Diabetes Metab J.  2022 Jan;46(1):154-159. 10.4093/dmj.2021.0011.

Do-It-Yourself Open Artificial Pancreas System in Children and Adolescents with Type 1 Diabetes Mellitus: Real-World Data

• Choi MS
• Lee S
• Kim J
• Kim G
• Park SM
• Kim JH

• KMID: 2525135
• DOI: http://doi.org/10.4093/dmj.2021.0011

Abstract

Few studies have been conducted among Asian children and adolescents with type 1 diabetes mellitus (T1DM) using do-it-yourself artificial pancreas system (DIY-APS). We evaluated real-world data of pediatric T1DM patients using DIY-APS. Data were obtained for 10 patients using a DIY-APS with algorithms. We collected sensor glucose and insulin delivery data from each participant for a period of 4 weeks. Average glycosylated hemoglobin was 6.2%±0.3%. The mean percentage of time that glucose level remained in the target range of 70 to 180 mg/dL was 82.4%±7.8%. Other parameters including time above range, time below range and mean glucose were also within the recommended level, similar to previous commercial and DIY-APS studies. However, despite meeting the target range, unadjusted gaps were still observed between the median basal setting and temporary basal insulin, which should be handled by healthcare providers.

Keyword

Algorithms; Diabetes mellitus, type 1; Insulin infusion system; Pancreas, artificial

Figure

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  Fig. 1. Graphs of insulin delivery and blood glucose levels for representative cases. GMI, glucose management indicator; CV, coefficient of variation; TDD, total daily dose of insulin.

Reference

1. Sherr JL, Cengiz E, Palerm CC, Clark B, Kurtz N, Roy A, et al. Reduced hypoglycemia and increased time in target using closed-loop insulin delivery during nights with or without antecedent afternoon exercise in type 1 diabetes. Diabetes Care. 2013; 36:2909–14.

2. Garg SK, Weinzimer SA, Tamborlane WV, Buckingham BA, Bode BW, Bailey TS, et al. Glucose outcomes with the in-home use of a hybrid closed-loop insulin delivery system in adolescents and adults with type 1 diabetes. Diabetes Technol Ther. 2017; 19:155–63.

3. Melmer A, Zuger T, Lewis DM, Leibrand S, Stettler C, Laimer M. Glycaemic control in individuals with type 1 diabetes using an open source artificial pancreas system (OpenAPS). Diabetes Obes Metab. 2019; 21:2333–7.

4. Lewis D, LeibrandS S; #OpenAPS Community. Real-world use of open source artificial pancreas systems. J Diabetes Sci Technol. 2016; 10:1411.

5. Petruzelkova L, Soupal J, Plasova V, Jiranova P, Neuman V, Plachy L, et al. Excellent glycemic control maintained by open-source hybrid closed-loop androidAPS during and after sustained physical activity. Diabetes Technol Ther. 2018; 20:744–50.

6. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes-2021. Diabetes Care. 2021; 44(Suppl 1):S73–84.

7. Breton MD, Kanapka LG, Beck RW, Ekhlaspour L, Forlenza GP, Cengiz E, et al. A randomized trial of closed-loop control in children with type 1 diabetes. N Engl J Med. 2020; 383:836–45.

8. Aleppo G, Webb K. Continuous glucose monitoring integration in clinical practice: a stepped guide to data review and interpretation. J Diabetes Sci Technol. 2019; 13:664–73.

9. American Diabetes Association. 7. Diabetes technology: standards of medical care in diabetes-2020. Diabetes Care. 2020; 43(Suppl 1):S77–88.

10. Braune K, O’Donnell S, Cleal B, Lewis D, Tappe A, Willaing I, et al. Real-world use of do-it-yourself artificial pancreas systems in children and adolescents with type 1 diabetes: online survey and analysis of self-reported clinical outcomes. JMIR Mhealth Uhealth. 2019; 7:e14087.

11. Schoelwer MJ, Kanapka LG, Wadwa RP, Breton MD, Ruedy KJ, Ekhlaspour L, et al. Predictors of time-in-range (70-180mg/dL) achieved using a closed-loop control system. Diabetes Technol Ther. 2021; 23:475–81.

12. Bergenstal RM, Nimri R, Beck RW, Criego A, Laffel L, Schatz D, et al. A comparison of two hybrid closed-loop systems in adolescents and young adults with type 1 diabetes (FLAIR): a multicentre, randomised, crossover trial. Lancet. 2021; 397:208–19.

13. Ahmed SH, Ewins DL, Bridges J, Timmis A, Payne N, Mooney C, et al. Do-it-yourself (DIY) artificial pancreas systems for type 1 diabetes: perspectives of two adult users, parent of a user and healthcare professionals. Adv Ther. 2020; 37:3929–41.

14. Burnside M, Lewis D, Crocket H, Wilson R, Williman J, Jefferies C, et al. CREATE (Community deRivEd AutomaTEd insulin delivery) trial: randomised parallel arm open label clinical trial comparing automated insulin delivery using a mobile controller (AnyDANA-loop) with an open-source algorithm with sensor augmented pump therapy in type 1 diabetes. J Diabetes Metab Disord. 2020; 19:1–15.