April 17, 2015

Testing Tuesday - Not Blood Testing (unless you have a better idea on how to that)

From my good friend Joyce Lee and our merry band of innovators:

Initiating a Collaborative Innovation Network for Healthcare Transformation in Type 1 Diabetes

We #makehealth!
We are a group of patients, caregivers, healthcare providers, designers, innovators, advocates, quality improvement specialists, technologists, and engineers who are passionate about transforming healthcare for type 1 diabetes.

Be part of this crowd sourced effort!

This collaboration was inspired by the work we have been doing for the T1D Exchange and the C3N Project. See Storify #1; see Storify #2 to take a peek at what we have been up to!

Why is the page called Testing Tuesday? (http://testingtuesday.org)

Testing Tuesday Projects are projects, collaborations, improvements in healthcare that we can do to start the transformation now! Watch this video by Mike Evans to learn about how we chose the name!

April 14, 2015

IBM Watson Teaming up With Medtronic. Will Your Pump Kick Butt at Chess?

... or maybe Jeopardy? 

Medtronic is teaming up with IMB's Watson. The full press release is here. I thought these comments were the most interesting part:

"Devices alone cannot transform diabetes care. The combination of leadership technologies, big data, informatics and world-class patient management are all required to drive effective results in diabetes care," said Hooman Hakami, executive vice president and president of the Diabetes Group at Medtronic. "Medtronic and IBM intend to bring these capabilities together to pioneer a new level of care that will improve outcomes and lower cost so people living with diabetes can enjoy greater freedom and better health." 

"We are building a secure, open innovation platform that could change the face of diabetes management," said John E. Kelly III, IBM senior vice president, solutions portfolio and research. "Medtronic and IBM can marry the power of analytics, cognitive computing and patient engagement with the world's most sophisticated diabetes management devices to truly change how people with diabetes live."

Maybe it will be DEWY.

See: Of Fantasy Diabetes Devices, Sheldon & Dewy.

Source: http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=2034597

April 7, 2015

PRESS RELEASE: DreaMed Diabetes and Medtronic Enter Strategic Collaboration

PETAH TIKVA, Israel, Apr 06, 2015 (BUSINESS WIRE) -- DreaMed Diabetes, developer of diabetes treatment and management solutions, announced today that it had signed an exclusive worldwide development and license agreement with Medtronic, the world's premier medical technology and services company, for the development and marketing of products incorporating DreaMed’s MD-Logic Artificial Pancreas algorithm in Medtronic’s insulin pumps.
Under the terms of the agreement, DreaMed Diabetes will receive undisclosed royalties from future sales of each device utilizing MD-Logic. Medtronic will be responsible for all development and marketing of such devices. In addition, Medtronic has made a minority investment in DreaMed Diabetes of $2 million.
DreaMed Diabetes’s CE approved GlucoSitter™, which is based on the MD-Logic Artificial Pancreas algorithm, is a fully-automated, artificial-pancreas system for controlling glucose levels. The system links the glucose sensor with the insulin pump through computerized control algorithms. It uses data of glucose levels from a continuous glucose sensor, analyzes them and directs the insulin pump to deliver the correct dose of insulin that should be released to the body in order to maintain balanced blood glucose. In effect, the software continuously monitors glucose levels, and defines precisely when and how to adjust insulin levels. more: http://www.marketwatch.com/story/dreamed-diabetes-and-medtronic-enter-strategic-collaboration-2015-04-06

March 26, 2015

SGR is on Congress’ Agenda This week: What is It? A Primer for Diabetes Advocacy

SGR is in health news. MedPage Today ran a piece March 25 by Joyce Frieden titled, "Bill to Kill SGR Likely to Pass House, but Fate in Senate Less Certain." Her opening sentence is:

WASHINGTON -- Negotiators are working feverishly and President Obama has a pen at the ready, but whether a permanent repeal of the widely disliked "sustainable growth rate" (SGR) formula for Medicare reimbursement can happen this week is still up in the air.
Wait. The house and the President are interested in the same thing passing. In health. What the... is SGR.

