL, USA
| | - Lisa R. Letourneau-Freiberg
- University of Chicago, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Chicago, IL, USA
| | - Rochelle N. Naylor
- University of Chicago, Section of Adult and Pediatric Endocrinology, Diabetes, and Metabolism, Chicago, IL, USA
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Wu N, Brazeau AS, Nakhla M, Chan D, Da Costa D, Mukerji G, Butalia S, Pacaud D, Henderson M, Panagiotopoulos C, Rahme E, Dasgupta K. Type 1 Diabetes Mellitus Virtual Patient Network as a Peer Support Community: Protocol for Social Network Analysis and Content Analysis. JMIR Res Protoc 2020; 9:e18714. [PMID: 32865502 PMCID: PMC7490683 DOI: 10.2196/18714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 06/05/2020] [Accepted: 07/21/2020] [Indexed: 01/26/2023] Open
Abstract
Background Type 1 Diabetes Mellitus Virtual Patient Network (T1DM-VPN) is a private Facebook group for youths with type 1 diabetes mellitus (T1DM) in Canada intended to facilitate peer-to-peer support. It was built on the finding that stigma is prevalent among youth with T1DM and impedes self-management. Objective We aim to determine if T1DM-VPN provides support as intended and to ascertain what type of members provide support. Specifically, we will (1) identify text consistent with any one of 5 social support categories, (2) describe the network by visualizing its structure and reporting basic engagement statistics, and (3) determine whether being a designated peer leader is related to a member’s centrality (ie, importance in the network) and how frequently they offer social support. Methods We will manually extract interaction data from the Facebook group (posts, comments, likes/reactions, seen) generated from June 21, 2017 (addition of first member), to March 1, 2020. Two researchers will independently code posts and comments according to an existing framework of 5 social support categories—informational, emotional, esteem, network, and tangible—with an additional framework for nonsocial support categories. We will calculate how frequently each code is used. We will also report basic engagement statistics (eg, number of posts made per person-month) and generate a visualization of the network.
We will identify stable time intervals in the history of T1DM-VPN by modeling monthly membership growth as a Poisson process. Within each interval, each member’s centrality will be calculated and standardized to that of the most central member. We will use a centrality formula that considers both breadth and depth of connections (centrality = 0.8 × total No. of connections + 0.2 × total No. of interactions). Finally, we will construct multivariate linear regression models to assess whether peer leader status predicts member centrality and the frequency of offering social support. Other variables considered for inclusion in the models are gender and age at diagnosis. Results T1DM-VPN was launched in June 2017. As of March 1, 2020, it has 196 patient-members. This research protocol received ethics approval from the McGill University Health Centre Research Ethics Board on May 20, 2020. Baseline information about each group member was collected upon addition into the group, and collection of interaction data is ongoing as of May 2020. Conclusions This content analysis and social network analysis study of a virtual patient network applies epidemiological methods to account for dynamic growth and activity. The results will allow for an understanding of the topics of importance to youth with T1DM and how a virtual patient network evolves over time. This work is intended to serve as a foundation for future action to help youth improve their experience of living with diabetes. International Registered Report Identifier (IRRID) PRR1-10.2196/18714
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Affiliation(s)
- Nancy Wu
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | | | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Deborah Chan
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Deborah Da Costa
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Geetha Mukerji
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sonia Butalia
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Daniele Pacaud
- Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, AB, Canada
| | - Mélanie Henderson
- Division of Endocrinology and Diabetes, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, QC, Canada.,Department of Medicine, McGill University, Montreal, QC, Canada
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Hussain S, Lewis D. Diabetes Podcast: Do It Yourself/Open Source Artificial Pancreas Systems: Part 2. Diabetes Ther 2020; 11:1621-1626. [PMID: 32524493 PMCID: PMC7376797 DOI: 10.1007/s13300-020-00828-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Indexed: 01/10/2023] Open
Affiliation(s)
- Sufyan Hussain
- Guy's and St Thomas' NHS Foundation Trust, London, UK.
- King's College London, London, UK.
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Kesavadev J, Srinivasan S, Saboo B, Krishna B M, Krishnan G. The Do-It-Yourself Artificial Pancreas: A Comprehensive Review. Diabetes Ther 2020; 11:1217-1235. [PMID: 32356245 PMCID: PMC7261300 DOI: 10.1007/s13300-020-00823-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Indexed: 12/16/2022] Open
Abstract
Diabetes technology (DT) has accomplished tremendous progress in the past decades, aiming to convert these technologies as viable treatment options for the benefit of patients with diabetes (PWD). Despite the advances, PWD face multiple challenges with the efficient management of type 1 diabetes. Most of the promising and innovative technological developments are not accessible to a larger proportion of PWD. The slow pace of development and commercialization, overpricing, and lack of peer support are few such factors leading to inequitable access to the innovations in DT. Highly motivated and tech-savvy members of the diabetes community have therefore come up with the #WeAreNotWaiting movement and started developing their own do-it-yourself artificial pancreas systems (DIYAPS) integrating continuous glucose monitoring (CGM), insulin pumps, and smartphone technology to run openly shared algorithms to achieve appreciable glycemic control and quality of life (QoL). These systems use tailor-made interventions to achieve automated insulin delivery (AID) and are not commercialized or regulated. Online social network megatrends such as GitHub, CGM in the Cloud, and Twitter have been providing platforms to share these open source technologies and user experiences. Observational studies, anecdotal evidence, and real-world patient stories revealed significant improvements in time in range (TIR), time in hypoglycemia (TIHypo), HbA1c levels, and QoL after the initiation of DIYAPS. But this unregulated do-it-yourself (DIY) approach is perceived with great circumspection by healthcare professionals (HCP), regulatory bodies, and device manufacturers, making users the ultimate risk-bearers. The use of the regularized CGM and insulin pump with unauthorized algorithms makes them off-label and has been a matter of great concern. Besides these, lack of safety data, funding or insurance coverage, ethical, and legal issues are roadblocks to the unanimous acceptance of these systems among patients with type 1 diabetes (T1D). A multi-agency approach is necessary to evaluate the risks, and to delineate the incumbency and liability of clinicians, regulatory bodies, and manufacturers associated with the use of DIYAPS. Understanding the potential of DIYAPS as the need of the present time, many regional and international agencies have come with strategies to appraise its safety as well as to support education and training on its use. Here we provide a comprehensive description of the DIYAPS-including their origin, existing literature, advantages, and disadvantages that can help the industry leaders, clinicians, and PWD to make the best use of these systems.
