Review: Accu-Chek Mobile

Last year I was fortunate enough to be one of the winners of an Accu-chek mobile during a competition held by Roche Diagnostics. I have now been using the meter for about 5 months so thought it was time to share some of my impressions.

The meter is available in all the usual places and at the time of publication the RRP was $150.  Strips are a different story. In Australia, strips are only available through the NDSS to people who use insulin. This is the only time I’ve seen a restriction of this kind, and makes me think that the full unsubsidized costs of consumables for this meter is considerably higher than for any of the others in the market.

Advantages:

Well, there is only one main but HUGE advantage on this meter…. it’s all in one!.

This meter doesn’t really use strips like most meter. It uses a cassette that contains 50 tests. Think of it as a continuos strip 50 times as long, that rolls around a casette like an audio tape (sorry, couldn’t find an analogy from the ipod era).  You install the casette, and the meter tells you how many tests remain, when it’s empty you just open the meter, take the old one out and put a new casette in. very cool….

Accu-check has also integrated a modified version of their multi-clix lancet device which provides 6 lances into once cartridge. It’s attached to the meter (although it can be detached if needed) and can be operated with the same hand that holds the whole unit. It’s perfect for one handed testing… Especially when driving… not that I would ever do that…

All this integration makes the traditional meter case completely obsolete. I now carry my meter in my pocket much like I would carry a mobile phone. In fact Accu-chek gave me a leather cover that reminded me of the mobile phone covers from the 90’s.

In addition to this, there are a few extra features…  display is bright yellow over black, so no back-light is necessary even in the darkest places (assuming you can find the tip of the test area to put blood in), has all the averages and other stats I have never used, and supports alternative site testing (AST) so you can give your fingers a break ( Thanks to whoever invented this, I can’t see myself ever testing in my fingers again )

Disadvantages:

There are a couple if minor disadvantages that I’m happy to live with. The first one is that you don’t carry a meter case anymore, so you’ll have to find a different place for things like hypo fixes and spare supplies. The second disadvantage is that it makes a bit more noise than traditional meters, mainly because of all the moving parts. The last one is its size… this is not a small meter by any means, but in my case I find it compensates with the fact that you don’t carry a case anymore.

Verdict:

This is probably the best meter I’ve tried so far and thus why I carry it every day. It’s not perfect but definitely makes testing 8 or 10 times a day a lit easier that most of the other meters I’ve tried.

Diabetes in my iPhone

I must now come clean and admit that I’m one of those….. I have an iPhone. My iPhone, like me, also lives with type 1 diabetes, and to be honest, I must say that it can be a great tool to help maintain good control. Recently Diabetes Health published a list of the best Free diabetes related applications for the iPhone. I would like to share some of those here.

Glucose Buddy – Diabetes Helper 3.2

“Created by Tom Xu and Matthew Tendler, Glucose Buddy was ranked the #1 diabetes iPhone application by Manny Hernandez, founder of TuDiabetes.com. It has also been featured in several publications, including Wired Magazine. Glucose Buddy is a data storage utility into which you manually enter glucose numbers, carbohydrate consumption, insulin dosages, and activities. You can view all of your data on your free Glucosebuddy.com online account, where your iPhone automatically syncs your logs.”

Diabetes Log

“Diabetes Log is a very simple, no frills application that allows you to log your glucose readings, food intake, and medicine records. You can then export records of your logs (CVS over email) to your computer for your personal use or to send to your health professional. If you are looking for a simple way to keep an on-the-go log of your readings, then this is the application for you.”

Log For Life – Diabetes Quick Entry

“The Log For Life application is a companion application for the subscription- based web application, Log For Life. Cost for subscription to this service is $9 per month after a free 30-day trial. Log for Life allows you to quickly log glucose, carbohydrates, medication, exercise, weight, and notes.”

Bant

“Bant allows you to enter your glucose readings with an easy-to-use reading entry system. Entries can be by the meal, time of day, or other factors. The information stores instantly on your Google Health account and in the “Bant Book,” which you can use to create trends and charts or share with members of your support team. You can also share your experience with diabetes through Twitter right from the application. It’s very easy to use, with a nice interface, and I like the Google Health account and Twitter features.”

Diabetic Meal Planner Lite – Glycemic Index

“This app calculates the overall glycemic index (GI) and glycemic load (GL) for individual meals and the entire day, to help you build a healthy diet. It provides carbohydrate, calories, protein, fat analysis, and future meal planning for numerous food items. (The free version, however, provides only 38 food items in the database: two per food group”

Glucose Mate Free

This app simplifies glucose data logging and automatically saves glucose level, relationship to the meal, and time of measurement. There’s a chart for glucose level trend analysis, to help you and your doctor decide on the best medicine and adjust daily drug dosage.

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Medtronic Safety Alert

Yes… that is the title of a letter I received from Medtronic Australia a few days ago. No wonder I instinctively reached for my pump and disconnected, even before reading the content of this “urgent” letter.

