The first day of DTM 2019 (Diabetes Technology Meeting) was crazy - so many incredible sessions and speakers to take in!
Takeaways on Day 1 (for me) primarily focused on CGMs, CGM adhesives, finger-sticks, and diabetes cyber security - no matter the tech.
Day one kicked off at 8 a.m. with a panel discussion on Continuous Glucose Monitoring systems consisting of company reps from Dexcom, Medtronic, POCTech, Eversense, and LifeCare (not yet on the market) discussing CGM usage and technologies to improve to performance.
Key Panel Points - In Order of Speaker Line-up
Dexcom’s new generation G7 promises a smaller sensor, a possible decrease in cost, and a target launch date of 2020.
No need for finger checks was also mentioned. More on that later.
Dexcom referred to their CGM as being a platform technology.
Sidebar: On Wednesday, November 13, Dexcom CEO Kevin Sayer told CNBC’s Jim Cramer, “This whole integration of health care data is really going to be the next frontier.” Interesting and concerning.
Medtronic is looking to focus on better and more skin friendly adhesives to integrate with new sensor technology that extends beyond 10 days.
POCTech’s CT-100 C #CGM System has a flexible sensor filament.
In Non-tech Speak: The sensor is flexible and allows for adjustment to sensor placement and depth control post insertion. YES.
FYI: A CGM sensor placed in the wrong spot not only hurts, it is also a waste of both money and the sensor.
The transmitter memory holds 15 days’ worth of data, glucose response time is fast — as in 20 seconds, and is water resistant.
Full Disclosure: POCTech is a Chinese medical device company formed in 2010, initiated CGM research in 2013, entered clinical trials in 2015, and hit selected Asian markets in 2017. In January 2019, Ascensia announced its global partnership with POCTech to distribute and co-develop CGMs.
Eversense discussed the possibility of including an activity tracker in the form of an Accelerometer and stated that their CGM will soon be available to people with diabetes on Medicare.
LifeCare’s Injectable Sencell Glucose Sensor is a Novel Osmotic, pressure-based implantable Glucose Sensor. FTR, it’s super tiny. A human pilot study starts in December 2019, with additional miniaturization and wireless data transfer capability in 2020.
Circling Back To Questioning The Need For Finger-Sticks
None of us in the US knows what our insurance will cover from year to year, and the rules change with Medicare and Medicaid frequently.
People with diabetes also deal with device alarm fatigue (the struggle is real) and require breaks from being “attached," because the fact is we’re all human and there are times when being part Diabetes Cyborg isn’t all it’s cracked up to be.
PWDs need access to the medications and devices that work for us.
It also takes up to 48 hours for CGMs (including Dexcom) to recognize an individual's glucose algorithms. So yes, in my opinion, (and many others) finger-sticks are still needed.
And I say this as a PWD who wears both a Dexcom G6 and an Omnipod.
Every CGM company has acknowledged and tried to address skin adhesive issues.
The skin of people with diabetes takes a beating with all the tech (pumps, pods, CGMs), general wear and tear, and adhesives, all of which are not user friendly.
We need to protect our "real estate” and I’m glad to hear that the industry is acknowledging and helping. THANKS.
One of the panelists mentioned that an invite should be extended to a Dermatologist for next year’s panel because of these skin/adhesive issues.
YES, that would be great. As would having multiple people with diabetes wearing different diabetes technologies, but I digress.
Post CGM Panel Discussion, other morning standouts include:
CGM sensor studies (implanted in pig skin) show that skin develops inflammatory reactions after 7 days, and vessel damage and scar tissue after 21 days. Not surprising and good to know.
Inquiring minds want to know: Is it possible to make sensors reusable so we can switch them out, preserving both our skin and the planet?
3,000 bio markers can be found in interstitial fluids. So can lots of drugs. Who knew?
Speaking of interstitial fluids… be on the lookout for sampling interstitial fluid via micro-needling patches.
Diabetes Devices Cybersecurity Talk By Robert Hurtz, MS - Director of Product Design & Engineering, Ascensia Diabetes Care
Robert began his talk by stating that: Blood glucose management has changed a lot in the last few years — moving from stand alone to interconnected diabetes management systems.
And then pointed out that diabetes device systems across the board are inherently more complex — now including cloud systems, phones and apps.
Cloud and app interconnectivity increases security risk for all connected D devices (insulin pumps, CGMs, meters) and lurkers are constantly trying to find alternative ways into systems.
All of the above demand new sets of security language to master (because language does indeed matter). Hurtz then stressed the importance of medical device companies having defense in depth via multiple layers of security, in order to provide a secure root of trust (the root of trust is a source that can always be trusted within a system).
It is clear that companies now require both security risk assessments and safety risk assessments of their devices and products, and need to remember both.
Incorporating security of a system in the beginning of the build is a must, beginning with standard based protocols first, followed by adding additional layers of defense.
Why? Because hackers think differently and have an amazing set of tools at their disposal to infiltrate systems in order to steal data or cause harm.
Sidebar: The plot line for the November 17th Episode of NCIS Los Angeles was about a Navy Officer’s insulin pump being hacked, causing him to go low in order for the hacker to access confidential information the officer was working on.
Did someone tell them that DTM 2019 was November 14th through the 16th?
Talk about a perfect intro!
A strong defense is the best offense. It’s therefore imperative that companies use external sources to get their security systems certified for safety.
Security certification is key because it proves that a company has done their due diligence from start to finish.
Bottom Line: Nobody want to be the one that’s on the front page with a security breach.
“In a connected world you want to be trusted member of the community - and you want your system and product to be a trusted!” Robert Hurtz