Navigating the Roadblocks: Identifying the Complexities and Challenges of Artificial Pancreas in Management of Type 1 Diabetes Mellitus

OBJECTIVES: Despite of significant scientific breakthroughs in managing Type 1 Diabetes Mellitus (T1DM), there are still numerous intangible challenges that need to be addressed. This systematic review of literature aimed to comprehend and communicate the current barriers in initiation and usage of Artificial Pancreas (AP).

METHODS: A systematic review adhering to PRISMA guidelines was conducted searching Embase® and MEDLINE® using the interfaces Embase.com and PubMed. Publications from last five years (1^st January 2019 – 31^st December 2023) reporting challenges associated with use of AP in management of T1DM were included. English only publications without any restriction of study design or geography were assessed. Evidence from included studies was assessed and summarized.

RESULTS: A total of 812 records were retrieved from the biomedical databases. After deduplication, 631 records underwent title/abstracts screening, followed by full-text screening of 191 publications. In addition, bibliographic searching was performed on relevant literature reviews. Finally, 24 unique publications were included with 22 journal articles and 2 conference abstracts. Four major challenges were observed impeding successful use of AP including technical complications (n=16) followed by psychosocial factors (n=6), economic burden (n=4), and lack of learning curve/training (n=3). Among the technical complications, device size, device malfunctioning, frequency of alarms, and impaired algorithmic predictions were the most reported ones. Further, device complexity was identified as one of the contributors to the emergence of psychosocial challenges. Inadequate financial support impacted the willingness of patients and caregivers to adopt AP and continued long term use. Lack of learning curve due to the overwhelming pool of knowledge leads to frustration and exhaustion, which negatively impacts trust.

CONCLUSIONS: The evidence provides an understanding of design, cost and training-related challenges faced by end-users. Recognition of these challenges can help pharmaceutical companies advance their technological capabilities, and enable healthcare providers develop better and structured training programs.