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Paper short abstract

Drawing on research with users and developers of the patient-led hybrid closed-loop diabetes system AAPS, the paper examines it as a site where surveillance is reworked into a collaborative and situated temporal practice, balancing predictability, uncertainty, and responsibility.

Paper long abstract

The paper examines patient-led hybrid closed-loop diabetes systems as a form of participatory surveillance that reconfigures how health is embodied, measured, and anticipated. In type 1 diabetes management, maintaining viable relations between exogenously administered insulin and the body has traditionally relied on strict, often unmanageable regimens. In contrast, hybrid closed-loop systems promise personalized and adaptive forms of care through data-driven technologies. Yet rather than resolving uncertainty, these systems foreground it as a site of ongoing negotiation.

Drawing on qualitative research with users and developers of the patient-led system AndroidAPS, we explore how diabetes care emerges through the alignment of heterogeneous temporalities and distributed forms of bodily and algorithmic memory. While co-constitutive, these forms of memory remain only partially synchronized, operating at different speeds, scales, and logics of retention and erasure. While bodies may retain metabolic traces that algorithms have already recalibrated away, algorithms may preserve patterns that bodies have already moved beyond.

The paper argues that these systems enact a form of participatory surveillance between algorithmic actions, bodily responses, and users’ decisions, continuously negotiating what counts as relevant past data and actionable futures. At the same time, developers design algorithms that connect past data to anticipated metabolic trajectories while pursuing ethical collaboration in balancing adaptability and safety.

By foregrounding temporal misalignment as intrinsic rather than problematic, the paper reframes hybrid closed-loop systems as sites where surveillance is reworked into a collaborative and situated practice of technological and bodily temporalization, balancing anticipation, predictability, and uncertainty.