Redefining and updating

Author: psonnera

docs/EN/Getting-Started/Introduction.md

@@ -9,13 +9,13 @@
 
 A human pancreas does a lot of things besides regulating blood sugar. However, the term **“Artificial Pancreas System” (APS)** usually refers to a system which works to automatically keep blood sugar levels within healthy limits.
 
-The most basic way to do this is by detecting **glucose levels**, using these values to do **calculations**, and then delivering the (predicted) right amount of **insulin** to the body. It repeats the calculation, every few minutes, 24/7. It uses **alarms** and **alerts** to inform the user if intervention or attention is needed. This system is typically made up of a **glucose sensor**, an **insulin pump** and an **app** on a phone.
+The most basic way to do this is by detecting **glucose levels**, using these values to do **calculations**, and then delivering the (predicted) right amount of **insulin** to the body. It repeats the calculation, every few minutes, 24/7. It uses **alarms** and **alerts** to inform the user if intervention or attention is needed. This system is typically made up of a **glucose sensor**, an **insulin pump** and a **controller** which runs the calculations. In **AAPS** and other open-source systems the controller is an app on a phone. In most commercial systems it is software built into the pump itself, with a phone app used mainly for display and control.
 
-You can read more about the different artificial pancreas systems currently in use and in development in this 2022 review article:   
+For background on how closed-loop systems developed and how they work, this 2022 review article is a good starting point. Bear in mind it predates most of the systems available today, so it is not a guide to what is currently on the market:   
 
-![Frontiers](../images/FRONTIERS_Logo_Grey_RGB.png) [Future Directions in Closed-Loop Technology](https://www.frontiersin.org/articles/10.3389/fendo.2022.919942/full#:~:text=Fully%20closed%2Dloop%20systems%2C%20unlike,user%20input%20for%20mealtime%20boluses).
+![Frontiers](../images/FRONTIERS_Logo_Grey_RGB.png) [Closed-Loop Insulin Delivery Systems: Past, Present, and Future Directions](https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2022.919942/full) (Templer, _Frontiers in Endocrinology_, 2022).
 
-In the near future, some so-called "dual-hormone" systems will also have the ability to infuse glucagon alongside insulin, with the aim of preventing severe hypos and allowing even tighter blood glucose control.
+So-called “dual-hormone” systems infuse glucagon alongside insulin, with the aim of preventing severe hypos and allowing even tighter blood glucose control. A first system of this kind has been approved in Europe, but it is supplied only through studies and projects, and others are still in development. None is on general sale yet.
 
 An artificial pancreas can be thought of as an [“autopilot for your diabetes”](https://www.artificialpancreasbook.com/). What does that mean?
 
@@ -26,15 +26,15 @@ In an aircraft, an autopilot does not do the complete job of the human pilot, th
 (Introduction-what-does-hybrid-closed-loop-mean)=
 ## What does hybrid closed loop mean?
 
-The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While the type 1 diabetic (T1D) community waits for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that doesn’t need any user input (like bolusing insulin for meals, or announcing exercise), with good regulation of blood glucose levels. At the moment, there are no widely available systems which are “full” closed loop, they all need some user input. The currently available systems are called “hybrid” closed loop, because they use a combination of automated technology and user input. 
+The best solution for type 1 diabetes would be a “functional cure” (probably an implant of pancreatic cells which are protected from the immune system). While the type 1 diabetic (T1D) community waits for that, a “full closed loop” artificial pancreas is probably the next best thing. This is a tech system that doesn’t need any user input (like bolusing insulin for meals, or announcing exercise), with good regulation of blood glucose levels. Nearly every system in everyday use is a “hybrid” closed loop, because it uses a combination of automated technology and user input. The first full closed loop systems were approved in Europe in 2026, but none is widely available yet. 
 
