Cellnovo: “Mobile-connected diabetes management system”

On February 9th, Cellnovo, a company based in the UK, announced they were launching a new system comprised of an integrated insulin pump connecting wirelessly to a touch-screen handset which then connects wirelessly to their software, allowing remote monitoring of a patient’s diabetes.  They also announced that they will be performing a clinical trial looking at their new system, as well as specifically focusing on the usability of insulin pumps and wireless diabetes technology

The Good:

  • Integrated pump with handheld and software: Everything looks to be well-designed and will work seamlessly together.  In fact, the handheld will also serve as a glucose monitor.
  • Wireless and automated: Anything that is going to succeed is going to have to be wireless.  Patients already spend enough time managing their diabetes.  Asking them to do more work and take extra steps is unfair and not going to work.  This system will record your glucose values and your insulin doses without you doing any extra work.  That is a big deal!

The Not-As-Good:

  • Closed system: Though the products designed by Cellnovo should all work well together, they represent yet another closed ecosystem in diabetes.  If you like one device from one company and one device from another, sorry.  Your data won’t be shared between them.

Medtronic makes a first step towards “closed loop” with “low glucose suspend” feature

Medtronic just published results from their ASPIRE study showing decreased time in hypoglycemia for patients using their new “low glucose suspend” feature.  The new system will automatically and temporarily suspend insulin delivery if the patient’s glucose falls below a set threshold value.  In this case, the threshold of <70 mg/dl was used.

Automatic prevention of hypoglycemia is a big step forward in assuring the safety of patients with type 1 diabetes.  What will be an interesting next step will be to see if this data is reproducible in a “normal,” home environment, since this study was done by inducing hypoglycemia through exercise in a research setting.  Though we may or may not see major improvements in long-term clinical outcomes with this new technology, it seems like it may start to reduce the need for waking up with hypoglycemia and having a snack at 4am, and it seems like a step closer to realizing a “closed loop.”

I know that there are a number of patients who use Medtronic pumps and Dexcom sensors because they find the Dexcom sensor more comfortable.   This new feature requires use of both the Medtronic pump and Medtronic sensor in order to create the first step towards a closed-loop system.  I wonder whether this new feature will convince at least a few patients to switch to using a Medtronic sensor.

I’d be curious to hear comments from any patients who are in this situation and what your thoughts are.

Graph below taken from the Diabetes Technology and Therapeutics publication showing glucose values from patients with and without the low glucose suspend feature.

Texts to diabetic patients between clinic visits suggestive of benefits to care

New study published by Harry Fischer and colleagues in Denver shows increased participation in care by diabetes patients who received text message reminders between visits.  It looks like there was a big increase in the number of patients who provided glucose readings among the group receiving text messages.  Most importantly, the patients reported that they felt “more accountable.”  Accountability and patient empowerment are the trends that will continue to be more and more important and essential.

Abstract below:

Objectives: To assess the feasibility of engaging adults with diabetes in self management behaviors between clinic visits by using cell phone text messaging to provide blood sugar measurement prompts and appointment reminders.

Study Design: Quasi-experimental pilot among adult diabetic patients with cell phones who receive regular care at a federally qualified community health center in Denver, Colorado, which serves a population that is predominantly either uninsured (41%) or on Medicaid or Medicare (56%).

Methods: Patients (N = 47) received text message prompts over a 3-month period. Blood sugar readings were requested 3 times per week (Monday, Wednesday, and Friday). Reminders were sent 7, 3, and 1 day(s) before each scheduled appointment. Acknowledgments were returned for all patient-sent messages. Focus groups were conducted in English and Spanish with selected patients (n = 8).

Results: Patients of all ages were active participants. Correctly formatted responses were received for 67.3% of 1585 prompts. More than three-fourths (79%) of the cohort responded to more than 50% of their prompts. The appointment analysis was underpowered to detect significant changes in attendance. Participants reported increased social support, feelings that the program “made them accountable,” and increased awareness of health information. Two-thirds (66%) of patients provided glucose readings when prompted during the study, compared with 12% at 2 preceding clinic visits.

Conclusions: For certain patients, cell phone–based text messaging may enhance chronic disease management support and patient-provider communications beyond the clinic setting.

(Am J Manag Care. 2012;18(2):e42-e47)

The UK National Health Service encourages physicians to prescribe mobile health apps

The United Kingdom’s National Health Service, according to this Telegraph article, plans to start recommending that physicians start prescribing certain mobile health apps to their patients.  Examples include electronic reminders to check blood sugar or take a medication.  Though I’m not sure that the examples provided present the strongest use cases possible for mobile health apps, I think they’re certainly on the right track.  An app that increases the probability that someone remembers to take their medications regularly should accomplish improved healthcare outcomes and improved value.

We have to find ways of building mobile applications that patients find engaging, that they are willing to use, and that will empower them to take charge of their health.   Apps that do these things should save the system money and improve healthcare outcomes.  The NHS clearly thinks that some of these apps are ready to start serving those functions.  It will be a nice experiment to see if they’re right.

A lot of attention for the Telcare glucose meter

The new Telcare glucose meter has received a lot of attention in the last few months (including Walt Mossberg in the WSJ and in the blogosphere from DiabetesMine), as well it should.  The most important advance that this meter brings is that patients no longer have to do a separate task to record their glucose value in a logbook or to download their meters.  Currently, the only way for a provider to see a patient’s glucose values is for either a) the patient to copy them down onto paper from the meter, or b) the patient or physician to download the data off the meter.  Both of these steps have proven to be barriers to efficient transmission of information.  The Telcare system removes this barrier because there is no extra step required once the patient checks his or her glucose.  It is all part of the same, usual workflow.  Brilliant.

The drawback is that you have to use Telcare’s hardware.  You can’t use your Contour meter or Freestyle meter, etc.  This limitation will, in my view, slow adoption of this technology.

But, it is an exciting advance nonetheless.

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One other noteworthy fact is that the Telcare system uses Qualcomm’s wireless technology.  Qualcomm has established themselves as leaders in mobile health and this certainly won’t be the last innovation that uses their technology.

170 million wearable, wireless health and fitness devices by 2017

From mobihealthnews, ABI Research predicts that by 2017, there will be 170 million wearable and wireless health and fitness devices in the US.  While I assume they include CGM (continuous glucose monitor) in these numbers, having more people with diabetes wearing devices like the Jawbone Up or the Fitbit is likely to happen.  The real win will occur when the data from these devices gets truly integrated with glucose data and insulin data to help make future management decisions.  If all the data stays in silos, it’s unlikely to be of much benefit.

Glooko: A cable to download glucose data from (most) meters

While I haven’t tested this cable or software from Glooko, they seem to be on the right track.  Largely for insurance reasons, patients use a wide variety of glucometers.  Many patients have one glucometer for home, one for the car, one for work, all different brands.  Being able to download all of the data from different devices into one location is very helpful.  It should make many providers happy that the Glooko app appears to let you display the downloaded data in the format of a traditional paper glucose logbook.  While it currently only supports seven meters, they seem to be working on supporting more.