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Kietaibl AT, Schütz-Fuhrmann I, Bozkurt L, Frühwald L, Rami-Merhar B, Fröhlich-Reiterer E, Hofer SE, Tauschmann M, Resl M, Hörtenhuber T, Stechemesser L, Winhofer Y, Riedl M, Zlamal-Fortunat S, Eichner M, Stingl H, Schelkshorn C, Weitgasser R, Rega-Kaun G, Köhler G, Mader JK. [Position paper: Open-source technology in the treatment of people living with diabetes mellitus-an Austrian perspective : Technology Committee of the Austrian Diabetes Association]. Wien Klin Wochenschr 2024; 136:467-477. [PMID: 39196351 PMCID: PMC11358222 DOI: 10.1007/s00508-024-02400-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2024] [Indexed: 08/29/2024]
Abstract
People living with diabetes mellitus can be supported in the daily management by diabetes technology with automated insulin delivery (AID) systems to reduce the risk of hypoglycemia and improve glycemic control as well as the quality of life. Due to barriers in the availability of AID-systems, the use and development of open-source AID-systems have internationally increased. This technology provides a necessary alternative to commercially available products, especially when approved systems are inaccessible or insufficiently adapted to the specific needs of the users. Open-source technology is characterized by worldwide free availability of codes on the internet, is not officially approved and therefore the use is on the individual's own responsibility. In the clinical practice a lack of expertise with open-source AID technology and concerns about legal consequences, lead to conflict situations for health-care professionals (HCP), sometimes resulting in the refusal of care of people living with diabetes mellitus. This position paper provides an overview of the available evidence and practical guidance for HCP to minimize uncertainties and barriers. People living with diabetes mellitus must continue to be supported in education and diabetes management, independent of the chosen diabetes technology including open-source technology. Check-ups of the metabolic control, acute and chronic complications and screening for diabetes-related diseases are necessary and should be regularly carried out, regardless of the chosen AID-system and by a multidisciplinary team with appropriate expertise.
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Affiliation(s)
- Antonia-Therese Kietaibl
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
- Verein zur Förderung der wissenschaftlichen Forschung am Wilhelminenspital, Wien, Österreich
| | - Ingrid Schütz-Fuhrmann
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner Institut für Endokrinologie und Stoffwechselerkrankungen, Klinik Hietzing, Wien, Österreich
| | - Latife Bozkurt
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner Institut für Endokrinologie und Stoffwechselerkrankungen, Klinik Hietzing, Wien, Österreich
| | - Lisa Frühwald
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
- Verein zur Förderung der wissenschaftlichen Forschung am Wilhelminenspital, Wien, Österreich
| | - Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Pulmologie, Allergologie und Endokrinologie, Medizinische Universität Wien, Wien, Österreich
| | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Allgemeine Pädiatrie, Medizinische Universität Graz, Graz, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Martin Tauschmann
- Universitätsklinik für Kinder- und Jugendheilkunde, Abteilung für Pädiatrische Pulmologie, Allergologie und Endokrinologie, Medizinische Universität Wien, Wien, Österreich
| | - Michael Resl
- Abteilung für Innere Medizin I, Konventhospital der Barmherzigen Brüder Linz, Linz, Österreich
| | - Thomas Hörtenhuber
- Universitätsklinik für Kinder- und Jugendheilkunde, Kepler Universitätsklinikum, Linz, Österreich
| | - Lars Stechemesser
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Yvonne Winhofer
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Michaela Riedl
- Klinische Abteilung für Endokrinologie und Stoffwechsel, Universitätsklinik für Innere Medizin III, Medizinische Universität Wien, Wien, Österreich
| | - Sandra Zlamal-Fortunat
- Abteilung für Innere Medizin und Gastroenterologie, Hepatologie, Endokrinologie, Rheumatologie und Nephrologie, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Österreich
| | - Marlies Eichner
- 3. Medizinische Abteilung mit Stoffwechselerkrankungen und Nephrologie, Karl Landsteiner Institut für Endokrinologie und Stoffwechselerkrankungen, Klinik Hietzing, Wien, Österreich
| | - Harald Stingl
- Abteilung Innere Medizin, Landesklinikum Baden, Baden, Österreich
| | | | - Raimund Weitgasser
- Kompetenzzentrum Diabetes, Abteilung für Innere Medizin, Privatklinik Wehrle-Diakonissen, Salzburg, Österreich
- Universitätsklinik für Innere Medizin I, Paracelsus Medizinische Privatuniversität, Salzburg, Österreich
| | - Gersina Rega-Kaun
- 5. Medizinische Abteilung für Endokrinologie, Rheumatologie und Akutgeriatrie, Klinik Ottakring, Wien, Österreich
- Verein zur Förderung der wissenschaftlichen Forschung am Wilhelminenspital, Wien, Österreich
| | - Gerd Köhler
- Klinische Abteilung für Endokrinologie und Diabetologie, Medizinische Universität Graz, Graz, Österreich
- Rehabilitation für Stoffwechselerkrankungen Aflenz, Aflenz, Österreich
| | - Julia K Mader
- Klinische Abteilung für Endokrinologie und Diabetologie, Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich.
