The Sad State of Diabetes Technology in 2012

http://www.hanselman.com/blog/TheSadStateOfDiabetesTechnologyIn2012.aspx

by dennisgorelik • 14 years ago

161 63 14 years ago

bdfh42• 14 years ago

Fair point: If you want to disrupt an industry which is entrenched by the legal/regulatory system - you have to find ways around it.

Think education, health, law ...

Any more?

In fact from the list of the oldest professions only the "oldest" is free from regulation (only, for the most part, suffering from prohibition).

shanselman11• 14 years ago

I wonder if there was an Open Source hardware way to do this...

wissler• 14 years ago

There's no really good way around it other than by changing the attitudes of the culture. At present, people generally like their nanny state and want more of it, not less. So we'll all suffer the consequences in the meantime.

roguecoder• 14 years ago

You would also have to change the culture of business. As long as companies are out to make money instead of contribute value the force of the state will be employed to keep snake oil off the market.

pimeys4• 14 years ago

I've had Diabetes since I was eleven years old. For the last seventeen years. To be in good health, every day I have to:

* Measure my blood sugar at least six times a day

* Take at least six shots of insulin

* Always think what I eat. How many grams of carbohydrates is in the stuff I put into my mouth.

* I have to be very careful with alcohol. I've once woken up by an emergency crew while having a hangover. Never again. (Weed is much better though.)

* I have lots of small annoyances which require medical care every now and then.

* Influenza is a catastrophe - it will take ages and my blood glucose is not going normal easily.

Try to forget any of these, and bam your general health is at risk. It's not so easy all the time to be fully with your body and take care of yourself.

What I would love is a bloodless way of measuring my glucose, a way to get the results to my iPhone and a way to calculate the amount of carbohydrates I have in front of me. No, a database of different foods is not enough. I have to do it 4-5 times a day, remember.

When you have to do something many times a day for the rest of your life, it should be as easy as possible.

shanselman11• 14 years ago

Have you thought about a pump (no shots, more accuracy) and a DexCom CGM (only finger stick a few times a day, pretty accurate). I complain in the post but I will say this, of you're serious about staying alive, you MUST get an Insulin Pump.

phren0logy• 14 years ago

MD here: (disclaimer - I'm A doctor, but not YOUR doctor, so ask YOUR doctor). Seriously consider a pump. Seriously.

pimeys4• 14 years ago

I've always thought the pump is not for me. It seems to be pretty big and you always have to carry around it with you. My life is still pretty fast paced and sometimes that kind of machinery is just an annoyance to get along with. The shots are not the problem, the everyday need of full control of your life is.

gte910h3• 14 years ago

You DO have to constantly calibrate the pump though. It's not a perfect solution.

I am astounded there is not a close loop system yet.

Shivetya• 14 years ago

A pump does not remove the need for shots and as for the accuracy, well that is up for debate. You still have to learn the bias of the readings it generates versus the manual test. It is a lifestyle change from shots, you will be moving the point of insertion quite a bit and some sports may be better served with a shot regimen.

There is one nice feature of having a pump, with an always attached device you can get warnings when your asleep which can save your life. Many of these devices will either beep or vibrate or both when you enter a danger range. Even if it does not alert you it could alert whomever your sleeping with; even pets will take notice and possibly wake ya.

Last note, most insurance plans expect the pump to be replaced after a couple of years so find out up front how many years before you should expect to replace it.

SkyMarshal• 14 years ago

You, and everyone with diabetes, should seriously read the first chapter of this book [1]. The author discovered he could treat his wife and son's diabetes with a major diet change, by eliminating all foods that cause a blood sugar (and resulting insulin) spike - sugar, HFCS, grains, most processed food, etc.

His assertion is that he current method of treating diabetes is based on classical mechanics, 1-in-1-out, etc., where you measure your blood sugar and try to manually maintain it at a certain level with sugar and insulin.

But ...

1) the human body is a complex, non-linear, dynamic system. It is based on and responds to signalling, genetic triggers, etc., and ...

2) you don't need to micromanage your body, it will take care of itself as long as you don't essentially poison it.

3) the old method presumes there is something wrong with your body, when in actuality, the problem is with the way your body reacts to 'modern' (post-agricultural) foods. Diabetes is a symptom of that, so cut those foods out, and diabetes goes away.

It may not apply to all types of diabetes, IANAE, but seriously, stop by a bookstore and spend 20m reading just the first chapter (maybe 2, can't recall exactly), and figure out if it's something worth looking into further.

1. http://www.amazon.com/The-New-Evolution-Diet-Paleolithic/dp/...

Daniel_Newby• 14 years ago

> ... the old method presumes there is something wrong with your body ...

