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Cited by 85Diabetes Management and ResearchDiabetes Management and EducationDiabetes and associated disorders

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

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Kesavadev, Jothydev, Srinivasan, Seshadhri, Saboo, Banshi, Krishna B, Meera, Krishnan, Gopika·2020·Diabetes Therapy
DOI 10.1007/s13300-020-00823-zPMC PMC7261300
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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 real-world 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 risk-bearers. 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 clinicians, regulatory bodies, and manufacturers associated with the use of DIYAPS. Understanding the potential of DIYAPS as the need of the present time, many regional and international agencies have come with strategies to appraise its safety as well as to support education and training on its use. Here we provide a comprehensive description of the DIYAPS-including their origin, existing literature, advantages, and disadvantages that can help the industry leaders, clinicians, and PWD to make the best use of these systems.

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  • The development of reliable and accurate continuous glucose monitors allowed for the possibility of integration of glucose data with pump insulin delivery and sparked interest to develop safe and effective algorithms for closed-loop systems.

    “The development of reliable and accurate continuous glucose monitors allowed for the possibility of integration of glucose data with pump insulin delivery and sparked a flurry of interest to develop safe and effective algorithms for closed-loop systems, notably championed by do-it-yourself movements from the diabetes community itself122,125.”

    From 100 years of insulin: celebrating the past, present and future of diabetes therapy (2021) · cites this paper as [125]

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Cited by

Sorted by citations

Authors
Kesavadev, J., Srinivasan, S., Saboo, B., Krishna B, M., & Krishnan, G.
Affiliations
  • Jothydev's Diabetes and Research Center (IN)
  • Kalasalingam Academy of Research and Education (IN)
Corresponding author
Kesavadev, Jothydev
ORCID
Venue
Diabetes Therapy
Publisher
Springer Science and Business Media LLC
Published
2020-04-30
Volume
11
Issue
6
Pages
1217-1235
ISSN
  • 1869-6953 (ISSN-L)
  • 1869-6961
DOI
10.1007/s13300-020-00823-z
PMC
PMC7261300
OpenAlex
W3022678696
Cited by
85
References
0
Citations by year
2026: 5 · 2025: 9 · 2024: 9 · 2023: 15 · 2022: 18 · 2021: 22 · 2020: 7
FWCI
2.38
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Therapy (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
Keywords
type 1 diabetes, continuous glucose monitoring, insulin pump, artificial pancreas, off-label device use, glycemic control, time in range, hypoglycemia, quality of life, regulatory liability, safety assessment, diabetes technology access

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