Two weeks ago, I went to the DiabetesSisters Weekend for Women conference Alexandria, Virginia. See disclaimer at the end. One of the outstanding presentations I attended was Melissa Lee’s “Diabetes and Technology”. Melissa is a respected blogger @SweetlyVoiced, patient advocate, former acting CEO of the Diabetes Hands Foundation and tech editor of ASweetLife online magazine. Qualified - YEP!!
Some people might assume that the word “Technology” means the discussion would be around Apps, Smartphones and computers. But in reality, people with diabetes have been using “technology” since insulin was first discovered. I would consider the topic of Diabetes Technology to include every device we use from the humble BG meter, insulin pens all the way to the DIY closed loop.
I met Melissa In 2015, when I was a scholarship winner at the MasterLab DHF conference and she was their acting CEO. She was diagnosed with type 1 diabetes in 1990 at aged 10 and is well known as a diabetes device diva.
She started her presentation with the basic Finger Pricker. I never thought about it before but there is so much more out there now in terms of what a glucose meter can do. For instance;
GLUCOSE METERS (The Finger pricker ones)
We have meters that are Bluetooth capabilities, connected to apps, built in bolus calculators , maybe even synced to an insulin pump, as well as the strips housed in the meter. I was actually late for Melissa’s presentation as I was talking too much with my breakfast companion :-) and only came in at the end of this slide so I can’t say anymore about it.
However, In Ireland, we have lots of choices when it comes to meters; Ascensia Contour, Glucomen, Abbott Freestyle, Lifescan OneTouch range, Roche Accu Chek range for starters. All have websites that you can google for more information.
Next up; CHOOSING YOUR THERAPY
What are our choices in how we treat our diabetes? If we didn’t consider accessibility it would be this;
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More on all of these below.
INJECTION PENS
The traditional injection pen is about to get a complete overhaul. We already have pens such as the NovoPen Echo and NovoPen 5 with memory function which has the ability to record hours since the last dose and amount of units. We also have caps that a fix to insulin pens to give you this information such as Insulcheck and Timesulin.
However, CONNECTED PENS will become a new standard in the not too distant future.
Companies such as Timesulin and Irish company Innovation Zed’s Insulcheck realized early on that the majority of the insulin dependent population uses pens and that there is a huge potential for innovation here.
In the next couple of years we are going to see Smart Insulin Pens which are connected to an electronic logbook app and will record the timing of insulin doses, how much and carb intake, etc. I really think this is going to make a difference in so many people's lives.
On July 12, both Novo Nordisk US and Glooko announced the first jointly developed product from the two companies since announcing their collaboration in January 2017.
See more information on the progress of these devices here;
- Next Generation Smart Insulin Pens
- NovoNordisk and Glooko Partner
- Five Innovators in Connected Insulin Delivery Pens not Pumps
INSULIN PUMPS
I spotted some research funded by the Health Research Board that estimates that only 14% of adults with type 1 diabetes in Ireland are using an insulin pump. This is not surprising but it’s nice to have a number. At the moment there are two pump companies available here as per HSE Contracts.
They are;
- Medtronic
- MiniMed® 640G
- MiniMed® Paradigm VEO
- There are older models available but not widely.
- Animas
- Vibe.
In the UK there are also the Roche Accuchek and the Omnipod. In the US there are only three insulin pumps companies on the market; Medtronic, Omnipod and Tandem.
With the foreseeable closure of Animas UK and Ireland I would consider the Irish insulin pump market to be an open one.
GLUCOSE SENSING (CONTINUOUS AND FLASH)
SENSING NOW
Melissa shared that only 10% of type 1 diabetes population in US using a CGM. The Freestyle Libre just got FDA approval but it’s not on the market yet. I would estimate that this is much, much smaller in Ireland, even with the Libre.
Here’s what we seem to have in Ireland;
From Medtronic
Pump with CGM
- Guardian™ 2 Link transmitter is only compatible with MiniMed® 640G insulin pump
- MiniLink™ transmitter is compatible with MiniMed Paradigm® Veo™ system and Guardian® REAL-Time CGM
- Stand-alone CGM Guardian® REAL-Time CGM system
From Dexcom
- G4
- G5 with Clarity app,
- both integrated with the Animas Vibe
Abbott FreeStyle Libre
- not integrated with any pumps or pens…. Yet and no app integration yet.
SENSING FUTURE
Dexcom G6
Medtronic 670G sensor more accurate and reliable than their current
Roche CGM Senseonics Eversense
- accurate
- implantable in doctors office.
- Transmitter worn over the sensor.
- Not waterproof.
APPS
There are a tonne of apps out there for diabetes. You will find one that meets your needs but it will take time and effort. There are apps where you manually do all the logging and there are apps that are synced to your devices.
There are also Apps such as Tidepool and Glooko, where you can upload all your devices too - neither are synced to my knowledge but I’m still researching this. This is a useful blog post on Tidepool from Test, Guess and Go.
The most used app in the diabetes community seems to be MySugr and in Ireland, both the “Carbs and Cals” and the “MyFitnessPal” apps are used widely.
Ideally, I would like a one4all app that syncs all devices. Still looking.
DIY SYSTEMS closed loop
What is closed loop? We have insulin pumps where we manually tell it how much insulin to give us and we have CGM’s that tell us what our glucose levels are at at any time. Closed Loop is creating the missing piece that allows the CGM to talk to the Insulin pump and tell it what to do.
Diabetes companies are working really hard to package a complete Closed Loop System, however, a couple of talented people have already done it by hacking the devices and creating a computer programme which they have shared online. In effect, people are creating their own DIY Closed Loop Artificial Pancreas. #Wearenotwaiting
There are two Automated insulin delivery systems;
- Loop
- OpenAPS
One of the benefits of automated DIY over smart pumps is that it gives you More control over your own perimeters.
Melissa has been using the Loop version for two years and showed us how the system changed her basal rates automatically 100 times the previous day. How can a human possible even try to do that manually????
I’ve been following Diabetogenic’s journey with The Loop to find out more.
THE FUTURE
The best thing about moving forward in diabetes tech is that so many companies are doing stuff here.
- Tandem, Dexcom and TypeZero are working together on the integration of their technologies into the NIH-funded International Diabetes Closed Loop (IDCL) Trial.
- Tandem is working on development of an insulin pump that integrates the data from a Dexcom G6 sensor and Type Zero's inControl algorithm directly into the pump’s touchscreen interface.
- Omnipod Dash coming to US in 2018 and integrates Bluetooth into the body-worn, tubeless pod, and use a transformed, locked down Android smartphone for functions currently performed on the personal diabetes manager (PDM) handheld device.
- Omnipod Horizon Automated Glucose Control System (to automate insulin delivery with Dexcom CGM) is slated for a “late 2019” launch.
- Beta bionics plans to launch it’s iLet artificial pancreas in 2019 but just insulin only followed soon after by dual hormone (insulin + glucagon) version.
- Bigfoot Biomedical automatic basal adjustments system completed clinical trials last year and is launching the next phase clinical trial in 2018.
In a nutshell, there is A LOT to watch!!! This makes me happy because there is a lot of research happening in this industry and a lot of investment.
Disclaimer: Diabetes Sisters paid for my conference registration and accommodation but also gave me a contribution towards my travel costs. All they asked for in return was that I would write a blog post about the conference which I had to do anyway because I learned so much that needs to be shared;-)