tag:blogger.com,1999:blog-56900844670702422152024-03-19T05:24:13.074-04:00The Corner BoothAn online brew of Coffee and Conversation about the Highs, Lows of living with diabetes... and focusing on coffee and beer.Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.comBlogger774125tag:blogger.com,1999:blog-5690084467070242215.post-34662898532013986332023-09-26T17:32:00.001-04:002023-09-26T17:32:29.007-04:00A Diabetes Anomaly for the Paramedics<p>You never look forward to an experience welcoming the paramedics to help deal with a diabetes emergency.</p><p>I'd gone over a decade since that was last needed.</p><p>But a paramedic-summoning Low blood sugar reaction at the start of September reset my tally clock, and now I'm working from 0 since the last time my diabetes required the paramedics.</p><p>It was a Friday morning.</p><p>I had planned the day well in advance, as it was one day following my wife's birthday. I would drive her to work, come home to do whatever work I needed before taking the dog to "camp" for the weekend, and then I'd go pick her up for a dinner reservation and drinks afterward.</p><p>That was the plan.</p><p>But I didn't sleep well overnight, and some blood sugar glucoastering messed up my normal sleep schedule. I ended up with only about 2 hours of sleep, and chose to instead stay awake and take care of some overdue work I hadn't finished earlier. With the coffee pot fully brewed, I plunked away at my keyboard and worked until the sun came up and the alarm clocks were ready to chirp again.</p><p>As you might imagine, I was tired.</p><p>And my blood sugars were all off because of this lack of sleep, combined with overnight coffee drinking. My overnight basal rates couldn't assess what was happening, so my blood sugar started dipping.</p><p>We got ready to leave, both of us in the car. But because I was still a bit low, she drove. The dog loved the unusual early morning CAR RIDE.</p><p>Knowing I was going low, I grabbed a banana and a small apple juice before we hit the road.</p><p>But given my routine variance and lack of sleep, I mistook my early Low symptoms for exhaustion and annoyance over needing more coffee. I found myself dozing off during the 30-minute drive, not eating the banana or drinking the juice nearby.</p><p>And despite my Tandem technology cutting off insulin because of the detected Low, it wasn't enough to counteract how low I was actually dropping.</p><p>I don't remember arriving at her office. I stayed in the passenger seat, with the dog in the backseat wondering what was happening.</p><p>Eventually, someone inside realized I was still sitting the parking lot and our SUV hadn't moved. My wife responded, but I was apparently too far gone to treat the Low ourselves.</p><p>Hello, Paramedics.</p><p>We hadn't had to call them since we moved back to Michigan in 2015.</p><p>They did what paramedics do, strapped me into a gurney and setup an IV of glucose into my arm. My wife disconnected my insulin pump from my body entirely before they carted me into the ambulance.</p><p>Before too long, I slowly came out of it. And I remember looking out the pair of windows in the back of the ambulance, realizing there was a strange woman in front of me and another stranger with a male voice over my right shoulder. The words didn't register at first, but within moments I recognized them as words a medical emergency responder would use...</p><p>"F***," was my first word.</p><p>I asked what day it was, and when being told it was "Friday" the day of the planned birthday dinner reservation, I repeated the curse word. But a bit relieved when hearing it was still the morning hours.</p><p>I asked what city I was in, and when I heard it was the city where my wife works, I used the same curse word again.</p><p>They told me that our SUV was outsie, and I repeated the word and then suddenly became fully aware:</p><p>"THE DOG. WHERE'S THE DOG?"</p><p>The pair of paramedics seemed baffled, unsure how to respond.</p><p>"Uh... was there a dog? We didn't see a dog. Is there a dog outside?"</p><p>I suddenly feared that the dog had been left inside the vehicle on the hot morning.</p><p>How long was I out? They responded that it hadn't been that long, maybe about 20 minutes.</p><p>Fortunately, my wife and a coworker had taken care of the dog and he was sitting comfortable in a different vehicle with the windows open. Patient boy, he is.</p><p>A couple fingerstick meter showed I was quickly rising, and in that "more than safe" terrority of blood sugar levels.</p><div>All the rest isn't important, including that I declined (as is always the case) of declining transport to a nearby hospital.</div><div><br /></div><div>Overall, it was a jarring experience, as any experience with paramedics would be expected to be.</div><p>I've narrowed down the issues behind this Severe Low, and have since discussed it with my endocrinologist. It was an anomaly, one that certainly was fueled by lack of sleep and caffeine combined with extra dawn phenom insulin before a typical morning drop.</p><p>Since then, I've also received the exciting invoice from the private ambulance company. Turns out, my insurance company does cover this and so I won't have to pay more than 20% of the total $270. So there's that, too.</p><p>These paramedic experiences used to happen more frequently when we lived in Indiana, before the days of getting a CGM.</p><p>My A1C has gone up slightly since February and this Low helped show me I needed to dial in my morning blood sugars and basal rates. That's a work in progress, as we enter the Fall months.</p><p>Here's to hoping that tbis diabetes anomaly doesn't repeat and I won't find myself greeting any paramedics again anytime soon.</p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com1tag:blogger.com,1999:blog-5690084467070242215.post-19747199215185480532023-03-08T11:58:00.001-05:002023-09-21T10:55:12.011-04:00Less Alcohol, Healthier Mindset for 2023<p>I've been enjoying my alcohol drinks a bit too much during the past several years.</p><p>This has not gotten to a point where I've developed a problem. But it's just been too much, which has led to a number of health-related effects: weight gain, less-stable blood sugars, and probably just a stresser on my kidneys overall.</p><p>Now granted, with the weight, alcohol alone hasn't been the issue. I've also enjoyed snacking. Working from home for so long has allowed this to happen in the middle of the day while working, as well as in the later evening hours when just relaxing and watching TV or hanging out at home.</p><p>However, my reality for a good amount of time has been to have multiple drinks per night — whether it's a beer, craft brew, or bourbon and Diet Coke.</p><p>As the saying goes, moderation is key. And I haven't been moderating to the best of my ability.</p><p>After experiencing a severe stomach flu in mid-January and being dry for a 2-week period, I'd lost the interest in drinking alcohol or anything carbonated in the immediate aftermath of that illness.</p><p>And it stuck.</p><p>While I haven't 100% given up alcohol, I have significantly stepped back from drinking since the 2nd week of January 2023.</p><p>This certainly wasn't a New Year's goal or a Dry January push, but it just happened to work out that way due to my illness and overall desire to lose weight, as well as be healthier now that I'm in my mid-40s.</p><p>Since early January, I've only had 6 drinks to date:</p><p></p><ul style="text-align: left;"><li>1 glass of red wine at Les Miserables show</li><li>1 Manhattan cocktail after a nicer dinner with wife</li><li>1 glass of red wine at a wine bar with my wife</li><li>a bottle of Michelob Ultra during guys' night</li><li>an Old Fashioned cocktail with friends</li><li>a tall 23-ounce Michelob Ultra over hot wings dinner</li></ul><div>Now, I will have more drinks as time goes on. For St. Paddy's Day, I'm planning to have some non-alcohol Guinness.</div><div><br /></div><div>One issue I've found with NA beers is that here in the States, they can still contain up to 5% alcohol even when they're dubbed "non-alcoholic." And sadly, they often make up the less alcohol with higher sugar and carb counts... which isn't great for someone with diabetes who must mind their carb counts and dose for anything.</div><div><br /></div><div>So while I might avoid the alcohol in a NA version of Heiniken, it's twice as much of a carb count than a regular bottle with the lower 4.2% alcohol count.</div><div><br /></div><div>For me, as someone who isn't vowing to be completely dry, a bit of alcohol every so often is a better option than making up for all of those extra carbs with more insulin.</div><div><br /></div><div>On top of the alcohol reduction, I'm also working hard to eat healthier foods, add more seafood to my weekly diet (in order to boost my eye health as much as possible), and I'm trying to not snack as often. Even just munching on low-carb carrots or veggies or mixed nuts is a better, healthier option.</div><div><br /></div><div>Is it working so far?</div><div><br /></div><div>Yes, it is. Overall, I feel healthier and better — if even just a mindset.</div><div><br /></div><div>I have noticed that my insulin resistance seems to be lower than it was before, and insulin seems to drop me much more dramatically than it has during the past years. I use Tandem's Control IQ for automated insulin dosing, and that technology does a remarkable job keeping my blood sugars in range and correcting when necessary. But without the extra alcohol in my system, I do feel the insulin's working and dropping me more.</div><div><br /></div><div>That can be problematic overnight, and I'm needing to adjust my basal rates and correction factors before too long in order to compensate.</div><div><br /></div><div>Also very noticeable, is my weight loss. My pants do seem to feel much bigger around the weight, and I've noticed that my belt is getting tighter lately.</div><div><br /></div><div>A recent weight measurement confirms this. It showed that I'd lost about 6 pounds since my first weight measurement closer to the start of the year.</div><div><br /></div><div>So, that's exciting to see that starting so soon, after only about 6 weeks or so.</div><div><br /></div><div>I hope to continue this throughout the year, as much as possible. Here's to being healthier!</div><div><br /></div><div><u><b>UPDATE:</b></u></div><div><br /></div><div>My "less alcohol" push lasted through July 4th holiday weekend, helping me lose several pounds by that time. While I returned to enjoying alcohol more frequently, it hadn't gotten back to the point of multiple drinks per night. So that's a continued win.</div><p></p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com3tag:blogger.com,1999:blog-5690084467070242215.post-54950925300119484092023-02-04T00:24:00.005-05:002023-02-04T00:34:02.054-05:00The Unpredictable Stability of Diabetes<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCS2-sCHQImq5FDrQQe4w8V3sVd-TCiYShSbu6jDSq3cm5n_febHh_DkuHRcLcberAGUV_CSV7G4soLsFaQxzeNggXSJL5bAjU3D8MJ--w7GlorApZG6PSALs3kT5V-bwP3VmnCKfeuzjFK7tUVq8pEZomygokvn2rzNVCKdN9BC2nIvqi7MtZtzRS/s900/Stability.jpeg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="600" data-original-width="900" height="266" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgCS2-sCHQImq5FDrQQe4w8V3sVd-TCiYShSbu6jDSq3cm5n_febHh_DkuHRcLcberAGUV_CSV7G4soLsFaQxzeNggXSJL5bAjU3D8MJ--w7GlorApZG6PSALs3kT5V-bwP3VmnCKfeuzjFK7tUVq8pEZomygokvn2rzNVCKdN9BC2nIvqi7MtZtzRS/w400-h266/Stability.jpeg" width="400" /></a></div><p>Not too long ago, I came down with an unknown viral bug that knocked me off my game for a couple weeks. It wasn't immediately diagnosed, but turned out being a viral stomach flu that was probably complicated by COVID-19 from more than a month earlier.</p><p></p><p>After 10 days of being unable to work and do much of anything, I turned a corner and started moving toward recovery.</p><p>This all made me realize how much I appreciate (at times) the world of life with diabetes.</p><p>As much as type 1 diabetes can seem the opposite of stable, it's also predictable at times in that instability. And that in itself, might very well be comfortable when compared to other health issues life throws at us.</p><p>By that, I mean that even when your blood sugars are jumping High or diving Low without any rhyme or reason, there's a certain amount of familiarity that comes with it.</p><p></p><ul style="text-align: left;"><li>If you're too High, take insulin. Maybe the injected insulin or pump boluses take too long because insulin isn't too quick-acting, so you opt for inhaled Afrezza insulin that works much faster to start bringing your blood sugars down.</li><li>If you're Low, drink juice or eat something. And as frustrating and scary as the hypo may be in the moment — let's not kidd ourselves: moments, plural — that treatment will work soon enough.</li><li>Navigating the Why of a High or Low can be a challenge in itself. Maybe a kinked cannula, or clogged insulin pump tubing. Or insulin isn't doing what it should. Or your body isn't absorbing the insulin the best it needs to.</li><li>Same on the Low end, from too much insulin or exercise or not enough food, or whatever else life throws at you and T1D doesn't adjust well enough.</li></ul><p></p><p>All of that being said, there's still a level of certainty. Even if it's the process of elimination that allows you to figure out what's happening in your diabetes.</p><p>With the recent stomach bug, it was anything but clear what was going on.</p><p>A migraine headache anytime I moved. That seemed to trigger neasau and vomiting, which fed the migraine. And no, I've never been a migraine person.</p><p>Weakness, lightheadedness, and so much more.</p><p>And no one could clearly diagnose the culprit. It was a "wait and see," a sort of "well, hopefully the meds starting working soon..."</p><p>I missed the ability to figure out what was happening based on my symptoms, like I can with T1D.</p><p>Maybe it's just the fact that I've been doing T1D for almost 40 years now. And so I'm familiar with it. I'm comfortable with a lot of what it brings, even the most scary life-altering complications — because I've been hearing about them since childhood. And pondering and fearing, dreading and accepting. And mentally prepping myself for the worst.</p><p>All of that is a sort of slow burn, compared to the sudden unknown illness that rocked me and kept me in bed for 2 weeks.</p><p>Predictable, stable. Not words I'd often use to describe T1D. But it's all a matter of perspective, I suppose.</p><p>More accurately, maybe it's Unpredictable Stability. Or something along those lines.</p><p>Here's to 2023. And whatever the next chapters bring in life.</p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com7tag:blogger.com,1999:blog-5690084467070242215.post-92228535396474678772022-06-02T23:01:00.002-04:002022-06-02T23:13:24.577-04:00The Dancing FlameMiddle of the night.<div><br /></div><div>My 2 AM ceiling transforms into a canvas, a lack of light creating the perfect patch of blank page for the mind to paint a masterpiece. A candle sits on the table below, the shadows of a single flame dancing on the darkened ceiling above.</div><div><br /><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7EqIho6N-_Wc4qx_yRgsIHq2a3B3jeq2ytkb6dWMsDwOwDw78S6z9yLyRNipl839jIyxgGSfVApWMBIknl_Lo_mhTT0KPId67XqihGtORXWqcXlK_zy-7oI1DcLMt8pDxAIUsJfigiUutXGxzpNRADQoAEFgImS3ui18W_E2ijTkl1eAmla3S0IWC/s3024/CandleFlame2%20copy.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="2452" data-original-width="3024" height="259" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj7EqIho6N-_Wc4qx_yRgsIHq2a3B3jeq2ytkb6dWMsDwOwDw78S6z9yLyRNipl839jIyxgGSfVApWMBIknl_Lo_mhTT0KPId67XqihGtORXWqcXlK_zy-7oI1DcLMt8pDxAIUsJfigiUutXGxzpNRADQoAEFgImS3ui18W_E2ijTkl1eAmla3S0IWC/s320/CandleFlame2%20copy.jpg" width="320" /></a></div><br /><div class="separator" style="clear: both; text-align: center;"><br /></div><br />I'd never dreamed of being a firefighter. But enough television and movies portrayed the life of flames, the mystery and danger. Free, a moment away from exploding into new spaces, but caged at times.<div><br /></div><div>Often, one's own human life and career could be described in much the same way.</div><div><br /></div><div>We mostly stay in our lanes but flirt with new challenges and experience at other times, eating up the oxygen around us and crawling on the walls of our known existence. Until that new burst of energy gives us a boost to explode outside the lines, into new chapters of the canvas before us.</div><div><br /></div><div>Above, the ceiling flame dances as the floor fan provides a soundtrack and oscillating choreography. It paints the canvas overhead, tempting my eyes with it's ever-evolving movement.</div><div><br /></div><div>Ink options may be a shade of dark red wine, a rich amber bourbon or a golden brew hue. But no matter the color, these crayons of my mind play a key part in the masterpiece above.</div><div><br /></div><div>The candle flame shadow wants to dance. Wants to create a picturesque scene. But the flame doesn't want to be confined to that one spot, even though it cannot escape. There is a fire inside, an inescapable desire for exploration and fiery creation elsewhere — despite the confines of the candle's glass prison. There is a stability, and yet a desire for more. A craving for more oxygen, an explosive evolution into those scenes from TV and movies we've had on display nearby.</div><div><br /></div><div>For the candle, this isn't a Rob Lowe firefighting tale in Texas. Instead, it's a philosophical flame story of what could be, what is, and what may never be.</div><div><br /></div><div>The flame shadow dances, nevertheless. Until the wax disappears and the candle flame burns out.</div><div><br /></div><div>Then a new candle with a different resume and career goals takes on this new role, creating new scenes on my living room ceiling.</div><div><br /></div></div>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com11tag:blogger.com,1999:blog-5690084467070242215.post-90141251037483659952022-04-22T16:00:00.002-04:002022-05-02T11:40:29.814-04:00Goodbye, DiabetesMine<i>"As one chapter closes..."</i><div><br />A decade ago in 2012, I had the privilege of joining with my friend and fellow diabetes advocate Amy Tenderich at DiabetesMine. At that time, <a href="#">my journalism career evolved</a> into one that could be combined with my passion for diabetes and my own life with type 1 diabetes. I'd been personally blogging since 2007 and had been actively involved in the DOC (Diabetes Online Community) for a handful of years at that time, attending various conferences and forums with fellow advocates looking to "do good" in the world.</div><div><br /></div><div><div class="separator" style="clear: both; text-align: center;"><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYbkKINN_xxThjMWi8EPBc_PA6ms09WD0pVFvAhLFgnxHzVS7npmL6qniYvYN0h8_MQHWd3qnDHku9lsnKM8nEyej3xMwiP5O7LTeIXGstlnz8gIHEMQNL88npkdaxiBKxgBpVMBWuR2MRJgnS9HBkC7P7rOKtB7XZU2BvSEL4k1qnXzB4Y5_8R2Gk/s960/FB_IMG_1651419263909.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="720" data-original-width="960" height="300" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjYbkKINN_xxThjMWi8EPBc_PA6ms09WD0pVFvAhLFgnxHzVS7npmL6qniYvYN0h8_MQHWd3qnDHku9lsnKM8nEyej3xMwiP5O7LTeIXGstlnz8gIHEMQNL88npkdaxiBKxgBpVMBWuR2MRJgnS9HBkC7P7rOKtB7XZU2BvSEL4k1qnXzB4Y5_8R2Gk/w400-h300/FB_IMG_1651419263909.jpg" width="400" /></a></div><br /><br /></div>I've been proud to be managing editor for so many years, covering this community and doing <a href="#">advocacy journalism</a> there - before and after we became part of Healthline in 2015.The time has come, though, for my career page to turn to the next chapter.</div><div><br /></div><div>Healthline made a decision that it's time to close down DiabetesMine. We first heard about this decision-making in early 2022, and by mid-March the final decision had been made by the higher-ups. The final details materialized from there, with April 22 becoming the final "official" day for the DiabetesMine site on HL and no more editorial content being published on the site.</div><div><br /></div><div>This wasn't a big surprise, as the writing had been on the wall for a while.</div><div><br /></div><div>Still, it's bittersweet for us both — especially Amy as this has been her "baby" for 17 years since February 2005. I'm proud of the work we've done together to inform, educate, impact, and advocate within the Diabetes Community and beyond.</div><div><br /></div><div><div>While we won't be doing this in the same way professionally at DiabetesMine any longer, I'm excited for what comes next. Amy will continue the DiabetesMine Innovation Project events - aka D-Data ExChange and Innovation Summit. These events have been game-changers in many ways for our Diabetes Community, not the least of which was being the birthplace of where #WeAreNotWaiting crystalized into a movement.</div><div><br /></div><div>These are some of the proudest times of my career, in being able to be a part of something for an entire decade that rarely felt like "work" but a privilege I've had in doing what I love. I've met and covered some of the most amazing people, and I'll cherish those moments and continued relationships wherever I go from here.</div><br /><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBid-XyTiU5iogJE-ppHyj45gh69WIMLUXktT7gh-iIRPIrXjIc4nxenx67iAh4BuBjIqy-NlwgNgTejpNYa7RyKsrIqie2AFvaYtplGtbqGDPTvg88v99z9q4Mrr7EY0xeZSIF8sUPTx2k8jhQt3R76CSmTf9m7HlMYKM_AwAdeER7j5xdnqShCde/s1906/DiabetesMine%20Team.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="1072" data-original-width="1906" height="225" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiBid-XyTiU5iogJE-ppHyj45gh69WIMLUXktT7gh-iIRPIrXjIc4nxenx67iAh4BuBjIqy-NlwgNgTejpNYa7RyKsrIqie2AFvaYtplGtbqGDPTvg88v99z9q4Mrr7EY0xeZSIF8sUPTx2k8jhQt3R76CSmTf9m7HlMYKM_AwAdeER7j5xdnqShCde/w400-h225/DiabetesMine%20Team.png" width="400" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>Mike Hoskins, Amy Tenderich, Wil Dubois</i></td></tr></tbody></table><br />Personally, I am staying on at Healthline in a different role on a different editorial team, where I will be doing editor tasks that probably won't touch on diabetes very much.<br /></div><div><br /></div><div>Though I am staying in the health information field, this new role also helps re-establish that line between my "personal" and "professional" sides — so that diabetes isn't front and center, all day all the time whether I am thinking about my work or not. That is something I've said for awhile, that my next chapter would likely take the diabetes out of that professional work. For me, this is the best time for this to happen.</div><div><br />That being said, I am planning to continue my own diabetes writing and advocacy on a personal level in my spare time.</div><div><br /></div><div>So that's the latest. Here's to moving forward on the next chapter.</div><div><br /></div>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com6tag:blogger.com,1999:blog-5690084467070242215.post-36400847542981224232022-02-02T10:00:00.012-05:002022-03-24T12:28:45.411-04:00Spare a Rose: Helping People with Diabetes in Need<div class="separator"><figure class="wp-block-image size-full" style="margin-left: 1em; margin-right: 1em;"><figcaption></figcaption></figure></div>So many people with diabetes whose lives depend on insulin are struggling to afford and get access to this life-sustaining medication, and in some cases, they're rationing and even dying as a result.<br /><br />That's why every year in February, our Diabetes Community gets pretty vocal about the <a href="https://www.blogger.com/#">"Spare a Rose" initiative</a>, a grassroots effort aimed at raising money to provide insulin and diabetes supplies for those in desperate need across the world. <br /><br />The idea is simple: Instead of buying the typical "dozen roses" that are so popular on Valentine's Day, you buy just 11 and donate the value of that last flower (roughly $3 to $5) to help someone with diabetes. You still get to be romantic and give roses, while also showing some love to someone who really needs it.<br />
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<p>Seriously, it really is <em>that</em> simple.</p>
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<p><img alt="Promotional graphic for the "Spare a Rose, Save a Life" campaign to help those in need living with diabetes." class="wp-image-1936470" height="384" src="https://post.healthline.com/wp-content/uploads/2022/02/DM-SpareARose-Instructions.png" width="640" /></p><p>You're literally just sparing a rose — at a minimum, because there is certainly an opportunity to spare all the roses and donate much more than just the cost of a single flower.</p>
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<p>Since the initial year in 2013, Spare a Rose has raised almost $400,000 from community donations, including support from companies in the diabetes industry. </p>
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<p>Originally, all the money was donated to the International Diabetes Federation’s (IDF) <a href="https://lifeforachild.org/about/" rel="noreferrer noopener" target="_blank">Life for a Child (LFAC) program</a>, which was founded in 2000 to help children with diabetes in developing countries who might otherwise die immediately or have a short life without this assistance.</p>
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<p>But for 2022, Spare a Rose has taken on a new charity beneficiary that expands the reach to more people who need help.</p>
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<div class="wp-block-image"><figure class="alignright size-full is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Spare a Rose single flower logo" class="wp-image-1936476" height="200" src="https://post.healthline.com/wp-content/uploads/2022/02/DM-SpareARose-Rose.png" width="200" /></figure></div>
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<p>Spare a Rose donations are now being directed to the <a href="https://insulinforlife.org/who-we-are/" rel="noreferrer noopener" target="_blank">Insulin For Life Global</a> organization, a registered charity that since 1984 has been providing insulin, supplies, education, and advocacy to children and adults alike in many under-resourced countries worldwide.</p>
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<p>With that change, the campaign name <strong>"Spare a Rose, Save a Child"</strong> is being revised to <strong>"Spare A Rose, Save a Life"</strong> — embracing those in need of all ages, in keeping with the reality that you can be diagnosed with type 1 diabetes (T1D) at any age, and the need for insulin and supplies is universal.</p>
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<p>"The campaign is doing something different and broadening its outlook to support people with diabetes diagnosed as adults, or who 'age out' of programs that have an upper age limit," said diabetes advocate Renza Scibilia in Australia, who blogs at <a href="https://diabetogenic.blog/2022/02/01/sparearose-2022-same-but-different/" rel="noreferrer noopener" target="_blank">Diabetogenic</a> and volunteers with #SpareARose. </p>
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<p>"With this in mind, #SpareARose has changed... to recognize how the campaign will be helping adults with diabetes now. It's so wonderful to know that these people will continue to receive insulin and other diabetes supplies, even once they hit 26 years of age, and beyond."</p>
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<h2>Seeding an idea</h2>
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<p>For those not familiar with this annual campaign, it's important to remember the history of how this all came to be. Spare a Rose is one of the few enduring initiatives to come from the Diabetes Online Community (DOC) at a time when many were just beginning to discover the online universe as a source of support and information, and just as the insulin pricing crisis in America was beginning to bubble up as a major point of concern.</p>
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<p>A small group of passionate D-advocates came together in 2013 looking for a way to use social media and our ever-growing online D-community to do social good.</p>
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<p>That small group of diabetes advocates — including <a href="http://diatribe.us/" rel="noreferrer noopener" target="_blank">Kelly Close</a> of <em>diaTribe</em> and Close Concerns, Manny Hernandez who'd led the Diabetes Hands Foundation organization at the time, D-Dad <a href="http://www.ydmv.net/" rel="noreferrer noopener" target="_blank">Bennet Dunlap</a>, <a href="http://www.sixuntilme.com/" rel="noreferrer noopener" target="_blank">Kerri Sparling</a> of <em>Six Until Me</em>, and <a data-id="https://childrenwithdiabetes.com/about-us/" data-type="URL" href="https://childrenwithdiabetes.com/about-us/" rel="noreferrer noopener" target="_blank">Jeff Hitchcock</a> of Children With Diabetes — met early that year to brainstorm ways to use social media to help the broader Diabetes Community offline. The Spare a Rose idea came from their discussions, which have continued organically through the years during down-time at conferences, Pharma-sponsored summits, and smaller local meetups.</p>
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<p>The group initially considered many different avenues, from helping those on Medicaid whose insurance coverage is limited or possibly helping patients who may be uninsured. But in the end, they settled on IDF’s Life for a Child program, as the critical need for insulin to keep T1D's alive is a glaring and obvious one.</p>
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<p>Importantly, Spare a Rose remains true to its grassroots, community spirit.</p>
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<p>"No one person 'owns' this campaign, which makes it all the more powerful," Sparling said. "The entire Diabetes Community plays a role and stakes a claim in its success, making every voice matter and every donation more poignant. This campaign is not about big companies making big donations... but about the community coming together in small ways to make a big difference."</p>
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<p>You can see some of the participation and connect with others following this effort by following the #SpareARose hashtag on <a href="https://www.facebook.com/sparearose" rel="noreferrer noopener" target="_blank">Facebook</a>, <a href="https://www.instagram.com/sparearose/" rel="noreferrer noopener" target="_blank">Instagram</a>, and <a href="https://twitter.com/SpareARose" rel="noreferrer noopener" target="_blank">Twitter</a>.</p>
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<h2>Expanding reach of #SpareARose efforts</h2>
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<div class="wp-block-image"><figure class="alignright size-full is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Spare a Rose for people with diabetes in Ukraine" class="wp-image-2012846" height="252" src="https://post.healthline.com/wp-content/uploads/2022/02/DM-SpareARose-Ukraine.png" width="252" /></figure></div>
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<p>In early 2022, as the Russia and Ukraine conflict took shape, the <a href="https://sparearose.org/" rel="noreferrer noopener" target="_blank">#SpareARose effort</a> expanded its focus beyond just the traditional timeframe of February for fundraising. Throughout the month of March 2022, money raised would be earmarked to support people with diabetes in and out of Ukraine. The money continues to go through Insulin For Life, and that group's international consortium and network in Europe — along with partners in Ukraine and neighboring countries — will help supplies be ready to go if and when and where needed.</p>
