Thèse numérisée par la Division de la gestion de documents et des archives de l'Université de Montréal

The diploma aims to ascertain the opinions of diabetics on the current system of reimbursements of medical devices and medical procedures from the public health insurance. The diploma thesis is strategically divided into theoretical and practical bases. The theoretical bases are divided into three parts. The first part is focused on the disease diabetes mellitus, the second part provides a basic description of the concept of health insurance, and the third part describes the facts arising from the relationship between health insurance and diabetes, including e.g. provision and reimbursement of medical devices or medical procedures. The practical bases include the thesis objective, hypotheses, methods, research results and discussion. In order to process the data, a quantitative research strategy was used, and the data were collected by the questioning method and the questionnaire technique. The questionnaire I drew up for the diploma thesis started with the introductory page on which I introduced myself to the respondents and informed them about the purpose of the questionnaire survey, anonymity and use of the obtained data. The research set comprised the diabetics registered with a selected physician running an outpatient diabetes office. I distributed 300 questionnaires and received 248 completed questionnaires. So the rounded return rate was 82.7%. From the total number of 248 questionnaires, only 232 questionnaires could be used for the research, while 16 questionnaires were excluded because the respondents gave incomplete, inaccurate or logically incorrect answers to the questions important for the research. In order to achieve the set objective, two hypotheses were raised. The first one was: Type 1 diabetics are satisfied with the number of medical devices reimbursed from the public health insurance more than type 2 diabetics. Based on the research results, the conclusiveness of this hypothesis was found statistically significant so it was confirmed that type 1 diabetics are satisfied with the number of medical devices reimbursed from the public health insurance more than type 2 diabetics. The second hypothesis was: Type 1 diabetics are satisfied with the number of medical procedures reimbursed from the public health insurance more than type 2 diabetics. Based on the research results, the conclusiveness of this hypothesis was not found statistically significant in this case so type 1 diabetics are not satisfied with the number of medical procedures reimbursed from the public health insurance more than type 2 diabetics. The diploma thesis could be helpful in extending the knowledge of not only diabetics but also the general public. I would also be very glad if my thesis was used by health insurers as a source of information about clients covered by public health insurance, namely about people with the chronic disease diabetes mellitus. In later years, this thesis might also inspire further research in this issue.

Com o aumento da capacidade de processamento de dados dentro das empresas de todos os portes e da disponibilidade de informações cada vez maior nos tempos atuais, o uso de indicadores e ferramentas de análise quantitativa tornam-se cada vez mais comuns nas mais diversas áreas, buscando-se eficiência, uma correta alocação de recursos e na geração de expectativas mais realistas de vendas e resultados. Enquanto muitos mercados apresentam uma variedade de dados e de estudos para serem usados como bases de referência, existem outros que ainda são carentes de informações básicas para planejamento e análise. O mercado de materiais cirúrgicos é um destes, onde não estão disponíveis as demandas dos clientes, as projeções de mercado ou as estimativas de market share. Este estudo busca, através da análise das vendas em 43 territórios de empresas de dispositivos médicos com atuação no Brasil nas áreas de ortopedia traumatologia, neurocirurgia e buco-maxilo-facial, aplicar a técnica de Análise Envoltória de Dados (DEA, do inglês “Data Envelopment Analysis”) como um modelo de análise comparativa de eficiência que possa auxiliar nos processos de tomada de decisão, mesmo com uma base restrita e limitada de informações. A aplicação da técnica de DEA apresenta resultados que permitem [1] destacar os pontos de melhoria para os territórios ineficientes buscando [2] homogeneizar a eficiência de atendimento por meio do [3] benchmarking entre as regiões buscando [4] uma maior competitividade neste mercado. / With the increased capacity of data processing within companies of all sizes and the currently availability of all sort of informations, the use of indicators and tools for quantitative analysis become increasingly common in many areas, allowing companies to achieve better efficiency, proper resources allocation, and the settle of more realistic performance expectations. While many markets feature a variety of data and studies, others are deprived of basic information for planning and analysis. Among these, the medical devices market have almost unavailable informations of customers demands, markets forecasts or estimated market share at a regional level. Through the analysis of 43 sales territories of medical devices companies in Brazil, this study uses the technique of data envelopment analysis (DEA) as a model for comparative efficiency analysis that can assist the processes of decision making, even with a restricted and limited database. The application of DEA technique provide results that [1] highlight the points of improvement for inefficient territories [2] in order to homogenize the efficiency of regions through [3] benchmarking between them, [4] to improve overall competitive level.

