Tech on the Horizon: Where Will Automated Insulin Delivery (AID) be in 2021?

This content originally appeared on diaTribe. Republished with permission.

By Albert Cai

What AID systems are currently available, what can we expect in the next year, and where is AID technology headed?

Want more information just like this?

As we enter 2021, we’re taking a look at what’s ahead for automated insulin delivery (AID) systems. Because the COVID-19 pandemic delayed many clinical trials and FDA reviews in 2020, several companies are expecting to launch new AID systems in 2021. This list covers many of the most notable upcoming products, but there are likely others on the horizon – if you know of a system you think we should track, please let us know.

Click to jump to a product, organized by expected launch date. You’ll find detailed descriptions and possible launch timelines for each, reflecting US availability.

What is automated insulin delivery (AID)?

Automated insulin delivery has many names – artificial pancreas, hybrid closed loop, bionic pancreas, predictive low-glucose suspend – but all share the same goal: combining continuous glucose monitors (CGMs) with smart algorithms to automatically adjust insulin delivery via an insulin pump. AID systems aim to reduce or eliminate hypoglycemia, improve Time in Range, and reduce hyperglycemia – especially postmeal and overnight.

When thinking about the development of AID technology, it’s often helpful to think in stages.

  • Stage 1: The most basic AID system might shut off the insulin pump whenever the user’s CGM readings drop below a certain number, such as 70 mg/dl, to reduce time spent in hypoglycemia and help prevent severe hypoglycemia.
  • Stage 2: The AID system could predict when glucose is going to go low and automatically reduce or stop insulin delivery to further help prevent hypoglycemia.
  • Stage 3: The AID system may be able to automatically adjust basal insulin delivery depending on whether the user’s glucose is trending up or down, and taking into account other factors, such as insulin on board. This adjustment of basal insulin would aim to increase Time in Range (TIR), and help prevent both high and low glucose levels. At this stage, the user would still have to manually give meal boluses and correction boluses.
  • Stage 4: The AID system will be able to deliver correction boluses when glucose values are high. These small adjustment boluses would be a further step in improving TIR, with less time with hyperglycemia.
  • Stage 5: The systems will be able to detect meals and automatically deliver a system-calculated meal bolus to reduce postmeal high blood glucose levels. With the elimination of manual meal bolusing, the system is considered to be a “fully closed loop” System.

Currently available products are in stages 3-4. By the end of 2021, we may have multiple stage 4 systems available.

Medtronic MiniMed 670G and 770G – already available 

AID

Image source: diaTribe

Now available for people over the age of two.

What is it? Medtronic’s MiniMed 670G has been available since spring 2017 and was the first stage 3 AID system to be cleared by the FDA. Prior to the 670G, Medtronic released stage 1 and stage 2 systems (Medtronic MiniMed 530Gand 630G, respectively). More recently, the MiniMed 770G system was cleared in the US in September 2020. Both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm, which adjusts basal insulin delivery every five minutes based on CGM readings, targeting 120 mg/dl. The target glucose level can be temporarily raised to 150 mg/dl when low blood sugar (is a concern, such as during exercise or sleepovers for children. Both systems come with Medtronic’s Guardian Sensor 3 CGM, which has seven-day wear and requires two fingerstick calibrations per day (although four are recommended). See our article from 2016 for a full breakdown on the MiniMed 670G and from September for more on the 770G.

What’s the difference between the MiniMed 670G and 770G? As mentioned, both the MiniMed 670G and 770G systems use the same insulin adjustment algorithm and the same CGM. However, the newer MiniMed 770G has an improved pump: the 770G pump includes Bluetooth connectivity and can be paired to the MiniMed Mobile smartphone app (available for the iOS and Android) for users to view their CGM and pump information without pulling out their pumps. The app also allows users to share their data with others in real-time. Note: users can only view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates) from the app. Bluetooth connectivity also means the system’s insulin adjustment algorithm can be updated. Medtronic has promised current MiniMed 770G users a free upgrade to the MiniMed 780G when that system becomes available (more below). Finally, the MiniMed 670G is only cleared in the US for people over the age of seven, while the MiniMed 770G is cleared for people over the age of two.

Medtronic management recently shared that algorithms will become an increasingly important part of the diabetes ecosystem, and presumably, a key differentiator for companies – lots of exciting times ahead with AID, that is for certain.

Tandem Control-IQ – already available in US

AID

Image source: diaTribe

Now available for people six years and older.

