Tag Archives: Diabetes Technology

Let’s step back and review.

Interesting headlines this week out of the annual Endocrine Society meeting in New Orleans, as Medtronic received some scrutiny after a presentation revealed that over a third of study participants using the Medtronic 670g here in the USA abandoned the system.

This is one of those stories where I feel we need to take a step back and consider all sides of this revelation.

First, from what I’ve been hearing and reading from others, this is not a complete surprise. This is also in keeping with word of mouth I’ve been getting from users of the 670g myself. What was most surprising to this observer is that it was actually put in writing and published.

But let’s look a little closer: the study cited in the presentation included only 93 participants, aged 6 to 25… hardly a large cross-section of users of this device. In fact, I know users in their 30s, 40s, and 50s who are still using the 670g.

According to the news report linked above, while the primary reason for giving up on the system was trouble staying in automode, other reasons given included “technical difficulties with use of the system, such as frequent alarms, premature sensor failure, requirement of calibration, skin adhesion problems, and sensor supply issues”.

Most of those other reasons are things we’ve heard before, and should be things that can be improved upon. I also remember reading about sensor supply issues after hurricane Maria hit Puerto Rico… something that, again, should not be a long term issue.

Look, I get it… who wants to sign up to wear a medical device after they hear that 38 percent of users in a study don’t want to use it anymore? But let’s remember this was the first system of its kind approved by the U.S. FDA. While no one was going to make a copycat device, submissions approved after the 670g did have something to go on when seeking approval for their systems.

And let’s be honest: weren’t we all clamoring for faster FDA approvals for new medical devices just a couple of years ago? Weren’t we saying that we’d take less than perfect in order to have a better opportunity at time in range?

Now, before you decide that I’ve taken a stand on one side or other after hearing this news, please remember that I’m trying to stand right in the middle. Of course, if you stand in the middle of an intersection, you run a bigger risk of being run over by a truck. But I digress… what I’m really saying is, finding out that results of a study involving 93 people, all of whom are over 30 years younger than me, isn’t going to move the needle when it comes time to decide on a new insulin pump later this year.

We all have decisions to make when it comes to medical devices we wear, or whether we decide to wear any at all. Those are our own personal decisions. This story gives us more information to go on, but it’s still our decision to make when the time comes.

Being in a position where we actually have the opportunity to choose (I’m looking at you, United Health Care and Medtronic) is what’s most important. Because if either patients or companies are going to make decisions based on headlines like this, in my opinion, those decisions are a bit hasty indeed.

Recent Technology Developments: Where are we headed?

I don’t want to bury the lead here. Okay, I want to bury the lead slightly, because I’m hoping you’ll take the time to think about that question from every possible angle.

Okay… with that in mind, where are recent diabetes technology advancements headed?

I really have no freaking idea.

There have been developments though, and I’m more than interested in their impact on our community. Some of it involves rollout of new devices. Some of it is a form of consolidation within industry. Some of it involves individuals taking things into their own hands and accomplishing what industry has been unable to accomplish yet.

As far as not knowing about every last thing? That’s okay with me. Because things change all the time, especially when it comes to technology. And even if I knew the implications of everything today, when things change tomorrow, I’ll be right back where I am at this moment.

We know that in most cases, change is good for the technology landscape. Innovation and success in innovation often leads to better products down the road, even if the innovation is only improving on an existing idea.

You have to admit… it’s a pretty exciting time for diabetes technology. Consider these tech innovations that have hit our world in the last year or two:

– Medtronic 670g hybrid closed loop system
– Freestyle Libre CGM (no calibrations); followed shortly by
– Dexcom G6 CGM (no calibrations)
– Improvements of and an increase in the prevalence of diabetes management apps
The $250 Biohack That’s Revolutionizing Life With Diabetes
(from Bloomberg)

I have to admit that I haven’t followed diabetes technology developments as much as I used to. I’m just too busy. A couple of years ago, I would have been all over each of those bullet points. Today, each new development gets a quick read from me, and then it’s back to the advocacy part of my diabetes life.

