Conclusion

Artificial pancreas technology is here, and it’s here to stay. We still have work to do, though. We need to make it available, accessible, and affordable to every person with diabetes who wants it. We have to make sure that this tech is flexible enough for people to use in the real world and to achieve the best possible outcomes. We also need to make sure that it’s not burdensome for everyday use, and that it works for people who are recently diagnosed with diabetes as well as those with a deeper, longer background of living with diabetes. There are tradeoffs that individuals should be able to make, choosing between their behaviors and the number and type of interactions they have with such a system. And we should have interoperability, so someone can choose the best algorithm, CGM, pump body, and controller type for them.

We also should remember that not everyone will want, or choose, this type of technology. That’s absolutely fine, too. It’s about having choices for everyone, which includes the choice to not use APS (or pump, etc.). But, there are things we have learned in our pursuit of improving and developing APS that can apply to help improve technologies available to people without APS. There are management techniques and tricks that can improve life for anyone with diabetes, even if they’re not using a CGM. Even if they’re on MDI. We need to apply the lessons learned for everyone with diabetes.

We also need to recognize that people with diabetes themselves are the experts in APS. We’re the ones using these systems every day and night, and living real lives that are messy and gloriously full of edge cases that a typical medical device designer doesn’t think of - or is talked out of designing for, due to the lack of business case. We need to change the system around how these devices and systems are designed so that our feedback as patients is not only listened to, but incorporated into a much quicker design cycle for improving the next version and iteration.

APS technology has incredible benefits for a person with diabetes, their loved ones and friends, and even their HCP. But it requires change. Change for the person managing diabetes, to figure out how they might need to do things differently, and how to troubleshoot new technology. Change by payers/insurers for covering and reimbursing for these systems. Change for the healthcare provider to learn how to evaluate this new

technology differently (including how to conceptualize changes to diabetes therapy), and changing what they need do to help support their patients - even if they disagree with their patient’s choice of what is right, or best, for them.

***

I remember over four years ago when we announced that we had figured out how to close the loop. I remember the feeling when we announced OpenAPS and stated that we thought it should be possible for anyone to do APS if they wanted to. I remember the pushback of people saying - it works for you, but what about everyone else? We still get pushback today, telling us what we shouldn’t have done. And what we shouldn’t do now.

But I remember thinking that if it helped one other person sleep safely at night... it would be worth the amount of work it would take to open source it. Even if we didn’t know how well it would work for other people, we had a feeling it might work for some people. And that for even a few people who it might work for, it was worth doing. Would DIY end up working for everyone, or being something that everyone would want to do? Maybe not, and definitely not. We wouldn’t necessarily change the world for everyone by open sourcing an APS, but doing so could help change the world for someone else, and we thought that was (and still is) worth doing. After all, the ripple effect may help ultimately change the world for everyone else in ways we couldn’t predict or expect at the time.

That’s what APS is. It’s not a cure. It’s a ripple effect. It will affect and influence the life of someone with diabetes in ways they never could have imagined. You may have your own goal or idea of why you want an APS. It might be because it’d be safer, or let you get better sleep. It might be so that you can go back to work and your kid can go to school by themselves. It may be a safer or more easily managed and hopefully healthier pregnancy. It could be to help potentially reduce long-term complications that we can’t predict or control.

And I bet you’ll be surprised at what else it affects. It may give the gift of sleep and peace of mind to your spouse (or your parent(s)). It may make your children feel safer about your well-being, too. And it may give you more time and energy. What would you do if you had more “spoons” of energy, or another full hour, to spend on a given day? What ripple effect will you be able to have in the world, with less time and energy taken by living with diabetes?

I can’t wait to find out what you’ll do.