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<p>This is pretty incredible on several levels, not only that it's helping those in need at a critical time, but that it shows just how this D-Community's #SpareARose effort is scalable on so many fronts. That isn't necessarily the plan or the goal in the longrun, but it shows so much potential. Just imagine if we saw this grassroots community campaign expand every time there was a hurricane or natural disaster globally, and there was a specific campaign aimed at helping those most at need during those situations.</p>
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<h2>Impact of Spare a Rose diabetes campaign</h2>
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<p>The impact has been heartwarming to see over the years, with companies like <a href="https://www.prnewswire.com/in/news-releases/ascensia-diabetes-care-and-its-employees-excited-to-support-spare-a-rose-campaign-for-the-fourth-consecutive-year-884169296.html" rel="noreferrer noopener" target="_blank">Ascensia Diabetes Care</a> making global announcements of support, and patient-led initiatives like the well-received <a href="https://staceysimms.com/dpodcastweek/" rel="noreferrer noopener" target="_blank">Diabetes Podcast Week</a> helping promote the campaign.</p>
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<p>Spare a Rose has also honed in personal stories over the years. For example, the 2018 campaign focused on the story of a T1D brother and sister from a village in India who were both diagnosed at roughly the same time a year earlier: Poovarasi, diagnosed at age 18, and her younger brother Ruhan, diagnosed at 13. </p>
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<p>Without support, this pair would not have been able to afford insulin and supplies to manage their diabetes. Their doctor told the IDF. "They were provided with a glucometer and strips... and soon excelled in self-monitoring and their A1C dropped to near-normal levels. The boy soon returned to school and the girl has started to learn tailoring to complement the parents' income. Nearly a year following the diagnoses, the family has regained some of the original happiness that they had."</p>
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<p>With that, we just have to echo how hugely important <a href="https://www.endocrine.org/advocacy/position-statements/increasing-insulin-affordability" rel="noreferrer noopener" target="_blank">insulin affordability</a> is here in the United States and across the world; withholding access is an outrage.</p>
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<p>As we all mark the 100th anniversary of insulin's discovery in 1921 and that historic milestone in <a href="https://www.bbc.com/news/health-16657425" rel="noreferrer noopener" target="_blank">January 1922</a> when insulin was first given to a human with diabetes who would've died without it, we can't echo enough how important it is to raise the level of conversation globally about <a href="http://www.access2insulin.org/100-campaign.html" rel="noreferrer noopener" target="_blank">making insulin affordable and accessible</a> to every single person who needs it.</p>
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<p>Really, with the "Hallmark Holiday" of Valentine’s Day that encourages a celebration of love, it's a great moment for our Diabetes Community to step up.</p>
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<p>'Tis the season to celebrate both Love and Life. Enough said.</p><p style="text-align: center;"><i>- - - - - - - - - - - - - - - - - - - - </i></p><p style="text-align: center;"><i>Originally published on DiabetesMine</i></p>
<!--/wp:paragraph-->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com7tag:blogger.com,1999:blog-5690084467070242215.post-81158124915189796202022-01-09T09:25:00.002-05:002022-03-23T09:29:43.872-04:00Non-invasive Diabetes Tech: The Never-ending Dream<p> The invention of a "noninvasive" device that can measure blood glucose for people with diabetes with no need to poke the skin and draw blood has been the dream for decades.</p><!-- wp:paragraph -->
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<p>After all, why wouldn't people with diabetes (PWDs) flock to a skin patch that can detect blood sugar levels through sweat, or a wrist band that uses radio frequency technology to continuously beam glucose data directly to an app?</p>
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<p>Numerous companies are pushing forward in this noninvasive continuous glucose monitoring (CGM) space, even in the midst of a pandemic. </p>
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<p>To date, it's been mostly hype versus hope, as attempts to create those products have fallen flat.</p>
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<p>The Diabetes Technology Society (DTS) published a <a href="https://journals.sagepub.com/doi/full/10.1177/19322968211046326" rel="noreferrer noopener" target="_blank">scientific analysis</a> on this topic in October 2021, noting "the amount of interest in seeing the development of an accurate [noninvasive glucose sensor] and the amount of hyperbole by companies promising an accurate [product] both far outstrip the amount of publicly available data actually generated by these potential products."</p>
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<p>Yet, diabetes technology experts still believe potential exists for noninvasive devices to make it big, and industry analysts are predicting a <a data-id="https://www.biospace.com/article/non-invasive-blood-glucose-monitoring-devices-market-wearable-segment-dominated-the-global-market-in-terms-of-revenue/" data-type="URL" href="https://www.biospace.com/article/non-invasive-blood-glucose-monitoring-devices-market-wearable-segment-dominated-the-global-market-in-terms-of-revenue/">booming market</a> in the next 5 years.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="How does it work?" id="how-does-it-work">How does it work?</h2>
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<p>Analysts note that there are systems under development for both home use and in-clinic and hospital settings. The former are wearables, and the latter will be non-wearable or tabletop systems.</p>
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<p>They segment the systems under development by the type of technology used to take blood glucose readings — mainly, different types of <a data-id="https://www.theengineer.co.uk/spectroscopy-blood-glucose-levels/" data-type="URL" href="https://www.theengineer.co.uk/spectroscopy-blood-glucose-levels/" rel="noreferrer noopener" target="_blank">spectroscopy</a>, a technique that identifies chemicals based on the interaction of molecules with electromagnetic radiation.</p>
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<p>Spectroscopy, which uses lasers that don’t pierce the skin, has been under study for decades. <a data-id="https://www.mpo-mag.com/contents/view_breaking-news/2020-01-27/noninvasive-spectroscopy-could-monitor-blood-glucose/" data-type="URL" href="https://www.mpo-mag.com/contents/view_breaking-news/2020-01-27/noninvasive-spectroscopy-could-monitor-blood-glucose/" rel="noreferrer noopener" target="_blank">Researchers at MIT</a> and elsewhere are finding that when used properly, it can produce highly accurate continuous data on blood glucose levels. </p>
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<p>In a June 2021 <a data-id="https://pubmed.ncbi.nlm.nih.gov/34120487/" data-type="URL" href="https://pubmed.ncbi.nlm.nih.gov/34120487/" rel="noreferrer noopener" target="_blank">academic review article</a>, the DTS — led by <a data-id="https://profiles.ucsf.edu/david.klonoff" data-type="URL" href="https://profiles.ucsf.edu/david.klonoff" rel="noreferrer noopener" target="_blank">Dr. David Klonoff</a> of the University of California, San Francisco and medical director of the <a data-id="https://www.sutterhealth.org/research/diabetes-research-institute/about" data-type="URL" href="https://www.sutterhealth.org/research/diabetes-research-institute/about">Diabetes Res</a><a data-id="https://www.sutterhealth.org/research/diabetes-research-institute/about" data-type="URL" href="https://www.sutterhealth.org/research/diabetes-research-institute/about" rel="noreferrer noopener" target="_blank">e</a><a data-id="https://www.sutterhealth.org/research/diabetes-research-institute/about" data-type="URL" href="https://www.sutterhealth.org/research/diabetes-research-institute/about">arch Institute</a> at Mills-Peninsula Medical Center — highlighted the many barriers that exist, but still predicted that noninvasive devices are poised for success in the coming years.</p>
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<p>Notably, the article authors classified for the first time bloodless glucose monitoring products into three categories:</p>
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<ul><li><strong>Noninvasive optical glucose monitoring (NIO-GM):</strong> when a noninvasive measurement involves passing a type of radiation into a vascular region of the body</li><li><strong>Noninvasive fluid sampling (NIFS-GM):</strong> analyzes a fluid sample (tears, sweat, saliva, urine, etc.) that's collected without an invasive procedure</li><li><strong>Minimally invasive devices (MI-GM):</strong> involves insertion of a sensor into the subcutaneous tissue underneath the skin, such as existing continuous glucose monitoring technology that exists today</li></ul>
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<p>"Bloodless glucose monitoring products... are expected to become key components of novel wearable digital health tools for monitoring glucose concentrations in the diabetes market and the fitness market," the DTS authors <a href="https://journals.sagepub.com/doi/full/10.1177/19322968211007212" rel="noreferrer noopener" target="_blank">wrote</a>.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Who’s developing it?" id="whos-developing-it">Who’s developing noninvasive CGM?</h2>
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<p>Let's take a look at some companies making progress. Keep in mind, there are ambitious new companies emerging in this space regularly, despite decades of others trying unsuccessfully.</p>
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<h3>Scanbo</h3>
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<figure class="wp-block-image size-large"><img alt="Scanbo noninvasive glucose monitoring" class="wp-image-1902457" height="360" src="https://post.healthline.com/wp-content/uploads/2022/01/DM-Scanbo.png" width="640" /><figcaption><br /></figcaption></figure>
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<p>At the big Consumer Electronics Show (CES) in early January 2022, an artificial intelligence company based in British Columbia named <a href="https://www.scanbo.com/" rel="noreferrer noopener" target="_blank">Scanbo</a> gave a glimpse of its technology that would use a 60-second noninvasive finger measurement instead of a traditional blood drop required to measure glucose. The company has developed a prototype that combines a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036021/" rel="noreferrer noopener" target="_blank">3-lead ECG</a> measurement and a <a href="https://pubmed.ncbi.nlm.nih.gov/17322588/" rel="noreferrer noopener" target="_blank">Photoplethysmogram (PPG)</a> used to detect blood volume. You just put your fingers on the flat white sensors and the system uses a set of algorithms to analyze and offer insight on glucose values.</p>
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<h3>Hagar Technology's GWave</h3>
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<p>Another new company making headlines is <a href="https://www.hagartech.com/" rel="noreferrer noopener" target="_blank">Hagar Technology</a>, based in Israel, which received Food and Drug Administration (FDA) fast track designation last year after a series of investor fundraising. The company's developing what it calls the GWave, which is a sensor inserted into a "ceramic, lightweight, comfortable bracelet worn on the wrist" that uses radio frequencies to detect glucose levels. The device will be the size of a smartwatch and connect to a mobile app, enabling users to get glucose readings on their smartphones and share that data with their diabetes care team.</p>
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<p>Clinical trials are in progress, according to the company's public comments.</p>
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<h3>SugarBEAT </h3>
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<p>SugarBEAT, from U.K.-based <a href="https://nemauramedical.com/technology/" rel="noreferrer noopener" target="_blank">Nemaura Medical</a>, is already approved for use in Europe. It's a small peel-and-place patch that sticks onto your skin for 24 hours before needing replacement. The adhesive-backed rectangular transmitter sends wireless readings to a companion smartphone app via Bluetooth every 5 minutes.</p>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="SugarBeat noninvasive glucose monitor" class="wp-image-1108596" height="200" src="https://post.healthline.com/wp-content/uploads/2021/03/DM-SugarBeat-Arm.png" width="200" /><figcaption><br /></figcaption></figure></div>
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<p>According to the company, it works by “passing a mild, nonperceptible electric current across the skin, (which) draws a small amount of selected molecules, such as glucose, into a patch placed on the skin. These molecules are drawn out of the interstitial fluid, which naturally sits just below the top layer of skin.”</p>
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<p>Nemaura had originally submitted this to the FDA in mid-2019, but the company had to <a href="https://www.biospace.com/article/releases/nemaura-medical-submits-pma-application-for-sugarbeat-to-u-s-fda/" rel="noreferrer noopener" target="_blank">refile</a> the following year with additional study data. Then, the pandemic began. The company tells DiabetesMine they hope to continue conversations with regulators as soon as possible in order to move forward, but there's no expected timeline available.</p>
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<p>In the meantime, they're launching a nonregulated product called <a href="https://beatdiabetes.life/" rel="noreferrer noopener" target="_blank">proBEAT</a> in the United States, which is a professional CGM version developed for use in those with type 2 diabetes and others who don't need continuous glucose data. Their program incorporates the device into a meal replacement plan, originally developed by the Joslin Diabetes Center in Boston, Massachusetts, and overseen by healthcare providers.</p>
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<h3>Know Labs</h3>
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<p>Seattle, Washington-based <a href="https://www.knowlabs.co/" rel="noreferrer noopener" target="_blank">Know Labs</a> is developing two devices that employ Body-Radio Frequency Identification (Bio-RFID) technology, which uses radio waves to measure specific molecular signatures in the blood through the skin. Formerly known as <a href="https://www.businesswire.com/news/home/20180502005457/en/Visualant-Incorporated-Announces-Change-Labs-Files-Trade" rel="noreferrer noopener" target="_blank">Visualant</a>, this tech company changed its name in 2018 and is developing both a wristband-style device as well as a finger-scanning device that eliminate the need to pierce the skin to get glucose readings.</p>
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<ul><li><strong>UBand</strong> is a wristband with a built-in biosensor designed to continuously monitor glucose levels. It won’t have a display screen, but instead, the readings will be sent directly to a smartphone app. They’re expecting it to have a battery life of 7 days before you would need to recharge it. This product is aimed at people with diabetes who are interested in a noninvasive CGM.</li><li><strong>KnowU</strong> is a device that sort of resembles a traditional fingerstick glucose meter in that it's small enough to fit into your pocket — but it doesn’t require test strips. Instead, you’d take the sensor off the base and scan it over your palm to generate readings that would then display on the base device itself or be beamed wirelessly to a smartphone app. This is aimed mainly at PWDs who aren’t interested in a full CGM, but want more of an easy on-the-go use option for glucose monitoring without the finger pokes.</li></ul>
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<p>Know Labs previously told DiabetesMine it hoped to begin the FDA pre-approval process in 2022.</p>
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<h3>DiaMonTech</h3>
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<p>Out of Germany, <a href="https://www.diamontech.de/home" rel="noreferrer noopener" target="_blank">DiaMonTech</a> has developed a system that uses molecular spectroscopy — the science of absorption of light by molecules — to detect glucose molecules through the skin. They're currently working on three versions:</p>
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<ul><li>a phone-like "D-Pocket" handheld receiver that you press your finger on to get a glucose reading, which isn't expected before 2023 at the earliest</li><li>a small "D-sensor" embedded into watches or fitness bands, which is anticipated for 2024 for later</li><li>a more stationary, shoebox-sized device that would sit on a table and could be used in clinical settings, which is ready for use now</li></ul>
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<p>"Finger pricking is messy and inconvenient, and that’s why so many diabetics are not measuring enough to successfully manage their blood sugar," DiaMonTech CEO <a href="https://www.linkedin.com/in/thorstenlubinski/?originalSubdomain=de" rel="noreferrer noopener" target="_blank">Thorsten Lubinski</a> told DiabetesMine. "Noninvasive measurements lower this hurdle, as measuring your blood sugar is as easy as using the fingerprint sensor on your mobile phone."</p>
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<p>Lubinski recognizes that others before have failed to develop noninvasive D-tech, but emphasizes that his company's technology is more accurate and focuses specifically on the glucose molecule itself (rather than other things). </p>
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<p>Created by startup co-founder <a href="https://scholar.google.com/citations?user=tWES8MIAAAAJ&hl=de" rel="noreferrer noopener" target="_blank">Dr. Werner Mäntele</a>, this technology has shown in research from 2020 that it has comparable accuracy to the minimally invasive FreeStyle Libre Flash glucose monitor from Abbott Diabetes.</p>
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<h3>NovioSense</h3>
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<p>The Dutch startup known as <a href="https://noviosense.com/" rel="noreferrer noopener" target="_blank">NovioSense</a> is working on a glucose sensor that is placed under the lower eyelid, from where it can wirelessly send glucose measurements directly to a smartphone. </p>
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<p>The NovioSense device consists of a flexible metal coil just 2 centimeters long that contains nanosensors inside. The coil is covered by a protective layer of soft hydrogel, and it could measure constant changes in glucose levels from tear fluid using the same enzyme technology employed in conventional glucose test strips.</p>
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<p><a href="https://journals.sagepub.com/doi/abs/10.1177/1932296820964844?journalCode=dsta" rel="noreferrer noopener" target="_blank">Clinical trial research</a> published in late 2020 shows promising results for the technology and accuracy similar to the FreeStyle Libre, but there are few details available beyond that.</p>
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<h3>LifePlus</h3>
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<p>This Silicon Valley, California-based startup is developing a noninvasive wearable wristwatch called <a href="https://www.lifeplusinc.net/" rel="noreferrer noopener" target="_blank">LifeLeaf</a>. The company <a href="https://www.wearable-technologies.com/2018/06/lifeplus-announces-first-noninvasive-continuous-glucose-monitoring-wearable/" rel="noreferrer noopener" target="_blank">says</a> it can detect blood glucose levels, blood pressure, heart rate, sleep apnea, and more by using sensors already on the market and an additional light sensor to enhance accuracy.</p>
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<p>According to <a data-id="https://www.youtube.com/watch?v=5jJasNerxmg&t=9s" data-type="URL" href="https://www.youtube.com/watch?v=5jJasNerxmg&t=9s" rel="noreferrer noopener" target="_blank">this demo presentation</a> at DiabetesMine's D-Data ExChange forum in June 2020, it uses a "novel approach based on spectroscopic principles... to determine an accurate spectral signature for glucose."</p>
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<p>Their phase 1 product is aimed at consumers and people with prediabetes, and phase 2 will be for type 2 PWDs and eventually also those with type 1, with high and low alerts and guidance. </p>
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<p>The company has conducted clinical trials around the world, and at last count, was aiming for FDA clearance by June 2022. </p>
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<h3>Afon Technology</h3>
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<p>Out of Wales, a startup called <a href="https://afontechnology.com/" rel="noreferrer noopener" target="_blank">Afon Technology</a> is developing a sensor that would fit inside a smartwatch band to monitor glucose levels. Per the company's website, it will provide real-time data and alert PWDs to high and low sugars, as well as track other health data. The company is working on clinical trials outside the United States, with plans for a launch starting in mid-2022.</p>
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<p>Afon shares feedback from <a data-id="https://info.profil.com/contact-hans-de-vries" data-type="URL" href="https://info.profil.com/contact-hans-de-vries" rel="noreferrer noopener" target="_blank">Dr. Hans de Vries</a>, medical director at diabetes research organization Profil in Germany and a principal investigator at the University of Amsterdam's Faculty of Medicine, who says: “We evaluated the Afon device under both hyper- and hypoglycemic conditions during the clinical trials and we were surprised and excited by the possibilities of this technology.”</p>
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<h3>Apple and Samsung </h3>
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<p>Both Apple and Samsung are rumored to be developing noninvasive CGM sensors of their own.</p>
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<p>In fact, for years, many have confused the Apple Watch's capability to display Dexcom’s CGM data with the notion that Apple itself offers CGM technology. But that buzz may finally be coming true soon.</p>
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<p>According to a <a href="https://9to5mac.com/2021/01/25/concept-visualizing-what-apples-blood-sugar-watch-app-might-look-like/" rel="noreferrer noopener" target="_blank">January 2021 report</a>, Apple may be working on their own glucose monitoring tech that would use an integrated optical glucose sensor. The report has some fascinating visuals on what the Apple Watch display could look like. </p>
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<p>Samsung may have its sights on this tech, too. This <a data-id="https://english.etnews.com/20210125200002" data-type="URL" href="https://english.etnews.com/20210125200002" rel="noreferrer noopener" target="_blank">January 2021 news report</a> states:</p>
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<p>“Samsung Electronics will be equipped with a blood glucose measurement function in the new smartwatch ‘Galaxy Watch 4’ [tentative name] to be introduced in the second half of this year. It is a no-blood sampling method that detects the level of glucose in the blood without blood collection using an optical sensor, and is expected to contribute to the health management of the general public as well as diabetics.”</p>
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<p>There had been talk years back about a Samsung and Medtronic Diabetes partnership aimed at integrating glucose data into Android watches, but that relationship faded without any product materializing beyond prototypes.</p>
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<p>There are numerous other small companies and universities currently working on noninvasive glucose monitoring technology, too.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Early attempts" id="early-attempts">Gone but not forgotten</h2>
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<p>DiabetesMine has been covering attempts at noninvasive diabetes tech since 2005, and a couple of the gadgets that captured headlines at the time remain legendary. </p>
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<h3>GlucoWatch</h3>
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<p>The first and best-known example is the infamous <a href="https://pubmed.ncbi.nlm.nih.gov/15320999/" rel="noreferrer noopener" target="_blank">GlucoWatch</a>. This product made it to market briefly in the early 2000s, but it ended up being totally unreliable and actually started burning some patients' skin while they were wearing it! It was later recalled by the FDA.</p>
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<h3>Contact lenses</h3>
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<p>Google and Novartis were <a href="https://www.labiotech.eu/in-depth/contact-lens-glucose-diabetes/" rel="noreferrer noopener" target="_blank">once developing</a> a contact lens that could use fluorescent light to monitor sugars through the eye, but that research was eventually scrapped because the company determined it wouldn't work. That hasn't <a href="https://www.technologynetworks.com/diagnostics/news/smart-contact-lenses-for-diabetes-monitoring-334052" rel="noreferrer noopener" target="_blank">stopped others</a> from pursuing that same path in recent years.</p>
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<h3>C-8 MediSensors</h3>
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<p>Another notable name in noninvasive CGM tech for several years was <a href="http://www.c8medisensors.com/" rel="noreferrer noopener" target="_blank">C-8 MediSensors</a> based in San Jose, California. This gadget promised to use light to identify and analyze glucose molecules under the skin via interstitial fluid, just like other traditional CGMs.</p>
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<p>This company even obtained European CE Mark approval in 2012, but a launch never materialized and, eventually, the company went bankrupt a year later. Many of the C-8 scientists moved on to other companies like Apple and Google, before the company eventually rebranded and relaunched as C-Eight without any focus on noninvasive glucose monitoring.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="What skeptics say" id="what-skeptics-say">What the skeptics say</h2>
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<p>Some industry experts who've watched this field for many years still insist that it will <a data-id="https://www.wareable.com/health-and-wellbeing/noninvasive-glucose-tracking-impossible-valencell-1268" data-type="URL" href="https://www.wareable.com/health-and-wellbeing/noninvasive-glucose-tracking-impossible-valencell-1268" rel="noreferrer noopener" target="_blank">never happen</a>.</p>
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<p>"It's the easiest slide-deck pitch to make, but it never seems to go anywhere," said JDRF CEO <a href="https://www.linkedin.com/in/aaron-kowalski-3221a35/" rel="noreferrer noopener" target="_blank">Dr. Aaron Kowalski</a>, who has been knee-deep in the world of emerging diabetes technology for decades. "There are major technology challenges that are so big, and you have to wonder if there is even a need anymore with what we have in diabetes technology today."</p>
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<p>"Noninvasive still has a lot of challenges," said <a href="https://www.diabetestechnology.org/dtm/bios/2020/ginsberg.html" rel="noreferrer noopener" target="_blank">Dr. Barry Ginsberg</a>, who runs Diabetes Technology Consultants in New Jersey and is considered a premier expert on noninvasive diabetes tech after analyzing this trend for more than a decade. He predicts the market will be dominated by products that are simply "less invasive" and smaller than what we have now, such as the Dexcom G7 model expected in 2022.</p>
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<p>Semiretired industry consultant John L. Smith is another of the foremost experts on this front, author of the seminal paper “<a href="https://www.nivglucose.com/" rel="noreferrer noopener" target="_blank">The Pursuit of Noninvasive Glucose: Hunting the Deceitful Turkey</a>” article first published in 2006 and last updated in a 2020-seventh edition.</p>
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<p>He writes that one of the most disturbing aspects in this field has been the “perennial” announcements by young companies that believe they’ve reached a solution for PWDs to no longer have to prick their fingers. Without exception, Smith says these announcements have been premature and are meant to generate hype, raising false hopes.</p>
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<p>He estimates that it would take a minimum of 5 years and as much as $25 to $30 million in funding just to get a product to market, so it's no wonder that most have pretty much failed to date. </p>
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<p>He points to the wearables technology trend in recent years as growing strong beyond diabetes, but notes that the economic impact of the COVID-19 pandemic will likely push out many wannabe noninvasive tech developers.</p>
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<p>Diabetes industry analyst <a href="http://www.diabeticinvestor.com/about-us" rel="noreferrer noopener" target="_blank">David Kliff</a>, an insulin-using PWD himself and notorious devil’s advocate, has maintained longstanding skepticism over noninvasive tech during his 20-plus years of writing for Diabetic Investor.</p>
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<p>“It’s one of the better scams I’ve ever seen in the diabetes world,” he told DiabetesMine. “It sounds so appealing with all kinds of 'Star Trek'-y elements. They sell the hype and there’s just enough science to back it up so it looks great. The mainstream media give it more play and people buy the dream.”</p>
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<p>Kliff decries the millions of dollars that investors are tempted to "throw at this tech."</p>
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<p>The base problem, he says, is not so much having an easier way to get a glucose reading, but knowing what to do with that reading in order to improve your health outcomes.</p>
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<p>“I’ve contended from day one, that whether it’s invasive or not, if the person doesn’t understand the number, it doesn’t matter if it’s given to them by God. I’m more impressed with practical technology that works and you can trust. For any patient, that’s the bottom line.”</p>
