Open Source Closed-Loop Insulin Delivery Systems: A Clash of Cultures or Merging of Diverse Approaches?

J Diabetes Sci Technol. 2018 Nov;12(6):1223-1226. doi: 10.1177/1932296818792577. Epub 2018 Aug 6.


Biomedical outcomes for people with diabetes remain suboptimal for many. Psychosocial care in diabetes does not fare any better. "Artificial pancreas" (also known as "closed-loop" and "automated insulin delivery") systems present a promising therapeutic option for people with diabetes (PWD)-simultaneously improving glycemic outcomes, reducing the burden of self-management, and improving health-related quality of life. In recent years there has emerged a growing movement of PWD innovators rallying behind the mantra #WeAreNotWaiting, developing "do-it-yourself artificial pancreas systems (DIY APS)." Self-reported results by DIY APS users show improved metabolic outcomes such as impressive stability of glucose profiles, significant reduction of A1c, and more time within their glycemic target range. However, the benefits remain unclear for the broader population of PWD beyond these highly engaged, highly tech-savvy users willing and able to engage in the demands of building and maintaining their DIY APS. We discuss the challenges faced by key stakeholder groups in terms of potential collaboration and open debate of these challenges.

Keywords: automated insulin delivery system; diabetes technology; do it yourself; inequality.

MeSH terms

  • Blood Glucose / analysis*
  • Blood Glucose Self-Monitoring / instrumentation
  • Blood Glucose Self-Monitoring / methods
  • Blood Glucose Self-Monitoring / psychology
  • Culture*
  • Diabetes Mellitus, Type 1 / blood*
  • Diabetes Mellitus, Type 1 / drug therapy*
  • Diabetes Mellitus, Type 1 / ethnology
  • Equipment Design
  • Equipment and Supplies / standards
  • Equipment and Supplies / supply & distribution
  • Health Status Disparities
  • Healthcare Disparities / ethnology
  • Healthcare Disparities / statistics & numerical data
  • Humans
  • Insulin / administration & dosage*
  • Insulin Infusion Systems* / standards
  • Insulin Infusion Systems* / supply & distribution
  • Pancreas, Artificial* / classification
  • Pancreas, Artificial* / psychology
  • Pancreas, Artificial* / supply & distribution
  • United Kingdom / epidemiology
  • United States / epidemiology


  • Blood Glucose
  • Insulin