A scoping review of Do-It-Yourself Automated Insulin Delivery system (DIY AID) use in people with type 1 diabetes

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.

Automatische Insulinabgabe-Systeme („AID-Systeme“)

“…Unter Ausnützung von Sicherheitslücken und mit Reverse Engineering gelang es PwD1 s kollaborativ, CGM-Systeme und Insulinpumpen zu alltagstauglichen AID-Systemen zu verschalten. Die programmierten Algorithmen verfügen zwar über keine Zulassung durch die Aufsichtsbehörden und primär über keinen wissenschaftlichen Nutzennachweis, doch liegen mittlerweile auch Übersichtsarbeiten in der Literatur vor [11]. Bemerkenswert ist eine Publikation im renommierten Journal "Nature" vom 30.…”

Automated Insulin Delivery (AID) Systems: Use and Efficacy in Children and Adults with Type 1 Diabetes and Other Forms of Diabetes in Europe in Early 2023

“…Even if extensive real-world data are available, healthcare providers report a lack of confidence in supporting, DIY artificial pancreases despite impressive observational and user self-reported improvements in glycemic variability, without any reported safety issues. This is probably due to the user-driven, unregulated nature of these systems [ 88 ].…”