Table 2.
Pros and cons of DIY APS as compared to traditional sensor-augmented pump therapy
| Pros | Cons |
|---|---|
| Reduction in number and severity of hypoglycaemic episodes | Limited interoperability which means limited number of pumps and CGM devices compatible for DIY systems. However, the pool of different models that can ‘loop’ is gradually expanding |
| Improved glycaemic stability, reduced variability | Financial costs for additional hardware not covered by insurance |
| Improvement of time-in-range (TIR) | Warranty will not cover accidental damage of the pump or CGM, caused by use within an unlicensed system |
| Reduced cognitive burden, as less time spent thinking and planning about diabetes. Less time spent on diabetes-related activity, giving more time and cognitive space to focus on other activities in life | Additional hardware components such as the RileyLink/xDrip wireless bridge/radioboard/stick/minicomputer along with the battery and cables will have to carried along in a separate case/purse or pocket, for the system to work. However, the newer hybrid closed-loop systems have Bluetooth connectivity, obviating the requirement of intermediate hardware |
| Greater piece of mind and psychological reassurance to users (and caregivers) regarding variables such as overnight hypoglycaemia etc., leading to a better quality of sleep | Perceived and real technical barriers limiting individual patient uptake |
| Improved overall quality of life | Perceived and real lack of knowledge and understanding of DIY systems among healthcare professionals |
| More responsive to an individual’s change in physiology | Requires investment of time and effort to learn and set up the system |
| Remote monitoring option by cloud-based system such as Nightscout | Faster drain of pump and smartphone batteries |
| Supportive online DIY community | Lack of randomised clinical trials to assess safety and efficacy |
| Regular software updates and refinement of algorithms that are user-sensitive, and assist users to manage glycaemia with minimal user input | Neither medically authorised nor regulated |
| Better flexibility and customization allowing communication with portable devices e.g. Harry’s uses his smartwatch to bolus from his pump |