But I’m still excited about the next shiny new diabetes technology toy that rolls out from one place or another. I don’t expect everything to be perfect for everyone. But let’s face it… Banting and Best had to start somewhere too.

Here’s hoping that today’s efforts result in tools that will have impacts that last just as long and help just as many people as their efforts.

The Last Five Years.

There’s a play, from a few years back, with words and music by Jason Robert Brown, called The Last Five Years. This post isn’t anything like that, but when I was listening to music from this show a few days ago, I did, indeed, reflect on the last five years in diabetes.

Have you thought about how much has changed in diabetes in the past five years?

You need to go no farther than your Facebook, Instagram, or Twitter feed to find examples of the latest drug, device, app, or DIY AP (Acronyms!) that someone is using. And that’s just fantastic, whether you use any or all of these things.

The Lions Club meeting I attended and spoke at last week had to do with food, and its role in helping People With Diabetes get and stay healthy. One of the things I told this group is that our food choices are important. But I also think of using a toolbox approach to managing life with this condition.

Knowing what specific groups of food do to your blood sugar, and making informed choices based on what you know, is just one tool in the box. Now, let’s take a look at some of the other tools added to our toolbox in just the last five years:
 
 
What about the new classes of drugs available today? They may be expensive, but there’s no question that medications like Victoza, Farxiga, and Afrezza have been beneficial to managing blood sugar, and helpful in just giving us more options to choose from.

I’ve been one of the loud lamenters of the fact that PWDs are down to just three insulin pump choices in the USA now. But what is available seems to be an improvement over previous versions of insulin pumps. Just ask anyone using the t:slim x2, the latest Omnipod, or the Medtronic 670g.

While insulin pump choice is shrinking in my country, continuous glucose monitor options are expanding. Abbot’s Freestyle Libre has been approved by the Food and Drug Administration, and we’re all anxious to find out if it works as well as we’ve heard it does. Which brings me to…

DIY artificial pancreas adopters! This is what the hashtag #WeAreNotWaiting is all about. There are Facebook groups, in-person user group meetings, and people flashing their rigs on Instagram and Twitter. Did you see this coming five years ago? Where will it be five years from now?

There are tons of diabetes apps out there. And more are coming online every day. Some do bolus calculations, some display your CGM reading on your phone (thanks Dexcom), and some allow you to download all of your devices in one place, then allow your medical professionals access to the uploaded data. I’m sure someone was thinking about this five years ago, but it wasn’t me.
 
 
Our lives with diabetes, much like diabetes itself, is ever-changing. It’s interesting to look back on the Last Five Years and see the myriad of changes that have occurred. It’s exciting to think about what The Next Five Years will bring.

Technology: More to think about, in a good way.

I got through reading this thouroughly engaging post from Kerri Sparling over at diaTribe. It’s a very helpful post that gives People With Diabetes real information to consider when deciding whether to share or not share continuous glucose monitor (CGM) data via NightScout, the Dexcom G5 Mobile CGM, or MiniMed Connect/Carelink.

As I said, I thought the post was very helpful, but what also struck me was how we now have three different BG data sharing platforms to choose from.

When I considered that, I had a reaction that went something like: “Wha… what? Two years ago we didn’t have any! Now there are three!”. On the surface, it’s a no-brainer. Why not be able to share data from your CGM? But it took Nightscout, in my opinion, to get that ball rolling. Once people, and mostly device makers, saw that, and considered the possibilities for themselves, they were all on board. Makes perfect sense.

But there’s something else to consider too. Think about this: If you’re using a CGM and you decide to share, you now have to decide who to share your data with, and the rules regarding that shared data. It’s as if the gods said “Well, you don’t have enough diabetes stuff to think about already, let’s roll out something new to give you even more to worry about”.

That’s in addition to the fact that we now have, essentially, three separate apps sharing data across three separate platforms. It’s great to have choices. The more choices we have, the more likely it is that we’ll find something we really like. We need that. But again… more decisions. Which to choose? That’s easy if you’re using the Enlite sensor from Medtronic. But if you’re a Dexcom user, you have two options to choose from.

