Purpose
Truthfully, if I could let someone take away my diabetes, I would. Finger pricks, carb counting, carrying around testing stuff, making sure you always have insulin on you, bringing needles with you, always having sugar within reach, dealing with insurance, learning to sleep with a pump, uncontrollable mood shifts, unproductiveness when you’re high, chills when you’re low and excessive worrying that the next one might be different, explaining to your boss that sometimes you need to step away from the desk, talking with friends about how they can help, working with your family to not let diabetes get in the way of a healthy, happy relationship. That’s been my burden for the last 15 years, and until recently, I haven’t been big on talking about it.
I worry that facts sound like complaints of which most people have no solution to offer besides their sympathy, which is nice but not necessary. I worry that the positives sound like brags, either tied to some inaccessible technology and money or which sit outside the realm of diabetes.
I struggle to ask people for money to fund an organization that I don’t have faith in and a cure that I don’t see on the horizon. I wonder if the people at the top are doing their best to make a positive impact in improving access to diabetes management or if a conflict of interest is a better explanation for only small changes to the status quo.
Above all, I worry that if I don’t speak up, nothing will change.
My goal isn’t to beat up Eli Lilly for taking advantage of a reasonably small market with perfectly inelastic demand — insulin should be cheaper, but the company is making some effort, however little, to be accommodating with programs like Lilly Cares. Similarly, I don’t intend to press Medtronic for taking the hard-earned research & development of a small company based in San Diego and marketing it as a breakthrough treatment — hybrid closed-loop technology for all diabetics of any age is essential. I also don’t want to call out Abbott for their efforts to brush under the rug how their original Libre CGM which required NFC scanning to get a reading, is inferior to Dexcom or insurance companies for not covering the clear better option. That’s for Medicare, in addition to the FDA and other government agencies, to regulate.
What’s important to me is that everyone has access to the best tools available to lead a healthy, happy life, regardless of their ability to pay.
What’s a diabetic?
The diabetes burden affects people of all ages, ethnicities, and social classes from coast to coast. According to the most recent “National Diabetes Statistic Report” report by the CDC, which considers data up to 2018, there are at least 34.1 million Americans — or 13% of the population — labeled as diabetics. If that number seems surprising, consider recent projections of the future diabetes burden for the next 40 years.
Whether you’re someone walking down the street or someone sitting in Washington, D.C., chances are you know someone that falls into that group. But what about one of approximately 2.9 million people who rely on insulin to some extent to fuel their lives with diabetes? Or roughly 1.4 million who are Type 1 and completely insulin-dependent?
The problem is that Type 2 Diabetes and Type 1 Diabetes are the same to a certain extent but vastly different at the same time. They are both metabolic disorders involving insulin, usually secreted by the pancreas and used to turn glucose into energy. Type 2 Diabetics still make their own insulin, but, in short, something is blocking its ability to enter into the cells and do its job. Type 1 Diabetics can’t make insulin on their own and must inject it to survive.
Type 2 Diabetes can be controlled by once-daily medication, diet, and exercise. These are essential aspects of managing Type 1 Diabetes, too, but, in contrast to Type 2 Diabetes, our reliance on insulin brings a whole new layer of complexities to the table. For all the new blood glucose, exercise, and food tracking apps celebrated as major breakthroughs in diabetes management, very few are useful to people with Type 1.
In contrast to Type 2 Diabetics who, in addition to having some gene, make a series of poor lifestyle decisions that ultimately diminish the efficacy of insulin produced by their pancreas, I understand the immediate impact my choices can have on my health. My health didn’t slowly deteriorate. I was diagnosed at nine years old, two weeks after I was named to the AYSO all-star team, and I still take care of my physical fitness. I just woke up one day and couldn’t decide if it was more pressing to run to the bathroom to pee out all of the ketones, to go chug water from the sink to replenish my kidneys, or to go back to sleep. Ever since the nurse at CHOC Hospital gave me my first shot of insulin and DKA symptoms went away, I have treated the relationship between what I do and how I feel with the utmost respect.
People much smarter and with more time can explain the number of variables causing such an incongruous rise in incidences between the two types of diabetes but, to be completely frank, I see no excuse for letting your health get to a point where the insulin your body creates isn’t able to enter the cells carrying sugar. In addition to the intricacies of optimal insulin dosing, these general population differences are not as universally understood as the simple fact that we are facing a diabetes epidemic, and we need to do something about it.
