American Diabetes Association Philadelphia session

Last weekend, I headed to Philly for the ADA’s 72nd Scientific Sessions. It was my first time attending an ADA event and I found it quite interesting. Throughout the day there were speeches on all the major topics, with researchers presenting their most recent findings. The exhibition hall was also filled with device manufacturers and pharmaceutical companies.

The most interesting session I attended was on closed loop systems, the combination of insulin pumps and continuous glucose monitors. It was my first chance to hear Edward Damiano, the Boston University biomedical engineer. He was one of several speakers researching a combination pump/CGM that delivers both insulin and glucagon. The thinking is that having both hormones available allows for greater control, with one lowering and one raising blood sugar levels. Other speakers noted the encouraging results from the Medtronic Paradigm Veo. It suspends insulin delivery if blood sugars go low and the patient does not respond to alarms. Together, all the research looks quite encouraging. At the same time, I highly doubt that this technology will be widely available for several years. Multiple presenters talked about how difficult it has become to get government clearance for the U.S. market, even after approval in multiple other world markets.

Strolling through the exhibition hall, I checked out several new insulin pumps and CGMs. I was certainly impressed with the Cellnovo pump. Produced by a British team, it is one of the most stylish and well designed systems I have seen. They have certainly studied the Apple design aesthetic. The device is a small patch pump with an accompanying touch screen handset. The handset has a glucose monitor conveniently built in. Most interestingly, their pump contains an internal accelerometer for sensing the activity level of the patient. The thinking is that the pump can warn a user if excessive activity levels are about to lead to low blood sugars. Cellnovo is still awaiting approval for their system in the U.S.

Tandem’s new T:Slim insulin pump also got a fair amount of attention. It bills itself as the first touch-screen pump on the market. The device is quite small and also has a carefully considered design. Yet when you look at the details, Tandem’s product fails to deliver as great a user experience as the Cellnovo. For example, the T:Slim gives a readout for insulin on board by noting the amount recently delivered and a countdown until the insulin has passed through the system. But since rapid-acting insulins have such a clear spike after their delivery, it would be more helpful to see this data displayed differently. The last 2-3 hours of activity are rather low and should only factor in minimally to patients’ decisions.

Nonetheless, I am excited to see more competition in the pump marketplace. Medtronic currently has 72% U.S. market share. The U.S. market also represents a similar 72% of global sales. More choices for patients will certainly inspire greater product innovation.

I also visited Dexcom’s booth, which also housed the team from SweetSpot (Dexcom acquired SweetSpot in February). I am often amazed by how accurate my Dexcom CGM is most of the time. On display was their next generation CGM. The transmitter remains about the same size but the receiver has gotten about 30-40% smaller. It closely resembles an older version of the iPod Nano. The transmission range will be greater as well. They are hoping to have it on the market within the year.

With every device manufacturer I visited, I asked them about data format standardization and accessibility. Each representative had no idea how to respond to my question. None seem particularly interested in building an API to allow patients greater access to their own data. Just like developments in the hardware design, I assume it will take one or more smaller manufacturers to disrupt the current system. I wholeheartedly believe the trends in patient-centric design will mean that patients will insist on having easy and complete control over their data. It is amazing to me that hardware manufacturers continue to produce these mediocre proprietary software. Let’s hope that a new system will emerge soon that gives patient full data portability, allowing for greater software innovation. This will give patients greater options for improved feedback loops, data analysis and notification systems. I am confident these changes will empower patients and lead to improved health outcomes.

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