 ## How and why did looping start?
 
-The development of commercial technology for people with type 1 diabetes (T1D) is very slow. In 2013 the T1D community founded the #WeAreNotWaiting movement. They developed systems themselves using existing approved technology (insulin pumps and sensors) to improve blood glucose control, safety, and quality of life. These are known as OS-AID (Open-Source Automated Insulin Dosing) systems (formerly DIY systems), because they are not formally approved by health bodies (FDA, NHS etc). There are four main OS-AID systems available: [OpenAPS](https://openaps.org/what-is-openaps/), **AAPS**, [Loop](https://loopkit.github.io/loopdocs/#what-is-loop) and [Trio](https://triodocs.org). 
+The development of commercial technology for people with type 1 diabetes (T1D) is very slow. In 2013 the T1D community founded the #WeAreNotWaiting movement. They developed systems themselves using existing approved technology (insulin pumps and sensors) to improve blood glucose control, safety, and quality of life. These are known as OS-AID (Open-Source Automated Insulin Delivery) systems (formerly DIY systems), because they are not formally approved by health bodies (FDA, NHS etc). There are four main OS-AID systems available: [OpenAPS](https://openaps.org/what-is-openaps/), **AAPS**, [Loop](https://loopkit.github.io/loopdocs/#what-is-loop) and [Trio](https://triodocs.org). 
 
 A great way to understand the fundamentals of OS-AID looping is to read Dana Lewis’s book “Automated Insulin Delivery”. You can access it [here](https://www.artificialpancreasbook.com/) for free (or buy a hardcopy of the book). If you want to understand more about [OpenAPS](https://openaps.org/what-is-openaps/), which **AAPS** has developed from, the [OpenAPS website](https://openaps.org/what-is-openaps/) is a great resource. 
 
-Several commercial hybrid closed loop systems have been launched, the most recent of which are [CamAPS FX](https://camdiab.com/) (UK and EU) and [Omnipod 5](https://www.omnipod.com/en-gb/what-is-omnipod/omnipod-5) (USA and EU). These are very different to OS-AID systems, mainly because they both include a “learning algorithm” which adjusts how much insulin is delivered according to your insulin needs from previous days. Many people in the OS-AID community have already tried out these commercial systems and compared them with their OS-AID system. You can find out more about how the different systems compare by asking on the dedicated Facebook groups for these systems, on the [AAPS Facebook group](https://www.facebook.com/groups/AndroidAPSUsers/) or on [Discord](https://discord.com/invite/4fQUWHZ4Mw).
+Several commercial hybrid closed loop systems have also been launched. These are very different to OS-AID systems, mainly because many of them include a “learning algorithm” which adjusts how much insulin is delivered according to your insulin needs from previous days. Many people in the OS-AID community have already tried out commercial systems and compared them with their OS-AID system. You can find out more about how the different systems compare by asking on the dedicated Facebook groups for those systems, on the [AAPS Facebook group](https://www.facebook.com/groups/AndroidAPSUsers/) or on [Discord](https://discord.com/invite/4fQUWHZ4Mw).
 
 ## What is Android APS (AAPS)?
 
@@ -44,7 +44,7 @@ Several commercial hybrid closed loop systems have been launched, the most recen
 
 Android APS (**AAPS**) is a hybrid closed loop system, or Artificial Pancreas System  (APS). It makes its insulin dosing calculations using established [OpenAPS](https://openaps.org/) algorithms (a set of rules) developed by the #WeAreNotWaiting T1D community. 
 
-Since OpenAPS is only compatible with certain older insulin pumps, **AAPS** (which can be used with a wider range of insulin pumps) was developed in 2016 by Milos Kozak, for a family member with type 1 diabetes. Since those early days, **AAPS** has been continually developed and refined by a team of volunteer computer developers and other enthusiasts who have a connection to the type 1 diabetes world. Today, **AAPS** is used by approximately 20,000 people. It is a highly customisable and versatile system, and because it is open-source, it is also readily compatible with many other open-source diabetes software and platforms. The fundamental components of the current **AAPS** system are outlined in **Figure 1** above.
+Since OpenAPS is only compatible with certain older insulin pumps, **AAPS** (which can be used with a wider range of insulin pumps) was developed in 2016 by Milos Kozak, for a family member with type 1 diabetes. Since those early days, **AAPS** has been continually developed and refined by a team of volunteer computer developers and other enthusiasts who have a connection to the type 1 diabetes world. Today, **AAPS** is used by many thousands of people worldwide. It is a highly customisable and versatile system, and because it is open-source, it is also readily compatible with many other open-source diabetes software and platforms. The fundamental components of the current **AAPS** system are outlined in **Figure 1** above.
 