La problématique initiale part du constat que les échecs d’implants sont souvent causés par une inadéquation entre les propriétés élastiques de l’os et celles de l’implant. Aujourd’hui, ce problème de biocompatibilité mécanique suscite un intérêt croissant et a conduit au développement d’alliages de titane β-métastables qui possèdent un module d’élasticité faible, moitié moindre que celui de l’alliage Ti-6Al-4V classiquement utilisé dans les applications d’implantologie. De plus, les structures architecturées ou treillis font, elles aussi, l’objet d’intenses recherches dans le but de réduire le module d’élasticité et de maximiser la résistance. Leur mise en forme, avec une maîtrise précise de l’architecture, est possible grâce à la fabrication additive et les nombreuses possibilités qu’elle offre : liberté de design, gain matière, pièces complexes, customisation de masse... Ce travail de thèse porte sur la mise en œuvre de l’alliage de titane à bas module d’élasticité Ti-26Nb(%at.) par la technologie de fusion laser sur lit de poudres. Une stratégie d’élaboration in situ de ces alliages à partir de poudres élémentaires de Ti et de Nb est explorée, à la fois pour permettre d’éventuels ajustements de composition, et pour pallier au manque de disponibilité des alliages de titane sous forme de poudres. La démarche est réalisée avec deux morphologies de poudre, irrégulière et sphérique. Les effets des nombreux paramètres de ce procédé (puissance du laser, vitesse et stratégie de balayage...) sur l’homogénéité et la porosité des pièces élaborées sont quantifiés. Un alliage homogène peut être obtenu sous réserve de l’utilisation d’une densité d’énergie adaptée et d’une granulométrie de poudre tenant compte des températures de fusion respectives des éléments. La caractérisation de la microstructure met en évidence une texture marquée, dépendante de la stratégie de balayage. Les pièces élaborées présentent un bas module d’élasticité associé à une résistance mécanique élevée, avec une déformation élastique favorable par rapport à un alliage de référence coulé. Par ailleurs, un algorithme d’optimisation est développé et permet de contrôler les propriétés mécaniques d’une structure architecturée à partir de ses paramètres géométriques (rayon, longueur et orientation des poutres). La combinaison de cet alliage de titane à bas module d’élasticité et d’une structure architecturée développée à partir ce cet algorithme a été appliqué à une prothèse totale de hanche, qui a fait l’objet de simulations par éléments finis. L’évaluation du phénomène de stress-shielding montre que, comparativement à un modèle massif plus rigide, ce type de prothèse permet de réduire de façon significative la déviation des contraintes. En se rapprochant du modèle dit physiologique, cette prothèse peut être qualifiée de « biomimétique » sur le plan du comportement mécanique / The initial problematic arises from the fact that implant failure is often caused by a mismatch between the elastic properties of the bone and those of the implant. Nowadays, an increasing interest is given to this mechanical biocompatibility and led to the development of β-metastable titanium alloys that possess low Young’s modulus, about half that of the conventionally used Ti-6Al-4V alloy. Moreover, lattice structures are currently being the subject of many investigations with the aim of achieving low Young’s modulus and high strength. Their fabrication, with accurate control over the architecture, is made possible thanks to additive manufacturing processes and the several possibilities they offer: design freedom, reduced material usage rate, complex shapes, mass customisation... The present work focuses on the implementation of low modulus titanium alloy Ti-26Nb(at.%) by the means of selective laser melting. An in situ elaboration strategy, based on a mixture of elemental powders, is explored in order to allow potential composition adjustments and to overcome the unavailability of titanium alloy powders. The approach is carried out using two distinct powder morphologies, spherical and irregular. The effects of the numerous parameters of the process (laser power, speed, scanning strategy...) on homogeneity and porosity of the manufactured parts is quantified. A homogeneous alloy can be obtained subject to the use of suitable energy density levels and powder size distributions that take into account the respective fusion temperatures of both elements. Microstructure characterisation highlights a pronounced texture resulting from the scanning strategy. The elaborated samples display a low Young’s modulus associated with a high strength, and hence a favourable strength to elastic modulus ratio compared to the reference cast alloy. Furthermore, an optimization algorithm is developed and allows controlling the mechanical properties of a lattice structure with its geometrical parameters (radius, length and orientation of struts). The combined use of this low Young’s modulus titanium alloy with a lattice structure developed through this algorithm was applied to the design of a total hip prosthesis that was subjected to finite element simulations. Stress-shielding evaluation shows that, compared to a solid design, this kind of prosthesis permits to reduce stress-shielding significantly. By getting closer to a physiological model, this prosthesis can be qualified as “biomimetic” in terms of mechanical behaviour

