J Korean Diabetes.  2020 Dec;21(4):197-203. 10.4093/jkd.2020.21.4.197.

New Insulin Pumps and Open Source Artificial Pancreas System in Korea

• Kim JH

• KMID: 2511886
• DOI: http://doi.org/10.4093/jkd.2020.21.4.197

Abstract

Diabetes technology that includes artificial pancreas system (APS) has achieved remarkable progress in the past decades. The first APS, the Medtronic MiniMed 670G system introduced in 2017, and other subsequent commercial APSs have come as answers to patient and clinician prayers. However, these devices are not accessible by most persons with type 1 diabetes (T1D) in Korea. Therefore, highly motivated, and tech-savvy persons in the diabetes community have started developing open source APS (Open APS) that integrate continuous glucose monitoring (CGM), insulin pumps, and smartphone technology to run their own do-it-yourself APS (DIYAPS). Observational studies have revealed significant improvements in HbA1c levels, time in range, and quality of life after the initiation of Open APS use. However, the use of regularized CGM and an insulin pump with an unauthorized DIYAPS makes these devices off-label and this has been a matter of grave clinical concern. In addition, lack of randomized controlled trials, insurance coverage, and legal issues are barriers to the general acceptance of DIYAPS among persons with T1D. In this article, I will summarize existing DIYAPS studies including those in Korea and their concerns. In addition, I will introduce new insulin pumps available in Korea.

Keyword

Diabetes mellitus; type 1; Insulin; Pancreas; artificial

Figure

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  Fig. 1. Component of do-it-yourself artificial pancreas system (DIYAPS). Continuous glucose monitoring (CGM) or intermittent CGM (iCGM) with transmitter transports glucose data to CGM app. CGM app displays glucose data and transmits them to Nightscout and DIYAPS software. DIYAPS software applies APS algorithm using the CGM data and insulin pump data and transmits the information of temporary basal insulin to the insulin pump. Nightscout, a cloud-based app receives and stores data from DIYAPS. Figure courtesy of Huons, Co., Ltd.

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  Fig. 2. Information of new insulin pump platform with bolus calculator. DIA:CONN platform connects insulin pump with mobile app, web, and many medical devices such as continuous glucose monitoring, glucometer and pulse pressure. It operates platform service for patient, care giver and health care professionals. New bolus calculator performs IOB (Insulin on Board) algorithm similar to the pattern of an actual insulin, and it has algorithm for rapid acting or ultra-rapid acting insulin. It can reflect trend arrow of continuous glucose monitoring and it can calculate amount of carbohydrates to correct hypoglycemia.

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  Fig. 3. EOPatch roadmap. Wearable insulin pump (2020), sensor augmented pump (SAP) with Dexcom G6 (2021), SAP with automated insulin delivery (Type Zero), and integrated wearable, disposable patch containing automated insulin delivery and continuous glucose monitoring (2022∼2023).

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