Guest Post by David Kliff, Editor, Diabetic Investor
Whether the toy makers realize it or not, the key to getting their toys played with is to make the toy as easy to use as possible. This ease of use does not just mean things like easy insertion of a sensor, like Dexcom has done with the G6 or Abbott has done with the Libre. It goes beyond not having to calibrate either of these sensors. When it comes to increasing the use of insulin, it means making dosing insulin as “stupid” as possible: take all the decisions out of the hands of the patient.
As I have noted before, with insulin-dosing algorithms, this is now possible. Whether the algorithm is connected to an insulin pump or the future type of “smart” pen/CGM/App system I’ve nicknamed a “Tyler,” does not matter. The key here is to let the system do all the thinking, and in the case of Tyler, all the patient needs to do is take the recommended amount of insulin, something a pump patient can avoid as the pump does this for them.
Prior to CGM and dosing algorithms, properly dosing insulin was one big pain in the rear. Patients had to understand numerous complicated concepts. Additionally, getting enough glucose readings was also a huge pain in the finger. Worse, patients had to do all the heavy lifting. Sure, bolus calculators helped, but back in the day for the most part only insulin pump patients had this luxury.
Yes, we have several way cool whiz bang apps that now crunch the numbers and spit out the dose. However, only a handful collect all the information needed to make the correct recommendation. Fewer still do what an algorithm does — they don’t learn. Worst of all, it’s the patient who must enter most of the information the app needs so it can crunch the numbers and come up with a recommendation.
Systems such as the 670G from Medtronic have proven that when the system has all the necessary data, diabetes management is relatively easy. Yes, the patient still must change their infusion set every three days, fill the reservoir with insulin, prime the pump, and make sure they have a working sensor inserted properly. But the heavy lifting — all the calculations and insulin delivery — are done by the system. Should the patient wish to go off the grid, the system allows that option too.
When Tyler gets here, insulin dosing for multiple daily injection (MDI) patients will also be pretty easy. It doesn’t take an advanced degree from MIT to put a “smart cap” on a disposable insulin pen, insert the G6 or Libre, and then let the system take over. All the patient has to do is follow the recommendations provided by the app. Since the patient is in control over when insulin is dosed and how much, they too can go off the grid if they choose to do so.
What both a “smart” insulin pump and Tyler have in common is they make insulin dosing stupid. They take all thinking from the patient and transfer it to the system. This is what makes these systems so compelling, as they meet the needs for the majority of patients. They make insulin therapy easy.
To put this in terms everyone can understand, even the toy makers look at the success of GLP-1 therapy. There are no dosing calculations. There is no need to monitor glucose or count carbs. The patient simply injects a predetermined dose either once daily or once weekly. That’s it.
Granted, most of the toy makers do not understand simplicity. As I say often, these people could screw up a simple peanut butter and jelly sandwich. They continue to be fascinated by whiz bang way cool, which matters little to the patient who seeks the shortest distance between two points. They continue to be fascinated by all the way cool reports their system can generate — reports that no patient will ever look at or care about. What patients want most is stupid: not having to think about their diabetes management.
There is a small subset of patients who fit the profile of the toy makers’ vision, but the vast majority of patients do not fall into this category. They don’t want whiz bang way cool, they want simple stupid. GLP-1 therapy is ‘simple stupid,’ and not just for the patient but for the physician too. The physician doesn’t have to worry about hypoglycemia, control, or weight gain. GLP-1 therapy is not complex to explain either, and as the GLP-1 companies make very clear in their TV commercials, it’s NOT insulin.
Well, with a “smart” pump or Tyler, insulin therapy too can be simple stupid. It can take away the fear of hypoglycemia, which prevents many physicians from prescribing insulin therapy. It takes away all the heavy lifting that must be done by the patient, which also pleases the physician. These systems also provide all reports that physicians want to see. The only thing a “smart” pump or Tyler cannot do is take away the belief by patients that moving to insulin therapy is a PERSONAL FAILURE.
Payors should also embrace these new “smart” insulin pumps and Tyler for they offer the potential to lower costs. As I have noted, Medtronic has already moved in this direction, but in the future this “guarantee” will be ubiquitous.
In the old days, and in some cases today, systems were designed by engineers to be used by engineers. Today, the opportunity exists to make insulin therapy easy. That is of course if these geniuses don’t over complicate matters by trying to overthink things. As Momma Kliff used to say, “The last thing you want to do is make people think. The less thinking the better. Or in other words, KEEP IT SIMPLE, STUPID.”