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Diabetes Metab. 2019 Jan;45(1):1-10. doi: 10.1016/j.diabet.2018.04.003. Epub 2018 Apr 25.

A critical review and analysis of ethical issues associated with the artificial pancreas.

Author information

1
Unité de recherche en neuroéthique, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, QC H2W 1R7 Montréal, Canada; Département de médecine sociale et préventive, École de santé publique, Université de Montréal, C.P. 6128, succursale Centre-ville, QC H3C 3J7 Montréal, Canada.
2
Unité de recherche sur les maladies métaboliques, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, QC H2W 1R7 Montréal, Canada.
3
Unité de recherche sur les maladies métaboliques, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, QC H2W 1R7 Montréal, Canada; Département de nutrition, Faculté de médecine, Université de Montréal, 2405, chemin de la Côte-Sainte-Catherine, QC H3T 1A8 Montréal, Canada; Montreal Diabetes Research Centre and Endocrinology Division, centre hospitalier de l'Université de Montréal, QC H2X 3J4 Montréal, Canada.
4
Unité de recherche en neuroéthique, Institut de recherches cliniques de Montréal (IRCM), 110, avenue des Pins Ouest, QC H2W 1R7 Montréal, Canada; Département de médecine sociale et préventive, École de santé publique, Université de Montréal, C.P. 6128, succursale Centre-ville, QC H3C 3J7 Montréal, Canada; Department of Neurology and Neurosurgery, McGill University, 3801 University Street, QC H3A 2B4 Montréal, Canada; Experimental Medicine and Biomedical Ethics Unit, McGill University, 1110, avenue des Pins Ouest, QC H3A 1A3 Montréal, Canada; Département de médecine, Université de Montréal, C.P. 6128, succursale Centre-ville, QC H3C 3J7 Montréal, Canada. Electronic address: eric.racine@ircm.qc.ca.

Abstract

The artificial pancreas combines a hormone infusion pump with a continuous glucose monitoring device, supported by a dosing algorithm currently installed on the pump. It allows for dynamic infusions of insulin (and possibly other hormones such as glucagon) tailored to patient needs. For patients with type 1 diabetes the artificial pancreas has been shown to prevent more effectively hypoglycaemic events and hyperglycaemia than insulin pump therapy and has the potential to simplify care. However, the potential ethical issues associated with the upcoming integration of the artificial pancreas into clinical practice have not yet been discussed. Our objective was to identify and articulate ethical issues associated with artificial pancreas use for patients, healthcare professionals, industry and policymakers. We performed a literature review to identify clinical, psychosocial and technical issues raised by the artificial pancreas and subsequently analysed them through a common bioethics framework. We identified five sensitive domains of ethical issues. Patient confidentiality and safety can be jeopardized by the artificial pancreas' vulnerability to security breaches or unauthorized data sharing. Public and private coverage of the artificial pancreas could be cost-effective and warranted. Patient selection criteria need to ensure equitable access and sensitivity to patient-reported outcomes. Patient coaching and support by healthcare professionals or industry representatives could help foster realistic expectations in patients. Finally, the artificial pancreas increases the visibility of diabetes and could generate issues related to personal identity and patient agency. The timely consideration of these issues will optimize the technological development and clinical uptake of the artificial pancreas.

KEYWORDS:

Artificial pancreas; Closed-loop system; Ethics; Psychosocial; Type 1 diabetes

PMID:
29753624
PMCID:
PMC6202257
[Available on 2020-01-01]
DOI:
10.1016/j.diabet.2018.04.003
[Indexed for MEDLINE]

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