Learning challenges of healthcare professionals supporting open‐source automated insulin delivery

Abstract

Background: Open-source automated insulin delivery (AID) is a user-driven treatment modality used by thousands globally. Healthcare professionals' (HCPs) ability to support users of this technology is limited by a lack of knowledge of these systems. Aims: To describe the challenges experienced by HCPs supporting participants' use of open-source automated insulin delivery in the Community deRivEd AuTomatEd insulin delivery (CREATE) study. Methods: Data were collected prospectively from the study team's fortnightly meetings and Slack Workspace (Slack Technologies, Ltd. 2018) during the first 4 months of the trial. Key topics were identified from minutes of meetings. Slack conversations were categorised by topic, with the number of posts per conversation, number of sites per conversation and involvement of experts in open-source AID being recorded. Results: In the first 4 months of the trial, there were 254 conversations in Slack with a mean of 5.2 (±4.25) posts per conversation. The most frequent learning challenge was insulin pump and cannula problems relating to the DANA-i TM insulin pump, which totalled 24.0% of all conversations. Experts on open-source AID use were involved in 83.3% of conversations. Conclusions: A significant proportion of challenges related to specific devices, rather than AID. Challenges relating to the functioning of open-source AID were more likely to involve input from experts in open-source AID. This is the first report of challenges experienced by a multidisciplinary team in a supported opensource environment that may inform expectations in routine clinical care.

Psychosocial Outcomes Among Users and Nonusers of Open-Source Automated Insulin Delivery Systems: Multinational Survey of Adults With Type 1 Diabetes

“…However, interview data show participants reported improved psychosocial outcomes. The authors state that multiple factors may have impacted the PROM findings, including low numbers of participants and control arm participants having funded access to CGMs [44]. Comparatively, this study has shown significant differences between those using open-source AID and nonusers in QoL, diabetes treatment satisfaction, and fear of hypoglycemia, plus additional apparent benefits.…”

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

“…In a survey of 104 school nurses, 23% reported a child using DIY AID attended their school, 46% stated they had no prior knowledge of DIY AID and 96% felt the child should be able to share their data with a parent or guardian during the school day [ 46 ]. HCP supporting AndroidAPS use as part of the Community Derived Automated Insulin Delivery study (CREATE) in New Zealand [ 81 , 82 ], found that user challenges with this system most frequently related to device issues (the insulin pump and cannula in 24% of analyzed conversations), as opposed to DIY AID specific challenges [ 54 ].…”

Practical Guidance on Open Source and Commercial Automated Insulin Delivery Systems: A Guide for Healthcare Professionals Supporting People with Insulin-Requiring Diabetes

“…Overall, much of the troubleshooting will be about the components of the system rather than diabetes itself [ 43 ] because the AID system, when operational, can help address much of the “noise” of blood glucose variation associated with insulin-requiring diabetes [ 35 ]. This change in behavior from managing insulin delivery manually to managing the devices used to automate insulin delivery will require learning and habit formation.…”