diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM13022diaendo-13022Research ArticleОбзорыReviewСистемы автоматизированного введения инсулина с открытым кодом: преимущества, ограничения и вызовы в лечении сахарного диабетаOpen source automated insulin delivery systems: benefits, limitations and challenges in diabetes carehttps://orcid.org/0000-0001-5552-9508ШишинК. С.ShishinK. S.

Шишин Константин Сергеевич - лаборант-исследователь лаборатории эндокринологии, магистрант.

Новосибирск

Konstantin S. Shishin - Research Assistant.

Novosibirsk

shishinkostya2000@gmail.comhttps://orcid.org/0000-0002-5407-8722КлимонтовВ. В.KlimontovV. V.

Климонтов Вадим Валерьевич – доктор медицинских наук, профессор РАН, заместитель руководителя филиала по научной работе, заведующий лабораторией эндокринологии.

630060, Новосибирск, ул. Тимакова, д. 2

Researcher ID: R-7689-2017; Scopus Author ID: 8295977000

Vadim V. Klimontov - MD, PhD, Professor, Deputy Director for Science, Head of the Laboratory of Endocrinology.

2 Timakov street, 630060 Novosibirsk

Researcher ID: R-7689-2017; Scopus Author ID: 8295977000

klimontov@mail.ruНаучно-исследовательский институт клинической и экспериментальной лимфологии — филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук»; ФГАОУ ВО «Новосибирский национальный исследовательский государственный университет»РоссияResearch Institute of Clinical and Experimental Lymphology — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of Sciences; Novosibirsk National Research State UniversityRussian FederationНаучно-исследовательский институт клинической и экспериментальной лимфологии — филиал ФГБНУ «Федеральный исследовательский центр Институт цитологии и генетики Сибирского отделения Российской академии наук»РоссияResearch Institute of Clinical and Experimental Lymphology — Branch of the Institute of Cytology and Genetics, Siberian Branch of Russian Academy of SciencesRussian Federation202329052023264352362Copyright © Шишин К.С., Климонтов В.В., 20232023Шишин К.С., Климонтов В.В.Shishin K.S., Klimontov V.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/13022

Системы автоматизированного введения инсулина с замкнутым контуром (АВИ-ЗК) и открытым кодом все чаще применяются в лечении сахарного диабета (СД). Собранные по принципу «сделай сам», эти системы объединяют инсулиновые помпы, устройства для непрерывного мониторинга глюкозы и алгоритмы, которые управляют скоростью введения инсулина с учетом уровня глюкозы. В данном обзоре мы рассматриваем технологические особенности некоммерческих систем АВИ-ЗК (OpenAPS, AndroidAPS, Loop и др.), преимущества и барьеры для их применения в клинической практике. Основные преимущества систем АВИ-ЗК с открытым кодом перед коммерческими системами включают низкую стоимость, возможность выбора совместимых устройств, широкий спектр функций, которые могут быть настроены пользователем, а также постоянное совершенствование алгоритмов. Растущий объем данных указывает на то, что некоммерческие системы АВИ-ЗК, такие как OpenAPS, AndroidAPS и Loop, обеспечивают достижение высоких значений времени в целевом диапазоне при минимальном риске гипогликемии и повышают удовлетворенность лечением у больных СД 1 типа. Широкий спектр настроек делает такие системы эффективным инструментом для контроля СД в ситуациях с быстро меняющейся потребностью в инсулине. Некоторые технологические, медицинские, юридические и этические проблемы, связанные с применением некоммерческих систем АВИ-ЗК, еще требуют своего решения. Сборка системы АВИ-ЗК с открытым кодом требует определенного уровня умений в области технологий, связанных с диабетом. Актуален и вопрос кибербезопасности. Отсутствие официальных одобрений регуляторами в сфере здравоохранения, низкая осведомленность медицинских работников, отсутствие возмещения расходов со стороны страховых компаний замедляют внедрение технологии в клиническую практику. Профессиональному медицинскому сообществу на международном и национальном уровне необходимо выработать свою позицию в отношении применения систем АВИ-ЗК с открытым кодом в лечении СД.

Open source closed loop automated insulin delivery (CL-AID) systems are increasingly used in the treatment of diabetes. Assembled on a do-it-yourself (DIY) basis, these systems integrate insulin pumps, continuous glucose monitoring devices, and algorithms that control the rate of insulin delivery based on glucose levels. In this review, we consider the technological features of open source CL-AID systems (OpenAPS, AndroidAPS, Loop, etc.), advantages and barriers to their use in clinical practice. Advantages of open source CL-AID systems over commercially available ones included lower cost, a choice of devices, a wide range of user settings, as well as continuous improvement of algorithms. A growing body of evidence indicates that open source CL-AID systems, such as OpenAPS, AndroidAPS, and Loop, provide an excellent time in range with minimal risk of hypoglycaemia and increase treatment satisfaction in patients with type 1 diabetes. A wide range of settings makes open source systems an effective tool for managing diabetes in situations with rapidly changing insulin requirement. However, some technological, medical, legal and ethical issues associated with the use of non-commercial CL-AID systems still need to be addressed. Assembling the system requires skills in diabetes technology. The issue of cybersecurity is also relevant. Lack of official approvals, low awareness of medical professionals, and reimbursement issues are slowing down the introduction of the technology into clinical practice. The professional medical community at the international and national levels needs to determine its position regarding the use of open source CL-AID systems in the treatment of diabetes.

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The authors declare that there are no conflicts of interest present.