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<p>Nevertheless, researcher Smith writes about noninvasive glucose monitoring: “In spite of all the failures (and quite likely because I have been close to so many of them), it is still my fond wish that someday, somewhere, someone will find the solution to this intensely recalcitrant problem and realize the benefits for all people with diabetes worldwide.”</p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com8tag:blogger.com,1999:blog-5690084467070242215.post-91934396938877010012022-01-02T07:00:00.001-05:002022-03-22T21:26:31.529-04:00New Diabetes Technology: What to Expect in 2022<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-CXI8BMoJwH55Fz-40taFa65sOrxtAWfU3O696F0wa95hzJGdVAh7X3SWKfhcYD--khPXKWFc1QkeuS37U8nLIeBe578oIeuoHiHlw5rlIbYjmzNW_fvRlD7D-zsLRkaB3y98P5lH5d3muyQp_Z6z0aCWOv6dkBvw4Lw9Orah1p08uz9fnWHhFVRq/s1296/DM-RoadAhead-Sunrise-HEADER.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-CXI8BMoJwH55Fz-40taFa65sOrxtAWfU3O696F0wa95hzJGdVAh7X3SWKfhcYD--khPXKWFc1QkeuS37U8nLIeBe578oIeuoHiHlw5rlIbYjmzNW_fvRlD7D-zsLRkaB3y98P5lH5d3muyQp_Z6z0aCWOv6dkBvw4Lw9Orah1p08uz9fnWHhFVRq/w640-h360/DM-RoadAhead-Sunrise-HEADER.png" width="640" /></a></div><br />As we look to what's ahead in new diabetes technology for 2022, many may experience a sense of déjà vu. After all, much of what we'd anticipated for 2021 was delayed because of the continuing global pandemic (much like the year before). That means a lot of the forecast for the year ahead resembles what had initially been on tap a year earlier.<p></p><!-- wp:paragraph -->
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<p>Still, it's exciting to look at new innovations anticipated to literally change the face of daily diabetes management — from new insulin pens and pumps, to CGMs, and smart closed loop tech, or Automated Insulin Delivery (AID) systems.</p>
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<p>Our DiabetesMine team has been listening to industry earnings calls, and talking with company insiders and other experts to compile this roundup of what’s expected to materialize in 2022, with some of our own insights and observations sprinkled in.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Tandem Diabetes" id="tandem-diabetes">Tandem Diabetes Care</h2>
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<p>For the first time, people with diabetes (PWDs) will likely see technology giving us the ability to control our medical devices via mobile smartphone apps — including remote insulin dosing! This functionality has been hinted at for many years but hasn’t yet been approved by the Food and Drug Administration (FDA) for use in diabetes devices. That's about to change.</p>
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<h3>Mobile bolusing by phone</h3>
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<p>Notably, Tandem Diabetes Care will likely be the first to cross the finish line in getting FDA clearance on a smartphone app that can be used to control an insulin delivery device.</p><p>With that added function, the newly designed <a href="https://www.tandemdiabetes.com/products/software-apps/tconnect-mobile" rel="noreferrer noopener" target="_blank">t:connect app</a> — launched in mid-2020 alongside Tandem’s Control-IQ system — will allow for remote bolusing (aka insulin dosing) via mobile app for the existing t:slim X2 insulin pump platform and beyond.</p>
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<p>The company had filed its expanded mobile app functionality with the FDA in late 2020, but the pandemic delays meant we didn't see that approval come in 2021 as many had hoped. [<strong>Tandem <a href="https://investor.tandemdiabetes.com/news-releases/news-release-details/tandem-diabetes-care-announces-fda-clearance-tslim-x2-insulin" rel="noreferrer noopener" target="_blank">announced</a> on Feb. 16, 2022 that it had received FDA clearance for the remote bolusing by mobile app for iOS and Android smartphones, with an expected launch in Summer 2022.]</strong></p>
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<p>This also paves the way for Tandem’s future insulin pump technology, which promises the first new form factor since its original t:slim model first launched in 2012.</p>
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<h3>Tandem Mobi (formerly t:sport)</h3>
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<p>The new mini-pump with smartphone control that was known initially by the prototype name "t:sport" is now publicly known as <a href="https://uspto.report/TM/90207218" rel="noreferrer noopener" target="_blank">Tandem Mobi</a>. Here's what we know about the design based on the company's first-ever R&D Day in December 2021:</p>
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<ul><li>roughly 50 percent of the t:slim X2 size</li><li>a hybrid mini-pump that has both a short, 4-inch tubing with the trademark “pigtail” connector that goes to an infusion set as well as adhesive on the back to stick onto the body — so it can be worn either way</li><li>will hold 200 units of insulin in the cartridge</li><li>has no display screen at all</li><li>will be operated solely by an iOS or Android smartphone app</li><li>allows for wireless charging</li><li>has a bolus button on the side of the device</li><li>waterproof</li><li>compatible with the latest “iCGM” devices like the Dexcom G6</li><li>has an embedded Automated Insulin Delivery (AID) algorithm to be compatible with Tandem Control-IQ features</li><li>compatible with current Tandem infusion sets as well as a future 4-inch set in development</li></ul>
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<p>DiabetesMine got a first glimpse of an early prototype at the company’s San Diego headquarters in 2017. Tandem had planned to submit this device to the FDA in 2020, but the pandemic delayed the clinical trial, and it’s now waiting on the new mobile app with remote bolusing feature.</p>
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<p>Tandem expects once it gets the FDA's OK on the mobile bolusing functionality, it will then finalize its Tandem Mobi plan and file that with regulators later in 2022. We may possibly see that approval and launch in '22, but it could be pushed to the following year.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Omnipod " id="omnipod">Omnipod 5 tubeless system</h2>
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<p>Another holdover from the year before is the new Omnipod 5 tubeless insulin pump system, formerly known as <a href="https://www.omnipod.com/healthcareproviders/about-omnipod/innovation" rel="noreferrer noopener" target="_blank">Omnipod Horizon</a>, from Massachusetts-based Insulet Corp. This will be the company's first closed loop system that automates insulin delivery based on CGM data.</p>
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<p>Like Tandem’s Control-IQ, Horizon is a closed loop system, aka Artificial Pancreas technology. It connects the Omnipod tubeless patch pump to a CGM via a smart algorithm, allowing for automatic insulin dosing adjustments.</p>
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<p>It’s based on the Omnipod DASH platform launched in 2019 and uses the same insulin pods and mobile app. It will first be available to connect with the Dexcom CGM and later with Abbott’s FreeStyle Libre.</p>
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<p>Omnipod 5 is also set to bring mobile app control and insulin dosing, eliminating the need to carry a separate Personal Diabetes Manager (PDM) around to control the Omnipod if you gave a compatible smartphone.</p>
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<p>Omnipod 5 is another one that had been originally planned for 2020 but was delayed because of COVID-19. Insulet filed it with the agency on Dec. 23, 2020, but it didn't materialize by the end of 2021. However, many believe it will get FDA approval in the first half of 2022. <strong>[Omnipod 5's FDA clearance came on Jan. 27, 2022.]</strong></p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Medtronic" id="medtronic">Medtronic Diabetes technology</h2>
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<h3>Minimed 780 and Guardian 4 CGM sensor</h3>
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<p>Many are also waiting for Medtronic's next-generation combo insulin pump and CGM sensor system, which will be the 780G — also known as the Advanced Hybrid Closed Loop (AHCL) system. This system will expand upon the foundation of Medtronic's first two iterations: the 670G and 770G; the latter already offers built-in Bluetooth for remote updating of the technology in the future.</p>
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<p>This new tech will keep the basic form factor of the company’s 6-series pump models with a vertical "modern" look, compared to the older models with a horizontal design that resembled 1980s pagers.</p>
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<p>The 780G has many new features:</p>
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<ul><li>works with Medtronic’s next-generation CGM sensor (the Guardian 4), which will require just one calibration on the first day of wear and no further fingerstick tests beyond that (this sensor is also made for 7-day wear, same as their current model)</li><li>provides automatic correction bolus delivery every 5 minutes to help keep users in an optimal blood glucose range and to automatically adjust for missed meal doses</li><li>has an adjustable glucose target between 100 to 120 mg/dL (compared to the 670G's fixed target of 120 mg/dL)</li><li>offers different insulin action duration times, unlike other commercial closed loop systems available</li><li>offers built-in Bluetooth necessary for data sharing and remote monitoring, as well as remote software updates so users won’t be required to buy a whole new device every time new features are launched (currently, only the Tandem t:slim X2 offers this remote updating capability)</li></ul>
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<p>Notably, right from the start, Medtronic has asked FDA regulators to OK this new system for adults and kids as young as 2 years old.</p>
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<p>The company had planned to file the 780G for review soon after its investor update in late 2020, but that ended up being delayed until Feb. 23, 2021. Due to concerning <a href="https://www.fda.gov/inspections-compliance-enforcement-and-criminal-investigations/warning-letters/medtronic-inc-617539-12092021" rel="noreferrer noopener" target="_blank">FDA warnings</a> about Medtronic's facilities and product development, the approval timeline and launch remains TBD.</p>
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<h3>Extended 7-day wear infusion set</h3>
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<p>Of course, Medtronic did get <a href="https://news.medtronic.com/featured-stories?item=231" rel="noreferrer noopener" target="_blank">FDA clearance</a> in July 2021 for its new extended-wear infusion set, designed to last more than twice as long as existing infusion sets that connect traditional tubed pumps to the body for insulin delivery. That means it can be worn on the body for up to 7 days — compared to existing sets that must be changed out every 2 or 3 days.</p>
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<div class="wp-block-image"><figure class="alignright is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Medtronic Diabetes new 7-day wear insulin infusion set. " height="200" src="https://i0.wp.com/post.healthline.com/wp-content/uploads/2021/09/DM-ExtendedWearInfusionSet.png?w=315&h=840" width="200" /><figcaption><br /></figcaption></figure></div>
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<p>This new extended infusion set introduces changes to the tubing material and a redesigned connector to reduce the loss of preservatives, prevent tube occlusions (insulin clogs in pump tubing) and keep the insulin <a href="https://pubmed.ncbi.nlm.nih.gov/33703930/" rel="noreferrer noopener" target="_blank">chemically and physically stable</a> over time. Medtronic specifically points to a “novel and proprietary approach” that addresses insulin degradation, preservative loss, and occlusions — all things that can result in disrupted insulin delivery and therefore higher blood sugars.</p>
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<p>The extended-wear set also has a more skin-friendly adhesive designed to allow longer, more comfortable wear on the body. The company reports that participants in a 100-person European study commented on the new infusion set being more comfortable compared to their previous infusion sets and saw this as a meaningful improvement that reduced the overall burden of insulin pump therapy.</p>
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<p>Clinical data also shows that people using this new set might save 5 to 10 vials of insulin per year because it eliminates the many units of insulin currently wasted by the requirement to change out an infusion set every few days. Less frequent set changes also allow skin site locations to rest and heal, Medtronic points out.</p>
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<p>Medtronic hasn't specified when this new extended-wear set will actually launch, but it will be in 2022, and the pricing details will be offered at that time.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Dexcom" id="dexcom">Dexcom G7</h2>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dexcom G7 combined sensor and transmitter" class="wp-image-881471" height="200" src="https://post.healthline.com/wp-content/uploads/2020/12/DM-DexcomG7.png" width="200" /></figure></div>
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<p>This latest model of the Dexcom CGM is set to bring a significant form-factor change: a combined sensor and transmitter design.</p>
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<p>Here are the G7 details:</p>
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<ul><li><strong>Fully disposable.</strong> Unlike Dexcom CGM models to date, the G7 will be fully disposable. This means there will no longer be a separate transmitter with a 3-month battery life. Instead, the sensor and transmitter will be integrated, and once the sensor’s run is finished, you’ll dispose of the whole combined unit.</li><li><strong>Wear time.</strong> While it will start off at 10-day wear like the current G6 version, the G7 is designed to eventually support longer wear for up to 14 to 15 days. No fingerstick calibrations will be required, but that will remain optional.</li><li><strong>Thinner.</strong> The G7 will be 60 smaller, as the thinnest generation of Dexcom's CGM sensors yet.</li><li><strong>Shorter warm-up.</strong> Instead of taking two hours to warm up before displaying glucose data, the G7 will only have a 30-minute warm-up period.</li><li><strong>Different mobile app.</strong> With the G7, Dexcom will roll out a completely new app. The company's a bit vague on what this new version will entail, but they've pointed to different alarms and alerts as well as more Clarity data integrated directly onto the G7 app compared to past app designs. The company points out this new software platform will also allow it to more easily update apps as features are changed, and that Dexcom plans to automate more services like customer assistance and tech support.</li><li><strong>Decision support.</strong> Dexcom has talked a lot about wanting to integrate software features like dosing assistance and information and prompts that help users make better health choices based on their CGM readings. Given Dexcom’s acquisition of TypeZero Technologies in 2018, they seem to be on the path to providing a smart algorithm for this kind of user support. This should also help the company in its goal to expand CGM use for more people with type 2 diabetes, as well as for users without diabetes.</li><li><strong>Follow app.</strong> As to data-sharing, Dexcom notes that its <a data-id="https://www.dexcom.com/dexcom-follow" data-type="URL" href="https://www.dexcom.com/dexcom-follow" rel="noreferrer noopener" target="_blank">Follow app</a> will work with the G7 at the time of launch. Dexcom also plans to update the Follow app at a later time.</li></ul>
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<p>At the big JP Morgan healthcare conference in January 2022, Dexcom CEO Kevin Sayer presented pivotal data that it had submitted to the FDA. Notably, this latest technology outperformed the regulatory iCGM standards with better time-in-range performance of 93.3 percent compared to the FDA's standard of 87 percent. The way CGM technology is measured for accuracy is by a standard known as MARD, or Mean Absolute Relative Difference, and the G7 registered an 8.1 percent in children and 8/2 percent in adults.</p>
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<p>"The results are much superior to G6 and any competitive product in the market," Sayer said at the JPM investor update. "We think it’s going to be a fabulous product across the board. It was very rewarding when we launched G6 to see how that changed the world. This product is going to do it again."</p>
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<p>In recent investor updates, Sayer explained that the company plans to eventually have different versions of the G7 for different groups of users. For example, non-insulin—using type 2s or general health consumers may prefer a much simpler interface than insulin-using type 1s who have experience with CGM tech and want all the advanced alarms and tracking features.</p>
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<p>Dexcom filed the G7 with the FDA by the end of 2021. So most likely, we will see that approved before too long in 2022 and Dexcom will conduct an initial limited launch before eventually rolling the G7 out more broadly across the United States later in the year.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Eversense" id="eversense">Eversense 180-day implantable</h2>
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<div class="wp-block-image"><figure class="alignright size-large is-resized"><figcaption>Made by Senseonics and sold by Ascensia Diabetes Care, the Eversense implantable CGM is a first of its kind that has been available in the United States since 2018.</figcaption></figure></div>
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<p>The next-generation version under development would allow for the same tiny sensor to be implanted for 180 days (or 6 months rather than 3). This version will also reduce the number of fingerstick calibrations needed down from two to just one per day, according to the company.</p>
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<p>In September 2020, <a href="https://www.senseonics.com/investor-relations/news-releases/2020/10-05-2020-123008373" rel="noreferrer noopener" target="_blank">Senseonics asked the FDA</a> to approve the 180-day wear version, but it's still TBD on getting approval. We may very well see this appear in 2022. <strong>[FDA approved the Eversense E3 on Feb. 11, 2022.]</strong></p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Eli Lilly" id="eli-lilly">Lilly’s Smart Tempo connected pen</h2>
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<p>The pharma giant Eli Lilly had planned to launch its new connected <a data-id="https://investor.lilly.com/news-releases/news-release-details/lilly-collaborates-internationally-leading-diabetes-technology" data-type="URL" href="https://investor.lilly.com/news-releases/news-release-details/lilly-collaborates-internationally-leading-diabetes-technology" rel="noreferrer noopener" target="_blank">Tempo Smart Pen system</a> during the second half of 2021, but that didn't happen and now it's expected in 2022.</p>
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<p>Lilly is collaborating with Welldoc to integrate a new version of Welldoc's BlueStar app into what's known as Lilly's Tempo Personalized Diabetes Management Platform. The first version of that platform will be a data transfer module known as "Tempo Smart Button," which attaches to the top of a prefilled disposal insulin pen (Tempo Pen) initially approved in 2019.</p>
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<p>The company submitted the Tempo Smart Button to the FDA in 2021, as did Welldoc with its new app. Those are still under FDA review and pending 510(k) clearance. The expectation is the system will get approval and launch in 2022. </p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Abbott FreeStyle Libre" id="abbott-free-style-libre">FreeStyle Libre 3</h2>
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<p>The FreeStyle Libre from Abbott Diabetes is known as a Flash Glucose Monitoring (FGM) system because it offers a “flash” of a glucose reading whenever you scan the sensor with the handheld receiver or smartphone app.</p>
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<p>Since hitting the U.S. market in 2017, this system has allowed PWDs to get a glucose reading whenever they want just by scanning the little white round sensor worn on the arm. The Libre 2 became available in 2020, offering optional alerts for low and high blood sugars. The mobile app was released in 2021, which eliminated the need to scan the sensor with the handheld reader.</p>
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<p>Abbott confirmed with DiabetesMine that it filed the Libre 3 with the FDA in 2021, so it's certainly possible we might see the agency approve this latest version at some point in 2022.</p>
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<p>But Libre 3 promises to elevate the tech to full-CGM functionality because it will no longer require any sensor scanning to provide real-time glucose readings. Instead, Libre 3 generates a real-time glucose reading every minute, displaying that result on the compatible mobile app on iPhone or Android. This continuous stream of data allows optional alerts for high and low blood sugars, along with glucose results. This is a big leap forward compared to Libre 2 that still requires a confirmation scan to get a numeric reading.</p>
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<p>Libre 3's round, fully disposable sensor is also much smaller and thinner, the thickness of just two pennies (rather than two stacked quarters in earlier versions). Per Abbott, that is a more than 70 percent size reduction that uses 41 percent less plastic.</p>
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<p>The Libre 3 <a href="https://abbott.mediaroom.com/2020-09-28-Abbotts-FreeStyle-R-Libre-3-System-Receives-CE-Mark-Features-Worlds-Smallest-Thinnest-Sensor-with-Best-in-Class-Performance-at-the-Same-Low-Cost-for-People-with-Diabetes" rel="noreferrer noopener" target="_blank">received international approval</a> in September 2020, and with a <a href="https://clinicaltrials.gov/ct2/show/NCT04464772?term=libre+3&draw=2&rank=1" rel="noreferrer noopener" target="_blank">pivotal clinical trial</a> completed and the technology now filed with FDA, we'll likely see the Libre 3 hit the market before too long.</p>
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<p style="text-align: center;"><i>Originally published at DiabetesMine in January 2022</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com6tag:blogger.com,1999:blog-5690084467070242215.post-22851046795762842252021-12-09T17:49:00.019-05:002022-03-25T17:53:52.333-04:00Tandem Diabetes Care Plans for Future with Technology Choices<p>In the coming years, Tandem Diabetes Care has ambitious plans to introduce the next version of its tubed t:slim insulin pump, a series of three smaller devices to reduce and eventually eliminate tubes completely, and features allowing users to fully control their insulin pump and even deliver bolus insulin with their smartphones.</p><!-- wp:paragraph -->
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<p>The San Diego, California-based company revealed all of this at its first-ever R&D Day on Dec. 6, 2021, mapping out its 5-year pipeline plan for new technology.</p>
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<p>While medtech timelines often slip, given corporate priorities and the Food and Drug Administration (FDA) review process, Tandem expects that it will be able to develop and launch most — if not all — of these new products on a rolling scale between 2022 and 2027.</p>
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<p>"As a diabetes care company, we realize there is not a one-size-fits-all solution to managing this complex condition," Tandem CEO John Sheridan said. "'Positively different' is a sum total of our brand... As we look to the future of our hardware strategy, we are moving away from offering a single platform and will be emphasizing choice."</p>
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<p>It's likely that as these new devices and mobile data options are launched, they will be compatible with Tandem's existing products including its <a href="/diabetesmine/tandem-diabetes-advanced-tech" rel="noreferrer noopener" target="_blank">Basal-IQ</a> and Control-IQ algorithms, and will continue to integrate with the latest Dexcom continuous glucose monitor system.</p>
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<p>Here's a look at the new products in development:</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Smartphone control " id="smartphone-control">Smartphone insulin dosing and device control </h2>
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<p>Pieces of Tandem's tech plan are already in the works, with a key first step already submitted to the FDA.</p>
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<div class="wp-block-image"><figure class="aligncenter size-large"><img alt="" class="wp-image-1803718" height="360" src="https://post.healthline.com/wp-content/uploads/2021/12/DM-Tandem-MobileApps-Control-1.png" width="640" /></figure></div>
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<p>There are two parts to their mobile data pipeline:</p>
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<p><strong>Bolus-by-phone.</strong> Tandem asked regulators in late 2020 to OK its mobile bolusing by phone app function, which would allow Tandem customers to use their iPhone or Android smartphone apps to dose insulin without needing to take out the pump itself. The company had hoped for approval and launch in 2021, but delays related to the COVID-19 pandemic have caused an FDA backlog, so review is taking longer than expected. <strong>[UPDATE: Tandem <a href="https://investor.tandemdiabetes.com/news-releases/news-release-details/tandem-diabetes-care-announces-fda-clearance-tslim-x2-insulin-0" rel="noreferrer noopener" target="_blank">announced</a> on Feb. 16, 2022 that it had received FDA clearance for its mobile bolusing feature for both iOS and Android, and it's expected to launch in summer 2022.]</strong></p>
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<p><strong>Full device control by phone.</strong> This would come down the road, going beyond just bolusing insulin remotely. It would allow for other features that include changing basal (background insulin) rates, turning alerts and alarms on or off, suspending and resuming insulin delivery, and more directly from your phone. The company has not yet named a specific timeline for this to be submitted to regulators.</p>
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<p>Tandem believes FDA clearance for the mobile bolusing function could come "any day now," and is planning for an early 2022 launch. There is no official word yet on whether existing Tandem pumpers will need to update or download an entirely new mobile app for their iOS or Android devices, to accommodate this new capability. That key detail will be shared once FDA's requirements are known.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Tandem Mobi" id="tandem-mobi">Tandem Mobi (formerly t:sport mini-pump)</h2>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-1805590" height="360" src="https://post.healthline.com/wp-content/uploads/2021/12/DM-Mobi2021.png" width="640" /><figcaption><br /></figcaption></figure>
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<p>The company has been developing a hybrid micro-pump of sorts, roughly half the size of the current t:slim X2 pump and without any display screen at all. Initially referred to as the t:sport and now branded as <a href="https://uspto.report/TM/90207218" rel="noreferrer noopener" target="_blank">Tandem Mobi</a>, this mini-pump has both a short, 4-inch tubing with the trademark "pigtail" connector that goes to an infusion set as well as adhesive on the back to stick onto the body — so it can be worn either way.</p>
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<p>Here is a rundown of the Tandem Mobi outlined at the recent R&D Day:</p>
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<ul><li>roughly 50 percent of the t:slim X2 size</li><li>will hold 200 units of insulin in the cartridge</li><li>operated solely by an iOS or Android smartphone</li><li>allows for wireless charging</li><li>has a bolus button on the side of the device</li><li>waterproof</li><li>compatible with the latest "iCGM" devices like the Dexcom G6</li><li>has an embedded Automated Insulin Delivery (AID) algorithm to be compatible with Tandem Control-IQ features</li><li>compatible with current Tandem infusion sets as well as a future 4-inch set in development</li></ul>
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<p>DiabetesMine got a first glimpses of the t:sport prototype at the company’s San Diego headquarters <a href="/diabetesmine/tandem-diabetes-staying-alive" rel="noreferrer noopener" target="_blank">in 2017</a>. Tandem had planned to submit this device to the FDA in 2020, but the pandemic delayed the clinical trial, and it's now waiting on the new mobile app with remote bolusing feature.</p>
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<figure class="wp-block-image"><img alt="" height="359" src="https://i0.wp.com/post.healthline.com/wp-content/uploads/2020/12/Tandem-tsport-compare.png?w=1155&h=1528" width="640" /><figcaption><br /></figcaption></figure>
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<p>Tandem now plans to file Mobi with the FDA after it secures regulatory approval for the mobile bolusing app feature, and finalizes any necessary revisions or clinical work needed from there. That could be as early as the second half of 2022, but there's no solid timeline yet.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Enhancements" id="enhancements">Enhancements to Tandem's Control IQ</h2>
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<p>Aside from brand new product offerings, Tandem is also planning to improve its existing software with new features. Specifically, that may involve lower glucose targets (ie 100 mg/dL instead of the current 110/112 mg/dL), which is something many Tandem tech users want to see.</p>
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<p>"We are driving innovation in our algorithms, emphasizing automation, personalization, and simplification, all intended to continue to improve therapeutic outcomes and provide a positive patient experience characterized by simplicity and ease of use," the <a href="https://www.tandemdiabetes.com/about-us/pipeline" rel="noreferrer noopener" target="_blank">Tandem product pipeline</a> says. "Examples of our efforts to provide enhanced personalization include alternative targets, settings optimizations, and enhanced exercise options. Examples of our efforts to provide greater ease of use include adaptations, smarter alerts, and new signal integrations."</p>
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<p>Tandem also plans to pursue expanded Control IQ indications for kids as young as 2 years old, as well as those with type 2 diabetes.</p>
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<p>There is no public timeline on these enhancements, but it seems likely that they'll be happening concurrently with other clinical trial research and regulatory discussion on everything else in Tandem's near-term pipeline. Hopefully, we can see some of these improvements by early 2023.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Tandem t:slim X3" id="tandem-t-slim-x-3">Tandem t:slim X3</h2>
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<p>This is Tandem's third generation of its t:slim pump, which soon marks its 10-year launch anniversary from August 2012. The second version came in 2016 with the t:slim X2, the first to be compatible with a CGM.</p>
