VIDEO: Areas of unmet need relating to diabetes technology

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We've made a lot of progress, and certainly, in the last 20 years, there are amazing tools that we didn't used to have. I remember 20 years ago people talked about an artificial pancreas. It's like the equivalent of a Tesla that's just like a Tesla will get you where you want to go with no input, an artificial pancreas will get your blood sugar where you want it to go with no input. It contains a continuous glucose monitor and an insulin pump and software, and the pump delivers the amount of insulin that you need. When we first started talking about that, many people said, "That's impossible. "It can't happen," but it did happen, but even the artificial pancreases of today are not perfect, and there's room for improvement. I know there are many companies who produce them and who want to start producing them that are going to come out with even additional features we don't see today.

Another area that I think is an unmet need is better use of data that's in the electronic health record. We've got to unlock this data. There are services that can do that, and they're going to be very useful. A hospital that has millions of patients has potentially so much information that could be extracted about which treatments work, which ones don't work, what are the side effects? And I'd like to see better use. Some hospitals just don't really know how to get into their electronic health record, or they get in poorly and the report they generate is not very complete, but I think we're learning more and more how to extract the information we want from the electronic health record.

A third area is that we need more education. There's a lot of technology the doctors haven't learned about. Some of them is so new that the doctor may have gone to medical school and then gone on to practice and the device didn't even exist, but maybe it's only existed for the last few years. Nurses are generally good about learning how to use devices, and they're the ones that teach patients how to use them. I have an outstanding diabetes research nurse at Mills-Peninsula Medical Center, Irina Nayberg, and she has taught many people how to use all the latest technologies, but doctors always benefit from knowing more about the technology, and their staff or their nurses also could benefit, and if the doctor doesn't know about the device or know how to use it, then chances are the doctor's not going to prescribe it, so we need even more education, and the last area that I'd say is an unmet need is the area of green diabetes. I was the senior author of the Green Diabetes Declaration, which is a call to action for different stakeholders involved with diabetes technology. This means doctors, patients, organizations, even the government. There are things that we should be doing to preserve the environment with all the diabetes devices that are being produced. Millions of people are using continuous glucose monitors. I don't know how many, but I would just say tens of millions in the U.S., and each person might use at least 10 a year, and so we're talking about hundreds of millions of these devices. Think about a hundred million of anything. There's a lot of waste. Takes a lot of material to build them, and the waste sometimes includes batteries. If you have to get rid of millions of batteries, those contain precious minerals, and they create waste, so the two areas that I'm interested in in the green diabetes field are sustainability so that we can reuse or recycle products or just not even use as much valuable material in the first place, and then, second is waste management. Many of the products that we see getting disposed contain blood waste or tissue waste in some way. You can't just throw them in the trash can. They have to be disposed of in a proper way and either burned or put into fill or decontaminated in some way. Those are expensive, but I think there might be some patients now who, either they don't have the right place to dispose of their needles or their continuous glucose monitor sensors or the batteries, or they, if they don't have the right place, they may not know what to do, so we need a combination of better education. Maybe companies will take back the products, or maybe there'll be more locations to get rid of waste, and maybe there can be some recycling of certain products. If you can separate the metal from the plastic of a device that has both, maybe you can use the plastic for one thing and the metal for something else. One company is taking back syringes and turning them, taking the plastic and grinding it up into powder, making tables out of it, so I'd like to see a greater awareness of what to do to make less waste and dispose of what waste we have safely to protect the planet, and that's the Green Diabetes Initiative, and that's something that I'm very interested in. I think we need more attention to that field.

We're working on another project that I think will be of interest. In a way, it's a two-part project. Each part is a year long. We finished the first. We're now early in the second called iCoDE and iCoDE 2, and those are devoted to automatic integration of sensor data into the electronic health record. iCoDE is for continuous glucose monitor data, and iCoDE 2 is for insulin dosing data from a pump or a pen, and the idea there is currently, if someone has a wearable device or a carriable device, the information goes to one of two places. It goes to an app, or it goes to a personal portal on the website, but it does not go into the electronic health record. Almost nothing from a wearable goes in the electronic health record, and it would be more useful if we could get into the electronic health record. It would be possible to share it with more doctors, and it would be easier for doctors to find the information, have it all in one place. What we've done is create data standards and workflow to break down this barrier, and we brought in so many stakeholders in digital health that it's impossible for anyone to avoid it, and it's impossible for a hospital to be sued for negligence if they use this method because if that was to happen, they'd say, "Well, we've got the FDA, Homeland Security, "NIH, CDC, U.S. Department of Defense, "several former Health and Human Services people, "an ex-CIA person, "as well as approximately 100 doctors, nurses, IT, "and cybersecurity people, and lawyers, "so how can anybody say that we were not careful?" And right now, some hospitals might be fearful of creating the software link to these sensors because someone will say they're negligent, but if they follow the pathway that we laid out in iCoDE and that we're laying out in iCoDE 2, then their defense will be, "Well, on this planet, these are the best people, "and this is what they say we should do, "so don't call it negligent," so I think that's going to be a big breakthrough for digital health, and then one sensor after another will probably just hop on and make a few modifications and get their product uploaded the way we're going to have continuous glucose monitors and insulin delivery systems, like pumps and pens, data delivered.