Friday, April 13, 2012

Inside the Hive

One of my key takeaways from the Medtronic Diabetes Advocates Forum 2012 was how this company is focused on patients and actually wants to know what we think about the products and bigger diabetes picture overall.

Set at the company's California HQ in Northridge (outside LA), this forum and particularly a tour of where the CGM sensors are made was something I was really looking forward to. In large part, because I've been using Medtronic Minimed for most of the past decade as my one and only insulin pump and have used the company's Continuous Glucose Monitor (CGM), before switching over to Dexcom. So, to see the place where these sensors and D-supplies are made was personally very exciting for me. But it's also a privilege being able to be a part of a broader discussion with fellow advocates, diabetes colleagues and industry folks about where we are and how can get to the next level.

For disclosure purposes: I'm sure most readers know that Med-T paid for airfare, transportation, two nights of hotel stay, and food. Plus, we got some "freebies" and "perks" that are being written about in other posts. But all that aside, these are my thoughts based on what I saw and experienced.

There's a lot to write about, and so this post specifically deals with one part of the overall experience.

The Tour
Photo taken, submitted by Medtronic
A unique aspect of this was a tour of the CGM sensor facility. Nine of us went on the tour, while the rest of the Diabetes Online Community members (many of whom went on the tour in 2011) took part in a Q&A with company executives.

Of course, on the tour we couldn't take pictures (read: "trade secrets"). And we had to deck ourselves out in cool hazmat gear, from hairnets to shoe covers to goggles and gloves. We had some fun with that, including some fun photos.

There's a handful of phases to making these sensors, but overall it takes a bit more than 4 hours to make a single sensor from start to finish. In the actual "hands on" assembly phase, it's only about four minutes from one end of the room to the other. Lots of microscopes, chemical processes, hand assembly and reviews as they work their way from one end of the manufacturing facility to the other.

Before seeing this up close and personal, I really thought that the process would have been more automated. Like with robots and moving parts more integrated, rather than human hands doing most of the work. But it was interesting to see the people doing the work, and seeing firsthand how the quality-control is built in to the system at each stage.

At various points, if a piece of the product doesn't meet a certain criteria and isn't 100%, then that item is discarded. Even the ones that our tour guide displayed and showed to us, and we got to hold, they were immediately disposed. As a user of these products for more than a decade, that makes me feel very good about the company I'm paying for these supplies.

The tour was very eye-opening to me, and I think it was a perfect compliment to the presentations we saw before and after that throughout the day.

Consumer-friendliness
Before the tour started, one of the Med-T execs was talking about the company's interest in strengthening its focus on "consumer-friendly" aspects of its products. He mentioned that pump skins (such as my patriotic American flag design or the bacon wrap skin) was one of the first of these heightened consumer-friendly moves. Another example that came up during the day, demonstrating that Med-T has end-users in mind: Color screen pump is coming to Europe in the next year.

Sure, these examples are aesthetically focused and may not seem important in the grand scheme. Critics may brush the pump skins or color screens off as something designed as "feel good" moves designed to just squeeze more money out of us. Those may not be "important" in the upgrades or improvements, some might say. I'm naturally cynical, but now after being there and getting this "inside view" I disagree with that sentiment. In my opinion, I think what the DOC saw through this forum demonstrates that the company execs and product-designers have us in mind, not just their bottom lines. They're putting real people preferences into the equation when brainstorming and designing the next generations of D-devices, giving us options - should we choose to use them - to personalize these devices that we're connected to most of the time.

Plus, everyone's preferences differ - "one person's trash is another person's treasures." Why I use one pump or blood meter may very well be why you don't. Your Diabetes May Vary.

In a side conversation with Jeff Hubauer, general manager of the Insulin Delivery Business division, I mentioned how important my local rep's customer service has been. I shared why I have chosen the Medtronic pump through the years, how convenience through the holster is a big thing for me, and why I didn't like the CGM. It all came down to being consumer-friendly, he reiterated.

That takes me back to the tour, where I mentioned something that is one of two key reasons why I don't like Medtronic's CGM and choose the Dex. First, it's basic economics of only being able to get 6 days (or FDA-approved 3 days) from the MM sensor versus at least two times that (FDA-approved for 7 days) from the Dex sensors. Secondly, it comes down to my perception that it's an intimidating sensor that I dread using.

I've written about this before: "Doesn't this (sensor) really sorta look like a BEE WITH A STINGER???? One that plunges into your body, sinks below the skin, settles in underneath that subcutaneous layer, and then lounges there for as long as possible."

That description may seem odd to some. But as someone who's really not a fan of bees or wasps or anything that stings, I get a little bothered by the black stripes that are on the CGM sensors. Our tour guide joked at one point that they could be painted yellow, which made me shudder. Overall, they got the point. At least one of the Med-T execs said they've heard this before from parents, and I know personally that some Parents of Children With Diabetes have made this same observation online and to me. So, it makes me feel good that these aesthetic "concerns" were addressed and seemed to fall on listening ears.