Com o aumento da capacidade de processamento de dados dentro das empresas de todos os portes e da disponibilidade de informações cada vez maior nos tempos atuais, o uso de indicadores e ferramentas de análise quantitativa tornam-se cada vez mais comuns nas mais diversas áreas, buscando-se eficiência, uma correta alocação de recursos e na geração de expectativas mais realistas de vendas e resultados. Enquanto muitos mercados apresentam uma variedade de dados e de estudos para serem usados como bases de referência, existem outros que ainda são carentes de informações básicas para planejamento e análise. O mercado de materiais cirúrgicos é um destes, onde não estão disponíveis as demandas dos clientes, as projeções de mercado ou as estimativas de market share. Este estudo busca, através da análise das vendas em 43 territórios de empresas de dispositivos médicos com atuação no Brasil nas áreas de ortopedia traumatologia, neurocirurgia e buco-maxilo-facial, aplicar a técnica de Análise Envoltória de Dados (DEA, do inglês “Data Envelopment Analysis”) como um modelo de análise comparativa de eficiência que possa auxiliar nos processos de tomada de decisão, mesmo com uma base restrita e limitada de informações. A aplicação da técnica de DEA apresenta resultados que permitem [1] destacar os pontos de melhoria para os territórios ineficientes buscando [2] homogeneizar a eficiência de atendimento por meio do [3] benchmarking entre as regiões buscando [4] uma maior competitividade neste mercado. / With the increased capacity of data processing within companies of all sizes and the currently availability of all sort of informations, the use of indicators and tools for quantitative analysis become increasingly common in many areas, allowing companies to achieve better efficiency, proper resources allocation, and the settle of more realistic performance expectations. While many markets feature a variety of data and studies, others are deprived of basic information for planning and analysis. Among these, the medical devices market have almost unavailable informations of customers demands, markets forecasts or estimated market share at a regional level. Through the analysis of 43 sales territories of medical devices companies in Brazil, this study uses the technique of data envelopment analysis (DEA) as a model for comparative efficiency analysis that can assist the processes of decision making, even with a restricted and limited database. The application of DEA technique provide results that [1] highlight the points of improvement for inefficient territories [2] in order to homogenize the efficiency of regions through [3] benchmarking between them, [4] to improve overall competitive level.

Com o aumento da capacidade de processamento de dados dentro das empresas de todos os portes e da disponibilidade de informações cada vez maior nos tempos atuais, o uso de indicadores e ferramentas de análise quantitativa tornam-se cada vez mais comuns nas mais diversas áreas, buscando-se eficiência, uma correta alocação de recursos e na geração de expectativas mais realistas de vendas e resultados. Enquanto muitos mercados apresentam uma variedade de dados e de estudos para serem usados como bases de referência, existem outros que ainda são carentes de informações básicas para planejamento e análise. O mercado de materiais cirúrgicos é um destes, onde não estão disponíveis as demandas dos clientes, as projeções de mercado ou as estimativas de market share. Este estudo busca, através da análise das vendas em 43 territórios de empresas de dispositivos médicos com atuação no Brasil nas áreas de ortopedia traumatologia, neurocirurgia e buco-maxilo-facial, aplicar a técnica de Análise Envoltória de Dados (DEA, do inglês “Data Envelopment Analysis”) como um modelo de análise comparativa de eficiência que possa auxiliar nos processos de tomada de decisão, mesmo com uma base restrita e limitada de informações. A aplicação da técnica de DEA apresenta resultados que permitem [1] destacar os pontos de melhoria para os territórios ineficientes buscando [2] homogeneizar a eficiência de atendimento por meio do [3] benchmarking entre as regiões buscando [4] uma maior competitividade neste mercado. / With the increased capacity of data processing within companies of all sizes and the currently availability of all sort of informations, the use of indicators and tools for quantitative analysis become increasingly common in many areas, allowing companies to achieve better efficiency, proper resources allocation, and the settle of more realistic performance expectations. While many markets feature a variety of data and studies, others are deprived of basic information for planning and analysis. Among these, the medical devices market have almost unavailable informations of customers demands, markets forecasts or estimated market share at a regional level. Through the analysis of 43 sales territories of medical devices companies in Brazil, this study uses the technique of data envelopment analysis (DEA) as a model for comparative efficiency analysis that can assist the processes of decision making, even with a restricted and limited database. The application of DEA technique provide results that [1] highlight the points of improvement for inefficient territories [2] in order to homogenize the efficiency of regions through [3] benchmarking between them, [4] to improve overall competitive level.