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Affiliation(s)
- Jothydev Kesavadev
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India.
| | - Seshadhri Srinivasan
- Kalasalingam Academy of Research and Education, Srivilliputtur, Tamil Nadu, India
| | | | - Meera Krishna B
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
| | - Gopika Krishnan
- Jothydev's Diabetes Research Centre, Mudavanmugal, Thiruvananthapuram, Kerala, India
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48
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Burnside M, Lewis D, Crocket H, Wilson R, Williman J, Jefferies C, Paul R, Wheeler BJ, de Bock M. CREATE (Community deRivEd AutomaTEd insulin delivery) trial. Randomised parallel arm open label clinical trial comparing automated insulin delivery using a mobile controller (AnyDANA-loop) with an open-source algorithm with sensor augmented pump therapy in type 1 diabetes. J Diabetes Metab Disord 2020; 19:1615-1629. [PMID: 32837953 PMCID: PMC7261211 DOI: 10.1007/s40200-020-00547-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 05/16/2020] [Indexed: 01/22/2023]
Abstract
Background Commercialised automated insulin delivery (AID) systems have demonstrated improved outcomes in type 1 diabetes (T1D), however, they have limited capacity for algorithm individualisation, and can be prohibitively expensive if an individual is without access to health insurance or health funding subsidy. Freely available open-source algorithms, which have the ability to individualise algorithm parameters paired with commercial insulin pumps, and continuous glucose monitoring make up the so-called "do it yourself" (DIY) approach to AID. Limited data on the open-source approach have shown promising results, but data from a large randomised control trial are lacking. Methods The CREATE (Community deRivEd AutomaTEd insulin delivery) trial is an open-labelled, randomised, parallel 24-week, multi-site trial comparing sensor augmented pump therapy (SAPT) to our AnyDANA-loop. The three components of AnyDANA-loop are: 1) OpenAPS algorithm implemented in a smartphone (a version of AndroidAPS), 2) DANA-i™ insulin pump and, 3) Dexcom G6R continuous glucose monitor (CGM). The primary outcome measure is the percentage of time in target sensor glucose range (3.9 -10mmol/L). Secondary outcomes include psycho-social factors and platform performance. Analysis of online collective learning, characteristic of the open-source approach, is planned. 100 participants with T1D aged 7 - 70 years (age stratified into children/adolescents 7-15 years and adults 16-70 years), will be recruited from four sites in New Zealand. A 24-week continuation phase follows, to assess long-term safety.
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Affiliation(s)
- M Burnside
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
| | | | - H Crocket
- Te Huataki Waiora School of Health, Sport & Human Performance, University of Waikato, Hamilton, New Zealand
| | - R Wilson
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand
| | - J Williman
- Department of Population Health, University of Otago, Christchurch, New Zealand
| | - C Jefferies
- Department of Paediatric Endocrinology, Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| | - R Paul
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand.,Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Paediatric Department, Southern District Health Board, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, 2 Riccarton Avenue, Christchurch, 8011 New Zealand.,Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand.,Endocrinology Department, Canterbury District Health Board, Christchurch, New Zealand
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49
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Crabtree TSJ, Choudhary P, Hammond P, Lumb A, McLay A, Wilmot EG. Health-care professional opinions of DIY artificial pancreas systems in the UK. Lancet Diabetes Endocrinol 2020; 8:186-187. [PMID: 32085825 DOI: 10.1016/s2213-8587(19)30417-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 12/10/2019] [Accepted: 12/15/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Thomas S J Crabtree
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 2NE, UK; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Pratik Choudhary
- Department of Diabetes, School of Life Course Sciences, King's College London, London, UK
| | - Peter Hammond
- Diabetes Resource Centre, Harrogate District Hospital, Harrogate and District NHS Foundation Trust, Harrogate, UK
| | - Alistair Lumb
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | | | - Emma G Wilmot
- Diabetes Department, Royal Derby Hospital, University Hospitals of Derby and Burton NHS Foundation Trust, Derby DE22 2NE, UK; Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
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Abstract
People with diabetes have been experimenting with and modifying their own diabetes devices and technologies for many decades in order to achieve the best possible quality of life and improving their long-term outcomes, including do-it-yourself (DIY) closed loop systems. Thousands of individuals use DIY closed loop systems globally, which work similarly to commercial systems by automatically adjusting and controlling insulin dosing, but are different in terms of transparency, access, customization, and usability. Initial outcomes seen by the DIY artificial pancreas system community are positive, and randomized controlled trials are forthcoming on various elements of DIYAPS technology.
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