What is it? The Control-IQ system from Tandem was cleared by the FDA at the end of 2019 and launched to customers in January 2020. It’s precursor – Basal-IQ – was cleared in 2018. The Control-IQ system uses Tandem’s t:slim X2 pump, Dexcom’s G6 CGM which requires no fingerstick calibrations, and the Control-IQ insulin adjustment algorithm. In addition to automatic basal rate adjustments and predictive insulin suspension, the Control-IQ system is the only AID system with automatic correction boluses: when it predicts glucose to be above 180 mg/dL in 30 minutes, the system will deliver 60% of the correction bolus needed to reach a target of 110 mg/dL. Control-IQ targets glucose values between 112.5 and 160 mg/dL, though users can turn on or schedule “Sleep Activity” mode to achieve 112.5-120 mg/dL by the morning. This past summer, Tandem launched the t:connect smartphone app (for iOS and Android), which allows users to check their pump and CGM data on their phones.

What’s next? With the current t:connect smartphone app, users can view information but cannot control the pump (e.g., deliver a bolus, adjust basal rates). Tandem has already submitted an updated app with pump control to the FDA and expects to launch that functionality in 2021. Tandem has also mentioned enhancements to the Control-IQ algorithm that are expected in 2021. While we haven’t heard many specifics, we believe it’s likely that these enhancements will focus on improving glycemic outcomes, personalization, and usability of the system.

Insulet Omnipod 5 – expected early-to-mid-2021 

AID

Image source: diaTribe

FDA submission is likely coming soon (if it hasn’t occurred already), and Insulet aims for a “limited” launch in early-to-mid 2021. Insulet has completed the clinical trial for Omnipod 5 but has not shared the results.

What’s new? Omnipod 5 is Insulet’s AID for its popular Omnipod disposable pumps, also called patch pumps. If you’ve been following the field, you’ll know that Insulet previously called the new system Horizon – same system, new name. Omnipod 5 uses Dexcom’s G6 CGM, and Insulet expects to launch the system with smartphone control capability; users can still opt for a dedicated controller device, since smartphone control will be available for Android users first. Insulet is working on an iPhone version for Omnipod 5, though that will not be available at launch. Insulet is also working with Tidepool (more below) on an iPhone-based AID system. Omnipod 5 will have adjustable targets between 100 to 150 mg/dl. Because the Omnipod pump will store the algorithm and communicate directly with Dexcom G6, the system will work even without the smartphone or pump controller nearby.

Medtronic MiniMed 780G – expected mid-2021

AID

Image source: diaTribe

Pivotal trial completed for 780G and presented at ADA 2020. Medtronic aims to submit the system to the FDA by January 2021 with launch coming around mid-2021 for adults (either ages 14+ or 18+).

What’s new? The MiniMed 780G will be Medtronic’s second AID algorithm and a significant upgrade over the MiniMed 670G and 770G systems. In addition to automatic basal rate adjustments, the MiniMed 780G will include automatic correction boluses and an adjustable glucose target down to 100 mg/dl. The system will also have fewer alarms and simpler operation with the goal of further increasing Time in Range. The MiniMed 770G and MiniMed 780G pumps are identical, meaning MiniMed 780G users will also be able to use the MiniMed Mobile smartphone app for viewing pump data, uploading pump data wirelessly, and updating their pump wirelessly. As the pumps are identical, Medtronic has promised that those who purchase the MiniMed 770G now will be able to wirelessly upgrade to the MiniMed 780G for free when 780G does become available. Finally, the MiniMed 780G will use the same Guardian Sensor 3 CGM as the 670G and 770G, which requires two fingerstick calibrations per day and has a seven-day wear time. As a sidenote, an improved CGM sensor is in development by Medtronic, but isn’t expected to be available when MiniMed 780G launches.

The MiniMed 780G is already available in many countries in Europe, and data from a clinical trial was presented at the ADA 2020 conference. On average, the 157 participants in the study (ages 14-75) saw their Time in Range improve by 1.4 hours per day (69% to 75%) while using the system – that’s particularly notable given the low baseline of the A1C. Speaking of A1C, the A1C improved by 0.5% (7.5% to 7%) after using the system.

Beta Bionics insulin-only iLet – expected mid-to-late-2021

AID

Image source: diaTribe

Pivotal trial underway with completion expected in the first half of 2021. Launch expected mid-to-late-2021, though this is subject to change.

What’s new? Beta Bionics is a Massachusetts-based startup developing an AID pump and algorithm called iLet. iLet will work with Dexcom and Senseonics’ CGMs (and possibly others in the future) and is designed to be especially user-friendly. diaTribe founder Kelly Close participated in an early Beta Bionics trial (2013!) and raved about the system and how easy the pump seems. At set up, users only need to enter body weight (no insulin-to-carb ratio, sensitivity factor, basal rates, etc.), and the system will learn more over time. To bolus, users will use icons to describe meals as containing more, less, or the same amount of carbs as usual (no carb counting). The insulin-only clinical trial for iLet began in the summer of 2020 and is expected to wrap up in the first half of 2021. Beta Bionics aims to launch iLet mid-to-late-2021, though this could be delayed as the FDA continues to prioritize COVID-19-related devices.

