In the interest of full disclosure, I confess: I wear a Medtronic Paradigm insulin pump, and am thus inclined to be particularly hard on Medtronic as a company; it’s easy to find problems with a device I interact with every day, while the grass of other companies seems so green just beyond the fence.
It comes as no surprise, then, that when I spoke to John Mastrototaro, Vice President of Research and Development at Medtronic Diabetes, about what’s next for Medtronic, I came away with a sense that while they’re doing certain things very right, they’re also doing certain things wrong.
First, the good news: Medtronic is the market leader by far right now in terms of algorithms, software, and closed-loop control. They have the right people on the job, the right goals in mind, and a massive set of data to work with. Already, the Medtronic Veo insulin pump, available in Europe (Mike Aviad just got one), is able to suspend itself when it detects from the continuous glucose monitor (CGM) that the wearer has dropped below the hypoglycemic threshold and not responded to any alarms. This feature is one of the first goals of the artificial pancreas project, and it is a good example of Medtronic’s key advantage in the field right now—they have pump and CGM integration, and they’ve had it long enough to give them a running head start towards intelligent, reactive pumping software.
And running ahead they are; while low-glucose suspend awaits FDA approval in the U.S., they’ve made substantial progress on developing algorithms that can reliably predict hypoglycemic events and preemptively suspend to prevent dangerous hypoglycemia. At the same time, they have been working on the other side of the equation—increasing insulin as the CGM wearer becomes dangerously hyperglycemic. Put together, these two protective barriers on either end of the glucose spectrum form a conservative first generation of the artificial pancreas goal of “treating to range”—that is, algorithmically predicting when glucose excursions are imminent, and adjusting insulin input accordingly.
Mastrototaro recognizes that other insulin pump companies like Animas and Cellnovo are fast on Medtronic’s heels, but says that Medtronic is going to stay one step ahead. “The way the world is moving, you’re going to have to integrate CGM,” he says, and as the other pump manufacturers work towards that, Medtronic will continue pushing forward, building pump software that takes advantage of their established integration.
And Medtronic is doing the right things to ensure good use of this early competitive advantage; they recently announced a collaboration with the American Diabetes Association in which they will fund a few (about three) small grants for researchers interested in analyzing the impressive amount of integrated CGM and insulin dosing data collected via Carelink, Medtronic’s pump-data-download software for consumers. They have an Oracle database housing over eight million patient days of pump data and millions of paired CGM-blood glucose meter reads—a big-data-nerd’s dream. Medtronic’s team has begun to look at the data and analyze what people are doing that works, but they are also opening up the data to the selected researchers. Granted, the current plan is to allow the researchers to formulate queries that Medtronic itself will run (lame), but Mastrototaro noted that if the researchers had the desire and background, Medtronic was willing to work with them to allow more direct database access (better).
Medtronic, then, is on the right path towards intelligent software in line with the goals of the artificial pancreas. So what’s the problem? Why do I walk away thinking they could be so much better if only?
Because my pump is big and plasticky, and the sensor hurts every time going in. Fine; but that’s not entirely Medtronic’s fault; their Enlight sensor, available in Europe and allegedly much less painful and more accurate, is ready to go, but being held up by the FDA. And, according to Mastrototaro, Medtronic is well on its way to a low-profile patch pump as well as the next generation of their tubed pump. Both “look more updated” and are designed to be “ergonomic,” he says.
But I am doubtful. I think they have the right idea, but suspect the execution isn’t there. While the passion and the love for data and the algorithm side is clear, I don’t see that the company ethos has an understanding of the aesthetic I really want—the user-friendly, this-wouldn’t-look-weird-next-to-my-Louboutins* aesthetic.
And I asked Mastrototaro—there is a theory that if you design a can opener, you should design it for the person with arthritis, because that will give you the best and most easy to use can opener. Who does Medtronic design for? “The non-specialist health care professional,” he said. Medtronic aims to make it as easy as possible for the non-specialist health care professional to teach someone to use the pump, to get them up and running on their own without much hassle. They want to create a “real simple solution for the very complex problem of dealing with diabetes every day.”
Really? Don’t get me wrong—that’s an admirable goal. Simple is good, and making a pump that’s easy for educators and doctors to use and to advise about is good. But really? You’re designing for the professional, and not the wearer? No wonder the Medtronic pump is so perpetually… unsexy. No wonder I can’t wait until the other pump manufacturers integrate CGM, so I can jump ship.
So, dear Medtronic, maker of my daily accessory, I implore you: you’re doing amazing things on the software side; please get your hardware act together! My non-specialist health care professional never touches the pump. I’m the one wearing the darn thing every day—design for me! Find the guy who won’t rest until every button and every edge feels like an extension of the body itself, and hire him, because it may be my pancreas that you’re replacing, but it’s my heart you’ll have to win.
* I wish. For the record, I do not have a pair of Louboutins—yet.
Editor’s note: Jessica Apple takes full responsibility for the title of this essay and apologizes for any embarrassment it may cause its author.
Photo of shoe from Kafziel/Wikipedia.