The comment you replied to is presumably about type 1 diabetes, an inflammatory disease that destroys the body's ability to produce insulin. You are referring to type 2 diabetes.

joeconway2• 14 years ago

I realise your intentions are good, but most diabetics get the paleo advice every other day.

AJ007• 14 years ago

First of all, the distinction needs to be made between type 1 and type 2, these are two different things.

If you respect Ray Kurzweil's ideas, which I think a fair number of people here do, then I would suggest anyone with diabetes concerns (at risk, got it, etc) read his book "Transcend."

Direct quote:

"Largely because of excessive consumption of simple carbohydrates and sugary foods, the number of people with type 2 diabetes in the United States has increased tenfold in the past 35 years, and as of 2008, type 2 diabetes affected over 21 million Americans. In just the 10 years between 1997 and 2007, the incidence of type 2 diabetes nearly doubled in the United States, from 4.8 to 9.1 per 1,000 people."

The reason why Paleo is recommended is because high glycemic index carbohydrates are virtually eliminated. That certainly is not the only diet that accomplishes this. In Transcend, a low calorie somewhat Japanese diet is encouraged. That is something that is extremely difficult, behaviorally, for Westerners to strictly adapt. In my own experience it took about 3-4 years of behavior modification to do that, and I ended up medically underweight. "Paleo", at least for males from what I've seen, is fairly easy.

If you disagree with Kurzweil, well then I can't say much else, he certainly knows more about this than I do.

pimeys4• 14 years ago

Yeah, but I have the type 1 diabetes, which is btw. the national disease in Finland.

One of the things that started the disease was an influenza back when I was kid. I also have the genes from my family, so suddenly I didn't have insulin in my body anymore. It has nothing to do with my lifestyles.

I've been taking care of my disease since I was a kid and believe me, I need my daily shots of insulin.

sergeo• 14 years ago

Please don't consider this as a plug, just trying to help.

Our company, MyNetDiary, provides an awesome food diary app (the only 5-star paid diet app on the iPhone). It's highly polished and uses some very advanced tech under the hood. The most frequent word in user review is "easy".

For almost a year, we are working on a special diabetes tracking app built on top of it. It does not integrate with BG hardware (would need FDA Class 1 approval), but we are exploring options.

The app will help you keep track of foods, exercise, and - with manual entry - your BG readings and insulin.

We've been doing this for 5 years and know what we are talking about - this is the best app for tracking diabetes.

It's a couple of weeks from release, we are testing release candidate. If you are interested in trying it sooner, we can provide an Ad-Hoc build for iPhone. More info: http://www.mynetdiary.com/diabetes-tracker-for-iPhone.html

My contact info is in profile.

johnnyg• 14 years ago

The CPAP industry is as bad or worse. Here are the drivers I see:

1. FDA -> Medicare -> Private Insurance. They set the reimbursement codes and what each code will pay. On the internet, you throw up a website and the customer decides if your approach has value. With a pay per code system, anything outside of the sanctioned approach is either puts you at legal risk ("you aren't allowed to do this, it is not sanctioned") or financial risk ("thanks for the better way, but it disrupts money flow X in the system, so we're not giving you a reimbursement code").

2. The "Insurance is better" customer bias. The average consumer of healthcare expects to show up, slap their insurance card down and receive treatment. This abstracts them from being the direct payment entity of the services they provide. If you piss off the patient but provide the service to code, then the insurance company will pay. If you please the customer but go outside the payment structure, the insurance will not pay. Businesses get paid.

3. Regulatory and bureaucratic haze. Go to a CPAP trade show some time, it is a different world. No one is focused on improving technology and services for the CPAP user. They want to get together and lobby to prevent reimbursement cuts. They want to make sure the business they run stays good with the new regulations and can survive the next wave of audits. They do not shop machines to find what works for the patients, they have too many other stakeholders to please: referring physicians, insurance payors, what their front lines people have experience setting up. They are an extension of a giant that has far more control and say about their own business than they do. They fight back or buck the trend, they are literally audited out of business or worse.

4. Talent Deficit. There are very few places to innovate and if you find a line and do it, you have to fight the system hating you for doing it on top of the normal startup pains. It takes very special people to want to walk that road with you. For the bigs in the industry, mfgs and large insurance based sellers of equipment, their HR departments are hiring for technical positions based on resume check boxes and history with microsoft. The products they put out are heavily windows, heavily compliant, fearful of making waves with any stake holder. You can't build a better one and win because you won't get paid and don't have a network to leverage. People who could come in and really make bold moves get on the ground, see the reality and leave to do something easier.

