New Trends in Diabetes Technology

What’s new and what’s on one device user’s wish list
By Bernard Farrell, PWD type 1

2013 Consumer Guide

I started the year with a black and white insulin pump, continuous glucose monitor, and blood glucose meter. Now I’m wearing and using, in living color, the Tandem T:slim insulin pump, Dexcom G4 Platinum continuous glucose monitor (CGM), and OneTouch VerioIQ meter. All have easy-to-read full-color screens with extra features. They’re also rechargeable and use standard USB cables.

Touch Me, Show Me
In the future, color screens will be a primary factor for me when choosing new devices. Standard cables and rechargeability are both close seconds; I won’t have to buy any more strange and expensive batteries or a special cable for each device.

Touch-screen mobile devices (think tablets, phones, and music players) are essentially ubiquitous; their rate of adoption shows no sign of a slowdown. Many people are used to always-on, wirelessly connected, easy-to-use devices. As with previous technology, costs are decreasing and capabilities are increasing. The ability to have larger fonts on these devices makes them usable even for those with severe vision problems. And if you have neuropathy, there are inexpensive pens and pen grips that make it possible to use touch-screen devices.

My Tandem T:slim is the first touch-screen insulin pump. It’s well designed and small. Tandem has done a great job using human-factors research to create the user interface, and it shows. The home screen displays all the information you need: date, time, insulin “on board,” duration of insulin action, battery charge, and amount of insulin in the reservoir.

In 2012, Abbott started selling its InsuLinx blood glucose meter, which has a large touch screen. The results are easy to read, and three lines of history can be displayed at a time. The screen also has room to display warning and error messages that are easy to understand.

The Customer Is Right
The Food and Drug Administration (FDA) tests new devices only for safety and efficacy—determining whether the device delivers an accurate dose or result safely and effectively. I strongly believe that human-factors, or user-experience, research produces technology that is not only safe and efficacious but enjoyable to use. Other research has shown that incorporating fun or enjoyment helps people while they’re completing difficult tasks. I hope we see much more of this in the next generation of pumps, meters, and CGMs.

Call Me, Maybe
For some CGMs and an increasing number of pumps (the existing OmniPod and Animas OneTouch Ping and the in-development Solo), a separate remote is currently used to display results and control the action of the device. As most people already carry phones (and meters, etc.), these extra, single-purpose devices are a burden. I believe this may pressure more device makers to consider integration with phones, which should also reduce the hardware cost of the devices.

Many wearable consumer devices wirelessly connect to smartphones and measure heart rate, exercise intensity and duration, blood pressure, and/or weight. The associated software already connects to websites so that information gathered is stored in the “cloud” and can be accessed anywhere, making it easier to share information with others, including health care providers and family.

Besides wearable devices, consumers already use more and more smartphone applications to track exercise, estimate calories/carbs, track blood glucose readings, and monitor heart rate. 

What’s in Store
I believe these forces will lead to:

Smarter, friendlier devices:
Tools that are smarter, easier to use, and much friendlier (more customization and automation so they demand less attention). Examples are the new Dexcom software and VerioIQ meter. Both point out patterns to users that may help them improve their blood glucose control.

Wireless connections: Communication between these devices and management software running on consumer smartphones, probably using Bluetooth connections, as most phones already support this.

Information sharing:
Users choosing what information they share with whom. Some of this sharing may include tweeting “good” or “bad” results for celebration or support from friends. If you don’t believe this already happens, watch a #diabetes or #bgnow Twitter feed for a while—you’ll see CGM readings and pictures of meters with 100 mg/dl on them. It’s all very encouraging.

Overcoming Barriers
There are several stumbling blocks on the way to continued device improvements.

Common language: There is no common standard for sharing diabetes data (insulin delivery, blood glucose readings, carb intake). Manufacturers or independent standards bodies must cooperate to develop standards. The recent focus on the artificial pancreas (AP) project by JDRF and the FDA may drive development of these standards to allow different combinations of devices for AP systems.

Regulation: The FDA does not currently regulate health-related smartphone software. But recent FDA guidelines will probably change this and temporarily slow U.S. development of this software.

Reimbursement: Health care providers will need to read and respond to the flood of data that will soon be coming from all these devices. If done properly, providers can use the data to recognize patterns and modify treatments to improve glucose control. Until there’s research that proves this, however, it’s unlikely that insurance companies will reimburse for this extra work.

My Wish List
Here are some of my wishes for the year.

Device makers: Form a consortium and agree on ways to get data out of all our devices. We can’t hope to get a clear understanding of our situation without this. A beneficial side effect? We won’t need logbooks anymore. Use standard cables, or Bluetooth, and make devices rechargeable. And please make control software work on Macs and PCs or, if on mobile phones, iOS and Android.

Designers: Usability is important—big bright screens so we can see results easily in sunshine and when we’re not wearing our reading glasses. Make health devices easy to use, with error messages that don’t force us to call technical support.

Users: Give feedback to the makers and designers. Ask them for features you’d like to see in future devices. Tell them that you need easy ways to get and use your data. Ask for software that runs on Macs. And watch out for chances to tell the FDA what you think. We all can benefit from your work.

