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Do-it-yourself and Commercial Automated Insulin Delivery Systems in Type 1 Diabetes: An Uncertain Area for Canadian Healthcare Providers

      Abstract

      In the past century, since the discovery of insulin, methods of insulin delivery and glucose monitoring have advanced technologically. In particular, the introduction of insulin pumps, providing continuous subcutaneous insulin infusion (CSII), and continuous glucose monitors (CGM) have been revolutionary for people living with type 1 diabetes. In this review, we have focussed on automated insulin delivery (AID) systems and discuss the implications of both approved and off-label options for the user and healthcare providers. By pairing insulin pumps with CGM, AID systems facilitate automated adjustment in insulin delivery based on CGM readings. A subset of these have been developed commercially and were granted regulatory approval. In contrast, unregulated do-it-yourself AID systems, designed and set up by people living with type 1 diabetes and their families, have advanced rapidly and are gaining popularity worldwide. These patient-driven technologies have demonstrated impressive user self-reported improvements in glycemic control and quality of life, but have not been evaluated in any formal randomized controlled trials or by regulators. This presents challenging uncertainty for healthcare providers, in addition to ethical and legal implications in supporting people with diabetes who wish to use these technologies. The current knowledge, opinions and practices relating to the use of AID systems across Canada are unknown. Gathering this information will highlight current practice and areas of knowledge gaps and concern and will assist in focussed education. This understanding is crucial to ensure people with type 1 diabetes using these systems have access to optimal, consistent and safe patient-centred care.

      Résumé

      Depuis la découverte de l’insuline au cours du siècle dernier, les méthodes d’administration de l’insuline et la surveillance de la glycémie ont connu des avancées technologiques. Particulièrement, l’introduction des pompes à insuline, qui offrent une perfusion sous-cutanée continue d’insuline (PSCI), et des moniteurs de glucose en continu (MGC) a révolutionné le traitement des personnes qui vivent avec le diabète de type 1. Dans la présente revue, nous nous sommes penchés sur les systèmes d’administration automatisée de l’insuline (AAI) et avons discuté des répercussions des deux options, homologuées et non conformes, sur les utilisateurs et les prestataires de soins de santé. En jumelant les pompes à insuline aux MGC, les systèmes d’AAI facilitent l’ajustement automatique de l’administration de l’insuline grâce aux lectures du MGC. Une sous-catégorie de ceux-ci a été mise au point commercialement et s’est vu accorder une approbation réglementaire. En revanche, les systèmes d’AAI non réglementés à faire soi-même, conçus et configurés par les personnes qui vivent avec le diabète de type 1 et leur famille, ont évolué rapidement et retiennent de plus en plus l’attention dans le monde entier. Ces technologies axées sur le patient ont démontré selon les utilisateurs des améliorations impressionnantes de la régulation de la glycémie et de la qualité de vie, mais n’ont pas été évaluées au cours d’aucun essai clinique à répartition aléatoire formel ou par les organismes de réglementation. Cela crée une grande incertitude chez les prestataires de soins de santé, outre les incidences éthiques et juridiques, pour aider les personnes diabétiques qui souhaitent utiliser ces technologies. Les connaissances, les opinions et les pratiques actuelles en matière d’utilisation des systèmes d’AAI au Canada sont méconnues. Le recueil de ces informations permettra de mettre en lumière la pratique actuelle et les lacunes et les préoccupations en matière de connaissances, et d’offrir une éducation spécifique. Cette compréhension est cruciale pour faire en sorte que les personnes diabétiques de type 1 qui utilisent ces systèmes aient accès à des soins axés sur le patient, optimaux, constants et sécuritaires.

      Keywords

      Mots clés

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