Aaronontheweb• 14 years ago

"2. The "Insurance is better" customer bias. The average consumer of healthcare expects to show up, slap their insurance card down and receive treatment. This abstracts them from being the direct payment entity of the services they provide. If you piss off the patient but provide the service to code, then the insurance company will pay. If you please the customer but go outside the payment structure, the insurance will not pay. Businesses get paid."

THIS. Combine this with the fact that most consumers receive insurance through their employer (and expect this too) further abstracts them from being the payment entity.

Cochise• 14 years ago

http://www.echotx.com/symphony-tcgm-system.shtml Wireless cgm and non-invasive. Passing every clinical trial with excellent accuracy too. "Coming soon" though.

brudgers2• 14 years ago

>"I've been diabetic for almost two decades"

I'd say that is more compelling evidence that the state of technology is good. Lack of bluetooth may be somewhat inconvenient, but it is not life threatening...and the lack of bluetooth is less inconvenient than dialysis several times a week.

I'm not unsympathetic toward the author's medical condition, but proprietary interfaces are even part and parcel of devices as successful as the iPhone, and it's hard to see a strong medical case for adding bluetooth to a medical device...sometimes hardwiring is just a better solution for life critical applications.

shanselman11• 14 years ago

Sure, I hear what you saying but even a crappy diabetic on shots live two decades. The tech hasn't kept me alive, diet and excercise has. Saying the current state of tech must be good because I'm alive doesn't hold, I'm afraid.

I'm concerned with quality of life and convenience. As the other commenter said, if it's something you are doing 10 times a day, thousands of times a year, you want it to be convenient.

Diabetes wears on you. It's the incessant nature of it that hurts.

brudgers2• 14 years ago

I look at the devices and think of the HP12B calculator or 37 Signals. Sometimes, a piece of hardware is just suitable for its purpose. Sometimes, less features is better design. Its a small step down a slippery slope between adding Bluetooth and requiring it to access device features.

There's a legitimate philosophy behind not treating medical devices as electronic gadgets.

hrktb• 14 years ago

Sometimes, life critical devices have to make themself desirable to the user.

It sounds stupid on the face of it, but for a 13 years old already stuffed to death with complexes, the difference between a bluetooth device no one sees and can be checked quickly, and something with tubes running through your clothes to your pants can be like night and day.

kamens3• 14 years ago

Ditto this. When I was 15/16 and considering a pump (I got one when I was 17), I was seriously concerned about social implications. That was an extra year or two spent injecting when I should've been on the pump.

I'm willing to take some of that blame for being shallow, but not all of it. I know I wasn't the last teen diabetic w/ similar thoughts.

jostmey• 14 years ago

I would have hoped that we would have a gene therapy to treat diabetes at this point in time. But alas, the medical industry has stagnated under the weight of bureaucracy and an overall decline of investment as investors demand the same kinds of ROIs as those seen in the dot-com sector.

chrisennis• 14 years ago

As an entrepreneur (and engineer) who has built two healthcare companies, I believe we'll get to a point where the speed at which innovation moves in other sectors will start to take foot in healthcare. But like everything in the space, it takes time. Sometimes too much time.

ippisl• 14 years ago

What changes you think will happen to make healthcare innovation go faster? And how can we help push those changes ?

joeconway2• 14 years ago

This is a very well articulated representation of the frustration I feel as a technically minded T1 diabetic. Thank you. I dream of the day when both my meter and insulin pen transmit data in an open format over bluetooth. It is clear that any steps that can make the monitoring and analysis of diabetic care more transparent to users will genuinely save lives.

For anyone who is disinclined to get a pump, I highly recommend the Bayer Contour USB. I've had it for a week and it is _leagues_ better than anything else I've used. I was so thrilled when I discovered that with it I could simply access my readings as an SQLite DB rather than the hell of trying to communicate with and parse the data from anything from Lifescan over a bloody 3.5mm serial port.

shanselman11• 14 years ago

SQLIte? That's brilliant.

dennisgorelik• 14 years ago

If sugar level meter and insulin pen start transmitting data in an open format - would non-technical diabetics be able to use it?

ck2• 14 years ago

The industry will never let you get off strips because the strips cost a penny or two to make but sell for $1 each.

So they make millions off insurance for the strips at the expense of society and the people who cannot get insurance.

If they ever invented a $100 device that doesn't need strips they would completely destroy the crazy profit they have.

The article didn't mention the Contour USB which is completely digital but of course still needs strips.

MrFoof• 14 years ago

>Now I wait 5 seconds but we still have blood sugar strips with +-20% accuracy

This is the part that still both sickens and baffles me. I had onset at about 20, despite not looking like a typical diabetic (5-foot-8, 140lbs). 11-years ago, my endocrinologist made sure to drill into my head this margin of error, and that the margin of error was highest in situations where I would be hypoglycemic or suffering from an insulin reaction. As a diabetic himself (and for the record, having a diabetic endocrinologist is the best thing you can hope for), he was all too aware and frustrated with the limitations.