SGR is a process Congress created in 1997, to restrain the cost Medicare pays doctors. The idea is that growth in Medicare cost should be linked to the growth rate in the US economy. SRG triggers cuts in physician payments if doctor costs exceed targets. It is very formula heavy. Congress has to March 31 to step in before there are cuts to doctors for seeing Medicare patients. Those cuts would be over 20%. The fear is then that doctors would stop seeing Medicare patients.

For the last decade, Congress has prevented these cuts with short term fixes. The Brookings Institute says, “However, since 2002, Congress has stepped in with short-term legislation (often referred to as the “doc fix”) to avert the payment reduction. These patches have kept increases in physician payments below inflation over time.” There are voices calling for a longer term process as well as those less concerned with regular consideration congressional action.

There are concerns over the SGR patch process as well. For example, since payments are on a fee for service basis they encourage volume of services billable Medicare over quantity of care. The process does not consider doctors or practices based on performance. Cuts may limit seniors access to care.

Because Congress has consistently passed SGR patches, the legislation often attracts other issues as riders. CHIP programs for children and  funding for the Special Diabetes Program are advocacy priorities of the American Diabetes Association and JDRF.

Here are some resources to learn more about SGR:

The Brooking Institute:
A primer on Medicare physician payment reform and the SGR

MedPage Today
Bill to Kill SGR Likely to Pass House, but Fate in Senate Less Certain

Internal Medicin News
FAQ: What’s in the House proposal to fix the SGR?

American Diabetes Asscocation Call to Action

JDRF Call to Action

March 18, 2015

Transparency on Insulin %&#%Problems

%&#% = pump

What were you thinking?

In "Experts call for transparency on insulin pump problems" - Kathryn Doyle - Reuters, there is a call for better data on insulin pump errors. It would be easy to read into this that pumps increase risk. I doubt that is the case.  All the data I have seen suggest that people on pumps do better with their diabetes management.

So when talk of Insulin Pump Problems, should be made in the context of insulin. Taking Insulin is risky - Diabetes is a Problem. Pumps are an imperfect but valuable mitigation of diabetes and its risk.

I would hope/think that clear direction on Medical Device Reports (MDR) to FDA and access to those MDRs would be useful in getting the information needed. I ma reasonably confident that pump companies are diligent about MDRs. Yes - Data is useful, so are pumps. Insulin is dangerous and THAT should be kept in mind when talking about pumps. People on pumps do better.

So how about transperencey on insulin problems too?

No throwing the baby out with the bathwater.

March 16, 2015

UnConference = UnBelievable

The UnConference was UnBelievable.

Full disclosure: I was and am a believer. I was part of the planning. I was a facilitator. I am an officer of the The Diabetes Collective, Inc... In short, I had high expectations.

This collection of people with diabetes exceeded my hopes, in spades.* 

The magic was the high degree of attention we gave to each other. We  were there, not on our phones. A huge part of success was respect and trust. To keep the resect for other's stories and the trust they invested in me by sharing those stories, I will only share my experiences. I hope others choose to share theirs as well. That is their choice.

I can say, I was moved by the stories shared. I have heard a lot of diabetes stories, none were more moving. I was empowered by the stories I heard, engaged by the trust of sharing them and honored to respond by sharing my story, knowing it was safe to do so. I was even more moved to be allowed to hear, hold, and help. Oh and pass the Kleenex.

Nobody every asked to have diabetes. Nobody. 



It is a disease. In every case, disease.

I was moved by a metaphor I picked up at the UnConference. I will use it, a lot. Diabetes is complex patch work quilt of metabolic diseases. That is true of all diabetes and that makes it an even better mental image.  

