Response to the Comment by K. Hood to “Do It Yourself” (DIY)—Automated Insulin Delivery (AID) Systems: Current Status From a German Point of View

Abstract

We thank our colleague for his comments1 to our review on Do It Yourself (DIY) Automated Insulin Delivery (AID) systems from a German point of view.2 His guiding principles for his work with patients with type 1 diabetes are that (a) every person is entitled to life-saving insulin and (b) the person should decide how to administer that insulin. We fully agree with his opinion that every person with diabetes (PwD) is entitled to insulin. When it comes to the second opinion, we agree that each PwD should decide how to administer the insulin once he or she has sufficient diabetes knowledge by participating in a (recent) training in insulin pump usage. But we were surprised by a number of statements in his comment. For us, diabetes self-management has been beyond doubt since we were—as young scientists in Germany in the early 1980s—most active in establishing intensified insulin therapy (IIT) with appropriate training programs for diabetes teams and persons with diabetes nationwide. IIT was used in our country for a number of years before it became an established therapy in many other countries, including the United States. Empowerment, as it was represented by Bob Anderson and his colleagues in the United States at a later time3,4, is still the philosophical approach that is accepted without exception among (older) German diabetes teams. And for more than one decade, we have participated in (psychological) studies on systems for AID.5 The cited review, “Do It Yourself” (DIY)-AID Systems: Current Status From a German Point of View,” aimed to review the challenging (medical-)legal situation for members of diabetes teams, who were asked for advice by their patients on DIY-AID systems. Our position is intended to provide maximum safety for PwDs, especially when the safety of uncleared products cannot be known by the patient users: