Prevalence, Safety, and Metabolic Control Among Danish Children and Adolescents with Type 1 Diabetes Using Open-Source Automated Insulin Delivery Systems

Abstract

Background: Treatment of type 1 diabetes mellitus (T1DM) has become increasingly technical with rapid developments in integration of pumps and sensors to regulate insulin dosage, and patient-initiated solutions as open-source automated insulin delivery (OS-AID) systems, have gained popularity in people with diabetes. Studies have shown increased glycemic control and mental wellbeing in users of OS-AID systems. The aim of this study was to estimate the prevalence, the effect on metabolic control, the risk, and the effect on everyday life for users and their parents of OS-AID systems in Danish children and adolescents with T1DM. Methods: This retrospective cohort study recruited participants through pediatric diabetes outpatient clinics and social media. Surveys were distributed and current and retrospective data on glycemic control (HbA1c, time in range [TIR] etc.) were collected. Results: Fifty-six users of OS-AID systems out of 2950 Danish children and adolescents with T1DM were identified from all outpatient clinics in Denmark. Thirty-one responded on contact and were included (55% of the identified), median age 12 [interquartile range: 11-14] years, 51% females, and mean duration of use of OS-AID systems 2.37 ± 0.86 years. Glycemic control increased significantly with TIR increasing from mean 62.29% ± 13.68% to 70.12% ± 10.08%, *P < 0.01, and HbA1c decreasing from mean 50.13 ± 5.76 mmol/mol (6.7% ± 2.7%) to 47.86 ± 6.24 mmol/mol (6.5% ± 2.7%), **P < 0.05. No changes were found in safety parameters. Parents reported better quality of sleep evaluated by Pittsburgh Sleep Quality Index. Conclusion: This study is the first to provide knowledge on pediatric users of OS-AID systems in Denmark and found a prevalence of 1.89% for OS-AID systems, improved TIR, and no increased risk associated with use of OS-AID systems.

Keywords: Artificial pancreas; Closed-loop systems; Do-It-Yourself Closed-Loop Systems; HbA1c; Open source; Pediatrics; Sleep; Time in range; Type 1 diabetes.

FIG. 1.

Showing percentage of time spent with BG in the following ranges: TIR 3.9–10.0 mmol/L (70–180 mg/dL); TAR 10.1–13.9 mmol/L (180–250 mg/dL); TAR >13.9 mmol/L (>250 mg/dL); TBR 3.0–3.9 mmol/L (54–70 mg/dL); TBR <3.0 mmol/L (<54 mg/dL). *Significant changes in percentage of time spent in the specific range when compared to baseline with P-value <0.01; **Significant changes in percentage of time spent in the specific range when compared to baseline with P-value <0.05. TAR, time above range; TBR, time below range; TIR, time in range.