This fantastic rant about the frustrating state of diabetes technology from Scott Hanselman, a type 1 diabetic, has been making its way around the blogosphere and a few of my email chains. In his blog post, he decries the slow pace at which diabetes technology is moving, showing an example of a program he wrote for his PalmPilot in 1998 that was able to give him in-depth analysis of his blood sugar management. He correctly points out some of the major technological issues that people with diabetes still suffer from today, including less-than-optimal accuracy of blood sugar readings, a lack of standards and interoperability, and a lack of useful wireless technology.
Scott is dead-on in the most critical respect here: The typical workflow that a type 1 diabetic still has to endure to acquire his or her glucose values, transmit/download the values, collate values from different devices, and analyze the values is entirely too cumbersome, slow, and inefficient. The current diabetes technology industry has done little to solve this.
There are two ongoing clinical trials to be aware of.
One is at the Univ of Maryland and is using the forementioned Telcare meter. This study is a 6-month pilot study taking 100 patients with diabetes (both types 1 and 2) and randomizing them to either typical glucose meter or the Telcare meter. The outcome measures will be to see if connecting the patients via the Telcare meter will improve self-monitoring of blood glucose (SMBG) compliance, to see if A1c is affected, and to see if patient satisfaction is improved.
The other is being sponsored by a company called Diabetech with a link to the trial information here. This study is using an investigational device designed by Diabetech that attaches a self-contained wireless accessory to a glucose meter, and then transmits data to a centralized data management system. The system then analyzes the data and either sends educational materials to the patient or alerts or reports to the healthcare team. The primary outcome measures in this study are glucose control and patient satisfaction. The secondary outcome measures are HbA1c, self-test frequency of glucoses, and standard deviation of HbA1c and SMBG.
I recently learned about the West Wireless Health Institute in San Diego, founded by philanthropists Gary and Mary West, and with vice-chair Eric Topol (author of recently released Creative Destruction of Medicine). This non-profit institute is focused on fostering innovation in the field of wireless health, specifically with an eye towards cost savings. I recommend browsing their website. I think they are going to be a major force for good and for future innovation in improving health care value using wireless technology.
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
- 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!
- 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.
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.
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.