Bernard Farrell has lived with type 1 since 1972. He works in software development, blogs about diabetes technology at diabetesdaily.com, and was a judge in the 2011 DiabetesMine Design Challenge.

Photo: Ted Morrison (G4 Platinum and T:slim)

Comments

Comments are subject to review and will not be posted immediately. If you have an urgent medical question, please consult a health care professional. If you have a question for the staff of Diabetes Forecast, please send it to replyall@diabetes.org.

VerioIQ

Have you been happy with the accuracy of the VerioIQ? I've been trying it along side my current meter and it seems to read consistently higher than the Accucheck.

Verio IQ and meter accuracy

I haven't been using the Verio IQ to compare it against an A1C result. So I can't give a direct comparison. Before the Verio IQ I used a meter from WaveSense that had very high accuracy ratings, and I noticed that it seemed to give higher readings that my previous meter. Despite this, I found that my A1C measurements improved.

Unfortunately testing one meter against another doesn't help determine which one is accurate. Meter accuracy is normally measured using a Clarke Error Grid that compares the meter against a highly accurate piece of lab equipment. I searched to see if I could find a grid for the Verio IQ, but no such luck.

I think (my opinion) that the only way to determine if a meter is better for you is to try it out for several months and see what it does to your A1C results. This isn't foolproof because so many factors affect A1C, but it may help you decide what works best.

Bernard

Agreed

I used the VerioIQ along side the Insulinx and contour USB and found the Contour and Insulinx always within .2 of each other and the IQ always 0.5-1.5 higher. I only did this 7-8 times so the sample size isn't huge. I stopped using the VerioIQ because of it.

Continuous Monitoring Device

Continuous Monitoring Device Dexcom: Wonderful device. It keeps me on track so easily and very comfortable. The only problem is now in the new year (even though I work for a Drug company) I can not afford to continue to use it. Is there a better way to lower the costs on some of these items that make it much easier for us to "DO THE RIGHT THING"! I have been at this for 45 years and nothing has kept me on track so well but with the costs of the other medicines I take to keep me alive it is out of my reach.

Reading devices

As a healthcare practitioner (with T1DM) my major problem is in the fact that my computers at work are locked down from importing information from pumps and meters. I have to use a standalone laptop that is shared among providers. Most of my patients still live in the digital divide and won't download prior to appointments. Handwritten logs are still the ONLY medium I have to place in the medical record to justify treatment decisions.

Smart phone apps

What is the best app for recording Bg, Carb intake, Sress, Exercise and insulin use? I'm looking fo an app that will let me use voice input to record events and hopefully graph relults. I know that"s asking a lot, but the phone can handle the processing.

Best Apps for diabetes

Anonymous, I'm not sure there's a definitive best app yet. On the iPhone platform I've tried about a dozen diabetes logging apps. To some extent they are variations on a theme and help you record some or all of the following. Blood glucose, medicines including insulin, carbs, exercise, weight, blood pressure. Some allow you to add notes with an entry. I haven't stumbled on one that records stress, though it probably would be very useful.

I have to say that some of these are very simplistic and most of them are hard to use. However this situation changes weekly and new apps should improve on the challenges with the earlier ones. For example, I recently backed an app on Kickstarter.com called The Diabetic Journal, that aims to make entering information much easier. There's another app called Endo Goddess that was funded on MedStartr.com. I expect we'll see much more of these shortly.

Bernard

CONTOUR USB

CONTOUR USB: I AM A TECHIE SO I PURCHASED THIS DEVICE ON AMAZON FOR LESS THAN $20. IT IS A THUMB DRIVE WHICH PLUGS INTO MY COMPUTER AND DOES ALL THE RECORD KEEPING YOU WOULD EVER WANT.

STEWART

T Slim

I am new to pump theropy. Just found out I am type I and not type II and am in the process of picking out a pump. I like the TSlim better than the others so far from what I have seen, read and has latest technology, etc. I am having trouble with my insurance though. I am on a diabetic program through my insurance and it has to go through the pharmacy side of my insurance to be covered under the diabetic program. The distributor said that it must have a NDC number for the pump as well as the supplies to go through the pharmacy side. Why do all other pumps and supplies have a NDC pharmacy number bar code and this one does not?
Also, I have started using the VerioIQ glucose meter as well as the lady at the top and the readings are so far off than my mini's and other meters. I like the options that the VerioIQ has, but if the readings are incorrect I do not feel comfortable using it. I have checked my figer/sugar 3 times in a row within just a minute or two and 1st time 189, 2nd 139 and 3rd 164. This is not very accurate. I tried washing my hands thoroughly and doing it again and it is the same. It is alway about 30 points off than my other meters. Is there a defect with these meters or something?
Thanks much!
Sheri Marcus

I am using a Minimed pump

I am using a Minimed pump and have thought about using a CGM, but since it is categorized as durable medical equipment, I have to meet a high deductible. Fortunately, t-strips and insulin aren't this way.

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