As it turns out, the supposedly important alert does not seem to be anything other than a simple clarifycation, probably made “urgent” by the need of Medtronic to cover any liability risk. Further to this, the letter is only related to the Continuous Glucose Monitoring capabilities of the Paradigm pump, so the amount of people potentially impacted is very small. Nevertheless all Paradigm users in Australia seem to have received the letter.

In October last year, Medtronic increased the lifespan of it’s sensors to 6 days instead of 3. While new pumps are programed for this change, everyone who got a pump a while ago is still faced with and “End of Sensor” message after 3 days.

The purpose of this latest message from Medtronic is to advise that “you should be aware of the following:

1.- The first sensor alert after 3 days of sensor use may be treated as an advisory reminding you that the sensor will need to be changed in a further 3 days”.

Is this a joke or what?

Ah!, and of course there is a subtle word or warning before the letter concludes:

“The sensor must not be used for more than 6 days as the accuracy of the sensor cannot be guaranteed”

Hmm… let me think… isn’t that the case for the whole life of the sensor.

I think Medtronic should pay more attention to communications with its consumers if they are to live to the expectations of being leaders in that market.

Sanofi Aventis enters the Glucose Meter race

Sanofi Aventis is responsible for single-handedly revolutionizing the diabetes market earlier this century with the approval of Lantus, the first “basal” insulin to be approved by the FDA.

Now, the french company has it’s eyes set on a new challenge: Blood Glucose meters. Sanofi-Aventis has “further broadened its healthcare business on Wednesday by agreeing to develop blood sugar monitoring systems with AgaMatrix, a privately held U.S. firm.” said a Reuters report.

The original press release also indicates that “The move takes the group into the world of medical devices and is part of a strategy by Chief Executive Chris Viehbacher to diversify Sanofi, reducing its traditional reliance on branded prescription drugs.

Viehbacher told Reuters last year he was interested in certain areas of medical technology, including devices that allow patients to measure their health at home.

“The vision of the company is to become a healthcare company (so) it’s logical to look at some kinds of devices,” he said at the time. [ID:nL5498514]

Under the terms of the agreement, AgaMatrix and Sanofi will co-develop blood glucose monitoring devices that can simplify the management of insulin therapy, where Sanofi is already a leader with insulin drugs such as Lantus and Apidra.

Sanofi plans to start selling the first products from the partnership in the second half of 2010, it said.

Financial terms of the collaboration were not disclosed but the blood monitoring systems will be exclusive to Sanofi and will be designed to work synergistically with its existing diabetes treatments.

“This agreement is a concrete step towards fulfilling our vision to deliver integrated solutions to patients and become the partner of choice in the field of diabetes,” said Pierre Chancel, head of Sanofi’s diabetes division.

New “Old” infusion set for Medtronic

Geoffrey Steinman, a user from TuDiabetes has recently mentioned in the Minimed group that he had the opportunity to try a new infusion set for the Minimed Paradigm, the Paradigm Mio. As a Paradigm 522 user myself, I’ve been battling with a number of set malfunctions from my favorite set, the Quickset. I was therefore, quite intereted in looking into thi new alternative.

Unfortunately, as soon as I saw the pictures published by Geoffrey, I discovered there is really nothing new in the Mio. When you compate this pictures of the Mio

With the pictures of the Unomedical Inset II

I must admit that these two sets look identical. I can only speculate and say that they are probably being made by the same manufacturer.  If this two sets are really identical, then the only benefit of the new set would be the Paradigm connector, which would make use of the Thinset reservoir unnecessary.

Now the big question is what impact will this have on the market. Will it kill the Thinset and ultimately reinforce the monopoly of Minimed in Paradigm consumables ? Only time will tell.

Cheaper pumps for Australian Kids

The Australian government announced yesterday an enhancement to the pumps subsidy program for children which could help in the path towards universal insulin pump adoption for people with Type 1 Diabetes.

In an article published in their regular newsletter, the Juvenile Diabetes Research Foundation indicates that the  “Minister for Health, Nicola Roxon MP, has announced an expansion of the Type 1 Diabetes Insulin Pump Program, with a dramatically increased government subsidy of up to 80% of the purchase price of an insulin pump.

The program was first launched in 2008 and provides a means-tested subsidy towards the purchase of an insulin pump for children under 18 who do not have access to private health insurance.

In Australia insulin pumps can cost up to $8,000, making them a medically desirable but unaffordable option for many without private health rebates.

Children under 18 with type 1 diabetes will now be eligible, on the recommendation of a health professional, for a subsidy of up to 80% of the cost of an insulin pump, to a maximum of $6,400 and a minimum of $500.”

Interestingly, the JDRF has also created a form in the website so members from the public can send thank you notes to the Minister.

CGMS costs slashed in half?