Reports highlighting the economic impact of diabetes are increasingly gaining relevance. However, little information is available about the number of people living with Type 1 Diabetes and the amount of time they spend each day dealing with high and low blood sugar. Fortunately, COVID-19 brings unprecedented population data, and new technologies that accurately measure glycemic variability in people with Type 1 Diabetes are quickly gaining relevance. Until now, many projections have underestimated the potential losses due to misleading data from A1C on the frequency and immediacy required to treat high and low blood sugars.
It does not take an expert to understand how unknown or misreported information can impact your entire outlook. In early March 2020, every rational person was glued to the television or Twitter in an endless attempt to make sense of the President of the United States declaring COVID-19 a national emergency. No one knew who had the answers we desperately needed to go about our lives safely and productively. It’s easy to understand how wild that time was in retrospect, but due to misunderstood and underreported facts about Type 1 Diabetes, this community’s uncertainty level still lingers.
Imagine if the top outlets didn’t share actionable insights as soon as they were available.
Using COVID-19 as a general example, consider the observational studies looking at the risk factors severe outcomes in patients with Type 1 and Type 2 diabetes and lack of mention from popular diabetes newsletters. This study published in August found that merely having a non-functioning pancreas does not significantly lead to an increased risk of hospitalizations or death. However, headlines reported by JDRF painted a much more ambiguous picture.
Current evidence suggests that individuals with T1D are NOT at higher risk of contracting COVID-19.
A new study shows that people who get COVID and have diabetes, whether type 1 or type 2, have three to four times higher risk of severe illness and hospitalization.
However, those at greatest risk are people with consistently elevated blood-sugar levels and those with a second comorbidity (such as obesity or heart, kidney or lung disease).
- https://www.jdrf.org/coronavirus/
Despite clear findings drawn from a much larger sample, JDRF still failed to accurately represent the level of risk in people living with Type 1 Diabetes. The non-funded study in England found, “COVID-19-related mortality was associated not only with cardiovascular and renal complications of diabetes but, independently, also with glycaemic control and BMI.” In other words, it can be interpreted from the data that high A1C’s and obesity are much better predictors of who is at risk of more severe outcomes. Are people with Type 1 Diabetes expected to subscribe to academic journals to stay up to date?
I get that it’s only one study, but you can’t write off the credibility of the sample size. Whether the ambiguity still reported by mainstream outlets stems from misfit data collection methods and a lack of analysis tools, or merely a lack of effort and unwillingness to take on certain risks, or JDRF’s inability to cite studies that aren’t at least partially funded by their donors, doesn’t matter. Type 1 Diabetes deserves better representation.
“Start with HOPE” — JDRF
Like most newly diagnosed families do, mine went searching for answers — literally, “tell us what we need to do,” and we’ll do it — only to be incredibly underwhelmed. The reality that we discovered from my endocrinologist is that diabetes is an imperfect disease, and it’s completely normal to have an average blood sugar of around 150. My parents weren’t willing to accept that as an answer and kept searching. The only place we could only find hope that, one day, it would be possible to live a life where I would be able to achieve steady blood glucose or, better yet, wouldn’t have to continuously monitor my blood sugar at all, required us to cross over into the world of non-profit research and fundraising.
I certainly appreciate the hard work of non-profits helping to broker research for a cure. The hope that perfect glycemic control is possible is a good thing. But in my opinion, the investment efforts of the two major diabetes non-profits are misguided and fall short of providing the type and level of services that could really benefit the diabetes community and bring their promise of a cure to fruition.
JDRF’s approach is three-pronged — prevention, mitigation, and adaptation. It’s selfish to think that Type 1 Diabetes screening deserves less attention than mitigating the disease’s effects by enhancing the tools that future diagnoses have available to them. It’s not selfish to ask why the tools which could minimize the diabetes burden for the next cohort of diagnoses are not being used to help the current group of people living with it adapt to the burden today.
There are several up-and-coming startups in the diabetes world that utilize artificial intelligence to understand patterns in individuals and recommend treatment interventions that are likely to be effective. But like the lack of coverage surrounding certainly life-changing findings, JDRF and others force you to do your own research.
It begs the question: Why should someone like you need to tirelessly search to find a treatment solution that could enhance your quality of life when well-funded organizations exist to precisely do that?
