Video transcript
The open-source community was actually the community that started the whole AID world, and they really drove the innovation. Without that community, we wouldn't have been where we are now. And I think that's the same thing for the future. If we can make AID systems more accessible, or give people the choice about which AID system they want to use, I think we can get more people with a better insulin regulation, and less complication and better diabetes care. I am Dr. Van Boxelaer. I'm an endocrinologist at the General Sint-Lucas Hospital in Ghent in Belgium. And I've been studying diabetes technology for the past five years, specifically about automated insulin delivery systems. I have tried every AID system myself, and also focused on the open-source AID systems, which I really liked, and I really love the community. Open-source AID systems are actually AID algorithms that are open-source available. So, they are freely available on the internet for everybody to use and to download. They are not an app that you can download from the app store, because they are actually not approved by any medical authority. But you can find the tools to make these apps online, and you can build the app then on your phone. They are available for Android phones and for iPhones, so most phones can work with these open-source AID systems. These algorithms can be connected to much more pumps and sensors than commercial AID systems. So, there are a lot more possibilities for people who might not have access to commercial AID systems, but with this free apps they can connect to the sensors at the pumps that they do have access to. Open-source AID systems proven to be as safe and effective as commercial AID systems. And in most guidelines, they state that we as healthcare providers, we should support persons that are wanting to use open-source AID systems. In the past, we only had real-life data of open-source AID systems. But in 2022, there was the first randomised control trial that actually proved that open-source AID systems worked as effective as commercial AID systems. And that's why, for the first time, in the ADA guidelines, it's also stated that we are allowed to support people who want to use open-source AID systems. Other research from this year showed that AndroidAPS was as effective if you announce meals or if you don't announce meals, and the time in range in both cases was about 80 %. So AndroidAPS is one of the best performing systems in these people and works as well with meal announcement as without meal announcements. I know a lot of people are scared to talk about open-source AID systems, because they think that their people or their patients will not be able to handle it. It will be too difficult, you really have to be a tech nerd to make apps, you have to do everything yourself. And I do have to acknowledge that it's not as easy as commercial AID systems. Commercial AID systems are much easier to set up and much easier to support as a healthcare provider. But it's not something that people have to do themselves. They do not have a customer support line, but they do have one of the biggest online communities out there on Facebook and on Discord. These are communities of 10,000 to 30,000 people. If your patients have any questions, they post it on Facebook. They will have an answer within the hour. And these groups are also moderated by really knowledgeable people. So DIY, it's not something they have to do themselves. It's really a community effort. I know that more and more commercial AID systems are becoming available, affordable and even reimbursed to more people with type 1 diabetes. So, you could think, what is the future of open-source AID systems? But we should not forget that the open-source community was actually the community that started the whole AID world, and they really drove the innovation. Without that community, we wouldn't have been where we are now. And I think that's the same thing for the future. If you look at innovation, the innovation is always first in the open-source community. They are really working on reducing the meal announcements. They are really working on reducing the meal announcements. They are the first one that has a smart watches that are connected and you can actually bolus from your smart watch. They also have features for parents with children with type 1 diabetes where the parents can give insulin boluses from a distance. So, they are really driving the technology that is needed for patients with diabetes themselves. I think as healthcare providers, we should really support the open-source community to be sure that innovation continues for people with diabetes. At the moment, there are 8 million people with type 1 diabetes, and only 1.2 million people are using an AID system, that's only 15 % that have put the step towards this technology. If we can make AID systems more accessible, or give people the choice about which AID system they want to use, I think we can get more people with a better insulin regulation and less complications and better diabetes care.