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<p>There is not currently much detail on what will change with the X3, but we were informed that it will have the same basic form factor with a color touchscreen as the current generation. Features will include:</p>
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<ul><li>holds 300 units of insulin</li><li>enhanced technology</li><li>refreshed user interface</li><li>increased battery life</li><li>wireless software updates</li></ul>
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<p>This new model will follow approval of the first-generation of Tandem Mobi, expected at some point in 2022 or early 2023.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="New tubeless pump" id="new-tubeless-pump">Tandem Mobi Tubeless pump</h2>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-1805776" height="360" src="https://post.healthline.com/wp-content/uploads/2021/12/DM-Tandem-MobiTubeless-Slide2021.png" width="640" /><figcaption><br /></figcaption></figure>
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<p>This new device is the second of a three-part plan moving toward a full patch pump without any tubes. While the first version of Tandem Mobi will be a hybrid with short tubing, the second iteration will go tubeless.</p>
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<p>Instead of pump tubing and the t:connect "pigtail" connector attaching to an infusion set, this Mobi Tubeless will replace that infusion set with a "disposable on-body kit." Conceptual designs appear to show the Tandem Mobi Tubeless adhering directly onto the body, with a black rectangle shape and removable insulin cartridge. As it uses the same Mobi pump design, it will likely also hold 200 units.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Disposable pump patch" id="disposable-pump-patch">Fully disposable pump patch</h2>
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<p>Finally, Tandem will develop what it describes as a fully-disposable pump patch. There wasn't much detail provided on this future product, as Tandem says it's very early in the development process. A conceptual image shows a thin white patch-like device adhered to the upper arm, but that may only be a prototype placeholder until the concept is more fully developed in the coming years.</p>
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<p>No doubt, with these tubeless patch pump devices, Tandem has in mind going up against its competitor — the tubeless Omnipod made by Insulet. That's not surprising, given the excitement over the sophisticated new Omnipod 5 system expected to become available in 2022 as the first tubeless closed loop system.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Infusion sets and more" id="infusion-sets-and-more">Infusion sets and more</h2>
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<p>Tandem is also expecting to launch new pump infusion sets as it moves forward with these next-generation devices. In addition, the company says it's working to allow its devices to use higher concentration insulin, as well as more personalized settings and management options for those with diabetes.</p>
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<p>Options are certainly the key, coupled with affordability and access. Way to go on bringing more flexibility and choice for people whose lives depend on insulin, Tandem!</p><p><br /></p><p style="text-align: center;"><i>----------------------------------------------</i></p><p style="text-align: center;"><i>Originally reported by Mike Hoskins at DiabetesMine</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-55203262822180338442021-12-01T08:30:00.015-05:002022-04-12T09:06:39.881-04:00MODY: A Rare but Increasingly Common Form of Diabetes<p>It wasn't until a quarter century after being diagnosed with type 1 diabetes (T1D) that Lori Salsbury in Arkansas realized the condition she'd been living with since she was 15 years old might not be what she thought it was.</p><!-- wp:paragraph -->
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<p>Though her mom and sister were both initially misdiagnosed with type 2 diabetes (T2D) and later correctly dubbed T1Ds, Lori didn't have a reason at first to be suspicious of her own T1D diagnosis. Not until 2015, when she began seeing more people with diabetes sharing their stories online and realized something was off for her.</p>
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<p>Sure, there is a mantra in our community that "Your Diabetes May Vary." But for Salsbury, the particulars of her T1D just "didn't match" what she saw others in the D-Community sharing or what doctors and nurses described as the symptoms most newly diagnosed T1D experience.</p>
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<p>At the time of her diagnosis, Salsbury was in her mid-20s and seemed quite healthy. She didn't get nauseous or sick, even a full day after missing an insulin dose. Her insulin dosing needs would change frequently, often sending her into super high glucose levels for weeks until adjusting her insulin or carb ratios; the same would happen on the low end of the scale.</p>
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<p>One day, Salsbury heard about a rare, inherited form of diabetes called <a data-id="https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/monogenic-neonatal-mellitus-mody" data-type="URL" href="https://www.niddk.nih.gov/health-information/diabetes/overview/what-is-diabetes/monogenic-neonatal-mellitus-mody" rel="noreferrer noopener" target="_blank">MODY (maturity onset diabetes of the young)</a>, that doesn't require as much insulin, at least initially. That piqued her interest.</p>
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<p>She did some online research, and then consulted her endocrinologist and received antibody tests that came back negative. He also ran a <a data-id="https://www.healthline.com/health/insulin-c-peptide" data-type="URL" href="/health/insulin-c-peptide">C-peptide test</a> that came back at T1D levels, but that was most likely due to her 20+ years of using insulin. A referral to a geneticist led to more bloodwork, and in January 2020 the findings came back showing a genetic mutation, which causes one of the several different known types of MODY.</p>
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<p>MODY has the potential of changing how you manage your diabetes, depending on the particular form you're diagnosed with. Some changes could include stopping medications completely or changing from insulin to a different injectable or oral medication, while some MODY forms mandate changes in your diet.</p>
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<p>In Salsbury's case, the MODY diagnosis brought her some clarity, and finally an explanation of why her diabetes experience seemed so different than others in the T1D community. But she continues insulin therapy. </p>
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<p>"Since I was originally diagnosed T1D, I am still (labeled that) in my charts so that I won't lose coverage for my insulin pump and CGM that I require to live by," Salsbury said. "Most often, if asked I just tell people that I was diagnosed with type 1. It's easier than going through the whole 'What is MODY?' spiel."</p>
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<h2>What is MODY?</h2>
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<p>The easiest way to think about MODY is that it's a subset of diabetes caused by a mutation in one of at least 14 genes in a person's DNA. That mutation impacts the insulin-producing beta cells, which in turn impacts insulin production and glucose regulation.</p>
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<p>Since just an estimated <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363133/" rel="noreferrer noopener" target="_blank">1 to 2 percent</a> of those with diabetes have a genetic mutation leading to MODY, there isn't much discussion about it within the patient community, and most medical professionals don't bring it up unless they are questioned. Yet some advocates and researchers believe the various types of MODY are more common than many think, and that view is becoming more accepted as genetic testing becomes more widely available.</p>
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<p>The term MODY was first coined in the 1970s by pioneering researchers who <a href="https://pubmed.ncbi.nlm.nih.gov/9472858/" rel="noreferrer noopener" target="_blank">identified</a> what appeared to be a mild form of diabetes in children that didn't necessarily require insulin as was needed for those with the more common "juvenile diabetes" (before it was later renamed type 1). At that time, MODY was <a href="https://pubmed.ncbi.nlm.nih.gov/9472858/" rel="noreferrer noopener" target="_blank">defined</a> as "fasting hyperglycemia diagnosed under age 25 which could be treated without insulin for more than two years," and it is inherited, as they found.</p>
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<p>While most research existing shows it's as rare as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363133/" rel="noreferrer noopener" target="_blank">1 to 2 percent</a> of all diabetes cases, more current research now indicates that as many as <a href="https://pubmed.ncbi.nlm.nih.gov/29734081/" rel="noreferrer noopener" target="_blank">6.5 percent</a> of children with antibody-negative diabetes may have a form of MODY. </p>
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<p>MODY is passed down genetically from parent to child, making that the common thread for this form of diabetes compared to the other types that are autoimmune, partially genetic, or more lifestyle-based. The typical diagnosis comes before age 25, and it's rarely diagnosed in those older than 35 or 40. While children have roughly a 50 percent chance of developing MODY if one of their parents has it, that does not mean mutations can't occur at random and appear in those without a family history of gene mutation.</p>
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<p>The gene mutations aren't the same for everyone, and they affect different organs in the body, meaning it's difficult to diagnose without genetic testing, and it can be more challenging to recognize glucose fluctuations commonly found in those who are newly diagnosed.</p>
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<p>Significantly, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871313/" rel="noreferrer noopener" target="_blank">80 percent</a> of MODY cases are misdiagnosed as T1D or T2D as the signs are pretty much the same — extreme thirst, increased urination, and weight loss. But some forms of MODY do not produce any symptoms. The number of misdiagnoses may be even higher at <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785020/" rel="noreferrer noopener" target="_blank">95 percent</a> in the United States, according to some researchers.</p>
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<h3 class="standout--heading">How many types of MODY exist?</h3>
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<p>Currently, there are <a href="https://www.ncbi.nlm.nih.gov/books/NBK532900/#" rel="noreferrer noopener" target="_blank">14 recognized types of MODY</a> caused by mutations in different genes. Those gene mutations can include, per the latest research: GCK, HNF1A, HNF4A, HNF1B, INS, NEURO1, PDX1, PAX4, ABCC8, KCNJ11, KLF11, CEL, BLK, and APPL1. The different genes vary with respect to age of onset, response to treatment, and the presence of extra-pancreatic manifestations.</p>
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<p>Three of the more common types of MODY are:</p>
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<ul><li><strong>MODY 1.</strong> Gene mutation in the hepatocyte nuclear factor 4 alpha (<em>HNF4A</em>). Although it's less common, it may account for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6031504/" rel="noreferrer noopener" target="_blank">5 to 10 percent</a> of MODY cases.</li><li><strong>MODY 2. </strong>Gene mutations in the glucokinase (<em>GCK</em>) enzyme account for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363133/" rel="noreferrer noopener" target="_blank">30 to 50 percent</a> of the cases of MODY. Patients with a GCK mutation typically display "mild and nonprogressive hyperglycemia," which is generally not symptomatic, meaning they don't notice it.</li><li><strong>MODY 3.</strong> Gene mutation in the hepatocyte nuclear factor 1 alpha (HNF1A) accounts for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3363133/" rel="noreferrer noopener" target="_blank">30 to 50 percent</a> of MODY cases. This is a progressive beta cell dysfunction, and diagnosis is typically made between ages 21 and 26.</li></ul>
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<p>Finding out the probability of developing MODY is becoming more accessible in recent years, with new tools like a <a href="https://www.diabetesgenes.org/exeter-diabetes-app/ModyCalculator" rel="noreferrer noopener" target="_blank">probability calculator</a> and <a href="https://www.diabetesgenes.org/exeter-diabetes-app/" rel="noreferrer noopener" target="_blank">subtype app</a> developed by the Exeter Centre of Excellence for Diabetes Research (EXCEED) in the United Kingdom.</p>
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<h2>Getting a correct MODY diabetes diagnosis</h2>
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<p><a href="https://connects.catalyst.harvard.edu/Profiles/display/Person/128403" rel="noreferrer noopener" target="_blank">Dr. Miriam Udler</a> at Massachusetts General Hospital is one of the more well-known names in MODY clinical research. She believes more cases are being diagnosed in recent years as genetic testing has become more available, particularly after COVID-19 led to a telehealth explosion and more at-home testing kits for bloodwork and diagnostic tests normally done in a lab.</p>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. Miriam Udler of Massachusetts General Hospital is an expert diabetes researcher focused on MODY diabetes. " class="wp-image-1828322" height="209" src="https://post.healthline.com/wp-content/uploads/2021/12/DM-Udler.png" width="209" /><figcaption><br /></figcaption></figure></div>
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<p>"It used to be rare and expensive, and that was a barrier to testing and diagnosing MODY correctly," she told DiabetesMine. "But now, more providers have access to this and can order the tests to their clinics or patients at home, and insurance is increasingly covering MODY genetic testing."</p>
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<p>While MODY is still less common and infrequently discussed in clinics, Udler says it comes down to that particular doctor or patient recognizing something might be "different" about their diabetes.</p>
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<p>"That matters a lot, and a correct diagnosis can change management," Udler said. "In most common MODY forms, it could mean coming off medication."</p>
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<p>For Salsbury, the particular BLK gene mutation she has causes <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2732833/" rel="noreferrer noopener" target="_blank">MODY 11</a>, an insulin secretion defect that makes her beta cells less responsive to glucose and leads to less insulin being sent out by the body when it's needed. Being overweight is one common feature of this particular gene mutation, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6986955/table/t1-yujm-2019-00409/?report=objectonly" rel="noreferrer noopener" target="_blank">according to research</a>.</p>
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<p>Once MODY is recognized and diagnosed, it can also be difficult to regulate glucose levels in the same ways that T1D and T2Ds often do, because the symptoms and glucose levels can vary significantly.</p>
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<p>As MODY 11 usually presents like T1D and is treated in much the same way, Salsbury has been using insulin since she was diagnosed at age 15 in 1991 and wears an Omnipod tubeless insulin pump and Dexcom CGM, combined into a homemade do-it-yourself (DIY) closed loop system. For her, life with MODY isn't much different from being T1D.</p>
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<p>But she knows everyone is not as fortunate on that front and can have many challenges in getting a correct diagnosis and finding a management routine that works for their particular form of MODY.</p>
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<p>In New York, Laurie Jones shares her story of being diagnosed at 30 with gestational diabetes late in her first pregnancy through the test often given to pregnant women. She changed her diet and followed it to the letter on exact carb and calorie allowances, and took varying doses of long and short-acting insulins. Though she describes it as "intense," all signs of diabetes went away after her first pregnancy.</p>
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<p>But within a few years during her second pregnancy, gestational diabetes returned. She began insulin injections right away as well as a strict diet, but Jones found it more difficult than before to regulate high and low blood sugars.</p>
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<p>A number of years later, her A1C results were creeping higher and that led to a T2D diagnosis. She took Metformin on the advice of her doctor, but it didn't work to keep her blood sugars in check. </p>
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<p>"Most adult medicine endos do not push for MODY testing even when the medicine is not working," she explained. "Being overweight is usually assumed the reason, therefore even star doctors don't push for MODY testing unless weight is lost."</p>
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<p>Her son's diagnosis changed everything. When he was 6 years old, he was diagnosed with <a data-id="https://www.healthline.com/health/eosinophilic-esophagitis" data-type="URL" href="/health/eosinophilic-esophagitis" rel="noreferrer noopener" target="_blank">eosinophilic esophagitis</a>, and that mandated a diet free of the top allergens. He was about 12 when she took him to an endocrinologist, as he was not growing and low on the weight scale and didn't show any signs of puberty. That endo noticed his blood sugars were elevated and assumed he was in the "honeymoon period" prior to becoming a fully diagnosed T1D.</p>
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<p>Months progressed, and the doctor suggested it was MODY. Genetic testing led to a MODY 2 diagnosis.</p>
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<p>"We had no idea what that was, and before [the doctor] explained it to us, she noted that most endocrinologists and almost all doctors outside of major medical teaching and research hospitals have not heard of it," the D-Mom said.</p>
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<p>After her son's diagnosis, Jones got her own genetic testing and learned she also had MODY 2.</p>
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<p>Most controlled by diet, MODY 2 is one of the more common but less intensive forms of MODY that usually doesn't require insulin or other glucose-lowering meds.</p>
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<p>That led her to stopping Metformin, and she's been eating healthier and managing her weight for better glucose levels.</p>
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<p>"MODY 2 is not just about how you produce or use insulin, but mainly when you produce the insulin," she said. "We were both told that our pancreas is like a house cooling or heating system that is off-kilter. Basically, our sugar levels have to get much higher than what is considered normal before the pancreas produces insulin. There are also insulin efficiency issues."</p>
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<p>Without her son's diagnosis, Jones doesn't think she would've ever had the needed genetic testing and would have remained with a T2D diagnosis taking the wrong medications.</p>
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<p>That's likely the story for so many people in our D-Community, she believes. </p>
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<p>"With a 50 percent chance of being passed on, chances are MODY is not as rare as it is now believed," Salsbury said. "If more people knew of it and were tested, we may come to find out that it is the most common or second only to T2D in commonality."</p>
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<h2>Possibility of other health concerns</h2>
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<p>Importantly, a correct MODY diagnosis can highlight other health issues that might potentially arise. For example, a MODY 11 mutation to the BLK gene can increase the chances of developing <a href="/health/systemic-lupus-erythematosus" rel="noreferrer noopener" target="_blank">systemic lupus erethematosus (SLE)</a>.</p>
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<p>"While being correctly diagnosed as MODY may not change your treatment, it can give you other information," Salsbury said. "Many forms of MODY also come along with other health issues that the mutation may have caused. Knowing you have MODY can alert your doctors to watch you or check you for other related health conditions."</p>
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<p>Researchers note the same, including <a href="https://www.medschool.umaryland.edu/profiles/Pollin-Toni/" rel="noreferrer noopener" target="_blank">Dr. Toni Pollin</a>, a genetic researcher and counselor who in 2016 co-founded the <a href="https://www.medschool.umaryland.edu/endocrinology/mdrap/" rel="noreferrer noopener" target="_blank">Monogenic Diabetes Research and Advocacy Project (MDRAP)</a> at the University of Maryland School of Medicine. The MDRAP effort promotes the correct diagnosis of MODY and also helps raise money for that effort. She co-founded MDRAP with a patient advocate who'd been diagnosed with a form of MODY.</p>
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<p>"While improving MODY diagnosis will certainly improve the clinical care for patients, it will also have broader implications," researchers wrote in this 2015-published <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4785020/" rel="noreferrer noopener" target="_blank">Undiagnosed MODY: Time for Action</a> manuscript. "Screening and genetic testing for MODY among patients with diabetes will provide a model for identifying and diagnosing highly penetrant forms of other otherwise common complex diseases [through] the power of genetics and genomics for improving patient care and public health."</p><p><br /></p><p style="text-align: center;">- - - - - - - - - - - -</p><p style="text-align: center;"><i>Originally published at DiabetesMine</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-38772849185841544682021-09-03T21:29:00.001-04:002022-03-22T21:35:02.168-04:00An Ode to the Diabetes Workforce on Labor Day<p>As Labor Day offrs a break from our usual work routines, let's take a moment to recognize all those who devote their lives to making a difference for the Diabetes Community -- everyone from researchers and medical professionals to all of us PWDs (people with diabetes) who work tirelessly just to <em>live</em> every moment of each day. And of course, we PWDs know there's <em>never</em> really a day off from diabetes.</p><p><br /></p><h2 style="text-align: center;">An Ode To All Diabetes Workers</h2><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>To those who make the "magic elixirs"</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Mixing the fast-acting or long-acting mixtures</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Storing these live-saving meds in bottles, pens or vials</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>To help us endure our daily blood sugar trials</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We thank you for the work you do.</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em> </em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>To the meter-makers and the pump assemblers</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Whose work rarely a patient remembers</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Building the systems and evaluating, testing</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We raise our calloused fingertips in thanks — no resting!</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We test our blood many times a day</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>On any meter brand, in many a way</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Waiting for the countdown to see our #bgnow</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Hoping for little effect of our chow</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Hoping, believing, the meter never lies</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We pay a lot, but we thank you for producing these supplies.</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>To the pump and CGM production people:</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>You give us sensors that require fewer jabs</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>('Cause no one enjoys those daily stabs)</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Now we can better manage each number and dose</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>And so we thank you ... almost the very most!</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Innovators all deserve our thanks</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Every single one among your ranks</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Because you've applied your imagination</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>To assist PWDs throughout the nation</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>And turned device dreams to reality</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>From 1921 insulin to 21<sup>st</sup> Century technology</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We are lucky that you work for us!</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Endos and educators, you're on our team</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Keeping us healthy and sane (it seems)</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>So thank you for data review and routine tweaks</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>In the little time we have every few months (not weeks).</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Lastly, to every Person with Diabetes (or PWD)</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>Who doesn't have one single day free</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>No matter if it's a holiday...</em></span></p><p></p><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>We salute you, for the "Manual Pancreas" you play</em></span></p><p></p><p></p><p><!-- wp:paragraph -->
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</p><p></p>
<!-- /wp:paragraph --><p></p><p style="text-align: center;"><span style="font-size: medium;"><em>On this yearly Labor Day!</em></span></p><p style="text-align: center;"><span style="font-size: medium;"><em><br /></em></span></p><p style="text-align: center;"><span style="font-size: medium;"><em>- - - - - - - - - - - - - - - - -</em></span></p><p style="text-align: center;"><span style="font-size: medium;"><em><b>Originally created by and published at DiabetesMine</b></em></span></p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-38350060876578239712021-07-07T12:52:00.030-04:002022-03-24T12:59:05.359-04:00Highlights of the American Diabetes Association’s 2021 Annual Meeting<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaeroesqa54Q5Ex8oiacCUSQdrsn1xfqLSf0r7TsGGvVLQHTLEJrSRHaW5gRKnlNtD5Ts4i2RJdH-XakWxaRZB1d5OO4v3f6Cw1NRbnbRSftqvBzPniIc-jvwZqwQSlX-L4Fqz8TAxY5e1iTjRNWrJGQEvlylqfYeia5lWYo9AfPK8CwFFCxIJV7C9/s1296/DM-WebConference-HEADER.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgaeroesqa54Q5Ex8oiacCUSQdrsn1xfqLSf0r7TsGGvVLQHTLEJrSRHaW5gRKnlNtD5Ts4i2RJdH-XakWxaRZB1d5OO4v3f6Cw1NRbnbRSftqvBzPniIc-jvwZqwQSlX-L4Fqz8TAxY5e1iTjRNWrJGQEvlylqfYeia5lWYo9AfPK8CwFFCxIJV7C9/w640-h360/DM-WebConference-HEADER.png" width="640" /></a></div><br />The American Diabetes Association's annual conference, known as the <a data-id="https://professional.diabetes.org/scientific-sessions" data-type="URL" href="https://professional.diabetes.org/scientific-sessions">ADA Scientific Sessions</a>, is always the biggest diabetes event of the year, and 2021 marked the second time this 5-day congress was held completely online because of the lingering COVID-19 pandemic.<p></p><!-- wp:paragraph -->
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<p>When held in person, the conference normally convenes roughly 16,000 physicians, researchers, and diabetes industry experts from across the globe. This 81st annual event drew 11,600 people from 119 countries between June 25 and 29 — slightly lower than the 12,527 registered attendees for the 2020 virtual event. For both, the event organizers expected more people to tune in afterward, thanks to the recorded online sessions being made available for up to 3 months following the conference.</p>
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<p>Despite its virtual nature, this year's conference included nearly 200 presentations with more than 900 presenters on any range of topics. And to top it off, there were roughly 1,100 research posters delving into the latest science in diabetes. You can catch up on some of the action by searching hashtag <a data-id="https://twitter.com/search?q=%23Ada2021" data-type="URL" href="https://twitter.com/search?q=%23Ada2021">#ADA2021</a>.</p>
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<p>Many of the big themes this year were extensions of what we saw in 2020 with the first-ever virtual SciSessions, but with even deeper focus. Below is our team's summary of conference highlights.</p>
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<h2 class="wp-block-healthline-tabbed-heading" id="">COVID-19 and diabetes</h2>
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<p>Of course, the novel coronavirus that took the world to its knees was a main focal point and recurring theme in a large majority of research presented at this year's Scientific Sessions.</p>
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<p>Whether the topic officially had to do with COVID-19 or not, this was on everyone's mind — from telehealth to research delays because of shutdowns, hospitalizations, etc. New research highlighted how people with underlying health conditions are <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6924e2.htm?s_cid=mm6924e2_w%23T1_down" rel="noreferrer noopener" target="_blank">6 times more likely</a> to die of COVID-19, and diabetes is the <a href="https://www.cdc.gov/mmwr/volumes/69/wr/mm6928e1.htm" rel="noreferrer noopener" target="_blank">second most reported</a> condition tied to those deaths in the U.S.</p>
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<p>"Seeing the devastating impact of the pandemic on people with diabetes, the ADA is emboldened to work even harder to lead the fight against diabetes," said the ADA's chief scientific and medical officer, <a href="https://www.diabetes.org/node/11476" rel="noreferrer noopener" target="_blank">Dr. Robert Gabbay</a>. "Our mission is reinforced by researchers from around the globe committed to closely studying specific impacts and interventions to help people living with diabetes during this COVID-19 era."</p>