In my opinion, JDRF’s reliance on donors to not only fund research but also cover the operating costs of their national organization with hundreds of employees limits their reach. It is well known that their major donor partners include two pharmaceutical companies with a combined market cap of $326,000,000,000 and two medical device companies with a combined market cap of $351,000,000,000. Are the real power brokers comfortable using our earned donations towards truly revolutionary treatment research, or does their conflict of interest drive them more towards something else with an equal likelihood of success?
When I was young, the very existence of JDRF seemed to promise a cure, and I thoroughly enjoyed the opportunities I had to speak at their galas and raise money for their walk to cure events. I am still genuinely appreciative of the numerous donors that invest their time and money in a cause that affects millions across the country and more worldwide. But the harsh reality for myself and those of us living with Type 1 Diabetes is that even after those donors cross the finish line of their “Walk to Cure” and after the gala closes, a cure is still right around the next bend. A breakthrough treatment is still right behind the next donation.
As I sit here, 12 years after my family and I led our last walk team, I’m not going to hold my breath for a cure or continue asking for money. If you want to help, many other ways could make a more significant impact.
Our success with diabetes — A1C, Time in Range, frustration, acceptance, ability to reach out for help, etc. — ultimately depends on me, my insurance company and ability to pay for treatment, my care team, and my support group.
Type 1 Diabetes does not discriminate. We come from all different backgrounds and share completely different passions, interests, talents, and careers.
The problem is that despite coming from such a diverse background, our treatment options are limited.
What are the treatment options?
To give you an idea of the number of variables that impact glycemic control and can help you improve your diabetes management, consider the 58-page FDA approved label for Humalog. It’s boilerplate, extensive, and ambiguous to cover anything and everything that could happen. The one below is more concrete — 42 Factors that affect Blood Glucose. Diabetic or otherwise, ask yourself how many you have experienced in the last 90 days.
Clearly, the “optimal” diabetes management plan depends highly upon the individual, and again, it’s an imperfect disease. What I mean by that is if you experience 1 of 14 factors one day and learn from the way you treat it and your body reacts, your response the next day could be completely different. How do we get to a place where, righteously, it’s possible to consider the other 28 factors with more predictable effects on blood glucose and deal with them using a strategy that allows for steady blood sugar levels?
Insulin
My hat goes off to you if you read all 58 pages of the FDA approved label. To me, insulin injections are just a part of life, so it’s less fascinating. I will say, though, the four clinical studies on “the safety and efficacy” in patients with diabetes are incredibly underwhelming. The bottom line is that insulin is safe and effective as long as you give yourself the right amount at the right time — not too much, not too little. Getting there is the hardest part.
Insulin Pump
I get that insulin pumps carry serious drawbacks — do you want to always have something diabetes-related attached to you? are you cool with being the person who can’t pack light for weekenders? what if your teacher tells you to put your phone away when you’re actually pressing a couple buttons to make the low reservoir alert stop beeping?
Not only is it annoying trying to get comfortable in bed with it dangling off to the side, but it’s also kind of embarrassing to walk into a meeting with it on and have to field a question about the “pager” clipped to your belt. But it does allow you to lower your A1C without as many needles as shots would. Remember the last time you ate pizza?
Compared to multiple daily injections, wearing a pump for 90 days has been shown to lower A1C by 0.3% without increasing your number of lows. A separate study monitored A1C in people with Type 1 Diabetes before and up to 15 years after switching to the pump and saw a clear and lasting impact of using a pump on A1C.
In reality, the downside factors get easier to deal with over time, and there are entirely tubeless options available to explore. To me, the decision to wear a pump is a no brainer.
Continuous Glucose Monitor
Continuous glucose monitoring works for a lot of reasons. I like it because I hated checking my finger all of the time. I felt like finger pricks were cumbersome and pointless because even when I did it by the book, my blood sugar would still go high or low. In all honesty, I went probably three years without testing my blood sugar more than once a month and, since my A1C was always below 8%, it didn’t strike me as alarmingly bad for my health.
My Dexcom G6 sensor helps me figure out when my blood sugar is going high or low so that I can adjust my bolus + correction insulin in the moment based on how much insulin is on board. That’s precisely why you see such a drastic improvement in A1C during the first three months of therapy. As the study shows, and as I experienced with my endo, tweaking your basal rates and carb ratios to achieve optimal control takes a lot more time.
CGM is another tool that can help lower A1C but ask yourself — do you really want to have something on you all the time? what about over summer when everyone goes to the beach? do you want to deal with another notification continually blowing up your phone? what about an alarm in the middle of the night?