 
 
@@ -207,7 +207,7 @@ It is important to note that the **AAPS** user needs to be proactive to troubles
 ## Is it safe to use open-source systems like AAPS? 
 
 ### Safety of the AAPS system
-A more accurate question is probably “is it safe **compared** with my current insulin delivery system?” since no method of insulin delivery is without risk. There are many checks and balances in place with **AAPS**. A recent [paper](https://www.liebertpub.com/doi/epub/10.1089/dia.2019.0375) looked at the use of **AAPS** in a computer-simulated setup, which was an effective way to objectively trial how safe and effective the system is. More generally, it is estimated that over 30,000 individuals worldwide are using open-source automated-insulin delivery systems, and uptake continues to increase globally.
+A more accurate question is probably “is it safe **compared** with my current insulin delivery system?” since no method of insulin delivery is without risk. There are many checks and balances in place with **AAPS**. A recent [paper](https://www.liebertpub.com/doi/epub/10.1089/dia.2019.0375) looked at the use of **AAPS** in a computer-simulated setup, which was an effective way to objectively trial how safe and effective the system is. More generally, many thousands of individuals worldwide are using open-source automated-insulin delivery systems, and uptake continues to increase globally.
 
 Any device that uses radio communications could be hacked, and this is true for a non-looping insulin pump as well. Currently, we are not aware of anyone attempting to harm individuals by hacking their diabetes-related medical equipment. However, there are multiple ways to protect against such risks:  
 
@@ -249,7 +249,7 @@ Ask if your team has any patients under their care who already use OS-AID loopin
 
 If you feel unsupported by your team to loop with **AAPS**, the following discussion points may help: 
 
-a) The **AAPS** system has been designed BY patients and their caregivers. It has been designed ultimately for safety, but also drawing on in-depth patient experience. There are currently around **20,000** AAPS users worldwide. There is therefore likely to be other patients using OS-AID looping in your clinic's patient population (whether they know about it or not). 
+a) The **AAPS** system has been designed BY patients and their caregivers. It has been designed ultimately for safety, but also drawing on in-depth patient experience. There are many thousands of **AAPS** users worldwide. There is therefore likely to be other patients using OS-AID looping in your clinic's patient population (whether they know about it or not). 
 
 b) Recent peer-reviewed published guidance in the internationally leading medical journal [The Lancet](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8720075/pdf/nihms-1765784.pdf)_(1)_ has confirmed that OS-AID loops are **safe** and **effective at improving diabetic control**, including time in range. There are regular articles in leading journals like [Nature](https://doi.org/10.1038/d41586-023-02648-9)_(3)_ which highlight the progress of the OS-AID looping community. 
 
@@ -309,7 +309,7 @@ Doctors (at least in the UK) are not prohibited from prescribing unlicensed medi
 
 The **AAPS** app is not provided in Google Play - you have to build it from source code by yourself for legal reasons. **AAPS** is unlicensed, meaning that it does not have approval by any regulatory body authority in any country. **AAPS** is deemed to be carrying out a medical experiment on yourself, and is carried out at the user’s own risk.
 
-Setting up the system requires patience, determination and the gradual development of technical knowledge. All the information and support can be found in these documents, elsewhere online, or from others who have already done it. Over 10,000 people have successfully built and are currently using **AAPS** worldwide. 
+Setting up the system requires patience, determination and the gradual development of technical knowledge. All the information and support can be found in these documents, elsewhere online, or from others who have already done it. Many thousands of people have successfully built and are currently using **AAPS** worldwide. 
 