What’s next? Beta Bionics’ iLet is unique from the other pumps on this list, because it is designed to work in either insulin-only or insulin-and-glucagon configurations. With glucagon, Beta Bionics believes the system can reduce hypoglycemia while maintaining stable glucose levels and potentially even better-than-average, lower glucose levels due to availability of glucagon. Currently, there are different views on using glucagon in an AID system – in addition to the potential for improved glycemic management, there are uncertainties around glucagon pricing and availability. Regardless, the insulin-and-glucagon version of iLet is still a few years away.

Tidepool Loop – launch timing unclear

AID

Image source: diaTribe

Online observational study completed, and launch timeline depends on FDA progress.

What’s new? Unlike the others in this list, Tidepool is a non-profit and is working on the AID algorithm only; Tidepool does not have its own insulin pump or its own pump and CGM combination (like Medtronic). About two years ago, Tidepool announced plans to submit the do-it-yourself (DIY) Loop app to the FDA to become an officially supported app available on the Apple App Store, compatible with in-warranty, commercially available pumps and CGMs. For now, DIY Loop is a free, publicly available, open-source, non-FDA-approved AID system that works with Dexcom and Medtronic CGMs and old Medtronic and Insulet pumps. Read about Adam Brown’s experience using DIY Loop here. For those who are very interested in the project, there is a great deal to learn from notes that Tidepool shares about its communications with FDA – the latest notes are from a mid-2020 meeting.

Initially, Tidepool plans to launch with Insulet Omnipod and Dexcom G6 compatibility. To set it apart from the DIY-version, Tidepool Loop will have different colors, guardrails around certain settings, and a built-in tutorial for new users. A 12-month, completely virtual study was performed with Loop users and will support Tidepool’s submission of Loop to the FDA. The six-month data was presented at ATTD 2020 showing a Time in Range increase of about 1.4 hours per day (67% to 73%) with Loop. Tidepool also announced in November, 2020 that its human factors study had also been completed – this is another required step of the FDA submission. Much of what Tidepool is doing is unprecedented, so the launch timing is unclear.  In an update on January 8th, Tidepool shared that it has now completed FDA submission of Loop.

Source: diabetesdaily.com

Teenager Builds T1D1 App After Diagnosis with Type 1 Diabetes

T1D1 (which stands for type 1 diabetes from day 1) is an app that was created by a newly diagnosed 13-year-old, Drew M, to help people better manage their condition. Determination coupled with being well-versed in coding led Drew to create this app almost immediately after diagnosis.

I thought it would be nice to hear Drew’s story and how he took his new diagnosis as an opportunity to help others.

Hi Drew, thank you for taking the time to speak with me. I know you were just diagnosed in September of this year. What signs were you showing and what made you see your doctor?

The only reason I went to my doctor was because we noticed I was losing weight while growing. I had lost more than 10 pounds and had grown over an inch over a three month period. I went to my pediatrician and they drew some blood. We left the office and before we even got home, my mom got a call from them and they said, “pack a bag and go to the ER at Children’s National right now!” My blood sugar level was 529 mg/dL and I apparently had large ketones in my urine test.

Drew recovery

Photo credit: Laura Mendelow

I know you were hospitalized, did you get a good education on how to manage this condition?

Yes – I think the diabetes team at Children’s National Hospital was awesome! They had a whole team of people that kept coming in to visit with me. Because of COVID, all group classes were now given one-on-one, so I got a great education.

Although I missed school when I was in the hospital, I still felt like I had math class because there was so much to learn about calculating my numbers and carbs. It felt like a lot to take in, but they did a great job explaining it to me. They taught me how to calculate my insulin doses and count carbs and I practiced on a sponge.

My grandma was diagnosed with type 1 about 10 years ago, when she was 61, so I was pretty familiar with seeing her managing it. That also helped me a lot knowing someone who has T1D so I wasn’t as scared when they told me that I had this disease.

I know you have a passion for coding and had just finished taking a summer course. At what point did it dawn on you that you were fully capable of creating something like this?

We were joking around about it with the nutritionist, Alex, that morning in the hospital. She was showing us some apps to help us out and said it was annoying that there wasn’t one app that did everything. My dad said jokingly, “Don’t worry, Drew will build you one.” When we got home I started looking at different ways to build apps and there are so many platforms now to choose from. I started playing around with it that same day and realized I had enough knowledge of coding that I could actually do it!

The stuff I was doing over the summer was just for fun because my soccer camp and my overnight camp got canceled because of COVID. Basically, I was bored and taught myself how to code using YouTube videos and a few classes that my dad shared with me. I learned how to code video games using Unity, but nothing like this app! I figured I knew enough about how to code that I could figure out how to build an app. It was like a cool challenge to take on.

My dad is a programmer but he had never built an app before either. But I figured if I got stuck, he could help me out. But, he really didn’t know anything about the program I was using, so a few times I got stuck and my dad was like, “I have no idea how to help you with that one, you’ll just have to google it.” So I did.