If your answer is no, I feel you. Most endocrinologists fail to recognize that lowering your A1C is worthless if you can’t find happiness — don’t feel guilty for pushing back. It’s all about balance.
In reality, most people who wear CGM don’t wear it all the time, and quantified health is robust when it is done correctly.
Hybrid Closed-Loop
“This significant milestone represents an important step forward in the management of type 1 diabetes and will improve the quality of life for those living with this chronic disease…We are very encouraged by the speed in which this groundbreaking technology was approved by the FDA, and we are proud of the role JDRF played in achieving this exciting breakthrough. Medtronic and JDRF are committed to ensuring appropriate patient access to this therapy.”
— Derek Rapp, JDRF President and CEO
Source: https://endocrinenews.endocrine.org/medtronic-receives-fda-approval-for-hybrid-closed-loop-system-for-people-with-type-1-diabetes/
The hybrid closed-loop system automatically adjusts basal insulin based on CGM values. Here are some studies on safety and efficacy.
https://www.tandfonline.com/doi/abs/10.1080/17425247.2020.1814734?journalCode=iedd20
Derek and I both know it works but, maybe someone more connected than us can explain why the #WeAreNotWaiting movement made this exciting breakthrough available four years before everyone else. Or why the manufacturers of the iLet bihormonal bionic pancreas, which was shown to achieve superior glycemic regulation without the need for carb counting, aren’t getting more attention — the company, Beta Bionics, incorporated as a public benefit corporation five years ago.
Are they helping?
In short, they could…but no… A study published by the T1D Exchange Network found, “the American Diabetes Association (ADA) HbA1c goal…for youth was achieved by only 17% and the goal …for adults by only 21%.”
T1D Exchange is a well-intentioned non-profit organization dedicated to improving outcomes for the entire T1D population by collaborating with clinics to identify and implement best practices and by attempting to bridge the gap between patients and their care team. I appreciate their efforts to aggregate data and incorporate our perspective as patients into T1D research and, although I am no longer subscribed to their question of the day email, I respect their triple aim areas of focus: (1) Treatment; (2) Policy; (3) Coverage.
The T1D Exchange highlights three key wins seen in their 23 partner clinics across the United States with a combined 40,000+ patients. Over two years, the T1D Exchange Quality Improvement Collaborative (QIC) has seen significant successes, including:
- 15% increase in the acceptance and use of continuous glucose monitoring, with some clinics achieving over 25%
- 64% increase in depression screening
- Overcoming barriers to tighter blood sugar control and monitoring, such as fears of hypoglycemia
It’s great that some of their partner clinics got 25% more patients on board with the potential benefits of CGM. From a macro level, targeting clinics with a track record of relative underperformance is an excellent way to boost usage and push the mean HbA1C down. However, it fails to significantly impact the number of people with Type 1 that actually achieve the ADA goal.
In my opinion, the T1D Exchange is another JDRF backed organization that takes too much credit for underwhelming results. Those things would have happened regardless of their presence.
The ADA recommends people with Type 1 Diabetes generally spend approximately 70% of the day between 70–180 mg/dL — 25% between 180–250 mg/dL — 5% below 70 mg/dL. This translates to an HbA1c of somewhere around 7%.
I can’t emphasize how important it is to recognize that despite all of the FDA’s emphasis on safety and conservatism expressed by endocrinologists in managing the risk of lows, the ADA says it’s okay that you spend 1 hour per day in a range below 70.
This points to another missing variable. Even though we have the technology that has proven to help you keep your blood sugar in range in a clinical setting, what else is missing?
“We don’t rise to the level of our expectations, we fall to the level of our training”
As you can see by the diverse group of people who live with Type 1 Diabetes and the number of factors impacting your blood sugar, managing Type 1 the right way requires a very individualized and day-to-day treatment plan. Finding and working with a committed endocrinologist should be of utmost importance. Sadly, due to geographic limitations, many people living with diabetes are forced to rely on their primary care physician.
Within the 3,143 US counties or county-equivalents, 734 counties (whose population represented 78.7 % of the US population aged ≥ 18 years) had at least one adult endocrinologist practice and 233 (whose population represented 52.0 % of the US population aged 0–17 years) had at least one pediatric endocrinologist practice.
Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4672571/
While an M.D. can prescribe insulin and medical devices to enable better management, interpreting and improving the data that results from that prescription is an iterative process that can’t be perfected without an endocrinologist.
