ESPE2022 Poster Category 1 Diabetes and Insulin (86 abstracts)
Do-It-Yourself Artificial Pancreas Systems in a PediatricPopulation with Type 1 Diabetes in a Real-life Setting: The AWeSoMe Study Group Experience
Judith Nir 1,2 , Marianna Rachmiel 1,2 , Abigail Fraser 3 , Yael Lebenthal 4,2 , Avivit Brener 4,2 , Orit Pinhas-Hamiel 5,2 , Alon Haim 6,7 , Eve Stern 5,2 , Noa Levek 8 , Tal Ben-Ari 9,2 & Zohar Landau 8,7
1Pediatric Endocrinology and Diabetes Institute, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel; 2Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel; 3Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom; 4Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; 5Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel; 6Pediatric Endocrinology and Metabolic Unit, Soroka University Medical Center, Beer Sheva, Israel; 7The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel; 8Juvenile Diabetes Center, Maccabi Healthcare Services, Raanana, Israel; 9Pediatric Endocrinology Unit, Edith Wolfson Medical Center, Holon, Israel
Aims: Do-It-Yourself Artificial Pancreas Systems (DIYAPS) represent a unique patient-initiated treatment in which commercially available and approved medical devices such as continuous glucose monitoring systems (CGMs) and insulin pumps are connected by an off-label algorithm, and are remotely controlled by open-source algorithms to automate insulin delivery. While these systems are co-created by the DIYAPS community, and access is open to everyone, users have to build their own individual system and use it at their own risk. Emerging data regarding the safety and efficacy of DIYAPS use in children and adolescents with type 1 diabetes (T1D), although reassuring, remains limited. We aimed to examine the impact of DIYAPS on glycemic parameters, characterize the socioeconomic position of individuals who switch to this mode of therapy, and identify factors affecting the successful use of the DIYAPS.
Methods: In this multi-center observational real-life study from the AWeSoMe Group, we compared glycemic parameters of 51 individuals with T1D (54.9% males, mean diabetes duration 4.2±4 years), who switched from therapy with various insulin pumps and CGMs to a DIYAPS. Data from the last clinic visit prior to DIYAPS utilization, was compared with data from the most recent clinic visit using DIYAPS. Socioeconomic position (SEP) index was retrieved from the Israel Central Bureau of Statistics (values ranging from -2.797 to 2.59).
Results: The mean age at DIYAPS initiation was 11.4±3.8 years, age range 3.4-20.7 years with a median usage duration of 13±9 months. Mean SEP Index was 1.051±0.956. Glycemic control improved following transition to DIYAPS: the mean percentage of time spent in glucose target range of 70 to 180 mg/dl (TIR) increased (from 69.1±12% to 75.1±11.6%, P<0.001), and HbA1c levels decreased (from 6.9±0.7% to 6.4±0.6%, P<0.001). Percentage of time spent in severe hypoglycemia (<54mg/dl), was significantly reduced (median before 1% and after 0.7%, P<0.001). No episodes of severe hypoglycemia or DKA were reported. Linear regression analysis revealed no associations between improvements in glycemic parameters, age at initiation of DIYAPS, duration of diabetes, or SEP index.
Conclusions: In our cohort of children and adolescents with above average socioeconomic position, the use of DIYAPS for diabetes management was beneficial, regardless of age, diabetes duration or socioeconomic position. Since our study population had excellent glycemic control at baseline, the improvement in TIR, with a simultaneous decrease in severe hypoglycemia, is all the more remarkable.
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