The platform I was using was limiting, like I couldn’t create a drop-down menu so I would have to learn how to go around the system to create some of the functions I wanted. I just kept teaching myself new things online until I found things that worked.

Drew with his father in the hospital. Photo credit: Laura Mendelow

I know the doctors at the Children’s hospital expressed a desire to create an app that was different than those that already existed. What was their wish list?

Well, they wanted a few things. First, it had to be simple and easy to use. And, it had to be something that a person could use from day one of diagnosis. There are so many apps out there but they may require you to have a CGM or a pump or they’re just too much for someone who is recently diagnosed and too complicated for kids to use. They wanted an easy way to calculate your insulin dose and also log your glucose levels.

People who are newly diagnosed are asked to call in every day after diagnosis for about 2 weeks and report their numbers from the last day (e.g. blood sugar, carb count, insulin taken for every meal, snack and at 2 am). So having a feature where you could email your logs straight to your doctor was a big request as well.

Then, they had more detailed ideas like the option to round to the nearest half or whole number. I didn’t even know some pens have half units and others only have whole units. The doctors knew what people needed, and I knew what I wanted as a person who was newly diagnosed, I just had to figure out how to program it on the app.

Your app has become quite a success! Now available on Android and iPhone, T1D1 has over 9,000 downloads already. What sets your app apart from the rest?

I think people like that the app is simple, yet does everything that they need right from the beginning of being diagnosed and has some cool features (like different settings for different meals) that other apps don’t have. Plus it’s completely free and has no annoying ads or any kind of in-app purchases.

Also, I think they like that it was created by a kid and not a big company, so they know I’m not out to make money or collect their data. I’m new to the T1D community but I can already see that people get annoyed when they see companies using their disease to make money off of them.

How long did it take to create this app and can you tell us a little bit about the beta testing process?

The first version took only about a week, but it was super simple. It was basically just a calculator with a few changeable settings. We then showed it to Dr. Marks and the diabetes team at Children’s and they came up with some suggested features. I would build in the features and then send it back to them for review.

Once we had a few features like a bolus calculator and an insulin log, we then reached out to online diabetes communities to see if anyone would volunteer to help us test the app. My dad reached out to groups on Facebook and Reddit and asked for volunteers. I remember that night, my dad was overwhelmed with how many people wrote back offering their help.

At that time, it was only being tested for Apple and we had about 70 beta testers. After a lot of testing, the app got published in the Apple Store on Halloween. So, that was about a month and a half after I started working on it. Then, a few weeks later we were able to get it published in the Android Google Play store.

I know you have received both national and international attention (Fox News, NPR and the Jerusalem Post to name a few!), how does that make you feel?

Honestly, I was so surprised at how it took off. It makes me feel really good knowing that the app will now reach so many more people. One of my main goals is to make the app accessible to as many people as possible and this publicity really helps me achieve that goal. Anyone who has T1D knows how tough it can be to manage this disease 24/7. Hearing stories about how I’ve really helped others, makes me feel so happy and helps me get through the tough moments. And, these stories keep me motivated to continue working on the app to make it the best I can.

Drew with family. Photo credit: Laura Mendelow

I know you are hoping to keep this app payment-free and ad-free. How can people help support you?

If people want to support the app, they can donate on the “support us” page on the IOS version of T1D1 or through the website T1D1.org. All donations are used to keep the app live and make enhancements. All profits get donated straight to JDRF. Another huge way to support us is to spread the word to their diabetes team and by posting about it on social media!

You are clearly an ambitious young man with a ton of determination! Do you see yourself doing more things with coding and diabetes? What do you think you would like to do when you are all grown up?

This opportunity to make an app really helped me to see the possibilities of being a programmer or developer when I grow up. It’s been really cool to talk with other organizations like Tidepool to learn how they integrate technology into improving people’s lives with diabetes. It’s awesome to think that I can use my coding skills to continue to help others with T1D. I now have a pump and am amazed by the pump technology. Who knows what others will create in the future. I’d love to take part in creating that new technology with them to help make all of our lives easier.

Thank you so much for taking the time to speak to me. You are a perfect example of someone who took an unfortunate situation and took the opportunity to help others.

I wish you much success and look forward to watching you thrive in both your future professional endeavors and managing your type 1 diabetes!

Source: diabetesdaily.com

Diabetes Doesn’t Have Me

This content originally appeared on Beyond Type 1. Republished with permission.

By Jasmine Wiese

Relief. That was the first thing I felt when I was diagnosed with type 1 diabetes.