My Trip to the Endo
The fact that your relationship with your endocrinologist could be considered the most critical factor in your diabetes management is incredibly ironic. According to Welldoc, a person with diabetes spends on average 8,760 hours per year self-managing and just 28 minutes per year with their provider.
There is little variation in medical treatments for Type 1 Diabetes, and it does not require a medical degree to decide which tools a patient could benefit from. All you need to do is subscribe to the right newsletter and stay up to date on the latest research and innovation. But they either don’t exist, or physicians don’t care. According to Dexcom’s research, as many as 75% of people with diabetes are unaware of CGM technology. If we can’t even expect providers to inform their patients of the most up-to-date technologies, it’s entirely off the table to ask them to look at quarterly trends in blood glucose, insulin, exercise, and food and deliver the best recommendations.
I was fortunate to see an endocrinologist who worked at the best publicly funded stem cell research clinics connected to a university in Southern California. Before making that transition to adult care, my pediatric care team at CHOC Hospital, led by Dr. Jodi Krantz and Dr. Mark Daniels, was phenomenal and set the standard. They took care of everything and helped me understand what it takes to manage life with Type 1 Diabetes.
I’ll admit that I wasn’t a model patient during my years as an undergraduate. I didn’t test my blood sugar as often as I should have. I missed appointments. I only communicated with my doctor in between the few visits I actually went to for prescription refills. It wasn’t until I was a senior, rounding the final turn and going into my last two quarters that I recommitted to my health.
12 months ago, I walked into my endocrinologist’s office with nothing to show for the last two years of my diabetes management. I purposefully forgot my meter at home to hide that I hadn’t been testing and accidentally left my pump sitting in the bathroom. I wasn’t proud of my record, but I was motivated to make massive changes to my care routine. All I needed were the right tools and proper guidance.
After sitting in the waiting room for what seemed like an hour, a nurse eventually called my name to walk back with her so that she could take my vitals. We joked about how I had packed on a few pounds since my last visit, but other than that, my temperature, blood pressure, and blood oxygen levels were utterly ordinary. She pricked my finger for an A1C check and told me the doctor would be right in.
Without the data from my blood glucose meter and insulin pump, it allowed me and my endo to dive right into the big picture changes that I wanted to make to my diabetes management. I expressed a serious interest in starting CGM and told them about some of the frustrations I had with the Medtronic 630G that I had been using since I was a freshman. They recommended that I explore the available in-network options online and send them a message via MyChart letting them know which one I wanted to start.
A few days later, I reached out and asked them to write a prescription for the Dexcom G6 system and Tandem TSlim X2 with Control I.Q. Neither system was the recommended and approved option of my health insurance provider, and getting either one would require a pre-authorization.
I’m trying to be fair because I know that my endocrinologist was a good person at their core but, their commitment to helping me get those devices was borderline negligent. I’m not sure why I had to explain to my care team why those devices were a medical necessity and would be better than the next best thing. It seems to me like it’s their job to intimately understand each option’s key features and differences. Maybe they were trying to see if I was bluffing that I was ready to take a more active approach to my diabetes management. It would also be unfair to blame them for how long the entire process of getting and learning how to safely use the devices took with everything going on with COVID.
What matters is that both the CGM and pump were eventually approved by my insurance, and I got them even amidst a global pandemic. I’m incredibly grateful to all medical device companies who took charge and adapted to the challenges last year. I can imagine ensuring the products that we, your customers, rely on were still available was no easy task. But my endocrinologist utterly failed to advocate on my behalf to get those tools and, even worse, failed to use them to make changes.
At my follow up appointment in June, I logged in to the telehealth portal armed with one months’ worth of CGM readings and data from my new insulin pump, prepared to make massive changes to my management. But despite the treasure trove of data that I previously thought prevented my endocrinologist from making positive changes to my basal rates and bolus ratios, I ended the video conference with only one minor adjustment. Those feelings of unimportance and loneliness are what started me on this journey to find a different solution.
Integrative diabetes care
I never liked going to the endocrinologist. The waiting rooms, the smell, the anxiety of handing over your devices, the painful single-use lancet for A1C tests. The whole experience never sat right with me.
I don’t want to feel bad about not remembering what led to a high blood sugar one night approximately 71 days ago. I don’t have the effort to log and track everything that happens in my life so that I can turn it over to an endocrinologist who’s just going to say, “diabetes is an imperfect disease” or, “everyone’s different, but try this next time, and we’ll talk about it in 90 days.”
