1st European Diabetes Technology and Transplantation Meeting (Montpellier, France, February 4-6, 2007)
While the rest of America was watching the Super Bowl, we were taking in the countryside in Montpellier, France, at first annual European Diabetes Technology and Transplantation Meeting. The US version, now in its seventh year, will take place in November, but in the meantime we were happy to learn what scientists in Europe and elsewhere.
“Perfection is the enemy of the good.” This sentence was a big catch phrase at the meeting, and we think it’s an important one to remember. How to translate? As patients, we know it’s easy to become overwhelmed with the endless therapeutic goals, but it’s good to remember that while meeting or sometimes exceeding those goals is important, the big picture is more important – if you miss your target, don’t despair. Instead, work with your healthcare team on how to fix it. The same goes for technological advances: many of the speakers at this meeting argued that patients should have easier access to technologies such as continuous monitoring that can safely improve their lives, even if those technologies are not yet perfect. In other words, the standard for regulators to pass judgment on these devices should be patient outcomes and satisfaction rather than statistical indications of accuracy. We agree, though we suspect that in the US insurers won’t be as easy to convince, nor will national health payors abroad.
Continuous glucose monitoring (CGM) is a slowly maturing technology. The more established manufacturers (Medtronic and DexCom) are working hard to improve their devices, and much work lies ahead, but to paraphrase Dr. Aaron Kowalski of JDRF, it's no longer a question of whether CGM will greatly change patients’ lives, only a question of when. We’re thrilled about Dr. Kowalski’s optimism and certainly hope he can lead the way on this front! As current users of CGM (including ourselves – see our Test Drive on DexCom’s STS) well know, there are still issues with product quality and reliability, not to mention, in the US, the absence of reimbursement from insurance companies and managed care organizations. Still, most of the participants at a CGM discussion group that we attended agreed that while the accuracy of current CGM devices isn’t perfect, it’s good enough to be useful. We agree that the area is poised for success. As Dr. Zach Bloomgarden told us in our interview, for type 1 patients with significant glycemic variability, having a continuous monitor can be nirvana.
Unfortunately, we are not going to see a fully closed loop artificial pancreas (AP) any time soon, but so far the hybrid (semi-closed loop) algorithms seem quite promising. A fully closed loop AP would include a continuous glucose sensor, an insulin pump, and a computer algorithm that takes data from the sensor and uses it to calculate the rate of insulin infusion the patient needs from the pump—all without any actual input from the patient. A semi-closed loop AP would be similar, but patients would have to help out a little by inputting data about their meals into the device so that the algorithm doesn't get surprised by rapid blood glucose changes (it's called a hybrid algorithm because it would take data from both the glucose sensor and the patient). So far, the experiments have only been done under controlled situations so we should be skeptical, but at least in these situations the hybrid algorithms actually did better than most patients would do by themselves. We expect this technology will take a while to reach patients, and as always reimbursement from insurance companies will be a major issue, but there is an exciting base of science here.
Non-invasive monitoring remains an area of unfulfilled expectations. We were discouraged with what we heard about the technology, though not surprised. We’ve heard that non-invasive monitoring was "just around the corner" for years, but despite over 5,000 patents issued and the dozens of companies working in this field, we’ve yet to see a reliable, convenient device and don’t expect one for some time. For now, fingersticks, and the emerging CGM devices, remain the only monitoring technologies for patients.