I was mildly sick for about a year and a half before my diagnosis. My skin healed slowly and I hardly slept. My mental health was pretty much nonexistent, but the most distinct memory I have is feeling like I had totally lost interest in the world around me. Then, a few days before my junior year of high school, I went to a physical exam and got a simple blood test. My resting blood glucose level after fasting was between 300-400 mg/dL, but everything else came back normal. I was told immediately that the most probable diagnosis was type 1 diabetes.

At that moment, I felt relieved. Suddenly, there was an answer for all the things I couldn’t explain – why I felt so sick (out of range glucose levels), why I constantly felt dehydrated, and why I felt like my life was spinning out of control. I decided right then and there that I would embrace my diagnosis and live with a positive attitude.

Image source: Beyond Type 1

My Education With Diabetes

Over the next few weeks, I went to lots of appointments and met different doctors, nurses, and certified diabetes educators. The best thing I did in the days after my diagnosis was reading the book, Think Like a Pancreas, by Gary Scheiner. If you haven’t read the book, I highly recommend it. I gained an understanding of diabetes that I would not have otherwise received.

From the beginning, I managed my diabetes myself. I counted carbs, calculated the insulin I needed, and kept myself healthy. I didn’t feel like I needed emotional support because for me, science has always been my way of coping. The more I learned about the immune system and diabetes, the more I felt in control, and I slowly began to regain confidence in myself.

I was extremely lucky when I was diagnosed because I received a continuous glucose monitor less than a month after my diagnosis, I met my first diabetes buddies a month after that, and I was training to use my insulin pump by Christmas. Thanks to the people I met at CarbDM and Tidepool, I learned about DYF’s Altitude 14,505 program. The program is a nine-day backpacking trip to climb Mt. Whitney, the highest peak in the contiguous United States, with a group of type 1 teens. I applied for the program in January, and I began training and buying lots of gear.

Last summer, before my first diaversary, I climbed Mt. Whitney. It’s one thing to know that you are physically and mentally capable of going on a long backpacking trip, but it’s another feat to actually do it. I carried thirty pounds on my back for over 75 miles. Some days we had thousands of feet of elevation gain, and other days hiked a (relatively) flat route for eleven miles. At one point, part of the trail and been blown off, so we had to climb along a cliff to keep going. There was a rest day at a natural hot spring, where we hopped back and forth from freezing river water to the steaming springs. On the day we reached the summit, we each enjoyed a Snickers bar – and it was delicious.

Image source: Beyond Type 1

Coming Full Circle

After climbing Mt. Whitney, I felt much more confident about my ability to travel alone and to deal with any diabetes surprises. I knew that if I could manage my health out in the wilderness, I could certainly do so in another part of the world. It was also my first diabetes camp and it was one of the most fun times I have ever had. I quickly felt empowered to keep managing my health and to keep going on adventures. I also made a lot of lovely diabuddies.

I realize I certainly had a whirlwind introduction to the diabetes community, but I learned that it’s all too important to know people your own age with diabetes, because the way you deal with diabetes is both similar and different from others. The things I worried about this time last year are so different from what I am worrying about today. I am fortunate enough to have diabuddies that I can rely on and commiserate with so I can share my experiences – both the good and the bad.

When all is said and done, I’m mentally and physically in a much better place now. I have diabetes, but diabetes doesn’t have me. I don’t hide my continuous glucose monitor or my insulin pump, and I don’t mind when people ask me questions about them. My devices are just accessories that I wear. If anything, I am more in tune with my health than I was before. I still have good and bad days, days when I am completely in range and days when I don’t feel like putting in a new infusion set. I know that diabetes will always be a challenge that I have to face, but I am optimistic about new treatments and research. From open source projects to clinical trials, I make a point to read about new developments every day.

I had my diaversary earlier this year, right around starting college, and I’m pretty excited for the future since I will be pursuing a degree in biology and hopefully doing diabetes research.

Source: diabetesdaily.com

How to Extend the Dexcom G6 Sensor Beyond the Ten Day Hard Stop

Some clever technologists have discovered how to restart a Dexcom sensor to extend its life beyond ten days. The process works by exploiting a bug in the sensor pairing process.

Katie DiSimone walked us through the process. Katie is involved in the community of people who are building homemade automated insulin delivery systems using current insulin pumps and continuous glucose meters. Since the original article was written, Katie has joined the Tidepool organization which is dedicated to making diabetes data more accessible, actionable, and meaningful for people with diabetes, their caretakers and for researchers as well.

Since our last update, new transmitters have been released. These newer models are more stubborn and are more challenging to “hack”. The specific transmitter ID  will dictate which restart sensor method you should use.

Please see Katie’s instructions to determine which is the preferred method for your transmitter ID.

The method that seems to be working amongst the diabetes online community (and myself; I currently have the transmitter starting with “8G”) is the “pop-out method.” This means you need to physically pop out the transmitter, which can be a little tricky but doable. Here is a video on how to do it, I have had luck with an old credit card.