The care team at CHOC was terrific in the months and years following my diagnosis and answered all of the questions we had for them. There was much more emphasis placed on getting immediate answers in those early days of learning to live with Type 1 Diabetes. Our questions weren’t as centered on reaching a sub-7.0% A1C as much as they revolved around what I needed to do to stay conscious, and it’s safe to say that their team did a great job. However, as I became more comfortable riding the sugar waves, their quick-fix solutions lost utility. The majority of adjustments to accommodate regular changes in my growing body came thirty to sixty days after they were needed.
It’s been over 7 years since I last saw the Type 1 Diabetes team at CHOC, so I don’t know what it’s like to go through their program now with CGM availability and more advanced ways to communicate. What I do know is that most adult care endocrinology clinics grossly fail to utilize the best technology and make effective treatment recommendations, and that their patients are struggling. My personal experience was not an outlier. It’s the standard.
Steady.Health raises the bar even further. Founded by people living with Type 1 Diabetes and designed to treat other people like them, Steady.Health is the first virtual endocrinology clinic that allows you to connect with your care team around the clock, from anywhere in the world, in real-time. As an integrator who takes responsibility for reducing costs, improving health, and improving care, Steady works to intimately understand your goals and acts to help you accomplish them.
What I said in October is still valid. I’m really not an employee. I really just use their services and meet with one of their endocrinologists — Calvin Wu, M.D. Luv u — and, as he can vouch for, I have really seen tremendous improvements in my overall health.
Other reviews of Steady.Health can talk more to the actual experience, but here are the highlights:
- $60/month
- Completely virtual endocrinologist appointments (…but optional, as always)
- Link to Dexcom/Libre apps and monitor your data in real-time
- Convenient messaging through the Steady.Health mobile app
- Logbook to improve and perfect your favorite meals and workouts
- Access to Steady network of providers and device manufacturer representatives
Steady.Health is the best solution available to people with Type 1 Diabetes right now, but is by no means perfect.
As an exclusively mobile app, it’s natural to have major concerns with regard to privacy. But unlike the data you share and companies like Facebook, Twitter, Instagram, etc. collect, what you provide to the team at Steady.Health targets your strengths and is used to enable better care, deliver support when you need it, and so on. Piggybacking off of the underlying theme of Congress’s move to allow for telehealth calls to take place over Zoom, what’s the worst that someone could do with your blood sugar and insulin data?
It needs to be easier to send messages to your care team through a web-based application. My diabetes care shouldn’t suffer if I drop my cellphone.
As an exclusively telehealth clinic, the signup process is so easy that you might wonder if you’re doing something wrong. Literally, just go to the app store and set up an appointment. Human touch is an important factor, especially during the first few years after diagnosis, and it would be good to see a more personal element added to the beginning steps.
See for yourself here: https://apps.apple.com/us/app/steady-health/id1458929653
Steady.Health uses all of the tools we have available to deliver better care, but it’s pricey. Personally, I think it’s better to mitigate the risks of long-term complications through better management today than paying for visits that might catch them earlier but that’s just me. More generally, diabetes is expensive enough already and knowing that it’s unreasonable to expect many to pay for the retail price of insulin, let alone a CGM or pump supplies, how can you expect them to afford an extra $720 annual expense?
A call to action
First, information and self advocacy is power. We also need to understand that people living with Type 1 Diabetes are a minority. Unless we speak up — no one else will. The current non-profit, media, mobile app, research, and provider landscape are simply not good or loud enough. They ask for so much of each donor and volunteer and offer little in return. We deserve better and must demand more in every aspect.
Second, we need to close the gap between research teams and clinicians, and patients. If we fail to do this, even scientifically valid, randomized, double-blind, controlled trials that receive funding will not result in the type of innovation required by diabetics. Why JDRF continues to dish out money to research and product teams so that they can continue their iterative process on stuff that nobody cares about except maybe medical device and drug manufacturer whales is beyond me.
Third, we need to ask ourselves if profit and returns to shareholders, or social benefit is more important. In my opinion, more companies should follow the lead of Beta Bionics and weigh the public benefit of their decisions BEFORE profit.
Fourth, we need to continue to demonstrate the value in more advanced treatments to insurance providers. Like I’ve seen with my endocrinologists, it’s not only a necessity that we all have access to the proper medical devices, we also need education and access to the tools required to make use of the data.
Then, let’s continue to innovate.
~ Adam Davis