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<p><a data-id="https://care.diabetesjournals.org/content/early/2021/06/18/dc21-0074" data-type="URL" href="https://care.diabetesjournals.org/content/early/2021/06/18/dc21-0074" rel="noreferrer noopener" target="_blank">Research from the T1D Exchange</a> presented at ADA showed that among people with type 1 diabetes (T1D), use of diabetes technology lowered the risk of adverse outcomes with COVID-19. That point was emphasized throughout the conference, though it was offset by the common barriers of access and affordability issues — as well as racial and ethnic disparities in diabetes technology use.</p>
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<p>One <a href="https://diabetes.diabetesjournals.org/content/70/Supplement_1/153-LB" rel="noreferrer noopener" target="_blank">disturbing research presentation</a> illustrated how type 2 diabetes (T2D) in children had skyrocketed during the COVID-19 pandemic. More pediatric patients were hospitalized between March and December 2020 than in the previous year. It also shows that stay-at-home orders resulting from COVID-19 exacerbated T2D risk for children overall, largely because of limited physical activity, more screen time and sedentary behaviors, disrupted sleep, and higher intake of processed foods and differing eating patterns during the day. A notable stat presented in one session showed that 1 in 4 PWDs in America reported the pandemic had interfered with their ability to obtain healthy food.</p>
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<p>"While our study examined hospital admissions for type 2 diabetes in children at one center, the results may be a microcosm of what is happening at other children’s hospitals across the country," said <a href="https://www.pbrc.edu/research-and-faculty/faculty/hsia-daniel-md.aspx" rel="noreferrer noopener" target="_blank">Dr. Daniel S. Hsia</a> of the Pennington Biomedical Research Center in Baton Rouge, LA. "Unfortunately, COVID-19 disrupted our lives in more ways than we realize. Our study reinforces the importance of maintaining a healthy lifestyle for children even under such difficult circumstances."</p>
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<p>Another study conducted in October 2020 showed that 1 in 5 adults with diabetes reported anxiety or depression. Nearly half of adults (or 47 percent) with T1D reported moderate to severe distress compared with only 11 percent of adults with T2D. That research came from <a href="https://ufhealth.org/sarah-c-westen-phd/research" rel="noreferrer noopener" target="_blank">Dr. Sarah C. Westen</a> at the University of Florida, and she told attendees that it meant PWDs with these pandemic-related psychosocial concerns needed follow-up diabetes care aimed at mental health.</p>
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<p>Overall, the most common themes were that COVID-19 led to increased health anxiety, limited social interaction, and routine disruption. Many presenters also emphasized the need for more longitudinal research to better understand how these psychosocial factors specifically impacted diabetes management during the pandemic.</p>
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<p>"While we are beyond eager to return to 'normal' and are well aware of the devastation that continues to occur because of COVID, we hope to take these silver linings, learn from them, and continue to implement things that we found particularly helpful that resulted out of necessity because of the pandemic," said <a href="https://www.ohsu.edu/people/catlin-dennis-mph" rel="noreferrer noopener" target="_blank">Catlin Dennis</a>, MPH, of the Oregon-based <a href="https://www.ohsu.edu/doernbecher/novel-interventions-childrens-healthcare-nich" rel="noreferrer noopener" target="_blank">Novel Interventions in Children’s Healthcare (NICH)</a> at <a href="https://www.ohsu.edu/doernbecher" rel="noreferrer noopener" target="_blank">Doernbecher Children's Hospital</a>. She presented in a session titled "<a data-id="https://eventpilot.us/web/planner.php?id=ADA21&table=agenda&tid=S1263" data-type="URL" href="https://eventpilot.us/web/planner.php?id=ADA21&table=agenda&tid=S1263">When COVID-19 Clashes with Diabetes</a>."</p>
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<h2 class="wp-block-healthline-tabbed-heading" id="">Health inequities and racism</h2>
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<p>Not surprisingly, racial disparities and inequities within diabetes care were a focal point at the ADA conference as well. Many presenters noted that existing disparities were brought to light quite glaringly during the height of COVID-19.</p>
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<p>In August 2020, the ADA published a "<a href="https://www.diabetes.org/sites/default/files/2020-08/Health%20Equity%20Bill_2nd_v2.pdf" rel="noreferrer noopener" target="_blank">Health Equity Bill of Rights</a>" that included statements on access to insulin and other diabetes meds, affordable healthcare, and ensuring that PWDs are able to be free from stigma and discrimination. As of April 2021, the ADA is encouraging scientists to <a data-id="https://www.diabetes.org/newsroom/press-releases/2021/ada-announces-new-grants-available-to-further-research-impact-of-health-disparities-on-diabetes-community" data-type="URL" href="https://www.diabetes.org/newsroom/press-releases/2021/ada-announces-new-grants-available-to-further-research-impact-of-health-disparities-on-diabetes-community">apply for grants</a> to conduct research touching on the impact of disparities in diabetes care.</p>
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<p>“We can’t improve the health of all Americans without first addressing health inequities in our healthcare system. It’s crucial that we take a groundwater approach to solving these problems so that the solutions are both sustainable and effective. We have an obligation to dismantle these inequities and eliminate the devastating impact they have on families and communities,” ADA CEO <a href="https://www.diabetes.org/node/2206" rel="noreferrer noopener" target="_blank">Tracey D. Brown</a> said.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Adult T1D" id="adult-t-1-d">Adult type 1 diabetes is real!</h2>
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<p>One of the few really eye-popping developments this year was the announcement of a consensus statement between American and European diabetes experts, recognizing for the first time ever that there is, in fact, such thing as adult type 1 diabetes (T1D). </p>
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<p>Yes, nearly a quarter century after T1D was officially classified and renamed from "juvenile diabetes," medical experts have now finally issued official guidance on standards of care for adults with T1D.</p>
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<p>The "<a href="https://eventpilot.us/web/planner.php?id=ADA21&table=agenda&tid=S1315" rel="noreferrer noopener" target="_blank">Management of Type 1 Diabetes in Adults—2021 Draft ADA/EASD Consensus Report</a>" is a multiyear effort between the ADA and European Association for the Study of Diabetes (EASD). It includes a new diagnostic algorithm for T1D that begins with measuring islet autoantibodies. </p>
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<p>“We know we have guidance for the management of people with type 1 diabetes, but this gets mixed into broader guidelines and many of those broader guidelines are mostly derived from data in people with type 2 diabetes,” said Dr. Anne Peters, a well-known endocrinologist at the University of Southern California (USC) and director of the USC Clinical Diabetes Programs. “The EASD and the ADA recognized that there was a need to develop a comparable consensus report that specifically addresses the needs of people with type 1 diabetes.” </p>
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<p>The report lays out that to achieve individualized care, patients should undergo an initial needs assessment. It also addresses behavior considerations such as alcohol and tobacco use, sleep, sick day management, driving, employment, physical activity, and nutrition.</p>
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<p>"There is no one eating pattern recommended," said Amy Hess-Fischl, a registered dietician and nutritionist and certified diabetes care and education specialist (CDCES) at the University of Chicago. "It is all based on the individual sitting in front of us."</p>
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<p>The report notes that there are four critical times for ongoing diabetes management support and education: at diagnosis, annually or when the patient is not meeting treatment targets, when complicating factors develop, and when transitions in life and care occur.</p>
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<p>Dr. Jeremy Pettus, endocrinologist at the University of California, San Diego, worked in the consensus group that evaluated an array of medications that might be useful for T1D — some of them more commonly used for type 2 diabetes currently.</p>
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<p>"There are other things wrong in type 1 diabetes physiology that we could potentially address with medications to help the vast majority of T1Ds get their blood sugars down to where they need them to be, help lose weight, improve cardiovascular outcomes," he said. "Type 1s, even with good glycemic control, are still at high risk for cardiovascular disease."</p>
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<p>A hope is that these newer guidelines can help better diagnose T1D in varying age ranges, to help quell common misdiagnosis. But also, to further emphasize that individualized care is necessary when treating someone with the condition.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Insulin and cure research" id="insulin-and-cure-research">Insulin and related ‘cure’ research</h2>
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<p>Another big theme for this Scientific Sessions — and 2021 overall — was the 100th anniversary of insulin's discovery.</p>
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<p>While so much progress has happened in diabetes and with insulin specifically since that game-changing discovery in 1921 by Drs. Frederick G. Banting and Charles Best in Toronto, the conference also highlighted how there is much left to be done for PWDs.</p>
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<p>Affordability is at crisis levels in the U.S. and too many can't get the life-sustaining insulin they need. Yet ironically, many people with type 2 diabetes continue to live in fear of being prescribed this medication.</p>
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<p>Sessions delved into the policy sides of insulin accessibility as well as research on new types of insulin and other islet and beta cell transplants, which fall under the "cure" umbrella.</p>
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<p><a href="https://guides.upstate.edu/c.php?g=621794&p=5616215">Dr. Ruth S. Weinstock</a> at State University of New York (SUNY) Upstate Medical University, who currently serves as the ADA's Science and Medicine division president, highlighted in her Sunday morning address that cutting-edge research is driving new therapies and technologies as well as hope for a diabetes cure. But there's a lot to be concerned about, too.</p>
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<p>"As wonderful as the discovery of insulin was, there was a need for purer and more physiological preparations and better insulin delivery systems," she said. "We have better insulins now, but their administration is still burdensome and associated with challenges. And importantly, hypoglycemia and hypoglycemia unawareness remain problems, increasing in prevalence with longer diabetes duration."</p>
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<p>She pointed to the price of insulin in the U.S. being higher than anywhere else in the world, and encouraged ADA attendees to work toward a goal of more affordable insulin by January 2022 — the century-mark since <a href="https://www.umassmed.edu/dcoe/diabetes-education/patient-resources/first-insulin-injection/">a 14-year-old received the first-ever dose</a> of insulin.</p>
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<p>Meanwhile, developments in pancreatic beta cells garnered attention at the SciSessions as a possible path toward a T1D cure.</p>
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<p><a href="https://www.linkedin.com/in/estherlatres/" rel="noreferrer noopener" target="_blank">Dr. Esther Latres</a> of the JDRF presented updates on manufacturing insulin-producing cells from stem cells, protecting the beta cells (without immunosuppressive drugs) from being destroyed during the immune system attack on a person's body that leads to T1D.</p>
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<p><a href="https://www.mayo.edu/research/faculty/peterson-quinn-p-ph-d/bio-20425563" rel="noreferrer noopener" target="_blank">Dr. Quinn Peterson</a> of the Mayo Clinic presented his latest research on growing pancreatic islets from stem cells, showing findings that scientifically significant insulin production can be prompted using his technique.</p>
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<p>As these researchers encouraged more advances in this type of diabetes research, it coincided with the <a href="https://www.sciencemag.org/news/2021/04/biden-wants-65-billion-new-health-agency-speed-treatments">recent news</a> of President Joe Biden's proposal for a Moonshot Initiative. This would provide $6.5 billion in the federal budget for the National Institutes of Health (NIH) to fund cure-focused research on cancer and other conditions like diabetes. If that proposal gets approved and implemented, it could lead to even more T1D research on advanced treatments and a potential cure.</p>
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<h2 class="wp-block-healthline-tabbed-heading" id="">Time in range</h2>
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<p>Another hot topic at the ADA conference this year was the growing emphasis on Time in Range (TIR), which provides more information about glucose control than the traditional 3-month average known as the A1C.</p>
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<p>Multiple diabetes experts in a variety of presentations highlighted the importance of TIR as they discussed latest research findings and management, complications that can materialize despite one’s A1C result, and even policy implications from looking at TIR rather than just A1C.</p>
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<p>Generated mainly from the use of continuous glucose monitors (CGM), TIR was highlighted for how it helps people stay within the ideal 70-180 mg/dL range as often as possible in order to improve their diabetes management. This was mentioned in countless presentations and research posters.</p>
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<p>In one of the sessions posing the question "Is CGM use an effective tool in primary care?" medical professionals and diabetes experts debated whether this tech can be useful for health consumers beyond diabetes care.</p>
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<p>Short answer: It depends on the level of engagement a patient may have, but for those with diabetes who are dependent on insulin, the benefits of CGM are no longer in question. Presenters noted that CGM use allows a move away from focusing solely on A1C, with TIR data instead allowing healthcare providers to make better adjustments to insulin or diabetes meds, as well as determine how eating patterns or other aspects of a person's life might be tweaked to achieve better outcomes.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="New T2D combo drug" id="new-t-2-d-combo-drug">New weekly injectable med for type 2 diabetes</h2>
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<p>The eagerly anticipated full results of the <a href="https://www.endocrinologynetwork.com/view/ada-2021-tirzepatide-demonstrates-potential-in-type-2-diabetes-with-surpass-trials" rel="noreferrer noopener" target="_blank">phase 3 SURPASS trials</a> were shared at ADA 2021, generating a lot of buzz.</p>
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<p>The study followed up on results from early 2021 focused on <a href="https://www.drugdiscoverytrends.com/why-lillys-tirzepatide-has-blockbuster-potential/" rel="noreferrer noopener" target="_blank">tirzepatide</a>, a new once-weekly injectable glucose-lowering combo drug (dual GIP and GLP-1 receptor agonist) from Eli Lilly. It’s still in development, but like the exciting <a href="https://investor.lilly.com/news-releases/news-release-details/tirzepatide-achieved-superior-a1c-and-body-weight-reductions" rel="noreferrer noopener" target="_blank">initial results</a>, this latest research shows the new drug leads to a sizable A1C reduction as well as weight loss and fewer hypoglycemic episodes for people with type 2 diabetes.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="‘Foot selfies’" id="foot-selfies">Diabetes complications and the ‘foot selfie’</h2>
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<p>The ADA conference also traditionally features many different research talks focused on diabetes complications. This year, there were multiple sessions aimed at kidney and cardiovascular risk for PWDs, including how various medications — especially for those with T2D — can reduce the risk of these possible complications.</p>
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<p>There were sessions focused on spinal cord stimulation to treat painful neuropathy in the feet and toes, as well as how retinopathy is being treated more effectively now than even just a few years back.</p>
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<p>One topic that caught our eye was “diabetes foot selfies.” Although some medical appointments to diagnosis, assess, or treat D-complications must happen in person, during the COVID-19 crisis there was a larger trend of people snapping photos of their feet and toes to have their clinicians look at those virtually to help guide decision-making.</p>
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<p>“The COVID-19 pandemic required a rapid shift in best care practices,” said <a href="https://medicine.umich.edu/dept/diabetes/brian-m-schmidt-dpm" rel="noreferrer noopener" target="_blank">Brian M. Schmidt</a> from the University of Michigan Medical School. “This had a huge impact on patients with diabetic foot ulcers and other complications because most of the time those patients were seen exclusively in face-to-face interactions.”</p>
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<p>In California, <a href="https://keck.usc.edu/faculty-search/laura-shin/" rel="noreferrer noopener" target="_blank">Dr. Laura Shin</a> discussed how her clinic had also used telemedicine and other methods to provide virtual care for patients with diabetes foot issues. They sent info packets to patients, families, and caregivers on conducting “three-minute foot exams,” and how to take selfies in helping clinicians prescribe care and identify high risk instances.</p>
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<p>“A large part of us being able to treat these patients as best we could, especially with using different telemedicine technologies, was the ‘foot selfie.’ If they were flexible or agile enough, they could take the pictures themselves using their cell phones, or have a family member or caregiver take the pictures,” she said.</p>
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<p>“With COVID-19, we have learned a lot about accessing patients,” Shin added. “Utilizing different tools and avenues for telemedicine was extremely helpful for us and for our patients with diabetes and diabetic foot care needs. And although it’s not a replacement for inpatient visits, I think we were still able to manage to keep a lot of these patients safe, keep them out of the hospital, and keep them moving in the world.”</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="New diabetes tech products" id="new-diabetes-tech-products">Diabetes tech and tools on display</h2>
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<p>An anticipated highlight of the ADA SciSessions each year has traditionally been the sprawling exhibit hall, where scores of diabetes companies go all out with elaborate displays. Sales reps try to woo physicians with the latest and greatest new gadgets and tools, and many companies coordinate timing of announcements and new products with this large conference — particularly since it falls in the final month before the fiscal quarter ends and they're eager to wow investors.</p>
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<p>Of course it's just not the same with the event being online. The virtual exhibit hall is more of a rudimentary marketing tool where you can click on materials and videos but without the fanfare and opportunity to ask questions face-to-face. But there were still some topics of interest here.</p>
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<h3>Afrezza inhaled insulin</h3>
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<p>New research was presented on MannKind's Afrezza inhaled insulin. This ultra rapid-acting inhalable drug has been available in the U.S. for adults with T1D since 2015, but it's still being studied for possible use in children and adolescents as well as for those with T2D.</p>
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<p>In <a href="https://investors.mannkindcorp.com/news-releases/news-release-details/mannkind-presents-two-posters-american-diabetes-associations?utm_campaign=cityfalcon&utm_medium=cityfalcon&utm_source=cityfalcon" rel="noreferrer noopener" target="_blank">two smaller studies</a>, MannKind showed data that Afrezza is safe in children and adults with T2D.<br /><br />Researchers tested Afrezza in 30 children between 8-17 and found the inhaled insulin was safe and saw its peak action about 10-15 minutes after inhalation. Within 2 hours, it was out of their systems. For post-meal glucose drops, the children saw the peak decrease 30-60 minutes after inhalation. All of that shows Afrezza works the same in children as it does in adults. While there was a slight cough observed for some after inhalation, there was no severe hypoglycemia. This research shows a final phase 3 clinical study can now move forward, paving the way for eventual pediatric approval.</p>
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<p>As for T2 adults, Afrezza improved their TIR throughout the day to a total 62 percent of time, or 4 additional hours each day with lower amounts of highs and lows.</p>
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<h3>Medtronic’s new products</h3>
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<p>Medtronic presented important data on its future technology, including its Extended Wear Infusion Set that is already approved in Europe but is still in development for the U.S. This infusion set could last twice as long as existing infusion sets available for insulin pumps today — meaning it could be worn on the body for up to 7 days, compared with the traditional 2 or 3 days. <a href="https://news.medtronic.com/2021-06-23-Medtronic-Announces-Real-World-Data-on-InPen-TM-and-Extended-Infusion-Set-Pivotal-Trial-Data-at-the-American-Diabetes-Association-81st-Scientific-Sessions" rel="noreferrer noopener" target="_blank">Research presented</a> at the ADA conference shows that Medtronic's extended wear set lasted that long for up to 75 percent of the 350+ study participants, which beat out the 67 percent for the current 2-3 day sets.</p>
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<p>This extended wear set is already filed with the Food and Drug Administration (FDA) and is awaiting review and approval, and if OK'd it would be the first time the U.S. would see an infusion set allowed to be worn for this long.</p>
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<p>Medtronic also <a href="https://news.medtronic.com/2021-06-23-Medtronic-Announces-Real-World-Data-on-InPen-TM-and-Extended-Infusion-Set-Pivotal-Trial-Data-at-the-American-Diabetes-Association-81st-Scientific-Sessions" rel="noreferrer noopener" target="_blank">presented data</a> on Time in Range for its Bluetooth-connected 770G system, keeping up with competing diabetes device companies that presented TIR research but also setting the foundation for its upcoming 780G device (aka the Advanced Hybrid Closed Loop system) that is pending before the FDA. </p>
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<p>With that approval, we will soon have a trio of closed loop commercial systems to choose from: Medtronic's 780G, Tandem's Control-IQ and Omnipod 5, the latter of which will be the first tubeless patch pump option with automated glucose control.</p>
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<h3>CamAPS FX closed loop system</h3>
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<p>In a clinical study from the University of Cambridge, Dr. Julia Fuchs presented data on the future CamAPS FX closed loop system in kids and teens with T1D. This technology is U.K.-based <a href="https://camdiab.com/" rel="noreferrer noopener" target="_blank">CamDiab's</a> version of a hybrid closed loop system, combining an Android smartphone app with a Dexcom G6 CGM and an internationally available insulin pump (either the Dana Diabecare RS pump or the Dana i-pump by Korean company SOOIL).</p>
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<p>This system adjusts insulin every 8-12 minutes based on the user's needs, with a set target glucose of 105 mg/dL. For study participants in the U.S. who didn't have access to those international pumps, the researchers used a Medtronic insulin pump and CGM. After 6 months, participants spent an average of 3.6 hours more time in range each day, or 68 percent TIR. Their A1C results also dropped by 1.1 percent, and use of the system also had other glucose-lowering benefits, they say.</p><p><br /></p><p style="text-align: center;"><i>- - - - - - - - - -</i></p><p style="text-align: center;"><i>Originally reported by Michael Hoskins and Amy Tenderich at DiabetesMine on July 7, 2021</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-63282817181100812822021-05-17T11:00:00.021-04:002022-03-24T21:56:49.434-04:00Flipping the Script on Diabetes Awareness in Movies and TV<p>You may have seen diabetes weaved in to the storyline of a favorite TV show or new movie every so often. The condition is frequently used as a quick punchline or one-liner, or some kind of a foil that trips up the characters.</p><!-- wp:paragraph -->
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<p>These portrayals matter because movies and media have the power to shape the public's view regarding people with diabetes (PWDs). Movies and media can shape how people react in certain emergencies, kids' experiences at school and adults' experiences in workplaces, and how people make healthcare policy decisions. </p>
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<p>Popular shows like "The Blacklist," "Law and Order: SVU" and "Person of Interest" have all briefly incorporated insulin pumps and device-hacking into their storylines — but they didn't always handle it well.</p>
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<p>"Nobody likes seeing any part of diabetes portrayed incorrectly, but certainly, I think it's a lot better in today's media than it was years ago. We've made huge strides and we're a lot more 'right' than we have been," says D-Dad <a href="http://diabetesdad.org/about-me/" rel="noreferrer noopener" target="_blank">Tom Karlya</a>, who has two adult children with type 1 diabetes (T1D) and has long advocated for factual representation of diabetes in the media. </p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Mistakes on TV" id="mistakes-on-tv">Misrepresenting diabetes on TV</h2>
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<p>Historically, movies and TV often got it wrong when delving into diabetes.</p>
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<p>A few examples that stand out in TV series include:</p>
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<ul><li>A "Big Bang Theory" episode tied diabetes to a group of individuals with overweight ordering dessert, including one PWD with an insulin pump.</li><li>In a "Walking Dead" episode a single character recovered immediately from passing out after receiving an insulin injection.</li><li>In the short-lived "Do No Harm" series, a neurosurgeon with T1D had to be cleared for surgery by checking his blood sugar with a futuristic hospital-version fingerstick meter the size of a tabletop.</li><li>In a "Hannah Montana" spot, a character was teased for not being able to eat candy because of his T1D. Disney eventually revised that and later pulled the episode.</li></ul>
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<p>More examples where advocates called out errors and misinformation in TV shows include multiple mentions on medical dramas “<a href="https://www.tvfanatic.com/2021/03/new-amsterdam-season-3-episode-3-review-safe-enough/" rel="noreferrer noopener" target="_blank">New Amsterdam</a>” and “<a href="https://www.nbc.com/nurses" rel="noreferrer noopener" target="_blank">Nurses</a>” on NBC, as well as an insulin affordability storyline written into a different “New Amsterdam” episode, and “<a href="/diabetesmine/the-resident-insulin-affordability" rel="noreferrer noopener" target="_blank">The Resident</a>” on FOX.</p>
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<p>Some also took notice of the mention of an “artificial pancreas” in the April 28, 2021, episode of ABC’s new sitcom “<a data-id="https://abc.com/shows/home-economics" data-type="URL" href="https://abc.com/shows/home-economics">Home Economics</a>,” where the grandfather character spoke with his young grandchildren in one scene, but there was absolutely no context for the mention of diabetes technology.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Misinformation in movies" id="misinformation-in-movies">Diabetes done wrong in movies</h2>
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<p>On the big screen, errors seem to take on a whole new dimension.</p>
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<h3>"Hansel & Gretel"</h3>
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<p>One striking example of getting it glaringly wrong was the 2013 movie "<a href="https://www.imdb.com/title/tt1428538/" rel="noreferrer noopener" target="_blank">Hansel & Gretel: Witch Hunters</a>," in which the director used a "spin on diabetes" in the fanciful script. </p>
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<p>Star actor Jeremy Renner played Hansel, who lives with "the sugar sickness," an uncanny resemblance to T1D that Hansel contracts after the evil witch force-fed him candy as a child. Thanks to all that candy, Hansel grows up needing regular daily injections at the beep of his timepiece. Without those injections, as we see at one point in the movie, he will go into immediate convulsions — apparently the result of high blood sugar?</p>
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<p>Of course, the big takeaway from this movie is that candy consumption leads to T1D, which is clearly not the case. Some in the community found that portrayal to be a form of bullying, and a whole advocacy campaign of letter-writing to the director ensued.</p>
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<h3>"Panic Room"</h3>
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<p>Another movie often cited for inaccuracies and misinformation is the “<a href="https://www.imdb.com/title/tt0258000/" rel="noreferrer noopener" target="_blank">Panic Room</a>” from 2002, starring Jodie Foster and Kristen Stewart.</p>
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<p>The story centers on a divorced mom and her teen daughter, who hide in their brownstone’s secret room after burglars break into the home to steal a hidden fortune. The daughter Sarah has T1D, and at one point experiences an urgent low blood sugar while trapped in the panic room. </p>