For this method you will need to:

  • Stop session (it does not matter if the sensor expires on its own first or not)
  • Pop out the transmitter (Some people cover the site during the 30 min period or even insert an old transmitter to prevent stuff from getting in there/ also the wire moving, as the transmitter holds it in place)
  • Set a timer for 30 minutes (I’ve heard that 15-20 minutes works, but have not tried this)
  • Pop the transmitter back in
  • Restart the sensor (make sure to save the previously used code; I snap a picture of it so this way you will not have to calibrate)

There are instructions on how to restart the sensor using the receiver so that you continue to receive current glucose values throughout the 2-hour wait. Here are the instructions on how to do so.

Caveats

The Dexcom G6 has not been tested or approved by the FDA for restarting sensors. There is no guarantee of sensor accuracy. Extend the sensor life only at your own risk.

A previous version of this post has been updated.

Source: diabetesdaily.com

Feeling Helpless? Here’s What You Can Do

This content originally appeared on Beyond Type 1. Republished with permission.

By Beyond Type 1 Editorial Team

Feeling helpless in the midst of COVID-19? You’re not alone. There’s a lot we still don’t know about the virus and the situation is changing by the hour. One important thing to think about is separating what you can do from the things you cannot control. We’ve compiled a list of specific actions you can take to have a real positive impact for yourself, your family, and your community.

People with diabetes may be at higher risk should they contract COVID-19, so please take all of the personal precautions you need to at this time. Not everyone’s risk is the same, so be mindful of yourself and others. Take what works for you from this list and leave the rest.

Take Basic Precautions

Wash your hands often for a minimum of 20 seconds with soap and water. Practice social distancing, limiting travel, working from home, and rethink big events – these precautions are not solely for you but for those around you who may be susceptible.

Stay up-to-date with your local health department about COVID-19 in your area.

Connect With Family

Stay in touch with friends and family virtually. Up the frequency that you communicate, and be clear about how you’d like to stay in touch. FaceTime or video chatting can be an awesome tool to feel close to those who are far away – without adding any risk for you or your loved one. Other ideas for staying in touch: start a family or friend group text, find games you can play together remotely, or set a regularly scheduled phone call.

Talk to the children in your life about what’s going on. Tell them we’re washing our hands and keeping to ourselves to protect ourselves and others to help them understand that this is about all of us, not just one of us. Ask if they have any questions and explain as best you can. For older kids and adolescents, asking “what are your friends saying about the coronavirus?” might be a good jumping-off point for starting a conversation to help clear up any misinformation.

Make a list of projects for children to help you with around the house, and teach them how to cook with your extra time at home – you’d be amazed at what they want to help with and how good they will feel knowing they are contributing.

Reach out to People Who Are Most Vulnerable

Think about the people you know, and be mindful of how the current situation might be impacting their specific circumstances. Elderly neighbors, grandparents, older relatives, friends with health conditions, anyone going through chemotherapy or the many, many, other circumstances that might contribute to the current level of anxiety. Reach out and ask how they are. Offer to listen or lend a hand — helping with simple tasks like grocery shopping and limiting the time they spend in public could make a huge difference. If you’re limiting your time in public, too, even just lending an ear at this time can help keep anxiety and loneliness at bay.

Don’t tolerate or perpetuate racism, particularly towards those of Asian or Chinese descent. Referring to COVID-19 as the “Wuhan” or “Chinese” virus may perpetuate racism and xenophobia. If you hear or read others referring to COVID-19 using those terms, please correct them. The importance and impact of being kind to one another cannot be overlooked.

Support Your Local Community

Follow local public health departments and support local news. Journalists everywhere are working hard to keep the public informed about this rapidly-evolving situation. Now is a great time to purchase a subscription to your local news source if it is in your budget. Please also think about the sources of information you read, and try to verify their trustworthiness before you repeat it – the CDC and WHO are good for receiving global updates you can trust.

Donate to your local food bank (find one here). Donating money might be more helpful than donating goods, as food banks often get their items at wholesale cost (in many cases, a $1 donation is equivalent to 5 meals). If you’re well, experiencing no symptoms, and have low risk, ask what volunteer opportunities are available to assist with food distribution.

Support local businesses. If you are fortunate to have uninterrupted income during this time (i.e. can do their jobs from home) and have it to spare, consider transitioning purchases from chains to local businesses, buying groceries from local stores rather than large online retailers.

Consider purchasing gift cards now for use later at a gift store, book store, or local restaurant. Call and ask what they need, or if they’ll accept the transaction over the phone. Ask if they deliver or ship.

If you’re out and about, tip your waiters and waitresses, Uber and taxi drivers, stylists, barbers, and other service industry workers as generously as you can afford. 

Offer support in other creative ways, like buying yourself or others a gift card online to use later, and shopping local businesses online if they have the capability. Reach out and ask what support these businesses need that you might be able to offer (i.e. even just sharing online about what they do).

