Technology

DX2 Sydney

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Two weeks ago, I had the privilege of attending Abbott’s Diabetes Exchange event in Sydney (see below for disclosures). I went into this event excited about trialling the FreeStyle Libre, and meeting some of the other Australian bloggers in person. Having only communicated with PR ladies Hannah and Laura prior to the event, I was surprised to learn that there was an Australian based Abbott team. I was also pleasantly surprised that they were such a core part of our proceedings over the two days.

Peter, Bruce, Michael, Pamela and Jen were with us throughout the whole two days worth of proceedings. They each presented in front of us, but they were also very much with us in a social context, too. They dined with us on Thursday evening, they sat next to us during the formal proceedings, and they also put their cooking skills to the test with us on Friday afternoon at the Sydney Fish Market.

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Going into this event, I honestly wouldn’t have thought I’d have anything in common with these guys. They were there to sell us a product, after all. However, I had some really great conversations with most of them. Although not all of them had diabetes themselves, I could see how genuinely passionate they were in the work they did. I could see how genuinely interested they were in us. Not just about the diabetes, either. I recall speaking with Jen, in particular, for at least an hour at dinner on Thursday.

One of the highlights of the event was hearing from Udo Hoss, who talked us through the “science” of the FreeStyle Libre.

We learned about how the Libre sensors were clinically proven to produce accurate and consistent results across their whole 14 day life. I learned about the term Mean Absolute Relative Distance (MARD) from regular blood glucose checking. From memory, the MARD must be below 15% in order to be a reliable indicator of glucose levels. The Libre system achieved a MARD of 11.4% across its 14 day sensor life, making it accurate enough to make insulin dosing decisions from. For this reason, Abbott are pitching the Libre as a replacement for finger pricks.

Given that the MARD is slightly higher during the first 24 hours, I cheekily put my hand up and suggested that we should receive an extra day’s worth of sensor life to compensate. There was a lot of laughter in the room, but sadly no leeway!

There were also three conditions where we were told to confirm a Libre scan with a finger prick.

  1. When glucose levels were low.
  2. When symptoms don’t match glucose readings. (Corrected)
  3. When glucose levels are rapidly changing.

We raised the question of how we would be able to push the sensor life beyond it’s 14 days. Unfortunately they automatically shut down, as Abbott cannot guarantee their accuracy or safety beyond the 14 day life.

We were also told that the data lagged by about 6 minutes.

It’s easy to sit behind a computer and complain about something being too expensive, or something else being difficult to access. Trust me, I’m guilty of it. Yes, Abbott are a business, and like any business they are trying to sell us a product. I acknowledge how privileged I am to be able to try this product free of charge. The $95 price tag for each sensor will place it out of reach for many, I’m sure.

That being said, sitting in with the team from Abbott really gave me a greater appreciation for the whole product. I had a much greater appreciation for the whole research and development process, and not just the item that I see on the shelf at the Chemist.

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Thanks again to the team at Abbott for your great hospitality, and for having me at DX2 Sydney.

You can learn more about the Australian launch of the FreeStyle Libre at freestylelibre.com.au.

Disclosure: Abbott paid for my travel expenses to and from Sydney. I received a FreeStyle Libre reader and two sensors free of charge. There was no compensation, or expectation that I would blog about the event. All opinions expressed here are my own.

Saying ‘Yes’ To An Insulin Pump

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I’m a terrible decision maker. My family often laugh at how long it takes for me to decide what I’m going to have for lunch or what movie we should watch in the evening.

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Switching from Multiple Daily Injections to an Insulin Pump is arguably one of the biggest decisions I have made in my life. Thinking about the time, thought and research I put into that decision, I realise that this is one of the few instances where my meticulous decision making was worth it.

Thinking about an insulin pump? Although I’ve written a lot about this decision over the past few months, I really wanted to stress in one post just how big of a decision it was.

I never really thought too much about insulin pumps before I started my blog and made connections in the Diabetes Online Community. I thought that they were only for young children, or for people struggling with their diabetes. Seeing others share so openly about their lives with pumps, particularly those within the wonderful OzDOC community, motivated me to find out more.

I attended an information evening back in October that was hosted by Diabetes WA, the diabetes organisation in my state. The evening covered the basic concept of insulin pumping. Representatives from the pump companies were present to show us the devices themselves, and I was able to grab information packs to take home.

The downside of this session was that I found it a little too light and fluffy. I recall the host making the statement “very few people give these back to me and say they don’t like it.” The session brushed over the seriousness of pumping. The representatives from the pump companies were a little too pushy. I didn’t feel comfortable going over and talking to them, because I was only seeking information at the time. I wrote about that night in more detail here. I do wonder how many people were convinced into signing up for one straight away.