Submitted by Thiago Vicenzi (trvicenzi@hotmail.com) on 2018-05-04T01:03:47Z No. of bitstreams: 1 Dissertação MPA - Thiago Vicenzi - final.pdf: 1003712 bytes, checksum: d6fa4344f3c3bbc7e1a66ac65c18a30c (MD5) / Rejected by Mayara Costa de Sousa (mayara.sousa@fgv.br), reason: Thiago, boa noite Peço que ajuste os itens abaixo: 1. O título do trabalho deve ser em letras maiúsculas 2. Está sem paginação, é necessário incluir a paginação a partir da introdução, mas contando o elementos pré-textuais. Qualquer dúvida, fico à disposição Mayara on 2018-05-04T23:06:37Z (GMT) / Submitted by Thiago Vicenzi (trvicenzi@hotmail.com) on 2018-05-05T00:15:16Z No. of bitstreams: 1 Dissertação MPA - Thiago Vicenzi - final.pdf: 1003865 bytes, checksum: b3514389c04eefb82fbafb6dece70e36 (MD5) / Approved for entry into archive by Mayara Costa de Sousa (mayara.sousa@fgv.br) on 2018-05-05T00:22:09Z (GMT) No. of bitstreams: 1 Dissertação MPA - Thiago Vicenzi - final.pdf: 1003865 bytes, checksum: b3514389c04eefb82fbafb6dece70e36 (MD5) / Approved for entry into archive by Suzane Guimarães (suzane.guimaraes@fgv.br) on 2018-05-07T13:46:59Z (GMT) No. of bitstreams: 1 Dissertação MPA - Thiago Vicenzi - final.pdf: 1003865 bytes, checksum: b3514389c04eefb82fbafb6dece70e36 (MD5) / Made available in DSpace on 2018-05-07T13:46:59Z (GMT). No. of bitstreams: 1 Dissertação MPA - Thiago Vicenzi - final.pdf: 1003865 bytes, checksum: b3514389c04eefb82fbafb6dece70e36 (MD5) Previous issue date: 2018-04-06 / Este trabalho trata da servitização e criação de valor em relacionamentos de fornecimento de dispositivos e equipamentos médicos no Brasil. Essa questão é relevante uma vez que a competição no mercado é elevada e a diferenciação pela adição de serviços pode ser uma opção para se manter competitivo. Nesse contexto, o objetivo desse trabalho foi investigar como a servitização em seus diferentes níveis pode impactar a percepção de valor do cliente. Utilizou-se as teorias de criação e cocriação de valor, a lógica dominante de serviço, servitização e seus diferentes níveis, bem como o cuidado baseado em valor de forma a entender a relação entre fornecedor e hospital e como a percepção de valor deste é relevante para a escolha de produtos e serviços. A pesquisa de campo foi de natureza qualitativa. Foi conduzido um estudo de caso na instituição Beneficência Portuguesa de São Paulo. Análise de documentos, observações e entrevistas não estruturadas com gestores da instituição foram utilizadas para a coleta de dados. Os principais resultados obtidos foram: serviços agregados são determinantes como potencial competitivo para as empresas; o balanço adequado entre flexibilidade na customização de sistemas produto-serviço e a padronização para otimizar custos é algo essencial para a competitividade; e quanto maior o nível de servitização e o consequente grau de complexidade na tomada de decisão, maior o grau de confiança necessário entre os atores. Esse estudo apresentou como principais contribuições gerenciais, a revelação de como a servitização e seus níveis podem contribuir para aumentar a percepção de valor de hospitais em relação a seus fornecedores; como os diferentes níveis de sistema produto-serviço podem ser traduzidos para o mercado de saúde; e a caracterização de um nível complexo de servitização que é aderente à ideia de cuidado baseado em valor. / This work is about servitization and value creation in medical devices and equipment supply relationships in Brazil. This issue is relevant since the competitive and complex health care market environment make suppliers search differentiation new ways offering proposals with higher added value. Therefore, this work objective is to investigate how servitization and its different levels can impact the value perception. Value creation and co-creation, servicedominant logic, servitization and its different levels, and value based health care theories were considered to understand the relationship between supplier and hospital and how its value perception is relevant for products and services selection. The field research was qualitative. A case study was conducted in Beneficência Portuguesa de São Paulo institution. Documents analysis, observations and unstructured interviews with institution managers were used to data collection. The main results were: added services are determinants in companies’ competitive potential; the adequate balance between flexibility in product-service systems customization and standardization to optimize costs is essential to competitiveness; and the higher the servitization level and its consequent complexity level, the bigger trust level is necessary between the stakeholders. This study main contributions are the disclosure of how servitization and its levels can contribute to increase hospital’s value perception related to suppliers, how different product-service systems levels can be translated the health care market, and the description of the most complex level of servitization and its adherence to the value-based health care.