Support the Diabetes Community

Help drive research + innovation. Sign up for the T1D Exchange Registry, a research study that pulls from your personal experiences and data to help accelerate the development of new treatments. Previous T1D Exchange research efforts have led to things like insurance coverage for test strips and changes in guidelines for A1C goals – your input has the power to make a difference.

Donate your data + impact others. Join the Tidepool Big Data Donation Project, helping further the reach of our collective knowledge about diabetes. Your data gets anonymized and Tidepool will also give back 10% of proceeds to the nonprofit organization(s) of your choice.

Share your voice. Talk to your network about the importance of social distancing and other steps you’re taking to minimize contact and stop the spread of this virus.

Connect with the Beyond Type 1 Community. Download the the Beyond Type 1 App and chat with others living with diabetes. We need connection with others now more than ever.

If You’re Facing Challenges Around Work + Income

If your work hours were cut, file an unemployment claim.

Contact your creditors, electric, phone, and cable companies to see if any accommodations or payment arrangements can be made to make up for lost hours or pay shortages at work.

Worried about homelessness or evictions? Reach out to organizations dedicated to fighting homelessness and their plans to deal with the pandemic. Also, stay informed on if your city’s policies on halting evictions due to COVID-19.

What You Can Do to Support Mental Health

Look into telehealth options for mental and physical care. Check your insurance to see if there is a telehealth service offered, contact your doctor to find out if they have an option for remote visits, or check out services like DoctorOnDemandBetterHelp, or TalkSpace.

Find a new daily routine. Keep getting up early, making coffee, eating breakfast, getting ready for the day and choosing a space to work. Going about your day to day as regularly as you can will only do you and your family good.

Volunteer with animals. Dogs and cats appear to not be susceptible to the virus*, so if you are able to walk dogs at your local shelter or visit the cats, consider it. Animals can help reduce stress, and you might even end up with a new friend to take home.

*the virus may be able to survive on the animal if it has been touched by an infected individual, so know the risks here 

Volunteer your time remotely to help others experiencing distress. You can take the training to become a Crisis Counselor with Crisis Text Line from home, and work to support those in crisis.

Source: diabetesdaily.com

Cracking the Code: CEO Eran Atlas Talks Dreamed’s Revolutionary Tech

This content originally appeared on Beyond Type 1. Republished with permission.

By Jordan Dakin

Beyond Type 1: Can you talk about the founding of DreaMed?

Eran: DreaMed started as part of one of the biggest institutes for people with type 1 diabetes in Israel. The director of this institute is Professor Moshe Philip (co-chairman of ATTD). His vision was to bring in technological people to try to develop solutions to help the needs of people with diabetes. One of our first projects was to create an algorithm for automated insulin delive­ry… We were the first in the world to do automated insulin delivery clinical trials outside of a hospital and we published these results in the New England Journal of Medicine. This was the first manuscript about people looping and then we were the first to send people home with automated insulin delivery in 2012.

We created a relationship with Medtronic Diabetes, which allowed us to communicate with their insulin pump and a continuous glucose monitor. After we finished a lot of sessions of clinical trials, we decided we wanted to regulate our technology software as a standalone medical device. That’s why we established DreaMed in 2014. Since then, we’ve made a licensing deal with Medtronic. They were the first investor in the company and our technology will be part of their next-generation advanced hybrid closed loop system: the 780G. But working on the closed loop project, we always knew that not all the people with diabetes would have access to closed loop, but we very much believe that the majority will have access to continuous glucose monitoring (CGM) technology.

The thing that we were focused on is how we can use our expertise to create something that will be able to help the providers and the patient better dose insulin based on data that comes from CGM and from insulin delivery devices. For that purpose, we started to develop a technology that we call today the DreaMed Advisor. DreaMed Advisor is a decision support system that captures all data and recommends very precise, personalized insulin delivery for that specific patient. Not in a real-time manner, but in the manner of a treatment plan.

BT1: Can people on MDI utilize DreaMed advisor?

E: It’s not regulated for MDI patients at the moment. Our MDI version is on clinical trials, and I really hope that during this calendar year, we’ll be able to share the status of these programs and how fast we think it will be available on the market.

Do you think part of the reason people are sometimes slow to adopt technology is because there are some who question using it for matters like medical decisions?

I think what we’re experiencing right now are more logistical issues – how the data flows from the devices to the platform, the fact that clinics are using multiple platforms to download the data from the patient devices, and the fact that most of what we see today is not digitalized. Clinics are still printing reports – about 20 to 30 pages every visit. They don’t have the manpower because they are so overloaded with work: all the documentation, mailing the claims, dealing with that download of the data when the patient arrives at the clinic, etc.

But what I see when I visit clinics and when I talk to people and I hear lectures is that 2020 might be a moment where some of the barriers can be solved. Not all of them, but some of them can be overcome to allow us to implement such a program.