Yesterday I received a letter from Medtronic, informing me of a new approval after some recent changes to their CGMS products. Medtronic has completed a study titled “An Inpatient Evaluation of Six-Day Subcutaneous Glucose Sensor Performance” which proved that sensors can be used for 6 days instead of 3. Additionally, sensors where also tested in alternate sites, instead of just the abdomen.

According to the study “The Medtronic MiniMed Subcutaneous Glucose Sensor was originally approved by the FDA for commercialization as part of the Continuous Glucose Monitoring System (CGMS) on June 15, 1999 (PMA 980022). The Sensor is composed of a microelectrode with a thin coating of glucose oxidase beneath several layers of biocompatible membrane. This same sensor is used as part of the Guardian REAL-Time System, the latest advance in continuous glucose monitoring, which is based on the CGMS. Similar to the CGMS, the Guardian REAL-Time System has been developed for use in conjunction with a standard home blood glucose meter. The Guardian REAL-Time received regulatory approval from the FDA in 2006. As currently used, the Subcutaneous Glucose Sensor is labeled for a maximum use duration of 72 hours, using only the abdomen area as an insertion site. Recent studies have shown that the useful sensor life could extend beyond three days, and it is reasonable to expect a significant percentage of sensors to last six days. It is the goal of this study to confirm sensor performance accuracy data from one of these recent studies. The sensor is also commonly worn in body areas other than the abdomen (such as the buttock). This study will also demonstrate sensor accuracy when used in an alternate site.”

This is a very positive piece of news that means that people here in Australia can now get Continuous Monitoring for about half the cost of what was possible previously. This is particularly important since insurance coverage for CGMS is not available here in Australia and patients wanting to use it have to pay out of pocket.

Now, a lot of people where reusing the sensors to achieve the 6 day mark, even if it was not officially approved. It would be interested if that same people will now try to get it to work even longer than 6 days…

Insulin Pump Expo 2009

This week I had the opportunity to attend the Insulin Pump Expo 2009. This event is organized by The local chapter of Diabetes Australia, and brings together the diabetes community interested in Insulin Pumps. There were two presentaton tracks on the day, one for prospective pumpers and an advanced one for those of us who have been pumping for a while.

In the introductory session they introduce the basic concepts of pumping, with the objective of helping people decide whether they may be interested in an insulin pump. There is also presentations by most pump manufacturers and it’s an interesting to see them competing with each other for patients attention.

I’m already on a pump and pretty much locked to it for the next 3 1/2 years, so for me, the advanced session was where the real value was. Cheryl Steele from the Diabetes Department at Western Health, presented a very comprehensive presentation on bolus options, handling tricky food and continuous glucose monitoring.

Particularly interesting for m was the section on takeaway foods. I’ve always had issues with some foods and had assumed that there was not much you could do… Naughty eating gets naughty BGLs….  It turns out that what I’ve been doing wrong is using the wrong type of bolus.  I’ve been using normal bolus for everything while in reallity the fat content of the foods slows down the absortion rate.

Some of the recommendations were quite impresive… for a Big Mac, for example… 50% of the insulin immedicately and 50% over 3 or 4 hours… Pizza, 30-40% now and the rest over 6-7 hours. We were also told to include part of the fat content in the carb count as the liver will eventually turn it into glucose.

Overall was a great night and look forward to see whether I can used what I learned to get better control.

The end of insulin injections

Many people with chronic conditions successfully manage them with pills. This, however, is not the case for those of us living with Type 1 diabetes.

When first diagnosed I remember being told that the main issue with insulin is that it was a protein, and that as a consequence, it would be digested if taken in oral form. While there has been a number of attempts at alternative methods of delivery, we are still ultimately stuck with shots (or variations like a pump).

This may now be about to change. A group of scientists have combined nanotechnology and magnetism to create a delivery system that is simple, but extremely durable and accurate.

According to an article published in Diabetes Health, “The Boston researchers’ solution is a small implantable device, less than a half inch in diameter, that is placed in a patient’s body. The device contains a drug-filled membrane that is also embedded with nanoparticles of magnetite, a naturally magnetic mineral. The nanoparticles are about 1/100,000^th the width of a human hair.”

“The amount of the drug that a patient receives can be controlled by how long the magnetic field is applied. Longer pulses produce higher doses. Theoretically, diabetes patients using such a system would be able to self-administer insulin simply by passing a magnetic field near their implanted drug delivery devices for a set amount of time.”

New technology may revolutionize insulin pumps

Today I bumped into the website of a company from Israel that is working with some incredible technology for insulin pumps.

NiliMEDIX seem to have created the first insulin pump without a motor. This will, in theory, help eliminate a lot of the risks and malfunctions inherent to using a pump in the first place, and may also make pumps cheaper.

Here is a video from the company describing the product:

The company is also working on a patch pump to compete with Omnipod and a disposable insulin pump, likely aimed a type 2 diabetics.