Excellent Glycemic Control Maintained by Open-Source Hybrid Closed-Loop AndroidAPS During and After Sustained Physical Activity

Petruželková, Lenka; Šoupal, Jan; Plasova, Veronika; Jiranova, Pavlina; Neuman, Vít; Plachý, Lukáš; Průhová, Štěpánka; Šumnı́k, Zdenĕk; Obermannová, Barbora

doi:10.1089/dia.2018.0214

Cited by 62 publications

(57 citation statements)

References 24 publications

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“…Therefore, the present results cannot unrestrictedly be applied to the general population of individuals with diabetes. Still, the present results are in line with three observational studies that evaluated the efficacy of OpenAPS under everyday life as well as under extreme sports conditions, each of which showed similar glycaemic improvements in already well‐controlled individuals with type 1 diabetes . Furthermore, we acknowledge the following limitations to the present analysis: the OpenAPS Data Commons repository does not include data on specific insulin analogues or adjunctive therapies, which could significantly contribute to differences in glycaemic control.…”

Section: Discussionsupporting

confidence: 78%

Glycaemic control in individuals with type 1 diabetes using an open source artificial pancreas system (OpenAPS)

Melmer

Zueger

Lewis³

et al. 2019

Diabetes Obesity Metabolism

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Open source artificial pancreas systems (OpenAPS) have gained considerable interest in the diabetes community. We analyzed continuous glucose monitoring (CGM) records of 80 OpenAPS users with type 1 diabetes (T1D). A total of 19 495 days (53.4 years) of CGM records were available. Mean glucose was 7.6 ± 1.1 mmol/L, time in range 3.9–10 mmol/L was 77.5 ± 10.5%, <3.9 mmol/L was 4.3 ± 3.6%, <3.0 mmol/L was 1.3 ± 1.9%, >10 mmol/L was 18.2 ± 11.0% and > 13.9 mmol/L was 4.1 ± 4.0%, respectively. In 34 OpenAPS users, additional CGM records were obtained while using sensor‐augmented pump therapy (SAP). After changing from SAP to OpenAPS, lower mean glucose (−0.6 ± 0.7; P < 0.0001), lower estimated HbA1c (−0.4 ± 0.5%; P < 0.0001), higher time in range 3.9–10 mmol/L (+9.3 ± 9.5%; P < 0.0001), less time < 3.0 mmol/L (−0.7 ± 2.2%; P = 0.0171), lower coefficient of variation (−2.4 ± 5.8; P = 0.0198) and lower mean of daily differences (−0.6 ± 0.9 mmol/L; P = 0.0005) was observed. Glycaemic control using OpenAPS was comparable with results of more rigorously developed and tested AP systems. However, OpenAPS was used by a highly selective, motivated and technology‐adept cohort, despite not being approved for the treatment of individuals with T1D.

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Section: Discussionsupporting

confidence: 78%

Glycaemic control in individuals with type 1 diabetes using an open source artificial pancreas system (OpenAPS)

Melmer

Zueger

Lewis³

et al. 2019

Diabetes Obesity Metabolism

View full text Add to dashboard Cite

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“…Glycemic outcomes are either reported as changes from baseline or comparison to another intervention BG blood glucose, CSII continuous subcutaneous insulin infusion, CV coefficient of variation, DIY do it yourself, eA1c estimated HbA1c, SAP sensor-augmented pump, TAR time above range, TBR time below range, TIHypo time in hypoglycemia, TIR time in range winter ski camp resulted in a significant reduction in the BG levels, without any hypoglycemia episode. The study affirmed the safety, feasibility, and efficacy of AndroidAPS over SmartGuard Ò technology during and after prolonged physical activity [36]. In 2019, an in silico study using UVA/Padova Type 1 Diabetes Simulator proved that the AndroidAPS algorithm works safely and effectively and demonstrates great potential for use in home settings [37].…”

Section: Current Literature On Diyapsmentioning

confidence: 66%

The Do-It-Yourself Artificial Pancreas: A Comprehensive Review

Kesavadev

Srinivasan

Saboo³

et al. 2020

Diabetes Ther

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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 realworld 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 riskbearers. 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 Digital Features To view digital features for this article go to

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“…Ergebnisse von Beobachtungsstudien wurden bereits beim amerikanischen Diabeteskongress 2018 in Orlando als Poster präsentiert [10]. Kürzlich wurden die Ergebnisse einer kleinen klinischen Studie publiziert [11].…”

Section: Evidenzunclassified

„Do it yourself“ (DIY) Automated Insulin Delivery (AID) Systems: Stand der Dinge

Heinemann¹,

Lange²

2019

Diabetologie und Stoffwechsel

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Over the past few years, a group of dedicated people with an affinity for technology and type 1 diabetes has developed systems that enable automated insulin delivery (AID). Patients build these AID systems themselves (do it yourself; DIY). The quality of glucose control achieved with DIY AID systems is impressively good, but the effort for users in everyday life is considerable. So far, no results of clinical studies have been obtained that prove these individual experiences.Main obstacles for the use (also by more patients) are legal questions, because DIY AID systems do not represent approved medical devices. They must be regarded as “experimental” systems. As long as patients build and use these systems for themselves and do not endanger other people, they act at their own risk. Legal questions are more complex and more difficult to answer if, for example, a traffic accident occurs. A legal assessment (in particular of the medical situation) of such systems, initiated by the German Diabetes Society (DDG) (see DDG homepage), comes to the following key statements:– From the patient’s point of view, the assembly of a DIY AID system does not constitute a criminal offence. However, since the intended purpose of the devices is violated, there is no liability on the part of the manufacturers of the medical devices used for this purpose.– Patients who assemble DIY AID systems and “sell” them to other patients are liable to prosecution under the Medical Devices Act (MPG).– Doctors do not have to refer patients with type 1 diabetes to DIY AID systems.If a patient expresses interest in such a system or is already using it, the attending physician must inform the patient about the improper use of the medical devices used and about the associated risks. He should document this information accordingly.This overview presents the current status of this development from various points of view.

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Excellent Glycemic Control Maintained by Open-Source Hybrid Closed-Loop AndroidAPS During and After Sustained Physical Activity

Cited by 62 publications

References 24 publications

Glycaemic control in individuals with type 1 diabetes using an open source artificial pancreas system (OpenAPS)

Glycaemic control in individuals with type 1 diabetes using an open source artificial pancreas system (OpenAPS)

The Do-It-Yourself Artificial Pancreas: A Comprehensive Review

„Do it yourself“ (DIY) Automated Insulin Delivery (AID) Systems: Stand der Dinge

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