DIY . What do the clinicians think?

The same problems we raised with DIY and diabetes were in the minds of UK professionals , so last year they conducted a survey whose results have been published recently in The Lancet Diabetes and Endocrinology.

1. Most respondents were keen to support users of DIY artificial pancreas systems; few actively warned against the use of DIY systems
2. Most respondents did not initiate discussions about DIY artificial pancreas systems in clinic because of concerns that the systems are not regulated or approved, insufficient knowledge of the systems, and fears of indemnity
3. Almost all respondents had been able to provide ongoing care for users of DIY artificial pancreas systems, although more than half did not feel comfortable providing clinical support
4. Most respondents were not comfortable describing the risks and benefits of DIY artificial pancreas systems; many agreed that DIY systems could be “risky in the wrong hands” or were “riskier than approved systems”
5. Almost all respondents were keen to learn more about DIY artificial pancreas systems
6. Almost half of respondents indicated that they would opt to use a DIY artificial pancreas system if they had type 1 diabetes themselves

The same journal publishes a commentary by Emma G Wilmot and Thomas Danne «DIY Artificial Pancreas Systems: The Clinician’s Perspective» stating «Medical-legal issues of care delivery for DIY users continue being complex and uncertain» and conclude the following, with which I agree.

“DIY artificial pancreas systems are not regulated or approved, and the risks are unknown. It would be unwise for health-care professionals to actively promote use.  However, if a person comes to clinic using a DIY system,  there is a duty to provide ongoing care and support. Users of DIY systems do so at their own risk. 

The number of users of DIY artificial pancreas systems is increasing and health-care professionals should be prepared to encounter these users in the clinic. Ultimately, as health-care professionals we have an ethical duty to support people living with diabetes to achieve the best glycaemic control they are capable of, whatever the means, if they understand the potential risks of their chosen therapy.

As a diabetes community, we need work together to ensure that life-changing closed-loop systems can be safely made available to those who wish to use them, whether a commercial option or a DIY system.”