Following this session, I decided to get back in touch with my diabetes educator, Gwen. This was a big step for me, considering that I had not had a formal appointment with her in a few years. My nerves were instantly relieved, and Gwen picked up as if our last appointment was only yesterday. She covered the topic of insulin pumping comprehensively and with the seriousness it deserved. She never displayed any bias, and respected that the decision was mine to make. You can read more about our session here.

Gwen gave me the option of making the decision on that day back in November. I could have said yes then and there. I knew full well that the wait for the pump would be even longer if I went home that day and made the decision at our next appointment. I could have said the words “yes,” but I knew that I wouldn’t really be convinced. I fought my feelings of urgency, because I knew deep down that I wasn’t ready to make such a big decision. I went back home and talked about it. I read about it. I thought about it.

By the time I came back to see Gwen in February, I had a much clearer head.

By taking the time to say yes, I felt much more confidence in the decision I had made.

Let the countdown to the big day in May begin…

FreeStyle Libre To Hit The Australian Market

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Updated: You can read about the blogger event I attended in Sydney here, and my initial review of the product here.

Okay, well in case you haven’t heard this news already…

Abbott’s FreeStyle Libre Flash Glucose Monitoring System recently received approval from the Therapeutic Goods Administration in Australia, and is expected to be launched in the Australian market in the coming months.

The Glucose Monitoring System consists of a small round sensor that is worn on the back of the upper arm, and a “reader” that looks very similar to a blood glucose meter. Users need only scan the reader over the attached sensor in order to receive a reading, and 8 hours worth of historical data.

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The Libre has a few key differences that sets itself apart from a traditional Continuous Glucose Monitor (CGM). The sensor appears to be much more discrete, approximately the size of two stacked 20 cent coins. Sensors also have a life of 14 days, as opposed to traditional CGMs which last up to 7. Abbott also claims that the Libre eliminates the need for finger pricking, making glucose testing more convenient and discrete. Alternative CGMs need calibrating with finger pricks, and only guarantee glucose trends rather than historical data.

Unlike a CGM, however, the Libre is not a “live” glucose monitoring device. It is up to the user to complete the scan in order to obtain a glucose result and historical data. There are no alarms or indicators to alert the user when they are going high or low. I also don’t believe that there is any “sharing” functionality of data through smartphones, which many CGM users in the DOC place a high value on. It appears that data can be downloaded to a computer and generated in report format, similar to the Insulinx meter I have been using recently.

I know that many folks in the Diabetes Online Community do pay for the convenience, live data, sharing and peace of mind that a CGM offers them. I know that many have come to rely on this standard in their diabetes management, and I wouldn’t expect that the Libre would hold much appeal here.

I have previously expressed reasons for not wanting a CGM myself. I’m quite motivated to do my finger pricks as much as I need to. I’ll be switching to an insulin pump in May, and I can’t say I’m keen on wearing two devices. I can’t say that I could handle seeing “live” data all the time. At $75 for a sensor that lasts only 7 days, I can’t say that I can afford it either.

I believe that this is where the Libre would hold the greatest appeal.

I also know that for many who would like one, a CGM is out of reach. At a time where there is a strong push for greater access to glucose monitoring technology in Australia, the arrival of a new competitor in the Libre is an encouraging sign. I have only heard positive things about the Libre from European folks in the DOC who have tried it after traditional finger pricking.

The biggest factor here is likely to be the cost of the Sensors, which need replacing every 14 days. While Abbott is yet to comment, Seven News speculates a shelf price of $100 per sensor. Given that CGM sensors are not currently subsidised by the National Diabetes Services Scheme (NDSS) in Australia, I would not expect that Libre sensors would be, either.

You can read more about the FreeStyle Libre, and sign up for e-mail updates at freestylelibre.com.au.

Disclosure: Abbott sent me a Press Release regarding this news. I was not asked or paid to write this, and all opinions expressed here are my own.

Do Diabetes Tech Companies Really Care?

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A few weeks ago, a post from Medtronic Diabetes Australia caught my attention on Facebook.

“We are asking the Australian Federal Government for a commitment of $4.4 Million this current financial year to potentially save 1,537 lives from the devastating consequences of type 1 diabetes.”

Medtronic’s lengthy article, which you can read here, was basically advocating for the Australian government to fund Continuous Glucose Monitoring. Something that I would very much like to see happen in the near future, evidenced here and here.

I have nothing against Medtronic. I’m sure that my rant would be equally applicable to every other diabetes tech company offering products and services to people with diabetes.

However, I just find this difficult to wrap my head around.

