Do-it-yourself automated (DIY) insulin delivery systems have gained rapid uptake, leading to self-reported improvements in glycemic control and quality of life for patients, but creating unique challenges for healthcare providers (HCPs).
Researchers in Canada are highlighting the uncertainties and challenges posed by patient-designed automated insulin delivery (AID) systems, as this approach continues to gain traction among patients with type 1 diabetes (T1D).
‘Do-it-yourself’ (DIY) AID regimens, led and facilitated by people living with T1D, have gained rapid uptake, leading to self-reported improvements in glycemic control and quality of life for patients, but creating unique challenges for providers Services, because they did not, were evaluated in randomized and unstructured trials.
“The widespread use of unlicensed and unregulated insulin delivery systems presents challenges to health care systems and health care providers [health care providers]. The lack of legal, ethical, and regulatory guidance in the use of DIY AID systems creates uncertainty for healthcare providers regarding their ethical and professional obligations in prescribing the required technology and associated supplies.” From a clinician’s perspective, every component of a DIY AID system that The physician is responsible for prescribing an approved medical treatment or device; Insulin pump, insulin, glucose sensor and pump accessories. However, individuals using DIY AID systems combine these approved technologies in an unstructured, off-label fashion.”
Their findings have been published in Canadian Journal of Diabetes.
Recently, the international healthcare professional network OPEN and the Open Legal Advisory Group, which includes more than 40 presenters and legal experts globally, published a consensus statement on the use of DIY AID. In their statement, the groups acknowledged the potential of DIY AID systems, along with commercial AID systems, to benefit people with diabetes while noting that they do not support the global uptake of DIY AID systems over commercial systems. The statement also stressed the need for service providers to take into account local law and regulatory governance within their practices.
In a survey of 317 UK caregivers, the majority reported that they do not proactively discuss DIY AID with their patients and only discuss the approach if the patient brings it up.
“Collecting HCP’s views on DIY AID across Canada would be useful to target education and provide coherent and appropriate guidance on best practices,” the researchers explained. “If the capabilities of the commercial AID system continue to advance in line with user needs, this could lead to reduced use of the DIY system in the future. However, the ethical and professional obligations of clinicians who care for patients using these systems currently need to be clarified urgently, to ensure patient care Optimal, consistent and safe.”
The researchers also highlighted challenges for DIY AID users due to a lack of guidance, including potential disconnection between patients and their providers. For example, researchers note that if providers do not actively discuss DIY AID, patients may be reluctant to bring up the topic, and feel uncertain about the provider’s knowledge or opinion about the systems.
The group also expressed concerns about potential harm from inappropriate or improper use of the systems, as they are individually prepared and designed by patients.
Morrison A, Senior P, Bubela T, Farnsworth K, Witteman H, Lam A. Do-it-yourself and commercial automated insulin delivery systems in type 1 diabetes–an uncertain area for Canadian healthcare providers. Can diabetes J. Published online June 22, 2022. doi: 10.1016 / j.jcjd.2022.06.003
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