I had questions. I
walked into Medtronic Diabetes Headquarters in Southern California with three
pages full of them, and I was sure many would be left unanswered.
I had flashbacks of the first Medtronic Forum. I remember hearing excuses there. I remember finger pointing at the FDA. I remember hearing that the technology
approved now was developed many years before.
I remember thinking the lag time was unconscionable. Another 5 years here. Another 5 years there. We’re working on it… We’re working on it… Although I knew they had good intentions,
there was a wall there. Yes they were
smart, bright, good people, but nothing seemed to be getting done.
And then this year everything changed. It’s like the heavens opened and the walls
that stood crumbled effortlessly, pounded down by the power of purpose. Medtronic seemed less clunky. They were sleeker. Better.
Stronger. Faster. In almost thee years the energy had become
electrifying. You could feel it when we
walked in.
Things are moving.
They apologized up front.
They admitted to the faux pas of the “Artificial Pancreas” terminology used
for the new 530G pump and Enlite CGM that just rolled out. Although the semantics behind the name came
from the FDA, Medtronic didn’t do a lot to quash the rumors going around. They heard our cries. The new 530G is not an artificial
pancreas. They are painfully aware. Although later, when they spoke of the closed
loop system, the language seemed a little too forward still. Can it be called a closed loop system when we
are required to bolus for the food?
Medtronic thinks so.
In fact, after a little prodding I asked Katie Szyman,
Senior Vice President of Medtronic and Group President of Medtronic Diabetes, when
she hoped the true artificial pancreas would be made available. She was quick to point out that she doesn’t
believe there will be a successful closed loop system without the user’s
input. After all, a computer can’t guess
what we are going to eat, so bolusing when one eats will always need to be
accounted for. She thinks a system that
will regulate blood sugars by ramping up and shutting down insulin will be out
in less than 5 years. At this time she
doesn’t believe using glucagon in an artificial pancreas is a viable option. Sitting at a table with her and five other
bloggers, I was blown away at her willingness not only talk about such things, but
also have a two way conversation about it all.
My questions about the launch of the new 530G pump system
were also answered right out of the gate.
Why wasn’t it approved for children under 16? The protocol for trials set by the FDA were
so rigorous; putting children through the exercises would be akin to
waterboarding. The adults that volunteered for the study had
to run on a treadmill to induce a low blood sugar reaction, and then they had
to keep their blood sugar low to see if the new threshold suspend would
actually do it’s job properly. By
getting the system approved for adults, the studies for children were allowed to
be quite mild in comparison.
In brighter news, there are children in the U.S. already
taking part in a study for the next generation Enlite (pronounced EN-lite,) CGM
sensors. We won’t have to wait five
years for this next technology; in fact Medtronic is convinced we’ve turned a
corner with the FDA. Approvals should be
moving faster.
I was also told that they are continually looking for
children, (and adults,) to enroll in their studies. The faster they enroll, the faster technology
will become available to all. To find out
if there is a study near you, go to clincaltrials.gov and search for “Medtronic
Diabetes.”
Another notable bone of contention was the fact that the new
530G pump only came bundled with the Enlite CGM system. As far as I know, there is no way to simply
order a stand-alone pump from Medtronic anymore. I’m not sure that is the best move for them
moving forward, especially since many insurance companies have trouble approving
CGM’s…especially for children. I know
that our healthcare provider Kaiser Permanente had a big conversation with
Medtronic because of this snafu. It
seems that something has been worked out, but still. It’s all or nothing for the most part.
Medtronic made it clear that they are trying to make the
entire system’s price comparable to stand alone pumps. Also, we were told that there are quiet a few
programs in place at Medtronic to help financially. (Programs that are for everyone, in every
situation financially, and for those in and out of warranty.) They don’t
advertise these programs, so it would be beneficial for you to call in and
speak directly with a representative about your circumstances. Financially, Medtronic assured us they are
there to help you. Also, In exchange for
conducting surveys, Medtronic will reduce your cost for the system.
Watching the presentation regarding the new CGM, it seems
Medtronic listened to all our complaints.
The insertion needle itself went from 17.5mm to 10mm in length. The needle went from a 22 to a 27-gage
needle. They saw that they needed to
minimize insertion pain and keep the bleeding at a minimum. Because of this, there is an improved needle tip;
it is much sharper which lends itself to a 63% lower insertion force. The sensor left in body is 69% less volume,
falling from 14mm to 8.5mm in length. Their
goal was for users to heal more quickly after removing their sites.
Also, to reduce anxiety they created a new insertion device
that hides the needle completely upon insertion. A bonus is that this sensor
wets much faster, in fact it only takes about 15 minutes. A bonus bonus is that you can do the
insertion one handed, which makes it easier to insert the device behind the arm
or on the lower back.
When the system is approved for children, the big sell will
be the low glucose suspend feature on the pump.
If your child’s blood sugar falls under the parameters you set, and your
child does not respond to the low alarms, the pump will turn off for two hours
to prevent a severe low blood sugar and reaction. We’ll be able to resume the delivery at any
time, but the awesomeness lies in peace of mind at night.
In other news, they are aware of the problem of Bayer test
strips not being covered by certain insurances.
I am told they are actively working on it.
So when will the 530G be available for children under
16? In a perfect world, under a
year. There is hope it can happen in
that time. But with the landscape as it
is, it could take longer. The FDA is
picky on how studies are conducted.
Medtronic has to do it right, or again and again until they get it
right.
The give and take between Medtronic’s top brass and the
Diabetes advocate bloggers was refreshing to say the least. They wanted our input, they welcomed our
sass. It was liberating for me to be
able to blurt out, “Maybe you should just make a more accurate CGM,” and not be
glared at, but instead applauded.
They are working on it.
And it's not just lip service.
That, my friends…is called progress.
More to come! I need
to take a deep breath and recalibrate. Those questions I had walking in? 90% of them were answered. The 10% that weren't, I simply didn't find the right moment to ask. The winds of change are invigorating to say the least.
(In full disclosure, Medtronic Diabetes and Bayer Health paid for my plane ticket, my hotel and my food for this Medtronic Advocate Forum. They did not pay for me to write this post, in fact I was not asked to write about anything. The opinions here are 100% my own, and also subject to my own note taking skills.)