Artificial Pancreas Systems (APS) now exist, leveraging a CGM sensor, pump, and control algorithm. Faster insulin can help, too. #ADA2019
Traditionally, APS is developed by commercial industry, tested by clinicians, regulated, and then patients can access it. However, DIYAPS is designed by patients for individual use. #ADA2019
There are now multiple different kinds of DIYAPS systems in use: #OpenAPS, Loop, and AndroidAPS. There are differences in hardware, pump, and software configurations. The algorithm for OpenAPS is also used in AndroidAPS. #ADA2019
DIYAPS can work offline; and also leverage the cloud for accessing or displaying data, including for remote monitoring. #ADA2019
This study reviewed data from the OpenAPS Data Commons (see more here: openaps.org/data-commons/). At the time this data set was used, there were n=80 anonymized data donors from the #OpenAPS community, with a combined 53+ years worth of CGM data. #ADA2019
Looking at results for #OpenAPS data donors post-looping initiation, CV was 35.5±5.9, while eA1c was 6.4±0.7. TIR (3.9-10mmol/L) was 77.5%. Time spent >10 was 18.2%; time <3.9 was 4.3%. #ADA2019
We selected a subcohort of n=34 who had data available from before DIY closed looping initiation (6.5 years combined of CGM records), as well as data from after (12.5 years of CGM records). #ADA2019
For these next graphs, blue is BEFORE initiation (when just on a traditional pump); red is AFTER, when they were using DIYAPS. #ADA2019
Time in a range significantly increased for both wider (3.9-10 mmol/L) and tighter (3.9-7.8 mmol/L) ranges. #ADA2019
Time spent out of range decreased. % time spent >10 decreased -8.3±8.6 (p<0.001); >13 decreased -3.3±5.0 (p<0.001). Change in % time spent <3.9 (-1.1±3.8 (p=0.153)), and <3.0 (-0.7±2.2 (p=0.017)) was not significant. #ADA2019
We also analyzed daytime and nightime (the above was reflecting all 24hr combined; these graphs shows the increase in TIR and decrease in time out of range for both day and night). #ADA2019
Also, incidence of hypoglycemic events was reduced after initiating DIYAPS. #ADA2019
Conclusion: this was a descriptive study analyzing available CGM data from #OpenAPS Data Commons. This study shows OpenAPS has potential to support glycemic control. However, DIYAPS are currently not regulated/approved technology. Further research is recommended. #ADA2019
1/ What if there was a tool to help identify who might have exocrine pancreatic insufficiency (EPI/PEI)?
EPI is a significant issue for many people with diabetes (likely more common than gastroparesis or celiac).
Here's how such a tool can help PWD👇🏼🧵
#ADASciSessions #ADA2024
2/ The Exocrine Pancreatic Insufficiency Symptom Score (EPI/PEI-SS) has 15 symptoms, rated by how frequent they are and how bothersome they are (aka severity).
n=324 ppl participated in a real-world survey.
n=118 were people with diabetes (PWD)!
#ADASciSessions #ADA2024
3/ Methods:
EPI/PEI-SS scores were analyzed and compared between PWD (n=118), with EPI (T1D: n=14; T2D: n=20) or without EPI (T1D: n=78; T2D: n=6), and people without diabetes (n=206) with and without EPI.
📣 Presentation of the primary outcome results from the CREATE Trial, which assessed open source automated insulin delivery (AID) compared to sensor-augmented pump therapy (SAPT) in adults & kids with T1D, at #ADA2022!
The CREATE trial aimed to study the efficacy and safety of an open source automated insulin delivery system, with a large scale, long term randomized controlled trial.
I just realized it's been 3 (!) years since I published my book on automated insulin delivery, with the goal of helping increased conversation and understanding of AID technology for people with diabetes, their loved ones, and healthcare providers!
I'm still very proud that it is available to read for free online, free to download a PDF (both of which have been done thousands of times each: ArtificialPancreasBook.com), or as an e-book, paperback, and now hardback copy. Proceeds from the purchased copies go to Life For A Child.
And, more recently, it has also been translated into French by the wonderful Dr. Mihaela Muresan and Olivier Legendre!
The French translation is available in Kindle, paperback, hardback, or free PDF download formats as well.
1/THREAD - my presentation is kicking off at #EASD2020 about open source automated insulin delivery.
(You can see a full version of my presentation here: bit.ly/DanaMLewisEASD…, or read the summary below!)
Note we should differentiate between open source (where the source of something is open), and DIY (do-it-yourself) implementations of open source code. Open source means it can be reviewed and used by individuals (thus, DIY or #DIYAPS) or by companies.
Poster 988-P at #ADA2020 by Jennifer Zabinsky, Haley Howell, Alireza Ghezavati, @DanaMLewis Andrew Nguyen, and Jenise Wong: “Do-It-Yourself Artificial Pancreas Systems Reduce Hyperglycemia Without Increasing Hypoglycemia”
This was a retrospective double cohort study that evaluated data from the @OpenAPS Data Commons (data ranged from 2017-2019) and compared it to conventional sensor-augmented pump (SAP) therapy from the @Tidepool_org Big Data Donation Project. #ADA2020
One month of CGM data (with more than 70% of the month spent using CGM), as long as they were >1 year of living with T1D, was used from the @OpenAPS Data Commons. People could be using any type of DIYAPS (OpenAPS, Loop, or AndroidAPS) and there were no age restrictions. #ADA2020
Poster 99-LB at #ADA2020 by @danamlewis, @azure_dominique, and Lance Kriegsfeld, “Multi-Timescale Interactions of Glucose and Insulin in Type 1 Diabetes Reveal Benefits of Hybrid Closed Loop Systems“
Background - Blood glucose and insulin exhibit coupled biological rhythms at multiple timescales, including hours (ultradian, UR) and the day (circadian, CR) in individuals without diabetes. But, biological rhythms in longitudinal data have not been mapped in T1D. #ADA2020
It is not known exactly how glucose and insulin rhythms compare between T1D and non-T1D, and whether rhythms are affected by type of therapy (Sensor Augmented Pump (SAP) or Hybrid Closed Loop (HCL)). #ADA2020