Another aspect of this consumer-friendly discussion delved into how we as People With Diabetes download (or fail to download) our data. The consensus from most in the room was that we don't do it enough, and there was talk about figuring out a way to help on that front - maybe through text alerts or more convenience in not having to connect to a cable? (not everyone was on board with this concept, since it would probably become too intrusive and Big Brother like).

Someone mentioned that there's a difference between uploading/downloading data and interpreting that information displayed on often-confusing charts and formats. We need a more concise way of viewing data. Manny asked about the leap from uploading CGM data to an online cloud - something that would be not just for our own care, but also could be used for other platforms such as D-communities and research.

This all led to the group talking about the interesting issue of why we're so willing to share our diabetes data online (via Twitter and blogs) but why we don't track it for our own health benefits. Again, the point about our lack of logging came up and how so many of us go to our docs without a clear picture of what the numbers actually mean when they ask, "So, why were you High or Low here?" George offered a gem of an idea: Tie #bgnow or that type of concept of online health info through Twitter to uploading data, allowing us to extract what we may have done that day and at that time to provide a better picture of what may have led to our results.

Lane Desborough, product strategist who's a D-Dad himself, responded that getting that D-data into more hands is a key priority for Med-T. A slide later in the day went to the point that Medtronic is aiming to become the iTunes for the Diabetes Community, where everything will be basically connected to some degree and easily accessible to PWDs.

All of that seems well and good, and so I guess we'll see where that takes us... and how the future consumer friendly changes are unveiled.

What else?

During the course of the day we learned the company is working on a patch pump, although no dates are certain and we couldn't get any more detail out of them on this. Med-T is also already developing the Enlite Sensor 2, which is both exciting and depressing since we've yet to get the first generation here in the United States. We heard the good news that Med-T is preparing an application to the FDA for Enlite sensor approval here in the U.S., so hopefully the data from overseas will help speed that process along! Same goes for the Medtronic Veo pump, which is currently available in many countries but not the U.S. Greg Meehan said in response to questions about this FDA-reliant timing of the Low Glucose Suspend device getting through regulatory hurdles here, "We don't know, but we're optimistic that we'll see it in the near future."

Update: MedT actually hadn't even submitted to the FDA its application for review of the Enlite sensor or the Veo (or 530G), at the time of this summit. That submission didn't occur until June 2012. So, it's not fair to blame the FDA for any delays on this before that time (if even then) -- that falls solely on Medtronic in preparing and submitting this for regulatory review.

Of course, there was talk about accuracy and CGM lag times that are simply fundamental realities at where we're currently at in these early generations of technology and devices. I was really pleased to hear that in the past two years, Med-T has opened up it tech & algorithms for "open-sourcing" rather than maintaining the proprietary control it's been notorious for historically. Lots of progress happening, the company execs noted. So that's encouraging progress, in my eyes. 


Conclusion:
In the end, what I saw from this tour and discussion demonstrates that Med-T has quality and safety in mind at every level. That Med-T is listening to what we, the patients or end-users, need and want.

Sure, some may not care for Medtronic products or supplies. Some might not like the fact that basically all the pumps have looked the same for the most part for a decade. Customer service and cost considerations and so many other aspects may differ for people. But I think the message portrayed at this event goes beyond Med-T and its products:

"Good is not going to good enough" as we move forward, and really we're all in this together.

From what I observed, these people care and are doing what I think is important for not just those who use these products, but to touch the lives of so many others. To make a difference in the bigger picture. We have a long ways to go in many areas, and neither this company - nor any other - is perfect. But neither are we as PWDs. And they're doing some really importing things in the name of progress, and taking our voice into consideration.

And that makes me proud to have been a part of this, getting that perspective that I didn't really have before. Even if it meant traveling inside the bee hive.

4 comments:

Tricia said...

Mike, than you for sharing this info! As a Medtronic pump user (&also a Dexcom user) I thoroughly enjoyed this post! It makes me feel good that Medtronic is so concerned and involved at every level. Great post and great points made!

Kelly said...

Lots of awesome info, thanks for clueing us in! My daughter and I have used Medtronic forever, and it amazes me everytime I hear others opinions on their CGM the Minilink. I myself have always had incredibly accuracy, and would never consider changing. Always interesting to hear how YDMV!!

Sara said...

After taking the tour with you, I just love the title of this post. BZZZZZZ!!!!

It is funny the things that our brain latches onto. There is a specific meter brand that I just CAN'T used because it was the brand that I used while I was misdiagnosed. It was the source of so much confusion I just can't bare to see it now.

shannon said...

thanks for this very informative post. i loved reading about the cgm tour and that pic is great!

my daughter also dislikes the medtronic cgm and will only use it occasionally. i hope the enlite comes through soon.