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<p>In the movie, the teen gets “a shot” for the low blood sugar, which PWDs may recognize as rescue glucagon. But of course, most people with no knowledge of this condition could easily assume it was insulin. Unfortunately, several film reviewers incorrectly referred to this lifesaving shot as an “insulin injection.” This obviously imparts the dangerous misperception that a person having a low blood glucose level needs more insulin instead of sugar. </p>
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<p>Of course, the teenager recovers immediately after the injection rather than the several minutes it typically takes after using emergency glucagon. At one point, the writers even made Sarah turn blue — which doesn’t happen with hypos. And at another point in the film, the teen gets anxious, and the mom cautions her to not get worked up, as it can lead to diabetes problems.</p>
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<p>“There’s no law saying we have to be right in every movie scene,” the film's technical medical advisor Donna Cline says. “Frankly, we deliver what the public wants." </p>
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<p>Cline claims she researched the appearance and behavior associated with low blood glucose and other aspects of diabetes. She even consulted textbooks and sought help from experts in diabetes care, finding in one manual on cardiopulmonary resuscitation (CPR) that stated “great emotional stress” could lead to hypos. That’s what led to the mom's scripted comment about her daughter getting worked up.</p>
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<p>Even more interesting is the producer of “Panic Room” has a daughter with T1D, and still, the script was far from technically accurate in many spots. Although, one could argue that it got the urgency of diabetes emergencies across.</p>
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<h3>“Steel Magnolias” movie(s)</h3>
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<p>There’s also the classic example of the 1989 film “Steel Magnolias,” which upset more than one generation of PWDs even though it was based on a play that was based on a true story.</p>
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<p>The Shelby character played by Julia Roberts lives with T1D and, despite her mother and doctor’s concerns, she gets pregnant, which puts a strain on her kidneys and body. A signature scene for our D-Community is where she has severe low blood sugar while getting her hair styled for her wedding, and her mom says the classic line “Drink your juice, Shelby!” as Roberts’ character resists and sobs in her hypoglycemia confusion.</p>
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<p>That scene scarred many women with diabetes, who felt they’d be unable to have children safely. While that’s certainly not the case, it was a common prevailing medical opinion at the time of this original movie.</p>
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<p>The juice scene was quite dramatic, and many felt it didn’t accurately represent what PWDs experience. Yet many others it was spot-on and embodied their experiences having low blood sugar. So, accuracy is sometimes in the eye of the beholder.</p>
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<p>In the 2012 remake with a new cast, the storyline doesn’t shift much from the original but has updates with cell phones and modern diabetes tech making appearances. There is some dialogue that attempts to clarify the risk of pregnancy complications with diabetes.</p>
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<h2 class="wp-block-healthline-tabbed-heading" id="">Getting it right</h2>
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<p>Thankfully, there are also examples where diabetes is handled on-screen in ways that have positive impacts. It's important to point out what these shows did right.</p>
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<h3>"Body of Proof"</h3>
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<p>The ABC show "<a href="http://abc.go.com/shows/body-of-proof" rel="noreferrer noopener" target="_blank">Body of Proof</a>" featured a storyline in which the lead character's daughter was diagnosed with T1D and used a Medtronic Minimed insulin pump. The actress was Mary Mouser, who actually lives with T1D herself (and went on to roles like Daniel LaRusso's daughter in the Cobra Kai series picked up by Netflix).</p>
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<p>At the end of that episode, a 10-second message aired to inform viewers that every day 80 kids and adults are diagnosed with T1D and inviting them to contact JDRF for more information. The organization says the community <a href="https://www.facebook.com/myJDRF/posts/174979299286055" rel="noreferrer noopener" target="_blank">expressed widespread support</a> for the episode's accurate portrayal of the medical details, as well as the feelings and fears many families face during times of diagnosis.</p>
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<p>The JDRF told DiabetesMine that while it doesn't always proactively reach out to media regarding portrays of diabetes, the organization is always willing to work with TV producers and filmmakers who contact them to learn about T1D. That's what happened with the "Body of Proof" show.</p>
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<p>Medtronic confirmed that they were a part of that show, as well, providing information and lending the crew a Medtronic pump for Mouser's character to wear.</p>
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<p>"We thought they did a nice job of capturing on screen some of the emotions that many families with diabetes experience. And they allowed us to send a member of our clinical team over to the studio so that she could help them ensure that the pump was depicted realistically," former Medtronic spokeswoman Karrie Hawbaker tells DiabetesMine.</p>
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<h3>"New Amsterdam" on NBC</h3>
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<p>A 2019 "New Amsterdam" episode tackled insulin affordability in a storyline focused on drug pricing and pharma culpability. Then another episode in March 2021 had the main character's mom struggling with the learning curve after a new diagnosis — learning how to give insulin injections and calculate dosages for food.</p>
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<p>Impressively, the show's main character Max played by Ryan Eggold talked her through the initial diagnosis moments, explaining the basics on how to inject insulin with a syringe and even carb-counting for dosing.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-1218138" height="360" src="https://post.healthline.com/wp-content/uploads/2021/04/DM-NewAmsterdam.png" width="640" /></figure>
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<p>Yet, the needle used to demonstrate was HUGE... a point that many in the patient community griped about as being incorrect. </p>
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<p>Stepping back from what many of us know to be true about modern syringe sizes, it's important to recognize that many newly diagnosed adults perceive the insulin syringes to be large and scary.</p>
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<p>One of the likely reasons for these "New Amsterdam" scenes mentioning diabetes is <a href="https://www.linkedin.com/in/carolyn-gershenson-030a5519/" rel="noreferrer noopener" target="_blank">Carolyn Gershenson</a>, a D-Mom in New York who happens to be a set nurse for movie and TV show productions. She's a diabetes care and education specialist (DCES) whose son was diagnosed with T1D back in the late 90s, and she's had a hand in reviewing scripts to ensure they are medically accurate as it relates to diabetes.</p>
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<p>Her adult son is also involved behind the scenes on hit shows like "Blue Bloods" and "Mr. Robot," so no doubt their dual personal experience with T1D can make a difference when it matters most.</p>
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<p>Working with real patients and medical experts makes all the difference when it comes to accurately portraying any health condition on screen. </p>
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<h3>"The Baby-Sitter's Club" on Netflix</h3>
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<p>In 2020, Netflix produced a remake of this TV series adapted from a classic children's book series from the 1980s. In the third streaming episode, the main teen character Stacey McGill is hiding her diabetes from friends as much as possible, until word comes out about her recent diagnosis with T1D.</p>
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<p>The producers did a decent job, showing the teenager subtly avoiding candy and higher carb foods in the presence of friends, so she wouldn't' have to dose insulin with her pump. And then, the story has social media revealing that the girl left a previous school because of a seizure just before her T1D diagnosis, which triggers concern from the other girls parents. In fact, in one scene, the parents discuss their hesitancy about Stacey's diabetes and her being around their kids. </p>
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<p>Even though the pre-T1D seizure and the parents' meeting may seem a bit off, the producers focused on showing Stacy's feelings and how she handled her condition around others. In that sense, they did a great job. The episode felt true to life for many kids and teens living with diabetes.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="A screenwriter’s POV" id="a-screenwriters-pov">A screenwriter speaks out</h2>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" class="wp-image-1218149" height="200" src="https://post.healthline.com/wp-content/uploads/2021/04/DM-ChrisSparling.png" width="200" /><figcaption><br /></figcaption></figure></div>
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<p>In 2020, the fictional apocalyptic movie "Greenland" featured a main character with T1D. </p>
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<p>The screenwriter <a href="https://www.imdb.com/name/nm2133655/" rel="noreferrer noopener" target="_blank">Chris Sparling</a> is well-known in the diabetes community as the husband of longtime T1D advocate and author <a href="https://sixuntilme.com/wp/homepage/about-kerri-sparling/" rel="noreferrer noopener" target="_blank">Kerri Sparling</a>.</p>
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<p>The movie is about meteors crashing into Earth and potentially wiping out human existence, and people must scramble to avoid that apocalypse, in part by journeying to Greenland, where bunkers await them. </p>
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<p>Sparling made the main character's teenage son have T1D, which added another emergency scenario on top of the larger plot.</p>
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<p>He says he tried to stay true to T1D on the page as a writer, but the final production was beyond his full control as he didn't serve as a director or producer. </p>
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<p>He says he feels a strong responsibility even though it's not always as easy as some may think to "get it right" completely when it comes to representing diabetes on-screen.</p>
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<p>"There are blatant failures, and things that are blatantly offensive. But leaving those things aside... the maxim of filmmaking is show, not tell," Sparling says during a Children with Diabetes <a href="https://childrenwithdiabetes.com/cwd-news/writing-diabetes-into-a-feature-film-a-discussion-with-screenwriter-chris-sparling/" rel="noreferrer noopener" target="_blank">video interview</a>. "You don't want people to just be talking about something, you want to show it happening, to dramatize it. Diabetes is a slightly difficult disease to dramatize."</p>
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<p>He points out that there's always a risk of over-sensationalization that becomes inaccurate.</p>
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<p>"You have an obligation," Sparling says, so he always asks himself, "How do I show it in a way that gives it the weight it deserves, but also adds clarity to the audience?"</p>
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<h2 class="wp-block-healthline-tabbed-heading" id="">Why it matters</h2>
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<p>Tom Karlya, the parent of two T1Ds who's been involved in diabetes advocacy within media and film, reminds us that every little mention of diabetes in those mediums matters. That's because dangerous misinformation can carry over into real-life scenarios. And negative stigma can turn people off from donating to critical diabetes research, for example.</p>
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<div class="wp-block-image"><figure class="alignright size-large is-resized"><img alt="" class="wp-image-1218143" height="196" src="https://post.healthline.com/wp-content/uploads/2021/04/DM-TomKarlya-Spot.png" width="196" /><figcaption>Tom Karlya</figcaption></figure></div>
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<p>"Sometimes I wonder if the artistic license to make things suspenseful supersedes how much something needs to be 100 percent factual," he says. </p>
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<p>"And are we as a community OK with some of it being wrong, for artistic license, as long as it's not completely wrong or over-dramatized?"</p>
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<p>That's a question that our diabetes community revisits frequently, as new instances arise.</p>
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<p>He points to the controversial Dexcom commercial during Super Bowl 2021, where actor and singer Nick Jonas (a T1D himself) did a 30-second spot about the continuous glucose monitoring (CGM) system. While some criticized the commercial — the millions of dollars spent in the context of how unaffordable this technology can be for some people, as well as how it stigmatizes fingersticks — Karlya looks to the awareness it brought to T1D and CGM use in general.</p>
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<p>"Sometimes I feel like we're never happy, no matter what we get," he says.</p>
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<p>Karlya believes it's important for advocates to contact media, writers, movie producers when they get diabetes right, just as much as when they get something wrong.</p>
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<p>"I love how we're seeing them bringing in people with personal experience to oversee the writing or be involved on medical review to make sure the portrayal accurate," Karlya says</p>
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<p>"Sometimes you have to whittle away at the wrongness... to get it correct," he says.</p><p style="text-align: center;"><i> - - - - - - - - - - - - - - - - - -</i></p><p style="text-align: center;"><i>Originally published at DiabetesMine on May 17, 2021 </i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-1687316433273771222021-04-03T16:38:00.015-04:002022-03-25T16:42:45.531-04:00Buying CGM Supplies at the Pharmacy<p>People with diabetes could be seeing a turning point in ease of obtaining supplies for continuous glucose monitors, as more of these products make their way into local pharmacies.</p><!-- wp:paragraph -->
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<p>While CGMs have traditionally only been available direct from the manufacturer or third-party supply distributors, they're now finally making their way onto the shelves of local pharmacies and even Costco stores around the country.</p>
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<p>For example, the Dexcom G6 receivers, transmitters, and sensors are <a href="http://typeonediabeticwarrior.blogspot.com/2018/11/have-you-heard-of-costcos-cash-plan-for.html" rel="noreferrer noopener" target="_blank">sold at discounted prices in Costco Pharmacies</a> for the bulk chain's member customers. Opinions may vary on just how good those discounts are, but another big benefit for customers is that instead of waiting weeks for supplies to arrive in the mail, you may be able to walk out the door of your local pharmacy in a day or two with everything you need.</p>
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<p>Along with Dexcom, the Abbott FreeStyle Libre system supplies are also available at pharmacies, and CGM maker Medtronic Diabetes is exploring pharmacy availability, too.</p>
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<p>The takeaway is that lower-cost and more readily accessible purchase options are a must for any company wanting to succeed in the growing CGM market — that’s set to expand broadly to consumers, even beyond those with diabetes.</p>
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<h2><strong>How much do CGMs cost at the pharmacy?</strong></h2>
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<p>As always, insurance coverage varies by type, so the cost to each individual will depend on whether one even has pharmacy coverage for CGMs, and what copays or deductibles may apply. To keep it simple, here are the retail cash prices of the two systems currently available in pharmacies:</p>
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<h3><strong>Dexcom</strong></h3>
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<p>Users are thrilled to see the leading CGM on the market becoming more ubiquitously available.</p>
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<p><strong>At local pharmacies:</strong> Around the United States in CVS, Walgreens, and many other retailers, cash prices vary, but most locations we queried quoted the price for a G6 transmitter at just under $300, while a three-pack box of G6 sensors runs ~$400. Remember, too: Insurance may cover CGM supplies as a pharmacy benefit, meaning you could find these available at local or mail-order pharmacies for a flat copay, or with varying coinsurance and deductible amounts applied.</p>
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<p><strong>At Costco:</strong> To get the Costco pricing, you of course need to be a Costco member ($60) and also sign up for their free pharmacy program. </p>
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<p>As of April 2021, the Costco Pharmacy membership cash prices are as follows based on the <a href="https://www.costco.com/CatalogSearch?dept=All&keyword=Dexcom" rel="noreferrer noopener" target="_blank">latest company info online</a>:</p>
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<ul><li>G6 transmitter: $277.62 each (or membership discount price: $132.24)</li><li>Box of G6 sensors (three pack): $384.60 (or $303.74 membership discount price)</li><li>G6 receiver: $417.92 each (or $203.29 membership discount price)</li></ul>
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<p>Note that you may see online search results showing varying price points, based on an older Costco Pharmacy deal. That earlier discount was dramatically lower: a G6 transmitter only cost $28.88, and a G6 touchscreen receiver cost $35.96! Since Costco discount prices are periodically adjusted, be sure to check in advance of driving to the store to purchase.</p>
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<p>These Costco prices are self-pay only, as insurance isn't applicable there (also not Medicare or Medicaid). So for anyone who may have a lower insurance copay or deductible requirement, they may be better off sticking with their traditional purchase channels.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-298715" height="225" src="https://post.healthline.com/wp-content/uploads/2020/02/DM-CostcoDexcom.jpg" width="400" /><figcaption><br /></figcaption></figure>
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<p><strong>Caution: </strong>Unfortunately, lots of patients and even many Costco pharmacy folks are unaware of this savings program. So if asked, Costco employees may quote much higher prices, up to $1,100 for a single box of sensors — ugh! We're also hearing that some Costco pharmacists have been insisting that they must check insurance and that this G6 discount only applies if you've already been denied insurance coverage, which is NOT TRUE, as we have confirmed with Costco corporate contacts. Be sure to be insistent if you encounter this barrier.</p>
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<h3><strong>Freestyle Libre</strong></h3>
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<p>The Abbott Freestyle Libre Flash Glucose Monitoring (FGM) system is not (yet) what many consider to be a full-featured CGM with real-time glucose alerts for High and Low readings, but it does qualify as a continuous sensor and is growing in popularity.</p>
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<p>This system <a href="https://www.freestylelibre.us/content/dam/adc/freestylelibreus/documents/FreeStyleLibre-PharmacyGuide.pdf" rel="noreferrer noopener" target="_blank">has been available through national pharmacies</a> like Costco, CVS, Kroger, Walgreens, and Rite Aid since it launched in late 2017. Senior public affairs manager Jennifer Heth at Abbott tells us that a majority of their 500,000 users in the United States are already getting their Libre 14-day-wear sensors through retail pharmacies.</p>
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<p>Notably, Abbott says the Libre costs 70 percent less than the list price of other CGM systems currently available.</p>
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<p>Here are the approximate prices for the Libre system in pharmacies:</p>
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<ul><li>List price of $54 per sensor, according to Abbott (though retail pharmacies like Costco and Walgreens quote prices of $58–69)</li><li>With commercial insurance, most patients pay between $10 and $75 per month for Libre 14-day sensors at participating pharmacies</li><li>Handheld reader: $70 (though the separate receiver isn't required, as users can opt to use the FreeStyle LibreLink mobile app for iOS or Android for no charge)</li></ul>
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<p>Abbott tells us that building out their pharmacy purchase channel is an "area of focus" for the company that started in 2020.</p>
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<p>"Pharmacists play a central role in patient care and are valued for their impact on improving outcomes for people living with diabetes," Heth says. "Abbott is dedicated to providing education on the rapidly evolving diabetes technology... Abbott has provided educational grant support for pharmacist continuing education programs with the American Pharmacists Association, Pharmacy Times, among others."</p>
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<p>Heth also tells us that in addition to national and online programs, Abbott provides live peer-to-peer training sessions for pharmacists and webinars on the clinical application of FreeStyle Libre and CGM report interpretation using the Ambulatory Glucose Profile (AGP), a standardized one-page report that visually summarizes glucose trend data.</p>
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<h3><strong>Medtronic and Eversense CGMs: Not in pharmacies</strong></h3>
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<p>Sorry, friends. Medtronic confirms that it will be a while before their CGM supplies hit the pharmacy channel. Spokeswoman Pam Reese, director of global communications for Medtronic Diabetes, tells us: "We are currently exploring pharmacy options for our CGM. We have some pharmacy access already and are continuing to build our own internal pharmacy operations. In addition, we are exploring a retail pharmacy strategy."</p>
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<p>It makes sense that the fourth CGM sensor on the market, the implantable Eversense from Senseonics, would not be available in pharmacies. This sensor must be implanted under the skin via a minimal surgical incision procedure by a qualified doctor. Still, we asked the company about any plans to sell supplies (replacement transmitters or charging cords) in pharmacies.</p>
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<p>Senseonics' director of global PR and brand marketing Karen Hynes says no, explaining: "If Eversense is covered under someone’s pharmacy benefit, it would be mail ordered and shipped directly to the healthcare provider who is placing the sensor. Otherwise it would go through the DME (durable medical equipment) channel and would be shipped to the healthcare provider."</p>
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<h2><strong>Why is CGM access in pharmacies taking so long</strong>?</h2>
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<p>The effort to make CGM supplies more readily available for
retail purchase began back in 2015, when a half-dozen or more insurance plans
began covering CGM supplies in a different way than they traditionally had.</p>
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<p>They recategorized these devices as a <a href="https://www.anthem.com/wps/portal/ca/culdesac?content_path=shared/f3/s1/t0/pw_e169310.htm&label=Pharmacy%20Benefit%20-%20Frequently%20Asked%20Questions&rootLevel=2&name=ssb&">"pharmacy benefit"</a> rather than the traditional classification as <a href="https://www.healthcare.gov/glossary/durable-medical-quipment-dme/">"durable medical equipment" (DME)</a>. This meant people with certain plans would no longer be bound to buying supplies from designated third-party medical equipment suppliers or directly from the manufacturer, but rather could purchase them wherever medications are sold.</p>
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<p>Anthem and UnitedHealthcare (UHC) were among the big insurance carriers taking that important first step toward eventual over-the-counter access to CGM supplies in local pharmacy chains like CVS or Walgreens. Other insurers have moved in this direction over time.</p>
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<p>Even with some insurers now classifying CGM as a pharmacy benefit, it remains a "Your Insurance Coverage May Vary" situation in terms of how much any individual might pay for supplies — some plans require only a low, fixed copay applied to all pharmacy benefit items, while others require coinsurance, where you pay a percentage of the actual cost of the item. Still other plans require that you meet an annual deductible before any copay or coinsurance kicks in. It all varies.</p>
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<p>Currently, most CGM users are still purchasing their supplies from designated third-party medical equipment vendors or directly from the manufacturer. </p>
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<p>Per Dexcom’s talking points, pharmacy distribution allows for "a more seamless experience for physicians and patients, changing the once eight-step, month-long distribution process into four simple steps that enable a patient to get their Dexcom device in as few as 1–2 days through their pharmacist."</p>
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<p>When Dexcom began planning for pharmacy availability several years ago (during the early G5 model days), it pushed for access by mail-order as well as in retail pharmacies — including "drop shipments" of orders prepared for pickup 24 hours in advance. Presumably, that "just in time" shipping policy was meant to avoid pharmacies stockpiling expired sensors that they can't sell, or running out of supplies.</p>
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<p>Going into 2020, Dexcom is pushing for an increase in its CGM business going through pharmacy channels, by as much as 70 percent of their sensor business, to be exact. After 2019, the CGM manufacturer says it has now crossed the threshold of supplying more than 50 percent of its CGM supplies through pharmacies.</p>
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<h2>Walgreens makes CGM history</h2>
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<p>Walgreens made headlines in 2019 with its pharmacy expansion for the Dexcom G6, especially for <a href="https://news.walgreens.com/press-releases/walgreens-provides-faster-more-convenient-access-to-continuous-glucose-monitoring-devices-through-new-medicare-billing-solution.htm">Medicare beneficiaries</a> who can now obtain their CGM supplies within that local pharmacy. Many Dexcom customers who use Walgreens have also started receiving automated emails and messages about syncing pharmacy and CGM accounts for more efficiency.</p>
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<p>In fact, <a href="https://www.medtechdive.com/news/walgreens-adds-dexcom-propeller-to-digital-marketplace/559406/">Walgreens' Find Care marketplace</a> introduced a program in 2019 in which interested people with diabetes can proactively request a prescription for the Dexcom G6. They simply complete a questionnaire that is sent to their healthcare provider for review and potential prescription.</p>
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<p>No doubt, as the next-generation Dexcom-Verily G7 product (designed to be more consumer friendly, fully disposable, and lower cost) moves forward and launches in 2021, we will see more big pharmacy chains adding CGM tech to their shelves.</p>
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<p>Still, overall use of CGMs among people with type 1 diabetes <a href="https://care.diabetesjournals.org/content/41/8/1579">remains low at about 35 percent</a>. This is attributed in part to provider reluctance to prescribe the system.</p>
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<h2><strong>Why doctors are reluctant to prescribe CGM</strong></h2>
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<p>Dexcom execs tell us that 49 percent of doctors say all the insurance red tape currently impacts their willingness to prescribe CGM.</p>
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<p>The company believes that more than 50 percent of healthcare professionals would increase the number of prescriptions they write for CGM if it were available across the board as a mainstream pharmacy benefit to all patients. </p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-302177" height="360" src="https://post.healthline.com/wp-content/uploads/2020/02/DM-DexcomPharmacySlide-Gray.jpg" width="640" /></figure>
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<p>What they are essentially saying is that making CGM supplies
cheaper and more readily available could be the key to helping <a href="https://www.medpagetoday.com/endocrinology/type1diabetes/60493" rel="noreferrer noopener" target="_blank">CGM become a true standard of care</a>.</p>
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<p>As more people with type 2 diabetes are increasingly seeking access to CGM, it becomes even more critical to have lower-cost, easily usable options that can be purchased in mainstream places like local pharmacies. The rules may vary on how a prescription is written for a T2 patient on CGM, but that shouldn't interfere with buying in a pharmacy as long as the individual has a doctor’s blessing for using it.</p>