One of the things that is very interesting to me is the role of the people with diabetes in this. Everybody knows that people with diabetes pay a lot of money for healthcare costs, right? The majority of that is from the insulin costs, but even to see a doctor, there is a certain co-pay and co-insurance that patients are paying each visit. The question is how much patients will be open to removing the barriers, and saying, “I prefer to pay out of pocket for a service that will allow me to get the titration of my data with technology, together with a healthcare provider that is considered a top doc because they have clinical studies behind them. For that, I’d be willing to pay out of pocket and eventually, I will save costs because I will pay less, and I will get better outcomes, and I will spare my other costs of going to the ER in hypoglycemia and DKA because of that.” I think that patients are playing an important role in this equation.

I’m sure a big goal for DreaMed is to lessen the burden on physicians in terms of needing to see patients so frequently.

In no way are we trying to make providers obsolete. We think that they are an essential part of patient care because at the end of the day, caring for a patient with type 1 diabetes or any type of diabetes is not just about numbers, it’s not just about the type of insulin. There are a lot of things behind it and we need our providers in the game.

Dr. Greg Forlenza from the Barbara Davis Center very nicely told me, “With your technology, I’ll finally be able to go back and practice the art of medicine and not be a technician.” I think that this is the service that we would like to bring to providers because if we’re able to let them go back to dealing and practicing the medicine, and we can take away some of the barriers, all the technicality and calculations, and we’re going to provide better, more frequent care for their patients. I think that everybody will be happy about that. One of the goals that we have for this year is to try to build the right model in order to make that happen.

We’ve heard that certain endos are starting to charge a co-pay for visits where they review CGM technology, which hasn’t previously been the case. So costs in terms of things like that seem to only be going up for these patients.

I understand what you’re saying, I think that we need to look at that. We have two sides to this. Number one: there’s the side of the provider that spends a lot of hours caring for their patients and the majority of these hours are non-billable time. In the end, we want to find a way for the providers to collect some of this money because we don’t want our doctors to lose money. We want them to sustain their business so they will be able to provide us better care.

But the magic here is creating that without significantly increasing the costs on the patient side. Because if it will increase the cost from the patient’s side, the patient will say, “I don’t want to download my data, don’t charge me for that” and that means we lose because then they’re not going to get that same tight control. These are some of the questions that we are trying to find answers to. How can we be innovative not just on the technology side but also on the commercial side to find a model that will be good for providers but also good for patients?

If someone is interested in utilizing DreaMed’s technology, where do they go from there? Do they just contact their physician and ask if they can use DreaMed?

Right now, that’s the right process. They need to go to the doctor and tell them, “I’ve heard about this cool technology, here’s the information,” and put some polite pressure on the doctor to explore the technology and see if they can implement it. If the clinic is using Glooko, we are integrated, so they can continue to use their Glooko account and we will be able to get into agreement with the clinic and open Advisor on top of Glooko.

If the clinic is using Tidepool, or if the patient has an account, we are also integrating data from Tidepool, so we will be able to just provide a clinic our standalone platform and then connect the clinic’s Tidepool account. From there, every time that a patient downloads his data through Tidepool, we would be able to pull that data and analyze it, then provide recommendations for the provider.

What do you envision as the next step? What’s ahead for DreaMed?

I think that next step from our end is to develop more technologies so we will be able to expand our intended users. We’re working to reach patients on multiple daily injections – that’s our first goal. Then we’ll go to those on insulin with Type 2, either multiple daily injections or basal only. That’s from the development side. For 2020, our main goal is to try to find the right commercial model and how we can have as many patients as possible enjoy this technology as fast as possible.

Can you talk a bit more about the importance of patients having access to any and all options?

I think that patients should have the right to get access to the top tier docs anywhere, anytime that they want to. But that doesn’t mean that they will be able to make all of their treatment decisions alone. I think that there is a great deal of importance in having healthcare providers as part of patient care. But I do think that it’s wrong for patients to have to wait for six months to see a doctor in order to change something in their treatment.

We need to find ways to make top tier treatment accessible to everyone… This is what we believe in. It’s in our mission to provide the best solutions for people with diabetes with our technology.

Do you have a personal connection to type 1 diabetes?

Nope. I don’t have a personal connection. I’ve been working in this business for 14 years. Seven years of my career was spent in the hospital. I was the technical guy in the clinic sitting in the corridors, talking to patients. We did closed loop studies and in those closed loop studies, we did 24-hour studies, stayed overnight, and took care of patients. So I have a very strong connection to people with diabetes.

The fact that we have the ability to provide something to improve their care is a privilege. It’s not something that everybody gets the chance to do in their lifetime. That’s why I’ve been a part of this for so long, this same type of work, because I don’t have a personal connection, but I have an emotional connection to people with diabetes.

Source: diabetesdaily.com

Search

+