As I gathered my notes and thoughts about the potential of diabetes technology in 2018, I kept coming back to the running list of caveats and elephants in the room. Access and affordability have been headline-generating conversations across the diabetes community this year. On one hand, it feels a little weird to talk about crazy-advanced technology that will hopefully make its way to the diabetes community next year while we’re still trying to figure out why live-sustaining medication costs as much as it does. If you are struggling to afford insulin, do you have room to get excited about automated insulin delivery?
But, innovation is important.
The clinical trials and resources spent developing better, smarter, faster tools are essential to the grander conversation about improving the lives of people with diabetes. This shouldn’t ignore the Very Real issues that are being discussed, so I’m going to propose we try to walk and chew gum at the same time. Yes, I want better technology to help manage my diabetes. Yes, it should be affordable so that no one is priced out of quality diabetes care.
When I think about the scope and potential of diabetes technology, it’s more than just a specific product or products that may come to market. So here’s a glimpse at some of the companies and movements that I am going to pay close attention to next year as diabetes technology looks to take another major step forward in 2018.
Tandem’s PLGS Algorithm
PLGS, or Predictive Low Glucose Suspend, Tandem’s algorithm that will predict and prevent hypoglycemia events is coming next year. That’s a fact. What I’m curious to see is what’s next. Operating in the world of upgradeable firmware (instead of just hardware) is a bit of a new journey for consumer health technology. While the FDA is working to speed up their approval process, there’s certainly justification for adequate testing and validation of whatever new features that are being developed. That said, I’m quite curious to see more about what Tandem has planned beyond PLGS.
All eyes are on the blue sasquatch as their pivotal clinical trial takes center stage in 2018. After that it’s on to the FDA for submission, review, and approval. They’re anticipating a 2020 commercial release, but I just want to know: does it work? Ultimately, it will be exciting to have a new option for people with diabetes to consider as more and more technology moves in the direction of automation. And speaking of automation…
Can you close a loop if you’re wearing a tubeless pump? Insulet has a few updates coming, including the ability to control your pump with a phone through their Dash platform and Horizon, their automated insulin delivery system. Dash should be out in 2018, while pivotal trials for Horizon are expected to begin late next year. But the ones I’m most excited for are their U200 and U500 systems, which will deliver more concentrated doses of insulin to people with diabetes who require more insulin.
The G6 should bring some much-needed quality of life improvements to Continuous Glucose Monitoring. No more fussing over acetaminophen and a longer (FDA approved) sensor life are great. But I’m most excited by the potential of a no-calibration sensor. We can thank Abbott and their FreeStyle Libre for that one. Now that there’s legitimate competition, the race to innovate should accelerate improvements for everyone. But Abbott won’t be the only source of pressure for Dexcom in the coming years. With so many other systems relying on their data to automate insulin delivery: Tandem, Insulet, the Open Source community, they’ve put themselves in quite a position to support the growing landscape of diabetes technology and innovation in the coming years.
Dexcom’s API means your CGM data can show up in more places than just your receiver or phone. Dexcom and FitBit announced that early 2018 will bring the ability to see your CGM data on FitBit’s Ionic Smartwatch. What interests me is where else your data can show up as a result of Dexcom releasing their APIs to the world. I’ll be keeping an eye on Dexcom’s Developer Gallery next year, and you should too.
Open Source Solutions
I haven’t Looped. I don’t run an OpenAPS rig. I have tremendous respect for the work being done at the tip of the spear of diabetes innovation within the open source community, but respectfully, it’s not for me. That said, I look to this community for a glimpse at what may be possible “out of the box” for your typical person with diabetes who doesn’t want to get in the weeds of Pull Requests and Edison Boards. Dana Lewis reports that she hasn’t given herself a manual bolus in over 100 days? If it’s possible for the open source community, it should be possible for the device manufacturers with the resources to invest in developing a similar solution. I see the open source community as innovative fuel for diabetes solutions that I could never fathom on my own, and there’s no telling what 2018 will bring.
This one requires some disclosure. I’m the Community Manager at Tidepool. We create free software that integrates diabetes data from a wide range of devices – pumps, CGMs, meters – into one place. Interoperability and open data protocols are at the heart of what we do. My hope is that 2018 ushers in a spirit of cooperation and collaboration that is desperately needed in healthcare. Diabetes is unique with the tools and technology that can be utilized to help manage this disease, but I don’t want innovation if it comes with silos and closed development. The JDRF is in favor of open protocol automated insulin delivery systems, hopefully this enthusiasm carries on through 2018.
My last note is a bit of a wildcard. Advocacy is going to play a crucial role in how a lot of all of these fantastic new options develop. If we can’t afford insulin, then there’s no way we can afford an automated insulin delivery system. I look to T1International and the Diabetes Patient Advocacy Coalition (DPAC) to lead the way as we continue to fight for accessibility and affordability for our treatment and care. I can tie this in with my outlook on 2018 diabetes technology by reminding you all that DPAC has an app to help you stay up to date on what concerns the diabetes community most. I don’t blame anyone for wanting to run and hide from the political landscape in the United States, but if we won’t fight for the change we need, who will?
What will you be keeping an eye on next year?