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

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 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

Hybrid closed‐loop therapy: Where are we in 2021?

“…While commercial offerings have appeared in the past 2 years, there has been a vibrant community of people with type 1 diabetes writing their own insulin‐dosing algorithms that work with existing pump technology and releasing the code to open‐source repositories making it freely available for others to build 20–23 . These are commonly known as D.I.Y.…”

“…As of writing, there are over 4700 people worldwide using the various systems, with the preferred choice of system varying by geography depending on availability of different pumps. There are three systems available: OpenAPS (2015, running on small Linux computer); AndroidAPS (2017, running the same algorithm as OpenAPS on an Android phone) and Loop (2016, running on iPhone with RileyLink to talk to pumps) 20 . In the United Kingdom, the most popular is AndroidAPS (used by 66% of users) due to the range of pumps and continuous glucose monitors it works with.…”

“…In the United Kingdom, the most popular is AndroidAPS (used by 66% of users) due to the range of pumps and continuous glucose monitors it works with. Various retrospective studies have shown that, through the use of DIYAPS, there are reductions in HbA1c and increases in time in range and that the glycaemic benefit of DIYAPS is in reducing hyperglycaemia without compromising the low occurrence of hypoglycaemia 20 …”

7. Diabetes Technology: Standards of Medical Care in Diabetes—2021

“…Use of these systems depends on patient preference and selection of patients (and/or caregivers) who are capable of safely and effectively using the devices. Some people with type 1 diabetes have been using "do-it-yourself" (DIY) systems that combine a pump and an rtCGM with a controller and an algorithm designed to automate insulin delivery (184)(185)(186)(187). These systems are not approved by the FDA, although there are efforts underway to obtain regulatory approval for them.…”

AID(„automated insulin delivery“)-Systeme in der Diabetologie

“…Beruhigend ist an dieser Stelle, dass sich die Open-Source-Systeme als hocheffektiv erwiesen. Es gibt bisher keine abgeschlossenen randomisierten, kontrollierten Studien [26]. Aber die Erfolge, die in Einzelfallberichten, selbstberichteten Ergebnissen oder in den sozialen Medien zu finden sind, geben keinen Grund zur generellen Sorge, .…”