Rationally, I know that. I have been a patient reviewer of scientific grants by both PICOR and CDMRP. In my role for them, I was in rooms with a dozen and a half PhD physicians reviewing scores of research proposals. Each looked at a part of the patchwork of health. Those were intense intellectual process - detailed, rational, clear examinations of the finest threads of the various patches of life's quilt. By the nature of science, those are cold processes. 

I felt the warm comfort of the quilt at the UnConference. I was a patch, at teeny piece of cloth, in a multi color mix of parts new and old. Collectively we were so much more than scraps. Together we became a blanket of almost two thousand years of individual experience of living with diabetes. It feels great to be embraced by two millennia of wisdom. It is an UnBelievably good feeling to be able to help old friends, particularly the you just met.

I was trusted to hug, hand hold and say it not your fault. I could draw on those rooms full of PhDs and their microscopic views to say with confidence, this isn't your fault.

It is mix of metabolic diseases and we made a quilt. A warm embracing patchwork that a seemstress makes something amazing from what other may see as scraps.

I look forward seeing other share their experiences and together we will patch together thee UnConference  story. 

*(Obligatory Vegas gaming reference.) 

March 2, 2015

February 27, 2015

Finance Geeks are Talking Artificial Pancreas. James Cagney Wants a Cut.

Ok, I'm a business news kinda guy. My undergrad degree is finance; I was a banker (I apologize for what I did to the American Economy, it was clearly all my fault, I'm sorry.)

Interestingly this week a number of earnings calls (aka where businesses talk about their results to analysts each quarter) Artificial Pancreas was a topic:

Here's a few I just posted about:
Home Grown & Startup

Then there is Medtronic's latest not-in-the-USA-yet launch.

What I find interesting as a finance geek is the shift in tone from a kinda distant, "Hey this is some research someplace,"  to wall street asking, "Yo. Where's da product? And how'z youz gonna get a cut?" (Yes - analyst are James Cagney in some shoot 'em up film)

In my twisted mind, this is a significant sign of progress.

Keep it coming.

AP will come incrementally. These all suggest incremental steps. Like diabetes care perfection shouldn't be the Public Enemy of the good. 

Dexcom and Artificial Pancreas

From: http://seekingalpha.com/article/2951636-dexcoms-dxcm-ceo-kevin-sayer-on-q4-2014-results-earnings-call-transcript
We met with several groups utilizing G4, CGM and developing closely* and partially close with our efficient pancreas type systems. 
And a significant progress has been made by many of these groups, but the pathway to commercialization for many of these projects remains unclear and we will continually evaluate our own path to the artificial pancreas closely. 
With the world’s most accurate and reliable CGM system we intend to play in this arena. We left the meeting very confident that with execution of our plant, product portfolio we will remain the world’s leader in continues glucose monitoring 
With our new insertion system, the G6 and other advanced sensor platforms, expanding connectivity with user-friendly apps and the ability to perform advanced analytics, one CGM and other diabetes data is in the cloud we believe we are position to lead this industry for a very, very long time.

OmniPod's & Artificial Pancreas

OmniPod's CEO spoke of artificial pancreas in Q&A at the most recent earnings call:
Patrick Sullivan - President & CEO
Yes, I would say our strategy is that as it relates to the artificial pancreas, we are putting together strategy so that OmniPod is a very significant part of the artificial pancreas product offering in the future. And with that you need to have a CGM product offering, as well as an offering to put the three units together if you will, and as you know we have been working internally on our own CGM development which continues but also we have an agreement with - already have an agreement with Dexcom to use their CGM sensor along with our new PDM to integrate that those two products together, and I think with that combination used in algorithm and we're looking at opportunities to have an algorithm that we could then provide the full package. I'd also say that we would evaluate and look at opportunities with Abbott and others that would have potential CGM integration opportunities for us. So in the short term we're looking at other people that have CGM capabilities and algorithm capability, but at the same time we are continuing at a low level our own efforts in our own CGM product development.