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<p>Really, it's only a matter of time before all non-implantable CGM systems appear on pharmacy shelves, creating broader and (hopefully) more affordable access for everyone.</p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-42606312788940937192021-03-01T14:06:00.002-05:002022-03-23T14:18:48.636-04:00Honoring Women in Diabetes History<p> <em>Hopefully you’re all aware that March is <a href="https://womenshistorymonth.gov/" rel="noopener noreferrer" target="_blank">Women’s History Month</a>, and March 8 marks <a href="https://www.internationalwomensday.com/" rel="noopener noreferrer" target="_blank">International Woman’s Day</a> every year. With that, we are proud to highlight some of the influential women who’ve made an indelible impact on our Diabetes Community. The list below reflects on decades past as well as women out there who are actively making a difference even as you read this.</em></p><!-- wp:paragraph -->
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<p><em>Without a doubt, our D-world would not be the same without these women. So if you’ve never heard their names, now’s your chance to give a little nod of thanks.</em></p>
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<h3>Dr. Priscilla White</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. Priscilla White" class="wp-image-1015250" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-PriscillaWhite.png" width="200" /></figure></div>
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<p>An early pioneer in diabetes, <a href="https://www.joslin.org/priscilla-white-society" rel="noreferrer noopener" target="_blank">Dr. Priscilla White</a> practiced alongside the legendary <a href="https://www.joslin.org/about/history/our-founder" rel="noreferrer noopener" target="_blank">Dr. Elliot Joslin</a> in Boston and co-founded the Joslin Diabetes Center, not long after the discovery of insulin in the 1920s. She immediately began working with children with diabetes in that clinic, becoming a trailblazer in children's diabetes care and pregnancy in the 1920s-40s (including advocacy for women with diabetes to receive specialized care during pregnancy). She was instrumental in the creation of the <a href="https://www.bartoncenter.org/the-barton-center-overview/history/" rel="noreferrer noopener" target="_blank">Clara Barton Camp for Girls</a> in the early 1930s. History shows that the fetal success rate was 54 percent when Dr. White began working at Joslin, and by the time she retired in 1974, it had risen to more than 90 percent. During her 5 decades of work, she managed the deliveries of over 2,200 women with diabetes and the supervision of roughly 10,000 cases of type 1 diabetes (T1D). After retiring she continued working on the emotional problems of young people with diabetes. In 1960, Dr. White became the first woman to receive the prestigious <a href="https://professional.diabetes.org/content-page/banting-medal-scientific-achievement-award" rel="noreferrer noopener" target="_blank">Banting Medal</a>, and she's been named one of the 12 most outstanding physicians in the world.</p>
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<h3>Dr. M. Joycelyn Elders</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. M. Joycelyn Elders" class="wp-image-1015251" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-JoycelynEdwards.png" width="200" /></figure></div>
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<p>For starters, <a data-id="https://cfmedicine.nlm.nih.gov/physicians/biography_98.html" data-type="URL" href="https://cfmedicine.nlm.nih.gov/physicians/biography_98.html">this woman</a> was the first person in Arkansas to become board-certified in pediatric endocrinology. That was remarkable in itself, as she was born to poor farming parents in a poverty-stricken, rural area of the state. She scrubbed floors to help pay her tuition and her siblings picked extra cotton and did chores for neighbors to help pay for her bus fare for college. She then joined the Army after college and went on to train in physical therapy, before eventually devoting her career to pediatric endocrinology and publishing hundreds of academic papers on childhood diabetes and growth. If that accomplishment wasn't history-making enough, she went on to become the first African American to serve as <a data-id="https://www.statnews.com/2016/09/07/joycelyn-elders-race-medicine/" data-type="URL" href="https://www.statnews.com/2016/09/07/joycelyn-elders-race-medicine/">Surgeon General of the United States</a> in 1993 and was also the second woman to serve as head of the U.S. Public Health Service.</p>
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<h3>Dr. Helen M. Free</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. Helen M. Free" class="wp-image-1015252" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-HelenFree.png" width="200" /></figure></div>
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<p>Along with her husband Alfred in 1956, Dr. Free invented the <a href="https://www.acs.org/content/acs/en/education/whatischemistry/landmarks/diagnosticteststrips.html" rel="noreferrer noopener" target="_blank">Clinistix</a>, a chemically coated dip-and-read stick measuring urine that would change color based on the amount of glucose — long before fingerstick tests for blood sugar were established! After deciding on chemistry in college after many of the young men were drafted into World War II, she went to work in research at Miles Lab (which eventually became a part of Bayer) and developed early generations of urine testing. Known as Clinitest and Acetest, these were Alka Seltzer-like tablets that fizz when placed in liquid. This was the first diagnostic test of its kind that could be done in a doctor’s office or a hospital without elaborate laboratory facilities, and eventually it led to the Clinistix and <a data-id="https://jamanetwork.com/journals/jama/article-abstract/324390" data-type="URL" href="https://jamanetwork.com/journals/jama/article-abstract/324390">Tes-Tape</a> products allowing people with diabetes (PWDs) to check their glucose at home. She's been inducted into the National Inventor's Hall of Fame, among other distinctions. This <a href="https://www.sciencehistory.org/historical-profile/helen-and-alfred-free" rel="noopener noreferrer" target="_blank">Science History Institute profile</a> of Dr. Free sums up her historic career and legacy quite nicely, and we're certain that diabetes management wouldn't have evolved as it did without her groundbreaking work.</p>
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<h3>Dr. Dorothy C. Hodgkin</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. Dorothy C. Hodgkin" class="wp-image-1015253" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-DorothyHodgkin.png" width="200" /></figure></div>
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<p>This British woman's research starting in the 1930s eventually led to technology that could decipher the <a href="http://diabetes.diabetesjournals.org/content/21/Supplement_2/492" rel="noreferrer noopener" target="_blank">three-dimensional structure of insulin</a> (along with penicillin and vitamin B12). That work led to her receiving a Nobel Prize in 1969, as well as later research and development (R&D) on newer insulins and public awareness about insulin’s importance. Dr. Hodgkin has been honored with a tribute stamp in the United Kingdom, recognizing not only her scientific contributions but her passion for peace and humanitarian causes, including the welfare of scientists in the USA, UK, Korea, and Vietnam in the 60s and 70s. This <a href="https://www.sciencehistory.org/historical-profile/dorothy-crowfoot-hodgkin" rel="noopener noreferrer" target="_blank">profile by the Science History Institute</a> delves into her life.</p>
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<h3>Lee Ducat + Carol Lurie</h3>
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<p>These two D-Moms in Pennsylvania were the <a href="https://www.youtube.com/watch?v=pDeIkHdQpq0" rel="noreferrer noopener" target="_blank">original founders of the JDRF</a>, which at the time in 1970 was known as the Juvenile Diabetes Foundation (JDF) before the rebranding to add "research" into the name in the 1990s.</p><p></p><figure class="wp-block-image size-large" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="JDRF founders Lee Ducat and Carol Lurie" class="wp-image-1015254" height="181" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-JDRF-founders.png" width="320" /></figure><p></p><p>They were the ones who tapped actress Mary Tyler Moore in the 1970s to become the public face of T1D advocacy, something the actress had not been very vocal about up until that time. The work of this organization has changed the funding mechanism for diabetes research in Congress and beyond over the decades, focusing on finding a cure as well as advancements in treatments and technology that improve the way we live with diabetes until that cure is found. Without these women (and so many more involved in today's JDRF since then), our D-world would be dramatically different.</p>
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<h3>Dr. Rosalyn Sussman Yalow</h3>
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<p>A nuclear physicist by training, Dr. Yalow co-developed something called <a href="https://www.sciencedirect.com/topics/medicine-and-dentistry/radioimmunoassay" rel="noreferrer noopener" target="_blank">radioimmunoassay (RIA)</a>, used to measure concentrations of hundreds substances in the body, including insulin. The possibilities for research using RIA are seemingly endless, as it's been used over the years to identify hormones, vitamins, and enzymes for many different health conditions. Dr. Yalow <a href="https://www.nobelprize.org/prizes/medicine/1977/yalow/facts/" rel="noreferrer noopener" target="_blank">won a Nobel Prize</a> in 1977 for her work with Dr. Solomon Berson proving that type 2 diabetes is caused by the body’s inefficient use of insulin, rather than a complete lack of insulin as was previously thought.</p>
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<h3>Dr. Gladys Boyd</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dr. Gladys Boyd" class="wp-image-1015256" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-GladysBoyd.png" width="200" /></figure></div>
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<p>Another pioneering diabetes researcher in the early days of insulin, <a href="https://www.womenscollegehospitalfoundation.com/News-Media/Blog/Nov-2018/Dr-Gladys-Boyd-a-pioneer-in-childhood-diabetes-c.aspx" rel="noreferrer noopener" target="_blank">Dr. Boyd</a> was one of the first physicians in Canada to treat children with diabetes with insulin in the early 1920s. She was heavily influenced by insulin co-discoverer <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5331123/" rel="noreferrer noopener" target="_blank">Dr. Frederick Banting</a> and worked alongside him at the <a href="https://www.womenscollegehospitalfoundation.com/" rel="noreferrer noopener" target="_blank">Women's College Hospital</a>, where she served as chief of pediatrics and was the sole pediatrician there. She presented on her clinical research treating children with insulin at the Canadian Pediatric Society's first annual scientific meeting in June 1923, and went on to author the "<a href="https://journals.lww.com/ajnonline/Citation/1925/06000/MANUAL_FOR_DIABETICS__By_Gladys_L__Boyd,_M_D_,_and.41.aspx" rel="noreferrer noopener" target="_blank">Manual for Diabetics</a>" in 1925, which became the standard consumer health manual for diabetes at the time. During the next three decades, she published many academic papers on childhood diabetes that helped set the stage for how pediatric diabetes would be handled for decades to come.</p>
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<h3>Dr. Lois Jovanovic</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Diabetes researcher Dr. Lois Jovanovic" class="wp-image-1015257" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-LoisJovanovic.png" width="200" /></figure></div>
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<p>This Santa Barbara endocrinologist led pivotal research on gestational diabetes and more broadly <a href="http://www.diabetesincontrol.com/video-dr-lois-jovanovic-healthy-pregnancy-with-diabetes/" rel="noreferrer noopener" target="_blank">diabetes and pregnancy</a>. She was personally responsible for the safe delivery of hundreds of babies dating back to 1980. She was also a third-generation T1D herself, as her father also lived with T1D, and her grandmother was one of the first people to receive insulin at age 8 in 1922. Some describe Dr. Jovanovic as "the woman who changed the way we treat diabetes today," including her work to create a <a href="https://care.diabetesjournals.org/content/42/3/359">"Pocket Doc" insulin dosing calculator</a> in the 1980s along with involvement in the landmark Diabetes In Early Pregnancy and the <a href="https://care.diabetesjournals.org/content/10/1/1" rel="noreferrer noopener" target="_blank">Diabetes Control and Complications Trial</a> studies. She spent more than a quarter-century at the Sansum Diabetes Research Institute and served as chief scientific officer there from 1996 to 2013. She also helped pave the way for modern Artificial Pancreas research through her work. We were sad to report in September 2018 that Dr. Jovanovic passed away.</p>
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<h3>Barbara Davis</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Diabetes philanthropist Barbara Davis" class="wp-image-1015258" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-BarbaraDavis.png" width="200" /></figure></div>
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<p>The name behind the <a href="http://www.barbaradaviscenter.org/" rel="noreferrer noopener" target="_blank">Barbara Davis Center</a> in Colorado, this woman was an incredible philanthropist who began her work in diabetes by founding the <a href="https://www.childrensdiabetesfoundation.org/about-us/the-barbara-davis-center/" rel="noreferrer noopener" target="_blank">Children Diabetes Foundation</a> in 1977. Over the years, that foundation raised more than $100 million for diabetes research, education, and awareness. Davis serves on the Boards of Trustees of the Joslin Diabetes Center in <span class="mw-redirect">Boston and the</span> Cedars-Sinai Medical Center in <span class="mw-redirect">Los Angeles, among others</span>. She has received numerous awards, including the 1992 Promise Ball Humanitarian Award from then-Juvenile Diabetes Foundation; an Honorary Doctorate in Humane Letters from the University of Colorado in 1995; and the 2004 Angel Award from JDRF in Los Angeles.</p>
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<h3>Laura Billetdeaux</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Laura Billetdeaux of Children With Diabetes" class="wp-image-1015261" height="200" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-LauraB.png" width="200" /></figure></div>
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<p>Billetdeaux is a D-Mom in Michigan who in 2000 had the idea of taking a trip to Disney World in Florida with her family and inviting along other T1D families from the <a href="https://childrenwithdiabetes.com/" rel="noreferrer noopener" target="_blank">CWD (Children with Diabetes)</a> online forum. With that, she established the annual <a href="http://www.childrenwithdiabetes.com/activities/Orlando2018/" rel="noreferrer noopener" target="_blank">Friends For Life conference</a> that’s expanded and branched out tremendously in the years since, and has changed the lives of many with diabetes across the globe.</p><p>Today, both large and small events are held multiple times a year.</p><p><br /></p>
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<h3>Dr. Nicole Johnson</h3>
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<p>Crowned Miss America in 1999, <a href="https://www.nicolejohnson.com/meet-nicole/">Dr. Johnson</a> was the first woman to wear an insulin pump on stage and national TV, and in doing so became an inspirational force worldwide. She’s since earned her doctorate in public health, used her journalism experience to co-host the D-Life TV show reaching millions, and has created organizations such as Students With Diabetes and the Diabetes Empowerment Foundation that have touched countless lives. She joined the JDRF as National Director of Mission in 2018 before eventually moving on to other philanthropic ventures. In January 2021, she was named VP of science and healthcare for the American Diabetes Association (ADA). She's also written several books on diabetes topics, including a co-authored volume on diabetes spouses and significant others.</p>
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<h3>Tracey D. Brown</h3>
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<p>Named the president of the American Diabetes Association (ADA) in 2018, Tracey Brown was the first woman as well as the first African American to ever hold the organization's chief role since its founding in 1940. Not only that, but living with type 2 diabetes, she became the first person to actually live with diabetes be named to that position. She started out as an R&D chemical engineer at Procter & Gamble, and over the years she moved into management at RAPP Dallas and Sam’s Club (a division of Walmart) before joining the ADA.</p><p>She left the organization's top role in 2021, to return to the private sector. </p><p><br /></p>
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<h3>Dr. Anne Peters</h3>
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<p>A professor of medicine and director of the USC Clinical Diabetes Programs, Dr. Peters is a nationally and internationally respected diabetologist who treats a spectrum of patients, from the Hollywood elite to the underserved who populate her free diabetes clinic in East Los Angeles. At her research center in East LA, she works with her team to prevent diabetes in the surrounding communities. Her research has been published in all manner of leading medical journals and she’s a book author and frequent speaker as well. Her name seems to be everywhere in the diabetes world these days, and one of the continued drumbeats she echoes in public speaking roles is how important access and affordability are in diabetes. </p>
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<h3>Justice Sonia Sotomayor</h3>
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<p>The Diabetes Community was thrilled to see one of our own seated on the Supreme Court of the United States, with Justice Sonia Sotomayor becoming the first Hispanic woman named to the high court in 2009. She's lived with T1D since childhood, and has written two books on diabetes as well as shared her story publicly as a way to raise awareness and inspire others. Her SCOTUS appointment has meant the world to so many young girls, who've been inspired to believe "You Can Do This" in accomplishing their own dreams.</p><p><br /></p>
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<h3>Dr. Denise Faustman</h3>
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<p>A physician and researcher at Harvard University and Director of the <a href="https://www.massgeneral.org/endocrinology/diabetes/research/immunobiology-lab" rel="noreferrer noopener" target="_blank">Immunobiology Laboratory at Massachusetts General Hospital</a>, Dr. Faustman has become a controversial figure with her unorthodox approach to seeking a diabetes cure. Some years ago, her research team "cured" laboratory mice of T1D with a 40-day course of injections with a drug called CFA, which she strives to reproduce and scale. Despite naysayers, her work has sparked a wave of hope across the Diabetes Community. However it plays out, there's no doubt she's certainly made a dent in diabetes history with her efforts.</p><p><br /></p>
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<h3>Dana Lewis</h3>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="Dana Lewis" class="wp-image-1065321" height="200" src="https://post.healthline.com/wp-content/uploads/2021/03/DM-DanaLewis.png" width="200" /></figure></div>
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<p>A pioneer in the do-it-yourself (DIY) diabetes technology space, Lewis is renowned for creating one of the first-ever open-source homemade “artificial pancreas" systems known as <a href="https://openaps.org/" rel="noreferrer noopener" target="_blank">OpenAPS</a>. A longtime T1D1 in Seattle, Lewis and her husband Scott Leibrand developed a DIY system and paved the way for thousands — if not millions — of people with diabetes to benefit from the technology. Lewis was <a href="https://www.fastcompany.com/person/dana-m-lewis" rel="noreferrer noopener" target="_blank">named by Fast Company</a> as one of the “Most Creative People” of the year in 2017, and her work has not only helped shaped patient-led research but also how the FDA evaluates new diabetes technology, with an eye towards the burgeoning #WeAreNotWaiting movement. A tribute also to tech-savvy <a href="https://www.instagram.com/kdisimone/?hl=en" rel="noreferrer noopener" target="_blank">Katie DiSimone</a> in California and <a href="https://twitter.com/KateFarnsworth" rel="noreferrer noopener" target="_blank">Kate Farnsworth</a> in Canada for providing unequaled support with an online “how to” hub called <a href="https://loopkit.github.io/loopdocs/">LoopDocs</a>, and for making improvements to the core technology. This has all led to new DIY-inspired innovations from players such as <a href="https://www.bigfootbiomedical.com/" rel="noreferrer noopener" target="_blank">Bigfoot Biomedical</a> and the non-profit <a href="https://www.tidepool.org/" rel="noreferrer noopener" target="_blank">Tidepool</a>. From Lewis’ start to an ever-expanding community, this DIY movement is changing how the established diabetes industry develops products.</p>
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<h3>DOC (Diabetes Online Community) Female Powerhouses</h3>
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<p>A number of woman have played key roles in shaping the way diabetes is seen publicly, and the way PWDs can cope and thrive, through their work with online publishing and networking. A short list includes:</p>
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<div class="wp-block-image"><figure class="aligncenter size-large"><img alt="Women leaders in the Diabetes Online Community" class="wp-image-1015270" height="225" src="https://post.healthline.com/wp-content/uploads/2021/02/DM-WomenDOCleaders.png" width="400" /><figcaption><br /></figcaption></figure></div>
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<p><a href="https://diabetessisters.org/founder-staff" rel="noopener noreferrer" target="_blank">Brandy Barnes</a>: founder of DiabetesSisters </p>
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<p><a href="https://diatribe.org/editors" rel="noopener noreferrer" target="_blank">Kelly Close</a>: founder of the influential organizations Close Concerns and the diaTribe Foundation </p>
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<p><a href="https://www.umass.edu/pbs/news/christina-roth-11-founder-and-ceo-college-diabetes-network" rel="noopener noreferrer" target="_blank">Christina Roth</a>: founder and head of the College Diabetes Network (CDN)</p>
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<p><a href="http://sixuntilme.com/wp/homepage/about-kerri-sparling/" rel="noopener noreferrer" target="_blank">Kerri Sparling</a>: Six Until Me blogger and author of several D-books</p>
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<p><a href="https://about.me/cheriseshockley" rel="noopener noreferrer" target="_blank">Cherise Shockley</a>: founder of Diabetes Social Media Advocacy (DSMA) and a voice for diversity and inclusion in the community</p>
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<p><a href="https://blog.getbetter.co/tech-meets-diabetes-diabetes-meets-tech-c1eaaf48e086" rel="noopener noreferrer" target="_blank">Amy Tenderich</a>: founder and editor of DiabetesMine, and organizer of the DiabetesMine Innovation events, where the #WeAreNotWaiting movement was born</p>
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<p>Their work is multifaceted and wide-reaching:</p>
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<ul><li>connecting with countless PWDs and community members through blogs, video, social media, and in-person or virtual events</li><li>influencing industry/philanthropic/healthcare leaders behind the products, policy, medications, and care we rely on </li><li>founding organizations or leading initiatives and campaigns that work to help PWDs around the world</li><li>sharing their stories online and connecting with our D-Community, influencing the diabetes universe for the better on peer support, improved product design, industry and regulatory collaboration, and patient engagement</li></ul>
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<p><em>Thank you, to these and the many other hard-working and influential Women of Diabetes, who’ve devoted their lives to making a difference for our community!</em></p><p><em><br /></em></p><p></p><div style="text-align: center;"><em>- - - - - - - - - - - - - - -</em></div><em><div style="text-align: center;"><em>Originally published at DiabetesMine</em></div></em><p></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com1tag:blogger.com,1999:blog-5690084467070242215.post-7106427239279532242021-02-18T18:22:00.004-05:002022-04-13T18:24:03.215-04:00For Diabetes Care, Telehealth is a Keeper<p>Many experts believe that diabetes care is ideally suited to telehealth, given the fact that glucose readings and other data guide disease management — and that can easily be jointly reviewed and discussed by doctors and patients over digital platforms.</p><!-- wp:paragraph -->
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<p>While there is mounting evidence that the <a data-id="https://journals.sagepub.com/doi/full/10.1177/1932296820929359" data-type="URL" href="https://journals.sagepub.com/doi/full/10.1177/1932296820929359" rel="noreferrer noopener" target="_blank">explosion in telehealth due to COVID-19</a> is a boon to people with diabetes (PWDs), there's also a fight underway to make sure that new policies supporting this virtual care stay in place when the pandemic eventually subsides.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="New study data" id="new-study-data">New data on diabetes telehealth experiences </h2>
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<p>In its <a href="https://www.doximity.com/press_releases/doximity_study_finds_telemedicine_will_account_for_29_billion_in_healthcare_services_in_2020" rel="noreferrer noopener" target="_blank">2020 State of Telemedicine Report</a> published by physician network company <a href="https://www.doximity.com/about/company" rel="noreferrer noopener" target="_blank">Doximity</a>, endocrinology got the top ranking for the specialty that's using telemedicine the most since the onset of COVID-19. Among the other findings is how Americans with chronic conditions like diabetes increased their use of telemedicine to 77 percent during the pandemic.</p>
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<p>This isn't surprising, and it confirms research done by <a href="https://profiles.ucsf.edu/lawrence.fisher" rel="noreferrer noopener" target="_blank">Dr. Larry Fisher</a> at the University of California, San Francisco (UCSF). In a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7539933/" rel="noreferrer noopener" target="_blank">clinical study</a> published in December 2020 that looked at COVID-19 and diabetes, Fisher and fellow researchers examined the changing role of telehealth in the first months of the pandemic, by talking with nearly 1,400 PWDs.</p>
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<p>Many said they are happy to do telehealth because they don't have to travel to an appointment or be exposed to a health risk. But digging into the experience, the feedback was also much more nuanced.</p>
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<p>"The responses are generally positive, that (telehealth) didn't detract from their overall level of satisfaction," Fisher said, adding that diabetes data review from insulin pumps, continuous glucose monitors (CGMs), and glucose meters are a big part of what makes for a productive telehealth appointment.</p>
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<p>He reminds us that "telehealth is not one thing," so it's not as easy as simply asking, "How do people with diabetes respond to telehealth?"</p>
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<p>First, it comes down to the relationship a patient has with their clinician, and in large part, whether that's an established relationship. Someone going into a virtual visit with a new doctor will have a quite different experience than if it's a continued doctor-patient relationship over time.</p>
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<p>"It's much better, and you get so much more satisfaction when there's an ongoing relationship because the telehealth is an extension of that ongoing relationship," Fisher said.</p>
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<p>He said follow-up surveys of study participants found that after a visit, a large majority said they felt listened to, weren't pressured by time limitations as they often felt during in-person visits, and they saw an efficient use of time.</p>
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<p>But some patients said they didn't care for telehealth because they missed the element of physical contact. Clinicians have also reported that issue, he said.</p>
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<p>"These findings suggest the need for greater attention to the emotional and psychosocial impact of the pandemic on this population and its implications for disease management and diabetes-related healthcare delivery," Fisher's study concluded.</p>
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<p>Of the PWDs who indicated they had other issues with telehealth, the reasons generally broke down into two main categories:</p>
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<ul><li>30 percent are simply less satisfied and see it as less productive than in-person appointments </li><li>70 percent noted technical difficulties in audio and video functions for the appointment</li><li>some also mentioned trouble uploading glucose and diabetes device data for the clinician to review and discuss during the appointment</li></ul>
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<p>Fisher says he expects that the number of clinics doing data downloads from CGM and diabetes devices has increased significantly during the pandemic, although he doesn't have any data on this trend specifically. </p>
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<p>Meanwhile, lab visits have of course dropped significantly since the beginning of the pandemic. But interestingly, Fisher says many patients and clinicians are reporting that a decrease in lab work may be OK because they have a sense that tests were ordered more often than necessary previously.</p>
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<p>"We may have been doing A1Cs way too frequently for many people, but obviously that isn't the case for everyone," he said.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Fighting for support" id="fighting-for-support">The fight for telehealth support post-pandemic</h2>
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<p>Due to the pandemic restrictions, <a href="https://www.hhs.gov/about/news/2020/03/17/secretary-azar-announces-historic-expansion-of-telehealth-access-to-combat-covid-19.html" rel="noreferrer noopener" target="_blank">Medicare and private insurers have been forced to embrace telehealth</a> and even began reimbursing it at the same rate as traditional in-person appointments.</p>
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<p>Unfortunately, these are temporary changes. What the Centers for Medicare and Medicaid Services (CMS) put into place because of COVID-19 is set to expire in April 2021, and if that happens, doctors and clinics may be less willing to do virtual appointments without full reimbursement.</p>
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<p>But efforts are underway to cement those COVID-19 era changes in telehealth.</p>