Les conditions de sécurité sanitaire encadrant les pratiques d'hémodialyse (HD) et d'hémodiafiltration (HDF) n'intègrent pas les risques liés à des micropolluants comme les perturbateurs endocriniens (PE). Les patients dialysés présentent un risque de surexposition au Bisphénol A (BPA), reconnu comme PE, en raison de sa présence dans les dispositifs médicaux utilisés lors de la dialyse et du risque d'accumulation liée à leur état rénal.Nos premiers travaux ont confirmé la présence du BPA dans les dialyseurs et démontré pour la 1ère fois que l'eau utilisée en HD était également une source de contamination importante en BPA, via la production du dialysat. De plus, nous avons mis en évidence dans l'eau de dialyse la présence de dérivés chlorés du BPA (ClxBPA), sous-produits de chloration de l'eau connus pour leur activité œstrogénique supérieure au BPA. Nous avons ensuite montré que l'HDF entrainait un risque d'exposition aux PE plus important que l'HD, via la contamination du liquide de substitution perfusé chez le patient. Ces résultats permettront aux industriels de prendre en compte le risque de contamination à ces PE ainsi qu'aux médecins et pharmaciens impliqués dans la prise en charge des patients dialysés.Peu de données sont disponibles concernant l'impact clinique d'une telle exposition chez le patient dialysé et aucune étude n'a intégré le risque lié aux ClxBPA. C’est pourquoi, nous avons développé des biomarqueurs d'exposition en mettant au point des méthodes de dosage ultrasensibles du BPA et des ClxBPA dans les urines et le plasma. Ces biomarqueurs permettront d'étudier l'impact des différentes techniques de dialyse sur l'exposition des patients à ces PE. / The health safety conditions for the practice of hemodialysis (HD) and hemodiafiltration (HDF) do not integrate the risks associated with micropollutants such as endocrine disruptors (ED). Dialysed patients are at risk of overexposure to Bisphenol A (BPA), a well-recognized ED, due to its occurrence in medical devices used during dialysis and to the risk of accumulation due to their renal impairment.In a first step we have confirmed BPA contamination in dialyzers and demonstrated, for the first time, that the water used in HD was a significant source of BPA contamination, via dialysate production. Furthermore, we highlighted the presence of chlorinated derivatives of BPA (ClxBPA), by-products of water chlorination known to have higher oestrogenic activity than BPA, in dialysis water. Then, We have demonstrated that HDF leads to a higher risk of exposure to ED than HD, via the contamination of the liquid of substitution perfused in patient. These results will allow manufacturers to take into account the risk of contamination to these ED as well as physicians and pharmacists involved in patient care.Very few data are available regarding the clinical impact of such exposition on dialysed patient and no study has included the risk arising from ClxBPA. Therefore, we have performed exposure biomarkers using ultra-sensitive analytical methods to determine BPA and ClxBPA concentration in urine and plasma. These biomarkers will allow studying the impact of different dialysis techniques on patient exposure to these ED.

