The DIY artificial pancreas system: an ethical dilemma for doctors

Shaw, David; Crabtree, Thomas; Hammond, Peter J.; McLay, Alasdair; Wilmot, Emma G

doi:10.1111/dme.14270

Cited by 22 publications

(22 citation statements)

References 12 publications

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“…CLS have raised awareness in the population of people with T1D using continuous subcutaneous insulin infusion systems, which led to the popularity of do-it-yourself CLS that have become present within a small community of people with T1D. However, this still remains an ethical issue for health-care professionals since CLS, even though successfully tested for research purposes over decades, are not yet commercially available [ 46 ]. However, the complexity of implementing these devices in glycemic therapy and making them commercially available is reliant on research.…”

Section: Discussionmentioning

confidence: 99%

Time in Range for Closed-Loop Systems versus Standard of Care during Physical Exercise in People with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Eckstein

Weilguni

Tauschmann

et al. 2021

JCM

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The aim of this systematic review and meta-analysis was to compare time in range (TIR) (70–180 mg/dL (3.9–10.0 mmol/L)) between fully closed-loop systems (CLS) and standard of care (including hybrid systems) during physical exercise in people with type 1 diabetes (T1D). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Science from January 1950 until January 2020. Randomized controlled trials including studies with different CLS were compared against standard of care in people with T1D. The meta-analysis was performed using the random effects model and restricted maximum likelihood estimation method. Six randomized controlled trials involving 153 participants with T1D of all age groups were included. Due to crossover test designs, studies were included repeatedly (a–d) if CLS or physical exercise interventions were different. Applying this methodology increased the comparisons to a total number of 266 participants. TIR was higher with an absolute mean difference (AMD) of 6.18%, 95% CI: 1.99 to 10.38% in favor of CLS. In a subgroup analysis, the AMD was 9.46%, 95% CI: 2.48% to 16.45% in children and adolescents while the AMD for adults was 1.07% 95% CI: −0.81% to 2.96% in favor of CLS. In this systematic review and meta-analysis CLS moderately improved TIR in comparison to standard of care during physical exercise in people with T1D. This effect was particularly pronounced for children and adolescents showing that the use of CLS improved TIR significantly compared to standard of care.

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Section: Discussionmentioning

confidence: 99%

Time in Range for Closed-Loop Systems versus Standard of Care during Physical Exercise in People with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Eckstein

Weilguni

Tauschmann

et al. 2021

JCM

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“…[4][5][6][7] Therefore, many healthcare professionals treating PWD using DIY APS find themselves in a challenging dilemma, both from an ethical and legal point of view, since the responsibilities in the case of an adverse event are not clearly defined. [15][16][17] Secondly, the need to set-up the DIY APS manually may discourage patients without advanced computer skills. Furthermore, purchasing a suitable insulin pump can be challenging because of the fact that insulin pumps are typically protected against unauthorized access from third-party devices.…”

Section: Factors Limiting Greater Spread Of Do-it-yourself Artificial Pancreas Systemsmentioning

confidence: 99%

Efficient Closed Loop Simulation of Do-It-Yourself Artificial Pancreas Systems

Schmitzer

Strobel

Blechschmidt

et al. 2021

J Diabetes Sci Technol

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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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“…The results were impressive, with HbA 1c values ranging between 39 to 50mmol/mol and generally >70% of time in range. However, the use of these unregulated and unapproved systems brought significant medicolegal and ethical challenges 24 . To explore whether the approach in our service in Derby was in keeping with other centres, we ran a health care professional survey.…”

Section: Do‐it‐yourselfmentioning

confidence: 99%

Living with type 1 diabetes: what really matters?

Wilmot

2021

Practical Diabetes

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The DIY artificial pancreas system: an ethical dilemma for doctors

Cited by 22 publications

References 12 publications

Time in Range for Closed-Loop Systems versus Standard of Care during Physical Exercise in People with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Time in Range for Closed-Loop Systems versus Standard of Care during Physical Exercise in People with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Efficient Closed Loop Simulation of Do-It-Yourself Artificial Pancreas Systems

Living with type 1 diabetes: what really matters?

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