I get that Medtronic, along with every other diabetes tech company, is a business. I get that without companies like Medtronic, revolutionary technology like this would not be available to people with diabetes. I get that research, development, marketing, distribution and other operations cost money. A LOT of money. And then Medtronic is a business, and understandably wants to reap a nice reward for their efforts.

But still, Medtronic advocating for the consumer just doesn’t sit well with me.

I just don’t feel as though they would genuinely care, the same way that I do as I’m writing this post. I don’t feel as though they really care that, to quote Medtronic:

“People who are hypo unaware are six times more likely to have severe hypoglycaemia leading to seizures, coma and even death. Having hypos leads to more hypos and the increased risk of these severe events.”

It just seems as though it’s in their best interests to advocate. It seems as though they have something to gain from their advocacy efforts.

First up, it makes them look as though they are on the customer’s side. It makes them look like they care, lobbying the government for funding towards a life saving device. Big tick for Corporate Social Responsibility there.

Second up, if their advocacy is successful in obtaining government funding, Medtronic has everything to gain. Business! More people will adopt Continuous Glucose Monitoring devices because they are cheaper to run. More people will purchase the consumables in order to continue running the device. And since diabetes isn’t going away anytime soon, there’s a good chance that the customer will keep purchasing the consumables. Triple win!

I hold nothing against Medtronic for running a business. A business that, from what I hear, makes the daily management of type 1 diabetes much easier. A business that, should I choose to in the future, could make my own diabetes management much simpler.

But Medtronic does not have diabetes. Medtronic does not go to bed feeling defeated from a day of highs. Medtronic does not wake up in the middle of the night, sweating from an intense low. Medtronic does not feel the impact of dealing with a chronic condition day in, day out.

That’s why advocacy from a company with a financial interest in diabetes will never sit well with me.

Diabetes Tech: A Cure of Sorts?

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It’s no secret that my cure faith is not very strong. I don’t really live my life expecting, or hoping that my diabetes will be cured tomorrow. This post sparked a fair bit of conversation two weeks ago.

For the record, I define a cure as a means to regulate my blood glucose levels without any action from myself. No finger pricks, no carb calculating, no insulin injections, no treating hypos and no thinking about the whole diabetes thing! Long, uninterrupted nights of pure sleep and leisurely days free from the stress of managing diabetes would be very much preferred.

Although I’m hardly a diabetes veteran, technology has only come in leaps and bounds over the years. And I believe that’s what we are going to have to accept as a cure, of sorts, for the time being.

I believe that the right kind of technology could be a cure of sorts. There’s talk in the Diabetes Online Community of “closing the loop” – i.e. insulin pumps and Continuous Glucose Monitors (CGMs) that “talk” to each other. There’s artificial pancreases in development, and there’s always research surrounding insulin producing cells that could one day be a game changer for us all.

Technology will inevitably make diabetes easier to manage, going forward.

Technology is spectacular. Technology means a lot to many who already use it to manage our diabetes, evidenced here. Technology would be life changing to many, evidenced here and here. Technology provides our health with the best of prospects. And I know that I am extremely lucky to be living with diabetes in 2015, rather than 1915.

But technology is damn expensive, too. And that’s the one thing that worries me.

Research and development into new diabetes technology is costly. Then there’s marketing, promotion and distribution costs. And then of course, the business is a business and needs to make a nice profit from their efforts, too.

But where does that leave the humble young adult from suburbia, working his way through life on a less than spectacular wage? Where does that leave the parent of a young child, managing diabetes on top of family and work commitments? Where does that leave the person living in a developing country, unable to access basic healthcare and diabetes supplies? Did I mention these people are all affected by diabetes?

The sad truth is that diabetes technology, and the closest thing we have to a cure, is still out of reach for many of us. I refuse to adopt a CGM, because I can think of a million other things that I’d rather invest my hard earned money into. I count myself lucky that I am in an independent situation where having a CGM is not a necessity for the time being. For many people with diabetes, it certainly is.

Research and development needs to be conducted with an end game in mind – the consumer. These advances in diabetes technology need to be accessible and affordable to the consumer. Otherwise, I fail to see how we are doing anything to help people living with diabetes. Other than making them feel marginalised, deprived and isolated.

I don’t want to place the blame on any one party. Personally, I’d just love to see government, researchers, diabetes tech companies and diabetes organisations come together to find a solution. I know, easier said than done.

The only cure that I would give everything for, is a proper one. A cure with a one time cost that leaves me forever free of diabetes. A cure that is not reliant on devices, consumables, batteries, cable cords and credit cards. Now that, I would happily give all of my life savings for.

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