 The developers of **AAPS** take safety incredibly seriously, and want others to have a good experience of using **AAPS**. That is why it is essential that every user (or carer, if the user is a child):
 

docs/EN/UsefulLinks/Glossary.md

@@ -4,7 +4,10 @@
 
 __AAPSClient__ (or __NSClient__) = a remote control feature that can be used by caregivers via a follower phone to follow a user’s __AAPS__ by connecting to the user’s __Nightscout's__ site. Further info → Wiki - 'NS Client'. Objectives learning program within __AAPS__ provides step by step guidance. Further info → Wiki - 'objectives'.
 
-__APS__ = Artificial Pancreas System.
+__AID__ = Automated Insulin Delivery.
+The term generally used in clinical practice and research for a system which automatically adjusts insulin delivery using __CGM__ data. __APS__ and __closed loop__ mean the same thing → see also __OS-AID__.
+
+__APS__ = Artificial Pancreas System → see also __AID__.
 
 __AMA__ = Advanced Meal Assist.
 An algorithm which allows __AAPS__ to increase the user’s basal more aggressively after a meal bolus. Further info → Wiki - 'AMA'.
@@ -46,7 +49,7 @@ __CAN__ = status light for overdue cannula change, shown in the status row of __
 
 __CGM__ = Continuous Glucose Monitor → see also __FGM__.
 
-__Closed Loop__ = a closed loop system which makes automatic adjustments to the user’s basal delivery based on an __AAPS’s__ algorithm and the user’s __Profile__ settings without requiring the user’s-approval. Further info → Wiki - 'closed loop'.
+__Closed Loop__ = a closed loop system which makes automatic adjustments to the user’s basal delivery based on an __AAPS’s__ algorithm and the user’s __Profile__ settings without requiring the user’s-approval. Further info → Wiki - 'closed loop' and see also __HCL__ / __FCL__.
 
 __COB__ = Carbs On Board. 
 This is the amount of carbohydrates currently available for the user's digestion → see also IOB.
@@ -66,6 +69,9 @@ __Dynamic ISF (or DynISF)__ =  a feature within **AAPS** that adapts the insulin
 __eCarbs__ = extended Carbs.
 Carbs split up over several hours to accommodate/protein and permits __AAPS__ to deliver extended boluses.  Further info →  Wiki - 'eCarbs', 'eCarbs use'.
 
+__FCL__ = Full Closed Loop.
+A loop which needs no mealtime input from the user: no carb counting and no meal bolus. Further info → Wiki - 'full closed loop' and see also __HCL__.
+
 __FGM__ = Flash Glucose Monitor manufactured by Freestyle Libre.
  Further info →  Wiki - 'BG source' and see also 'CGM'.
 
@@ -76,6 +82,8 @@ It is also necessary for __APK__ updates.  Further info →  Wiki - 'update APK'
 
 __Glimp__ = an app to collect values from Freestyle Libre Glimp.
 
+__HCL (or Hybrid Closed Loop)__ = a loop which automates insulin delivery between meals, but still requires the user to bolus for meals. Nearly every system in everyday use, including __AAPS__, is a hybrid closed loop → see also __FCL__ / __Closed Loop__.
+
 __IC (or I:C)__ = Insulin to Carb ratio. 
 (i.e. how many carbs are covered by one unit of insulin?).
 
@@ -116,6 +124,9 @@ __Open Loop system__ = an __AAPS__ feature that will recommend adjustments and w
 
 __Oref0 / Oref1__ = sensitivity detection and "reference design implementation version 0/1". It is the key algorithm behind OpenAPS Wiki - sensitivity detection.
 
+__OS-AID__ = Open-Source Automated Insulin Delivery.
+An __AID__ system built from open-source software, such as __AAPS__, __OpenAPS__, Loop or Trio. These systems are not formally approved by health bodies (FDA, NHS etc.) → see also __AID__.
+
 __Peak time__ = time of maximum effect of insulin given. Further info → Wiki - 'config builder'.
 
 __PH__ = Pump History.