Teleoperation systems have been used in the operating rooms for more than a decade. However, the lack of force feedback in commercially available systems still raises safety issues and forbids surgical gestures like palpation. Although force feedback has already been implemented in experimental setups, a systematic methodology is still lacking to design the control laws.<p><p>The approach developed in this thesis is a contribution towards such a systematic<p>methodology: it combines the use of disturbance observers with the use of a structured fixed-order controller. This approach is validated by experiments performed on a one degree of freedom teleoperation system. A physical model of this system is proposed and validated experimentally.<p><p>Disturbance observers allow to compensate friction, which is responsible for performance degradation in teleoperation. Contrary to alternative approaches,they are based on a model of the frictionless mechanical system. This allows to compensate friction with a time varying behavior, which occurs in laparoscopy.<p><p>Parametric uncertainties in this model may lead to an unstable closed-loop. A kind of "separation principle" is provided to decouple the design of the closed-loop system from the design of the observer. It relies on a modified problem statement and on the use of available robust design and analysis tools.<p><p>A new metric is proposed to evaluate the performance of friction compensation systems experimentally. This metric evaluates the ability of a compensation system to linearize a motion system, irrespective of the task and as a function of frequency. The observer-based friction compensation is evaluated with respect to this new metric and to a task-based metric. It correctly attenuates the friction in the bandwidth of interest and significantly improves position and force tracking during a palpation task.<p><p>Structured fixed-order controllers are optimized numerically to achieve robust closed-loop performance despite modeling uncertainty. The structure is chosen among classical teleoperation structures. An efficient algorithm is selected and implemented to design such a controller, which is evaluated for a palpation task. It is compared to a full-order unstructured controller, representative of the design approach that has been used in the teleoperation literature up to now. The comparison highlights the advantages of our new approach: order-reduction steps and counter-intuitive behaviors are avoided. <p><p>A structured fixed-order controller combined with a disturbance observer is implemented during a needle insertion experiment and allowed to obtain excellent performance. / Doctorat en Sciences de l'ingénieur / info:eu-repo/semantics/nonPublished

Le pancréas artificiel, une technologie médicale portative, est développé pour simplifier et améliorer la gestion et le contrôle du diabète de type 1. Il est constitué de deux dispositifs médicaux déjà commercialisés, soit la pompe à insuline et le lecteur de glycémie en continu. Un logiciel spécialisé, qui est la composante innovante de ce système, ajuste automatiquement les infusions d’insuline de la pompe à insuline aux lectures prises par le lecteur de glycémie en continu. Comme toute technologie médicale, le pancréas artificiel engendre des enjeux psychosociaux et éthiques qui influenceront son succès clinique auprès des personnes atteintes du diabète de type 1, mais ces enjeux n’ont pas été suffisamment approfondis. Ainsi, ce projet de recherche a pour objectif d’identifier et de caractériser les enjeux psychosociaux et éthiques soulevés par le pancréas artificiel. Pour y parvenir, nous avons effectué une analyse éthique de la littérature biomédicale sur le pancréas artificiel suivie d’une étude qualitative des perspectives de personnes atteintes du diabète de type 1 sur cette technologie. Les enjeux psychosociaux et éthiques identifiés par l’analyse éthique et l’étude qualitative se regroupent en cinq catégories : (1) le partage du contrôle du diabète de type 1 avec le pancréas artificiel, (2) l’image corporelle et la corporalité, (3) l’encadrement optimal et les attentes réalistes, (4) l’accès au pancréas artificiel et (5) la confidentialité, la sécurité et la sûreté. Puisque ces enjeux influenceront le succès du pancréas artificiel, ils sont pertinents pour les professionnels de la santé, les développeurs de la technologie et les décideurs publics. / The artificial pancreas, a wearable medical technology, is being developed to simplify and improve type 1 diabetes management and control. It includes two medical devices that are already available on the market, notably the insulin pump and the continuous glucose monitor. Its innovative component is a software that automatically adjusts the insulin pump’s infusions to the continuous glucose monitor’s glycaemic readings. As with any other medical technology, the artificial pancreas likely raises psychosocial and ethical issues that could impact its clinical success among people with type 1 diabetes, but these issues have not been extensively studied. Consequently, the objective of this research project is to identify and characterize the psychosocial and ethical issues that could be raised by the artificial pancreas. To this end, we conducted an ethical analysis of the biomedical literature followed by a qualitative study of the perspectives of people with type 1 diabetes on this technology. The psychosocial and ethical issues identified through the ethical analysis and the qualitative study are grouped under five categories: (1) shared control of type 1 diabetes with the artificial pancreas, (2) body image and embodiment, (3) optimal support and realistic expectations, (4) access to the artificial pancreas, and (5) confidentiality, security, and safety. As these issues may influence the success of the artificial pancreas, they are relevant to healthcare professionals, technology developers, and policymakers.