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Do-It-Yourself Artificial Pancreas for Type 1 Patients

Jul 18, 2020
 
Editor: Steve Freed, R.PH., CDE

Author: Maya Palmer, PharmD. Candidate, Florida A&M University College of Pharmacy

The do-it-yourself artificial pancreas systems (DIYAPS) offer a solution to patients who lack access to, or can’t afford, other technological options.

Prior studies have linked diabetes technologies with better outcomes in type 1 diabetes (T1D) management. However, a decline in adherence from patients emerged due to high costs and a lack of accessibility to technological developments.

 Members of the diabetes community developed the do-it-yourself artificial pancreas systems (DIYAPS) to make self-management more custom and convenient. Systems include real-time continuous glucose monitoring (CGM) that provides readable data through a laptop or smartphone, a “loopable” insulin pump, and a minicomputer or smartphone app that can formulate the correct insulin dose and bring together all the components. There have been social network platforms such as GitHub, Twitter, and CGM in the Cloud that have made information more available to users, and allowed them to share their experiences.

Observational studies revealed that the systems could significantly improve quality of life, lessen hypoglycemic events, improve sleep, and lower HbA1C levels. Multiple studies have analyzed the results of using Open Artificial Pancreas System (OpenAPS) and Android Artificial Pancreas System (AndroidAPS), which are apps designed to maintain blood glucose levels by adjusting insulin doses between meals throughout the day and overnight. An analysis conducted on a cohort of OpenAPS adult users showed that when switched from a sensor-augmented insulin pump to OpenAPS, a significant reduction of HbA1c levels, mean glucose, and a higher percentage of time-in-range (TIR) results. Using self-reported surveys, another study chose the children and adolescent population (age range 3-20 years) to demonstrate the effectiveness of OpenAPS. The caregivers of this pediatric population reported improved HbA1c levels (6.91% to 6.27%) and higher TIR (64.2% to 80.68%). To investigate potential hypoglycemia risks of using OpenAPS, a study examined the comparison between patients with type 1 diabetes using OpenAPS versus using an insulin pump without the system. The patients using the system experienced at least one episode of hypoglycemia in the last month before the study; however, they saw noticeably lower HbA1c levels and fasting blood glucose levels, and had no signs of hypoglycemia after three months. Whereas, patients with solely the insulin pumps continued to have hypoglycemic episodes and saw no significant decrease in their HbA1c and fasting glucose levels.

The efficacy of AndroidAPS, which is the version of OpenAPS compatible with Google Android smartphones, was shown from a study among children (age 6-15 years) engaged in prolonged physical activity. An online survey reported significantly lower blood glucose levels and no hypoglycemia periods. A computer-simulated study tested five configurations of the AndroidAPS algorithm using the UVA/Padova Type 1 Diabetes Simulator to focus more on its safety. This study proved that AndroidAPS was indeed safe and effective, and encouraged use at home. Loop, another available system that converts data into an application, runs on an iOS operating system instead. This system can adjust insulin doses, provide bolus recommendations, and temporary basal rates. An observational study on Loop is being configured and will evaluate the use of iOS-APS in patients with T1D. DIYAPS is available for T1D patients of any age with access to the internet. These systems have proven to lessen hypoglycemic episodes, improve HbA1c levels, and increase patients’ sense of well-being. Another valued benefit included 24-hour global online support. Emotional, technical, and medical assistance all come free and readily available. 

There is no doubt that this patient-led initiative has broken ground in the diabetes community, but there are still technical, regulatory, and ethical concerns. Setting up these systems can be time-consuming and complicated. This issue could be discouraging to patients if they are not committed to reaching out to online support. As far as safety, most of the supporting evidence is deriving from selected groups of system users. Also, many of the system users use old and out-of-warranty insulin pumps due to their ability to read self-made algorithms when altered. Using old equipment poses a risky scenario for patients. AndroidAPS is compatible with newer, commercially available pumps and could help alleviate this safety risk. Still, necessarily, more studies are needed to provide holistic data on the safety of DIYAPS systems. Furthermore, these systems are not FDA regulated, and their off-label use prevents the endorsement from many health care professionals. Efforts are being made by innovators to try to mitigate these concerns and make DIYAPS use more widespread in the diabetes community.

Practice Pearls:

  • The diabetes community developed Do-It-Yourself Artificial Pancreas Systems due to lack of accessibility and high costs of current diabetes technology.
  • DIYAPS significantly improved quality of life, HbA1c levels, and time in range for patients with type 1 diabetes.
  • There are still technical, regulatory, and ethical concerns that may discourage patients and primary healthcare physicians from their use.


Kesavadev, Jothydev Krishna, et al. “The Do-It-Yourself Artificial Pancreas: A Comprehensive Review.” Diabetes Therapy, April 30. 2020, doi:10.1007/s13300-020-00823-z.

Koutsovasilis, Anastasios, et al. “1065-P: The Effect of a Closed-Loop Insulin Delivery System on Glycemic Control in Type 1 Diabetes.” Diabetes, vol. 68, no. Supplement 1, June 2019, doi:10.2337/db19-1065-p.

Maya Palmer, PharmD. Candidate, Florida A&M University College of Pharmacy

 

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