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65 changes: 33 additions & 32 deletions docs/EN/Getting-Started/Introduction.md
Original file line number Diff line number Diff line change
Expand Up @@ -14,18 +14,18 @@ In the near future, some so-called "dual-hormone" systems will also have the abi

An artificial pancreas can be thought of as an [“autopilot for your diabetes”](https://www.artificialpancreasbook.com/). What does that mean?

In an aircraft, an autopilot does not do the complete job of the human pilot, the pilot cannot sleep through the entire flight. The autopilot aids the work of the pilot. It relieves them of the burden of permanently monitoring the aircraft, allowing the pilot to concentrate on wider monitoring from time to time. The autopilot receives signals from various sensors, a computer evaluates them together with the pilot’s specifications and then makes the necessary adjustments, alerting the pilot to any concerns. The pilot no longer has to worry about constantly making decisions.
In an aircraft, an autopilot does not do the complete job of the human pilot, the pilot cannot sleep through the entire flight. The autopilot aids the work of the pilot. It relieves them of the burden of permanently managing the aircraft, allowing the pilot to concentrate on wider monitoring. The autopilot receives signals from various sensors, a computer evaluates the data together with the pilot’s specifications and then makes the necessary adjustments, alerting the pilot to any concerns. The pilot no longer has to worry about constantly making decisions and this analogy can be applied to **AAPS**.

![image](../images/autopilot.png)

(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 we are waiting 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. 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.

## 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 DIY 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 treat T1D is very slow. As a result, 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 DIY 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 DIY 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.

Expand All @@ -37,23 +37,46 @@ Several commercial hybrid closed loop systems have been launched, the most recen

**Figure 1**. Basic outline of the Android APS (Artificial Pancreas System), AAPS.

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 type 1 diabetes community.
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.



## What are the basic components of AAPS?

The “brain” of AAPS is an **app** which you build yourself. There are detailed step-by-step instructions for this. You then install the **AAPS app** on a [compatible](../Getting-Started/Phones.md) **Android smartphone** (**1**). A number of users prefer their loop on a separate phone to their main phone. So, you don’t necessarily have to be using an Android phone for everything else in your life, just for running your AAPS loop.
The “brain” of **AAPS** is an **app** which you build yourself. There are detailed step-by-step instructions for this. You then install the **AAPS app** on a [compatible](../Getting-Started/Phones.md) **Android smartphone** (**1**). A number of users prefer their loop on a separate phone to their main phone. So, you don’t necessarily have to be using an Android phone for everything else in your life, just for running your AAPS loop.

The **Android smartphone** will also need to have another app installed on it as well as **AAPS**. This [additional app](../Getting-Started/CompatiblesCgms.md) receives glucose data from a sensor (**2**) by bluetooth, and then sends the data internally on the phone to the **AAPS app**.

The **AAPS app** uses a decision making process (**algorithm**) from OpenAPS. Beginners start out using the basic **oref0** algorithm, but it is possible to switch to using the newer **oref1** algorithm as you progress with AAPS. Which algorithm you use (oref0 or oref1), depends on which suits your specific situation best. In both cases, the algorithm takes into account multiple factors, and performs rapid calculations every time a new reading comes in from the sensor. The algorithm then sends instructions to the insulin pump (**3**) on how much insulin to deliver by bluetooth. All the information can be sent by mobile data or wifi to the internet (**4**). This data can also be shared with followers if desired, and/or collected for analysis.
The **AAPS app** uses a decision making process (**algorithm**) from OpenAPS. Beginners start out using the basic **oref0** algorithm, but it is possible to switch to using the newer **oref1** algorithm as you progress with AAPS. Which algorithm you use (oref0 or oref1), depends on which suits your specific situation best. In both cases, the algorithm takes into account multiple factors, and performs rapid calculations every time a new reading comes in from the sensor. The algorithm then sends instructions to the insulin pump (**3**) on how much insulin to deliver by bluetooth. All the information can be sent by mobile data or wifi to the internet (**4**). This data can also be shared with followers if desired, and/or collected for analysis.

## What are the advantages of the AAPS system?

The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data. Some of the reported advantages of using AAPS are extensive fine-tunable options, automations and increased transparency of the system for the patient/caregiver. This can result in better control over your (or your dependant’s) diabetes, which in turn may give improved quality of life and increased peace of mind.
The OpenAPS algorithm used by **AAPS** controls blood sugar levels in the absence of user input, according to the users’ defined parameters (important ones being basal rates, insulin sensitivity factors, insulin-to-carb ratios, duration of insulin activity etc.), reacting every 5 minutes to the new sensor data.

Some of the reported advantages of using **AAPS** are extensive fine-tunable options, automations and increased transparency of the system for the patient/caregiver. This can result in better control over your (or your dependant’s) diabetes, which in turn may give improved quality of life and increased peace of mind.

With investment of your time, **AAPS** can potentially lead to:

- alleviating the stress and burden of managing type 1 diabetes;

- reducing the multitude of mundane decisions that arise from type 1 diabetes;

- the provision of personalised and dynamic insulin dosing based on real-time data which can cut down the need for hypo treatments and reduce hyperglycemia episodes;

- an increased knowledge of insulin management and confidence to better fine tune your settings;

- the ability to create automatic settings (**automations**) that are tailored to fit in with your lifestyle;

- improved sleep quality and overall reduction in the frequency of nighttime interventions;

- remote monitoring and administration of insulin delivery for caregivers of type 1 diabetics; and

- streamlining of all your portable diabetic equipment (continuous glucose monitor receiver and insulin controlling devices) by using an Android phone controlled by **AAPS**.


Ultimately, **AAPS** can empower individuals to better manage their diabetes, resulting in stable blood sugars and improved long term health outcomes.

