Diabetes technology is getting closer and closer to making life easier for patients.
For diabetics, keeping blood sugar in the normal range – not too high or too low – is a lifelong problem. New technologies to reduce the burden are emerging rapidly, but the challenges of insurance reimbursement, supply shortages and shifting competition make it difficult for patients to acquire these technologies quickly.
The new product is a fast-acting insulin from novo nord. It aims to help diabetics reduce the high blood sugar peaks that often occur when they eat a diet rich in carbohydrates.
The new formula, called Fiasp, adds nicotinamide (vitamin B3), which is twice as fast as insulin used in meals. The new insulin enters the bloodstream within three minutes.
Another improvement is abbott’s new monitoring device, FreeStyle Libre Flash. It is a new product in the United States, but has been available in Europe since 2014. It is a circular patch that can be inserted into a catheter for 10 days, and a durable scanner that allows users to read the sugar levels in their tissue by swinging on the patch, which reflects blood sugar levels.
FreeStyle flash allows users to monitor glucose levels without stabbing their fingers frequently for blood tests.
Libre works differently from two existing continuous glucose monitors (CGM) produced by Dexcom and Medtronic. Libre does not require users to have a blood test for blood tests, while other monitors must perform finger calibration twice a day.
In addition, freedom allows for longer wear – 10 days (euro14) and two current CGM days. Although abbott has yet to provide information on U.S. costs, its prices are likely to be relatively low. In Europe, the free system costs about 4 euros ($4.70) a day.
Unlike existing devices, however, freedom does not alert users when blood sugar levels are too high or too low. The us version does not allow “sharing”, and relatives can remotely track the glucose levels of the Dexcom glucose monitor via a smartphone app.
The free buffet for type 1 diabetes is popular in Europe. There, fewer people use traditional CGM than in the United States, mainly because they are not often protected by European insurance.
Type 1 diabetes requires regular insulin doses to allow cells to use glucose because the pancreas does not produce insulin itself. For type 2 diabetes, insulin is not produced enough to meet the body’s needs.
About a quarter of people with type 2 diabetes take insulin, some of whom take rapid insulin before meals. These doses can lead to low or high blood sugar levels if time and amount do not fully match the carbohydrates in the diet. There is a lot of user error space.
Dr. David says free radicals are more useful in people with type 2 diabetes in the United States. Ahn is a diabetes technologist at the university of California, Los Angeles. Most type 2 people don’t use CGM, and fingertick tests aren’t often used.
“I think it really gives people power, and it’s really exciting,” says Ann. “you see it directly in the effects of word exercise, diet, rest and stress on blood sugar.
Of course, he added: “everyone is fine, but the most important question is whether the cost is reasonable, at least for now I think insulin patients might be worth it, replacing insulin.”
Jared watkin, President of abbott’s diabetes care division, told Shots that Libre is designed for diabetics who need frequent blood sugar tests and that the lack of warnings is deliberate. “Alarm fatigue” is one of the two main reasons many patients are reluctant to use the CGM system, the study said. Another reason is cost.
He points out that studies of freedom have also shown that even without warning, better blood sugar control can be achieved while using the device, and less hypoglycemia can be experienced overnight, possibly because of more insulin dose adjustments, compared to finger-touch alone.
Aaron Kowalski is chief executive of JDRF, a former foundation for the study of diabetes in adolescents, which funds most research into diabetes technology. He says look at how the United States accepts people with type 1 diabetes in the free market. “If you come from your fingertips, it makes sense… For some first-class seats, I think it will be a very good choice.
End the cycle: progress and traps.
Continuous glucose testing and short-acting insulin are developing so-called “closed loops” or key parts of the artificial pancreas system that aim to automate insulin so that they don’t have to make patients complex and miscalculate how many of their dietary carbohydrates or reduce their insulin dose of exercise.
In September 2016, the U.S. food and drug administration approved medtronic 670 grams, the first of its kind to implement a closed-loop target device using an algorithm that allows the system to turn CGM’s blood glucose into an insulin pump at the user’s command, or to increase it if it is too high.
Several other companies are working on similar technologies. One of them, Bigfoot Biomedical, is working with abbott to use the next generation of Libre sensors. In addition to medtronic, other major closed-loop competitors Insulet, Tandem and beta-bionics also work with Dexcom.
Meanwhile, a group of do-it-yourself hackers has come up with ways to create their own closed-loop systems using old devices and free instructions. Because the work is not regulated by the U.S. food and drug administration, the people who did it – believe there are thousands of people – are taking risks. No big questions.
The road is bumpy, but the overall picture is positive.
Not surprisingly, everything in this field is not going well. Medtronic, which has been hit by hurricane maria because of heavy demand at its Puerto Rican manufacturing plant, will be unable to ship 670 grams of new customers, possibly unable to meet demand in 2018.
In addition, Anthem insurance said it would not cover 670G because it had concluded that “the long-term security and effectiveness of the system is not sufficient”.
Meanwhile, while Medicare agreed in January 2017 to let beneficiaries use an insulin Dexcom continuous blood glucose monitor, it recently determined that the device would not be covered if beneficiaries used a bluetooth smartphone app to read blood sugar levels at random, contrary to the definition of a “durable medical device.”
The decision means that older people must carry separate receiving devices and cannot access Shared functions. Dexcom is working with federal regulators to come up with solutions. “While Dexcom’s CGM approval is a huge overall victory, restricting smartphone integration is absurd,” Ahn wrote in a recent blog post.
In another blow to the world of diabetes technology, Animus, a major pump maker, recently announced it was pulling out of the market and moving about 90,000 existing customers to medtron. Not surprisingly, some medtronic competitors are offering deals that lure them into their own products.
“Despite the obstacles, I am very optimistic about the future of people with type 1 diabetes,” Kowalski said. “these tools are really starting to improve blood sugar and make life easier.