Now, a few days ago it was pointed out that the margin of error for test strips in a medical facility is much lower. The one thing I've been waiting for is to get that level of accuracy. If there's one thing I want, it's that. More than anything. I couldn't give a rat's ass about anything else.

Getting that number consistent could've sped up the timeline in which it took to get my blood sugar levels to be consistent. I'm not terribly methodical, but at the end of the day my endocrinologist doesn't complain when my HA1C results are consistently between 6.2 and 6.6, and have been for the past 6 years, despite relying only on subcutaneous injections(1) and continued dietary changes and experimentation. However, I bet I could keep it at 6 on the nose -- while "cheating" a bit more -- if I knew that a reading was nearly dead-nuts on every time.

(1) Not a fan of pumps. My mother was and still is on TPN. After seeing the joys of dealing with infections, I prefer the very rare dermatitis.

ssorc• 14 years ago

A major reason why the accuracy on blood sugar strips is +/- 20% is because that is all that the standard (ISO 15197:2003) requires:

* Within ±0.83 mmol/L of lab results at concentrations of under 4.2 mmol/L

* Within ±20% of lab results at 4.2 mmol/L or more

Companies are juggling cost, reliability and performance/accuracy, with the first two generally winning in the marketplace as key selling points.

Some devices offer significantly better accuracy than 20%, depending on the market that you are in (not all are for sale in USA, IIRC).

rlvesco7• 14 years ago

I'd like to see the Pebble watch serve as a way to view blood sugar levels and send commands to an insulin pump ... at one point I thought about setting up a kick starter project for this, but all the issues with bluetooth seemed daunting. Thank you to Scott for making these issues heard.

gonzo• 14 years ago

there are almost no issues with Bluetooth LE. Pebble supports it, the new MetaWatch supports it, iPhone 4S and many new Android phones support it...

crisnoble3• 14 years ago

My doctor visit routine goes like this: Nurse asks for my password to login into mymedtronic.com to "download my data" this costs me 20 dollars. Nurse gets access to special healthcare only charts, you know ones that are actually somewhat useful and prints them. My doctor looks at the prints and stuffs them into my file, rubs my feet and tells me to keep up the exercise. That was a 50 dollar foot massage. I don't want to think what that would cost without insurance.

DanBC• 14 years ago

Your doctor is looking for lesions - diabetic foot kills a large number of people. The ones that don't die have a leg amputated.

crisnoble3• 14 years ago

I know that is what he is doing, what I don't know is if that was worth my time or money. I am nimble enough to see lesions for myself and smart enough to see a doc if I get one.

But that was not my main concern...

The worst thing is that instead of using the the data in combination with all their patients to form some sort of massive dataset that could help everyone... they print a chart for my file.

glennos• 14 years ago

Keep an eye on the guys at mySugr. I've had a few interesting chats where they've told me about the issues you come up against in the medical industry. They're diabetics, they get it and they're working around (and through!) it to make a really usable and useful diabetes app. It's German only at the moment, but check it out at http://www.mysugr.com/.

earnon• 14 years ago

The industry will never come up with a cure because there's more money in chronic treatments.

At the same time, why do we even need diabetes technology? Just go on a low-carb diet. My grandma was borderline diabetic a year ago. She was getting very worried, so I was finally able to convince her to try it and now her test results are great.

Even if you're a type I diabetic, this will manage your symptoms although it won't cure you. Check out "Good Calories Bad Calories" by Gary Taubes.

nopassrecover• 14 years ago

I'm not sure low-carb is necessarily effective for people with serious insulin dysregulation. I'm pretty sure for Type 1 in particular, avoiding carbs is insufficient (you also require insulin injections). Personal bias: Dad has diabetes, caused by pancreatitis, and although minimising carbs led to some weight loss (not that he is/was overweight), it has no impact on his blood sugar.

Shorel• 14 years ago

Yes, type 1 is a different beast.

The latests theories point to gluten to cause a leaky gut, that causes complex foreign molecules to enter the bloodstream, and as some molecules are similar to our own, this causes the immune system to attack some cells in our body. The cells in the pancreas that make insulin are one of these.

The bad news is that if you have Type 1, you can't be cured, and need insulin for life.

verra• 14 years ago

Treatment = profit while cure stops all income.

akandiah• 14 years ago

I can't believe that no one has suggested the use of RFIDs to measure blood-sugar levels! These guys already have a product that's under testing: http://www.positiveidcorp.com/products_glucochip.html

The only trouble with things going inside the body is the need to get FDA approval and the vigorous testing that goes along with that.

The Sad State of Diabetes Technology in 2012

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