On the other hand, these are good problems to have. And parents of kids with diabetes, especially, have been wanting something like this since forever. I know, because I’ve asked them. I’ve been at JDRF Type One Nation events where parents see remote monitoring for the first time and simply ache for it. For them, it’s choices, schmoices. They’ll take anything as long as it works, because it allows for both more freedom for their child, and more knowledge of how the child’s diabetes is performing throughout the day. More choices? More decisions to make? Bring it on! They don’t care. Parents are awesome that way.

It’s very interesting for me, this realization that these three data sharing platforms seem almost ho-hum now. Sharing CGM data already seems like it’s been a part of our lives for quite a while. But it’s been less than two years between having and keeping CGM data to ourselves, and having the ability to share it with people a world away.

We live in a fast-paced world powered by technology. The latest innovations are making their way toward us faster than ever. The trick will be, of course, in not investing our time working for our data. But rather making the data work for us, for our health, for our safety, for our happiness.

You know what? We are worth it. #WeAreNotWaiting
 

What’s the ETA?

ETA… Estimated Time of Arrival. It’s almost an antiquated term in today’s english, often passed by in favor of terms like “When can I expect that?” and “What’s your hard deadline?”.

When it comes to diabetes, we’ve almost been conditioned at this point to stop asking when a cure will happen. Many don’t believe there will ever be a cure, and many more believe, but aren’t holding their breath for it.

In fact, hearing phrases like “We’re so close to a cure” or “It could happen in your lifetime” (to someone of my age), or the previously ubiquitous “Within five years” is one of the easiest ways to identify someone not in the know on such things.

Many organizations have, while championing a cure, backed off of anything that might even possibly be construed as a promise of a cure for diabetes couched within a specific time frame.

I’ll admit that this is good, because it keeps people from becoming overwhelmingly disappointed when a cure doesn’t happen within the window in which we might have expected it. Often, it allows us to say that a cure is not imminent, so let’s work on making diabetes easier to manage in the meantime. I am all for that.

But since I’m a both-sides-of-the-coin type of person, I will also admit that not expecting a “just around the corner” cure for diabetes, sometimes, feels like an excuse to hold off finding a cure for even longer. Sometimes, just to develop more products. Things that will keep us paying through the nose, that will make things easier for People With Diabetes, but will siphon off money for other things that family members of People With Diabetes could really use.

It’s the skeptic in me that asks: How many People With Diabetes can’t afford to send their kids to college due to the fact that their out-of-pocket medical expenses range in the thousands of dollars each year? How many can’t afford to keep up with repairs to their homes? I’ve been one of those people.

I don’t really sit on either side of this question. How could I? I mean, hell yes… I want a cure. I want it yesterday. But in the absence of a cure, I also think that an artificial pancreas system is a remarkable development, and should continue to be funded through to completion. And then improved upon after that.

That’s where I’m going with this post… how do I justify championing improvements in therapy, drugs, and devices, without losing sight of, even a little bit, of the need for a cure? I’m torn when I think about it. I get that little twinge in my gut that has always been a benchmark for me to look at a situation with a fresh set of eyes.

I also have a fresh sense of respect for those who are both working on ways to improve our lives with diabetes, and are still passionate about a cure for this awful disease. I think that’s a tougher tightrope to walk than I’ve been giving people credit for up to now.

My goal from this point forward? Right now, I think it’s to remember that a cure is still incredibly important, and it should be worked on and funded, and should not take a back seat to CGM In The Cloud or Inhalable Insulin or any of the latest developments. It’s important to keep asking: What’s the ETA on my cure? Yet both sides of the equation are important. In many ways, equally important right now.

When we talk about a cure, let’s remember the amazing steps in improving diabetes management that have happened, and are still happening. Likewise, when talking about improvements in diabetes management, let’s not lose sight of the ultimate goal:

The Cure.
 
 
 

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