Shortly after my daughter was diagnosed in 2001 I learned about the juvenile diabetes research foundation and the great work they had been doing to find a cure for her diabetes. Over the years I held hope that their investments in promising research done by trail-blazing scientists would pan out before she became an adult and had to deal with the potentially deadly effects of low blood sugar at night and awful complications from high blood sugar over time.

Through the course of the past 8 years I have gradually stopped trying to figure out how to get JDRF involved in the innovative research that I’ve had a hand in. My research has been focused on the here and now - lower hanging fruit for sure vs a cure found in the lab. In addition, mine is a commercial venture focused on helping people to more easily manage with the help of information technology in the form of wireless devices and some pretty slick software.

It’s taken a few $million to get here from a combination of credit cards, friends and family and the ability to win several competitive research grants from federal agencies and lesser known medical research foundations. We recently announced preliminary results from our most rigorous scientific study that showed how our technology, in the hands of patients, provides a clinically significant benefit vs. the current standard of care (ie - a full point reduction in A1c and reductions in glycemic variability all without the dependency on additional visits to the clinic or participation by their medical providers). A subsequent peer review and publication will be the final judge but I can already say that we now know a few special things that can be done today at very low cost to have a significant impact on reducing complications from type 1 diabetes.

I used to think this goal was something I had in common with the JDRF and always struggled with the fact that there has never been a constructive dialogue with them - only my pleadings and attempts to share what I have been learning along the way. Nothing ever came out of those discussions - absolutely nothing. Yet, the data shows that Diabetech and our research partners have the stuff that mitigates complications and makes life with diabetes easier for all concerned.

In light of JDRF’s recently accelerated behavior as some kind of new wave Robin Hood who takes donations from families who walk for a cure and gives millions to large multi-national corporations, I have to wonder if they are now my competitor? I also wonder if this precedent will stifle a company’s future willingness to fund R&D out of their own pocket when they know there is this JDRF bankroll in the wings? What about new investments into this field that don’t involve JDRF? It seems like that just got riskier too since your new fledgling project might find itself up against a giant waving the JDRF banner. So did they just monopolize innovation regarding diabetes technology?

Weird.

This is a topic I’ve been thinking about for a while but haven’t come up with the right angle or the interesting thoughts beyond the obvious until now I suppose. However, you the reader can be the judge of that.

Now it’s about the Medingo pump - a so-called ‘upgrade’ to the ‘revolutionary’ Omnipod by Insulet. Revolutionary in that it eliminates the tube (while simultaneously introducing several of its own technical issues and glitches). Does it make life with diabetes easier vs a pump with tubing or does it give the user better control over their blood sugars? Not so much. At least it’s not clear to me that the pump or any device for that matter can do that by itself. What if there was an all in one blood glucose meter that doubled as a cell phone with two way text messaging (they want you to say ooh here)… So what? There are already several of these by the way, including a few different versions created by Diabetech’s engineering team. My engineers would agree that these devices by themselves are a big so what. NONE of them have data to show that they are any better at helping a person to control their diabetes nor do they make life easier for the patient. What about the new iPhone diabetes mania? Again, just a tool… so what. CGM is here. Why such a mixed review by the people who are lucky enough to have this available as a covered benefit by their insurance? What about Health2.0? Again, a collection of discreet tools that ask you to spend more time figuring out how to use it by yourself as a one-off. Where’s the focus on solutions or integrating this tool with that tool… a real recipe for success? That group told me they’re not interested in that yet but maybe some day in the future. Huh?

We’re back to the question of how does all of this technology get used by the patient which determines the result.

I’ve been in this field for 8 years now and I still don’t know of any regimented program for how one would use an insulin pump to get specific outcomes. The analogy would be Dr. Bernstein’s low carb/ no carb diet as a prescriptive guide to do this behavior and get this outcome (a non-diabetic A1c below 6 aka the Under 6 Club). Perhaps this is because of the complexity of matching insulin to carbs and the myriad choices made every hour or two by the patient that makes this unrealistic to have a militaristic prescriptive for living with a pump. But why not attempt something like a diabetes boot camp for controlling blood sugar with the emphasis on the regimen and choices vs. ‘See all these new features’ and use them however you like or don’t or skip boluses or whatever. Rightly or wrongly we’ve come up with a term describing scenarios of patients and their random approaches to how they manage as The Free-Range Patient. We chuckle about this but isn’t this really at the root of why it’s so difficult for a provider to ‘manage’ their patients? The fact is that the only person who manages the patient is the patient himself. Providers should stop using ‘managing patients’ since it is entirely incorrect and perhaps gets in the way of the proper perspective which is more of a coach. Mentor isn’t even appropriate unless of course that level of relationship has truly been established which most often times it has not since that is a rare relationship indeed.

Now here’s something that doesn’t require a new device, which can save lives and give you back more sleepful nights while also helping you to improve blood sugar control. This little trick was implemented under the close supervision of our own Stephen Ponder (pediatric endocrinologist) and a team of medical staff ‘hovering’ over their kids. This revolutionary new technique is being written up by Dr. Ponder as we speak and hopefully we can grab an excerpt of it for publication on this blog soon. This new tool is called… wait for it… extended bolus. The trick is in how this tool is applied however. Very cool and worked wonders at diabetes camp this summer. That’s about all I can say so as not to steal his thunder but stay tuned for this awesome new technique that is sure to give many a real boost to their blood sugar control.

So when the bus comes by again to pick everyone up so that they can ooh and ahh about the next magical device for people with diabetes, you won’t see me getting on. What I will do is give it the sideways look and see if it helps to solve a certain problem or remove a barrier to improved self-care as part of a prescriptive program addressing a very specific lifestyle-demographic. More simply, is it truly useful or not by itself and if not, can we make it useful as part of a prescriptive system/program?

Insulet Establishes Eco-Friendly Disposal Program for the OmniPod(R) Insulin Management System Company is First in Industry to Offer Environmentally Friendly Disposal of Insulin Pump Components

Very nice to see Insulet continuing to demonstrate leadership in this field.