### **Specific advantages include:**

Expand All @@ -62,15 +85,15 @@ To read about the safety features of the algorithms, known as oref0 and oref1, [

#### 2) **Hardware flexibility**

**AAPS** works with a wide range of insulin pumps and sensors. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. That offers flexibility as life changes. You don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. AAPS is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves.
**AAPS** works with a wide range of insulin pumps and sensors and offers flexibility. So for example, if you develop an allergy to Dexcom sensor patch glue, you could switch to using a Libre sensor instead. Users don't have to rebuild or reinstall the **AAPS** app, just tick a different box in the app to change your hardware. **AAPS** is independent of particular pump drivers and also contains a "virtual pump" so users can safely experiment before using it on themselves.

#### 3) **Highly customisable, with wide parameters**

Users can easily add or remove modules or functionality, and **AAPS** can be used in both open and closed loop mode. Here are some examples of the possibilities with the **AAPS** system:

a) The ability to set a lower glucose target 30 min before eating; you can set the target as low as 72 mg/dL (4.0 mmol/L).

b) If you are insulin-resistant resulting in high blood sugars, **AAPS** allows you to set an **automation** rule to activate when BG rises above 8 mmol/L (144 mg/dL), switching to (for example) a 120% profile (resulting in an 20% increase in basal and strengthening of other factors too, compared to your normal **profile** setting). The automation will last according to the scheduled time you set. Such an automation could be set to only be active on certain days of the week, at certain times of day, and even at certain locations.
b) If you are insulin-resistant resulting in high blood sugars, **AAPS** allows you to set an **automation** rule to activate when BG rises above 8 mmol/L (144 mg/dL), switching to (for example) a 120% profile (resulting in an 20% increase in basal and strengthening of other factors too, compared to your normal **profile** setting). The **automation** will last according to the scheduled time you set. Such an automation could be set to only be active on certain days of the week, at certain times of day, and even at certain locations.

c) If your child is on a trampoline with no advance notice, **AAPS** allows insulin suspension for a set time period, directly via the phone.

Expand All @@ -84,7 +107,7 @@ These are all examples, the full range of features gives huge flexibility for da
There are multiple possible monitoring channels (Sugarmate, Dexcom Follow, xDrip+, Android Auto _etc._) which are useful for parents/carers and adults in certain scenarios (sleeping/driving) who need customisable alerts. In some apps (xDrip+) you can also turn alarms off totally, which is great if you have a new sensor “soaking” or settling down that you don’t want to loop with yet.

#### 5) **Remote control**
A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or AAPSClient) to send a wide range of commands back to the **AAPS** system. This is used extensively by parents of kids with type 1 diabetes who use AAPS. It is very useful: for example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is possible to monitor the system (_e.g._ Fitbit), send basic commands (_e.g._ Samsung Galaxy watch 4), or even run the entire AAPS system from a high-spec smartwatch (**5**) (_e.g._ LEMFO). In this last scenario, you don’t need to use a phone to run AAPS. As battery life on watches improves and technology becomes more stable, this last option is likely to become increasingly attractive.
A significant advantage of **AAPS** over commercial systems is that it is possible for followers, using authenticated text (SMS) commands or via an app ([Nightscout](https://nightscout.github.io/) or AAPSClient) to send a wide range of commands back to the **AAPS** system. This is used extensively by parents of kids with type 1 diabetes who use AAPS. It is very useful: for example, in the playground, if you want to pre-bolus for a snack from your own phone, and your child is busy playing. It is possible to monitor the system (_e.g._ Fitbit), send basic commands (_e.g._ Samsung Galaxy watch 4).

#### 6) **No commercial constraints, due to open application interfaces**
Beyond the use of an open-source approach, which allows the source code of **AAPS** to be viewed at any time, the general principle of providing open programming interfaces gives other developers the opportunity to contribute new ideas too. **AAPS** is closely integrated with Nightscout. This accelerates development and allows users to add on features to make life with diabetes even more convenient. Good examples for such integrations are [Nightscout](https://nightscout.github.io/), [Nightscout Reporter](https://nightscout-reporter.zreptil.de/), xDrip+, [M5 stack](https://github.com/mlukasek/M5_NightscoutMon/wiki) etc. There is ongoing dialogue between open-source developers and those developing commercial systems. Many of the DIY innovations are gradually adopted by commercial systems, where developments are understandably slower, partly because interfaces between systems from different companies (pumps, apps, sensors _etc_) need to be carefully negotiated and licenced. This can also slow innovations which are convenient for the patient (or a small sub-population of patients, who have a very specific requirement) but do not generate any sizable profit.
Expand Down Expand Up @@ -360,27 +383,5 @@ Done, just close the window! The screen reader should work now.



## What benefits can I get from AAPS?

With investment of your time, **AAPS** can potentially lead to:

- alleviating the stress and burden of managing type 1 diabetes;

- reducing the multitude of mundane decisions that arise from type 1 diabetes;

- the provision of personalised and dynamic insulin dosing based on real-time data which can cut down the need for hypo treatments and reduce hyperglycemia episodes;

- an increased knowledge of insulin management and confidence to better fine tune your settings;

- the ability to create automatic settings (**automations**) that are tailored to fit in with your lifestyle;

- improved sleep quality and overall reduction in the frequency of nighttime interventions;

- remote monitoring and administration of insulin delivery for caregivers of type 1 diabetics; and

- streamlining of all your portable diabetic equipment (continuous glucose monitor receiver and insulin controlling devices) by using an Android phone controlled by **AAPS**.


Ultimately, **AAPS** can empower individuals to better manage their diabetes, resulting in stable blood sugars and improved long term health outcomes.

Interested in how to get started with setting up AAPS? Take a look at the [preparing](../Getting-Started/PreparingForAaps.md) section.
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