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Burnside MJ, Lewis DM, Crocket HR, Meier RA, Williman JA, Sanders OJ, Jefferies CA, Faherty AM, Paul RG, Lever CS, Price SKJ, Frewen CM, Jones SD, Gunn TC, Lampey C, Wheeler BJ, de Bock MI. Open-Source Automated Insulin Delivery in Type 1 Diabetes. N Engl J Med 2022; 387:869-881. [PMID: 36069869 DOI: 10.1056/nejmoa2203913] [Citation(s) in RCA: 99] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Open-source automated insulin delivery (AID) systems are used by many patients with type 1 diabetes. Data are needed on the efficacy and safety of an open-source AID system. METHODS In this multicenter, open-label, randomized, controlled trial, we assigned patients with type 1 diabetes in a 1:1 ratio to use an open-source AID system or a sensor-augmented insulin pump (control). The patients included both children (defined as 7 to 15 years of age) and adults (defined as 16 to 70 years of age). The AID system was a modified version of AndroidAPS 2.8 (with a standard OpenAPS 0.7.0 algorithm) paired with a preproduction DANA-i insulin pump and Dexcom G6 CGM, which has an Android smartphone application as the user interface. The primary outcome was the percentage of time in the target glucose range of 70 to 180 mg per deciliter (3.9 to 10.0 mmol per liter) between days 155 and 168 (the final 2 weeks of the trial). RESULTS A total of 97 patients (48 children and 49 adults) underwent randomization (44 to open-source AID and 53 to the control group). At 24 weeks, the mean (±SD) time in the target range increased from 61.2±12.3% to 71.2±12.1% in the AID group and decreased from 57.7±14.3% to 54.5±16.0% in the control group (adjusted difference, 14 percentage points; 95% confidence interval, 9.2 to 18.8; P<0.001), with no treatment effect according to age (P = 0.56). Patients in the AID group spent 3 hours 21 minutes more in the target range per day than those in the control group. No severe hypoglycemia or diabetic ketoacidosis occurred in either group. Two patients in the AID group withdrew from the trial owing to connectivity issues. CONCLUSIONS In children and adults with type 1 diabetes, the use of an open-source AID system resulted in a significantly higher percentage of time in the target glucose range than the use of a sensor-augmented insulin pump at 24 weeks. (Supported by the Health Research Council of New Zealand; Australian New Zealand Clinical Trials Registry number, ACTRN12620000034932.).
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Affiliation(s)
- Mercedes J Burnside
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Dana M Lewis
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Hamish R Crocket
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Renee A Meier
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Jonathan A Williman
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Olivia J Sanders
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Craig A Jefferies
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Ann M Faherty
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Ryan G Paul
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Claire S Lever
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Sarah K J Price
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Carla M Frewen
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Shirley D Jones
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Tim C Gunn
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Christina Lampey
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Benjamin J Wheeler
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
| | - Martin I de Bock
- From the Departments of Pediatrics (M.J.B., R.A.M., O.J.S., M.I.B.) and Population Health (J.A.W.), University of Otago, and the Department of Pediatrics, Canterbury District Health Board (M.J.B., O.J.S., M.I.B.), Christchurch, Te Huataki Waiora School of Health, Sport and Human Performance, University of Waikato (H.R.C.), and Waikato Regional Diabetes Service, Waikato District Health Board (R.G.P., C.S.L., S.K.J.P.), Hamilton, the Department of Pediatric Endocrinology, Starship Children's Health, Auckland District Health Board (C.A.J., A.M.F., C.L.), and the Liggins Institute, University of Auckland (C.A.J.), Auckland, the Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago (C.M.F., S.D.J., B.J.W.), and the Pediatric Department, Southern District Health Board (B.J.W.), Dunedin, and Nightscout New Zealand, Hamilton (T.C.G.) - all in New Zealand; and OpenAPS, Seattle (D.M.L.)
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