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<p>Groups like the <a href="https://diatribechange.org/take-action" rel="noreferrer noopener" target="_blank">diaTribe Foundation</a>, American Diabetes Association, and the Diabetes Policy Collaborative are working to persuade policy-makers to make the new telehealth improvements permanent.</p>
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<p>For example, diaTribe has been crafting a <a href="https://www.dropbox.com/s/akpmx7bydpejp3x/Telehealth%20CTA%20Letter%209-22.pdf?dl=0" rel="noreferrer noopener" target="_blank">community advocacy letter</a> that will be sent to the new Biden Administration and Congress at the end of February 2021, emphasizing the need for permanent telehealth legislation. Nearly 2,000 people had signed the letter by mid-month.</p>
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<p>diaTribe also joined the <a href="https://telehealthadvocates.org/" rel="noreferrer noopener" target="_blank">Patient & Provider Advocates for Telehealth (PPATH) initiative</a>, recently launched by the <a href="https://allianceforpatientaccess.org/" rel="noreferrer noopener" target="_blank">Alliance for Patient Access (AfPA) coalition</a>, as a way to build more collaboration in pushing for policy change.</p>
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<p>"Telehealth is not a perfect option for everyone with diabetes, but it gives people more healthcare options," said Julia Kenney, an associate at the San Francisco-based diaTribe Foundation. "We want to make sure it's an option... so that people with diabetes can access their healthcare in whatever way works best for them."</p>
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<p>For some PWDs, this is a big deal — including for Emily Ferrell in Kentucky, who tells DiabetesMine that she's found a new fondness for telehealth in the past year. At one point, her insurer even waived copays for telehealth during the pandemic. She hopes this option won't go away once the COVID-19 crisis starts fading.</p>
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<p>"I know that telehealth has existed for many years, mainly to increase access to care in rural areas, and it's awful that it took a pandemic for it to become mainstream," she said. "I only hope that once the pandemic is over, our healthcare systems and insurers will work together to not only continue but improve telehealth and other remote service delivery options."</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Good experiences" id="good-experiences">Loving virtual visits</h2>
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<p>Before the global pandemic began, Ferrell didn’t have much exposure to virtual visits with her healthcare team. Diagnosed with type 1 diabetes (T1D) as a child back in 1999, she generally wasn’t a fan of the idea of seeing her providers over a screen.</p>
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<p>But the COVID-19 crisis changed that. Now, the 30-something says she is successfully using telehealth with her endocrinology team and prefers it for many reasons.</p>
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<p>Not only does it save time on travel, but Ferrell is able to review her insulin pump and CGM data alongside her doctor virtually with ease.</p>
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<p>“I plan on utilizing it as long as it’s available,” she told DiabetesMine.</p>
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<p>Like Ferrell, Mariana Gómez in Los Angeles hadn't done any telehealth visits before the pandemic. Diagnosed with T1D at 6 years old in 1984 when her family lived in Mexico City, she strongly believed that consulting with an HCP would always be better in person because of the human contact.</p>
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<p>But once the pandemic hit in 2020 and she started working from home, Gómez found herself driving almost an hour to her appointment and needing to take time off and deal with the stress. That also led to other expenses like travel, and all of that impacted her emotional health — which of course, impacted her blood sugars and diabetes management.</p>
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<p>"I thought telehealth would be complicated but it turned out it was just what I needed," Gómez said, noting her endo analyzes her diabetes data using the Tidepool platform and shares the screen to go through everything together.</p>
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<p>"Not only am I able to see the trends, but also I have been able to learn how to interpret my data in a new way," she said. "I am sitting in my own living room, with a coffee next to me and my family sometimes really close and listening, as well. I feel no stress whatsoever. Which is also nice during a pandemic."</p>
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<p>These PWDs are certainly not alone. When DiabetesMine recently <a href="https://www.facebook.com/DiabetesMine/posts/10158078927003008" rel="noreferrer noopener" target="_blank">queried our Facebook community</a> on what COVID-related changes in healthcare people might want to keep post-pandemic, we heard a lot about loving telehealth. Comments included:</p>
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<ul><li>“Telehealth for sure. I usually drive 45 min each way to see my endo. Now the whole appointment takes a half-hour at most, and I felt like I had more time to talk to my doctor.”</li><li>“I do not drive, so the telephone or video appointments have helped. I email my Dexcom reports before the appointment. My insurance doesn’t cover any endocrinologists, so this is a little cheaper too.”</li><li>“Telehealth should have been done ages ago. COVID has allowed this to be mainstream… need this to stay.”</li></ul>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="The downsides" id="the-downsides">The downsides</h2>
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<p>With the good, there can also be bad — or challenging, at the least.</p>
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<p>Healthcare professionals can experience their own hurdles in navigating virtual visits, from typical tech glitches to patients not being as focused on engaging with the doctor.</p>
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<p>There can also be physical demands, according to many doctors.</p>
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<p><a href="http://www.copeds.com/providers" rel="noreferrer noopener" target="_blank">Dr. Jennifer Dyer</a>, a pediatric endocrinologist in Columbus, Ohio, says she’s generally pleased to be using telehealth quite regularly nowadays.</p>
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<p>That said, downloads can complicate virtual visits and there’s also no way to address pump site issues or complaints like neuropathy pains or tingling.</p>
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<p>If something like that arises, she has to ask the patient and family to make an in-person office appointment for a further look.</p>
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<p>Administratively, Dyer says telemedicine is more work for the office in preparation for the appointment. But other than that, it’s a great way to continue excellent diabetes care for the patients she knows well; it’s not as personal a medium for new patients.</p>
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<p>Longtime T1D Katarina Yabut in Union City, California, can attest to that. When she went back to nursing school and had to transition to Medi-Cal coverage just before COVID-19 hit, she found herself searching for new doctors in an online environment. Her experience was less than ideal.</p>
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<p>She found a primary care provider who referred her to an endo, who she said was difficult to get along with. The typical challenges of starting with a new doctor seemed to be exacerbated online, she says, such as having only a 15-minute appointment in which the physician talks nothing but numbers.</p>
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<p>"You have concerns about being at home and no gym access, you have to get tapered off your thyroid meds, and you have concerns about basal rates and bolus settings..." she said. "But the only thing discussed was, 'Well, I don't really work with your insulin pump or insurance company but I'll try to get you supplies for the CGM.'"</p>
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<p>At UCSF, Fisher has also done research on clinicians using telehealth and says they are reporting some downsides too, such as more eye and back complications — leading to headaches, eye strain, and other physical ailments as a result of the surge in virtual appointments. One trick he's embraced is limiting the number of telehealth appointments in a given day; he won't do more than 3 hours at a time, before switching to in-person or taking a break.</p>
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<p>"It's taxing to do virtual appointments, and it can be a lot more exhausting," he said.</p>
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<h2 class="wp-block-healthline-tabbed-heading" data-toc-label="Disparaties in telehealth" id="disparaties-in-telehealth">Disparities exist in telehealth, too</h2>
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<p>Not surprisingly, systemic racism and implied bias in healthcare show up in telehealth settings, as well.</p>
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<p><a href="https://academic.oup.com/jamia/advance-article/doi/10.1093/jamia/ocaa216/5899728" rel="noreferrer noopener" target="_blank">Recent research</a> conducted in New York City points to lower levels of telemedicine usage since the pandemic's onset among Black and Latinx patients — particularly those older than 65 — as compared with white patients.</p>
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<p>In Los Angeles, where Gómez lives, she said <a data-id="https://www.healthline.com/diabetesmine/access-to-healthcare-through-languages-latinos-and-type-1-diabetes" data-type="URL" href="/diabetesmine/access-to-healthcare-through-languages-latinos-and-type-1-diabetes" rel="noreferrer noopener" target="_blank">language barriers are a huge problem</a> when considering telemedicine. Most platforms are in English, and email communication is often the same. When visiting in person, there's a likelihood patients can be assisted by an interpreter or bilingual nurse. But that's more complex in telehealth.</p>
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<p>"Language has always been a barrier, and that is now more evident," she said. "Access to devices are also a thing to consider, as most families will have one computer but... priorities are sometimes not the best when it comes to access to healthcare."</p>
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<p>Some hope may be on the horizon, though, in using telehealth to address disparities.</p>
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<p>Another 2020 New York City-based <a href="https://academic.oup.com/jamia/article/28/1/33/5899729" rel="noreferrer noopener" target="_blank">study on telehealth and disparities </a>suggests creating a standardized screen design that could possibly reduce providers' biases and the resulting disparities in healthcare.</p>
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<p>The authors also call for the development of "culturally and structurally appropriate tools and technology, representative provider presence and capacity, positive targeted outreach, and research."</p>
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<p>Finally, the study found that suspected COVID-19 diagnoses among Black patients, who on average were sicker at the time of seeking care, were more likely to be caught during telehealth visits than in-person appointments. As a result, the study authors believe it could offer a more equal playing field for Black and white patients to be treated the same.</p>
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<p>That's the hope Ferrell has, too, when thinking about health inequities.</p>
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<p>"I know that my experiences with healthcare are different than many others in the diabetes community who have faced discrimination and bias," she said. "I think telehealth has tremendous potential to promote health equity, but it will take thoughtful planning to make sure that these new advances minimize disparities instead of contributing to them."</p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-57793734954678591842021-02-03T09:29:00.006-05:002023-10-02T18:30:17.414-04:00COVID-19 Vaccine Researcher with Type 1 Diabetes Wins Nobel Prize<p><a href="https://www.pennmedicine.org/providers/profile/drew-weissman" rel="noreferrer noopener" target="_blank"></a></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-de0EY6ht57Pbfnz2Ujx9jTvVeXE9hcUroANOilOIlringwuuTskjSHfhEGNd_dAmKrQSKjtoZDyu3Uyffd7jl0npNJq5Ju44Rt_ereO93kIr-aia3yc76e_m4G7zC7DhNY7BMHtS65FMvuolLLif-ftf1DUsN3trzirmN0VZpjgxxms-YHLbNsn4/s1296/DM-DrWeissman-HEADER.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-de0EY6ht57Pbfnz2Ujx9jTvVeXE9hcUroANOilOIlringwuuTskjSHfhEGNd_dAmKrQSKjtoZDyu3Uyffd7jl0npNJq5Ju44Rt_ereO93kIr-aia3yc76e_m4G7zC7DhNY7BMHtS65FMvuolLLif-ftf1DUsN3trzirmN0VZpjgxxms-YHLbNsn4/w640-h360/DM-DrWeissman-HEADER.png" width="640" /></a></div><br /><div>Dr. Drew Weissman at the University of Pennsylvania isn't one to seek the spotlight.<p></p><!--wp:paragraph-->
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<p>But as one of the two key researchers behind the science used to develop the first COVID-19 vaccines, his name has leapt into public view as of late 2020.</p>
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<p>Self-described as "just a basic scientist," Weissman is a modest man who has spent his lifetime devoted to research.</p>
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<p>He also happens to be living with type 1 diabetes (T1D) for more than 50 years, spanning the two decades that he and his colleagues have spent digging into the vaccine-related research that's become so critical to public health at the moment.</p>
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<p>Weissman may not be advertising that he lives with T1D, but a recent photograph of him getting his own COVID-19 vaccine shot in mid-December tipped off the public that he's sporting an insulin pump on his belt.</p>
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<p>DiabetesMine spoke with Weissman by phone in early 2021, just as President Joe Biden took office and the scattered vaccine distribution was making headlines.</p><p>Since then, Weissman has gone on to become one of <a href="https://time.com/heroes-of-the-year-2021-vaccine-scientists/">Times’ Heroes of the Year for 2021</a>. because of his research. And then incredibly on Oct. 2, 2023, Weissman and his colleague who worked on the COVID-19 vaccines <a href="https://penntoday.upenn.edu/news/katalin-kariko-and-drew-weissman-penns-historic-mrna-vaccine-research-team-win-2023-nobel" target="_blank">received a Nobel Prize of Medicine</a>.</p><p>Here is my interview with Dr. Weissman in early 2021, where he shared his T1D story as well as his science-based thoughts on COVID-19 vaccine safety for those with diabetes, and how his career focus goes beyond just this particular chronic condition he's lived with since childhood.</p>
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<h3>Can you tell us about your diagnosis with T1D?</h3>
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<p>I was 5 years old when diagnosed, and there was no one else in the family with type 1. It was 56 years ago, and diabetes was very different then compared to how it is now. </p>
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<p>Control wasn't very good. We lived in the Boston area and I went to the Joslin Clinic, and what struck my parents the most was that our physician said that I probably wouldn't live past 50, because diabetics didn't live that long. </p>
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<p>Doctors finally told me things could be different when I was an adult... but I'd thought that my entire life.</p>
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<h3>Did that influence your career direction?</h3>
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<p>I'm not really sure it had any impact. I was always a scientist growing up. Maybe my diabetes pushed me toward medical school, but I doubt it. That was just an area I was interested in because of the science and research.</p>
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<h3>You’ve been shown in photos wearing an insulin pump.</h3>
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<p>Yes, I have had an insulin pump for about 20 years or so. I now wear the new Medtronic MiniMed insulin pump. It has shown up in some of the photos because of where I wear it.</p>
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<h3>How does it feel to be a driving force for something so critical in fighting this global pandemic?</h3>
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<p>My family always yells at me about that, about how I should be much more excited. I'm really just a basic scientist, and am happiest when I'm sitting in my lab thinking of and working on new things. </p>
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<p>I'm certainly excited that the vaccine is being used and that it's likely to get this pandemic under control. </p>
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<p>I am a clinician and researcher and, yes, ever since I started doing research, my dream was always to help develop something that could benefit people. Maybe that does go back to my type 1 diabetes, in wanting to do something to make people better, cure disease, or do something to help.</p>
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<h3>How did you actually get started in vaccine research?</h3>
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<p>I was an MD, PhD in medical school, and after my residency training I did a residency in immunology at the National Institutes of Health (NIH). I've been doing research ever since.</p>
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<p>I started in this <a href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/different-vaccines/mrna.html" rel="noreferrer noopener" target="_blank">messenger RNA (mRNA) research</a> area in the late 1990s. Along with my partner, <a href="https://www.linkedin.com/in/katalin-karik%C3%B3-a6b457a/?originalSubdomain=de" rel="noreferrer noopener" target="_blank">Dr. Katalin Karikó</a>, also a Penn researcher who has joined the company BioNTech, we started working in mRNA about 22 years ago. </p>
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<p>We made our big finding 15 years ago in mice, and that finding is what's being used in the <a data-id="https://www.fda.gov/media/144638/download" data-type="URL" href="https://www.fda.gov/media/144638/download" rel="noreferrer noopener" target="_blank">Moderna</a> and <a data-id="https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine" data-type="URL" href="https://www.fda.gov/emergency-preparedness-and-response/coronavirus-disease-2019-covid-19/pfizer-biontech-covid-19-vaccine" rel="noreferrer noopener" target="_blank">Pfizer-BioNTech vaccines</a>. It's that enabling technology that we and other scientists have been working on ever since, on how to use it to develop mRNA.</p>
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<h3>For all of us non-scientists, can you explain how these new vaccines work?</h3>
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<p>These recent COVID-19 vaccines use a breakthrough gene-editing technique that modifies mRNA — the molecule that essentially puts DNA instructions into action — to induce an immune response. </p>
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<p>Our discovery increases mRNA stability while at the same time decreasing inflammation, further paving the way for these modified mRNAs to be used in a wide array of potential vaccines and treatments. </p>
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<p>Unmodified mRNA molecules are normally unable to slip past the body’s immune system, but the research we've done made key changes to the molecular structure and manufacturing of mRNA that allow for it to avoid immediate immune detection, remain active longer, and enter into target sells to efficiently instruct them to create antigens or other proteins that fight or treat disease.</p>
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<p>The applicability of this mRNA technology is enormous. So, we're using it for autoimmune diseases, for Duchenne muscular dystrophy, for <a data-id="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800485/" data-type="URL" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4800485/" rel="noreferrer noopener" target="_blank">cardiac fibrosis</a>... just a whole bunch of genetic disorders. The list goes on and on, for everything that can be done with this.</p>
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<h3>How do you respond to those who feel these vaccines were ‘rushed’ and might not be safe?</h3>
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<p>They're certainly not unsafe. I look at it this way: It's not brand-new technology. Scientists had been studying vaccines using this mRNA platform for at least 6 or 7 years before 2020. </p>
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<p>What's new is that it's the first time this mRNA technology has been used in people. The research and clinical trials all happened and the regulatory side of this was what moved more quickly than it has before. </p>
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<p>Some say it was rushed or moved too quickly into people... but had we moved more slowly, we would've been yelled at for not developing this for people fast enough. We just can't win that one.</p>
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<p>What people have to understand is that the reason it was developed for people so fast is because the platform technology is so amenable to fast development. And that's based on many years of work and research. </p>
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<p>After that, all the <a data-id="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness.html" data-type="URL" href="https://www.cdc.gov/coronavirus/2019-ncov/vaccines/effectiveness.html" rel="noreferrer noopener" target="_blank">clinical trials for the COVID-19 vaccines</a> were done at the same time as each other. Nothing was rushed, no corners were cut. No safety profiles or analyses were avoided. </p>
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<p>Everything was done the way it's supposed to be. The reason it took this amount of time is because that's the amount of time it took to do everything required.</p>
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<h3>Is your team monitoring vaccine response data now that people are getting doses?</h3>
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<p>Not directly. The pharmaceutical companies control all of that data, and they don't like to share. </p>
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<p>I do hear about the data, follow it, and know it. But I'm really a basic scientist, who develops the vaccine, and then the pharmaceutical companies produce it and give it to people.</p>
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<h3>Can you talk about what it feels like watching the problematic vaccine rollout in the U.S.?</h3>
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<p>There are a lot of people to blame for the distribution, but in the end we've never made a billion doses of mRNA vaccine like this before. </p>
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<p>That means everything involved — places where the vaccine's produced, the raw materials, the people involved — needs to be scaled up to make this vaccine.</p>
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<p>There are not enough glass vials in the world for all of these vaccines, and it all takes time to develop and distribute the doses we need. I think everyone is doing the best they can, as quickly as they can.</p>
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<h3>As a T1D yourself, what do you say about the vaccines being safe for those with diabetes?</h3>
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<p>People characterize type 1 diabetes in different ways. Some describe it as an autoimmune disease, and it certainly is when it starts. </p>
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<p>But after the beta cells are gone, to me it's no longer an autoimmune disease. There are no more inflammations or immune system cellular attacks like there is with lupus, where you can control it for a while but it flares up and keeps coming back. </p>
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<p>So, yes, I do consider it an autoimmune disease, but I don't consider long-term diabetics as suffering from an autoimmune disease — which is the big concern. </p>
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<p>It's unknown how this vaccine is going to act in the setting of autoimmune disorders... likely, it will be fine. Twenty million people have received it and many have autoimmune diseases. </p>
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<p>We haven't heard of any bad flares or activations of autoimmune diseases. To me, the bigger concern is type 2 diabetes (T2D) in affecting poorer COVID-19 outcomes.</p>
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<h3>When getting your own COVID-19 vaccine shots, did you notice any diabetes effects?</h3>
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<p>I received my first injection in December and the second in early January, but no, I didn't see any noticeable effects on my diabetes. </p>
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<p>There may have been small fluctuations in my blood sugars, but I wasn't really paying too close attention to notice anything more than the usual. </p>
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<h3>What’s taking up your time now that the COVID-19 vaccines are launched?</h3>
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<p>My work is all mRNA-based. We're doing a bunch of different vaccines, for HIV, influenza, genital herpes, malaria, norovirus... just a whole bunch of different diseases. </p>
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<p>We're working on what we call a <a href="https://globalbiodefense.com/2020/11/18/niaid-looks-ahead-to-pan-coronavirus-vaccine-candidates/" rel="noreferrer noopener" target="_blank">"pan-coronavirus" vaccine</a>, which is more comprehensive. There have been three big coronaviruses in the past 20 years, and there will be more. </p>
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<p>We're trying to make a vaccine for the next one that will appear, so the vaccine is ready to go if and when the first cases appear. </p>
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<p>We also have a lot of gene therapy work ongoing, including a simple IV injection to cure sickle cell anemia. </p>
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<h3>The notion of gene therapy targeting T1D is fascinating, isn’t it?</h3>
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<p>Certainly, it is. I think right now the best developing therapies are the beta cell encapsulation and transplants. But in the future, who knows what gene therapy will lead to?</p>
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<h3>As a T1D, do you follow the progress of diabetes research too?</h3>
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<p>I certainly do follow it and find diabetes research interesting. I talk to the researchers at <a data-id="https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/endocrinology-diabetes-and-metabolism/diabetes-care" data-type="URL" href="https://www.pennmedicine.org/for-patients-and-visitors/find-a-program-or-service/endocrinology-diabetes-and-metabolism/diabetes-care" rel="noreferrer noopener" target="_blank">Penn Medicine</a>, who work on diabetes and beta cell transplants.</p>
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<p><em>Thanks for taking the time to talk with us, Dr. Weissman! Our Diabetes Community so appreciates all the years of work you and your colleagues have put into creating critical solutions for public health crises.</em></p><p><em>Congrats to Dr. Weissman and his colleague who were named Nobel Prize of Medicine winners for 2023. Read the <a href="https://penntoday.upenn.edu/news/katalin-kariko-and-drew-weissman-penns-historic-mrna-vaccine-research-team-win-2023-nobel" target="_blank">Penn News release</a> on that exciting development.</em> <i>Weissman’s work also made him one of <a href="https://time.com/heroes-of-the-year-2021-vaccine-scientists/">Times’ Heroes of the Year for 2021</a>.</i></p><p style="text-align: center;"><em>- - - - - - - - - -</em></p><p style="text-align: center;"><em>Originally published at DiabetesMine in February 2021, under headline "</em><span style="text-align: left;"><i>We Can Thank This Researcher with Type 1 Diabetes for the COVID-19 Vaccines"</i></span></p>
<!--/wp:paragraph--></div>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-10344610649235239852021-01-14T09:30:00.029-05:002022-03-23T09:38:05.992-04:00‘Star Trek: Discovery’ Actor Talks Diabetes and Insulin Prices<p></p><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR_HcJoawBJOojlo1Frc8lw-UJOww8kKvY4Qf7HgMxu7PWJpHbaarfDMAfT-OTwI_DguSX6tsp7Vjxgq6UWfWxbvRukDjaDNELKJkR95UVSO4zPP-nCKnt-PI3bWpDzug4pUSEHmVOZIsDR442QVVVAFZ_vP4f4dEf7cdDqr_5TQUWssU8AlGoa2LK/s1296/DM-RynArt-HEADER.png" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhR_HcJoawBJOojlo1Frc8lw-UJOww8kKvY4Qf7HgMxu7PWJpHbaarfDMAfT-OTwI_DguSX6tsp7Vjxgq6UWfWxbvRukDjaDNELKJkR95UVSO4zPP-nCKnt-PI3bWpDzug4pUSEHmVOZIsDR442QVVVAFZ_vP4f4dEf7cdDqr_5TQUWssU8AlGoa2LK/w640-h360/DM-RynArt-HEADER.png" width="640" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><i>Illustration by <a data-id="https://twitter.com/Ilnere/status/1346216558838820865/photo/1" data-type="URL" href="https://twitter.com/Ilnere/status/1346216558838820865/photo/1">@llnere</a></i></td></tr></tbody></table><br />Have you ever imagined playing a being from outer space, flying around the far reaches of the galaxy, all while managing your type 1 diabetes (T1D) under a heavy load of prosthetics and makeup?<p></p><!--wp:paragraph-->
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<p>Leave it to <a href="http://www.noahak.com/" rel="noreferrer noopener" target="_blank">Noah Averbach-Katz</a>, the New York-based 30-something actor who landed the role of the flaxen-haired, blue-skinned character Ryn on the third season of TV show "Star Trek: Discovery"<em> </em>streaming on CBS All Access. He's been living with T1D since 2003, when he was in eighth grade. </p>
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<p>He also happens to be married to fellow Discovery actor <a href="https://www.imdb.com/name/nm6384402/" rel="noreferrer noopener" target="_blank">Mary Wiseman</a>, who plays red-haired fan-fave character Ensign Tilley. The two met at the prestigious <a data-id="https://www.juilliard.edu/" data-type="URL" href="https://www.juilliard.edu/" rel="noreferrer noopener" target="_blank">Juilliard School</a> for performing arts.</p>
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<p>As a self-pronounced Trekkie since childhood, Averbach-Katz says being on the show is a dream come true and a career highlight. Fun fact: He originally auditioned for the legendary character <a href="https://memory-alpha.fandom.com/wiki/Spock" rel="noreferrer noopener" target="_blank">Spock</a> (famously played by the late Leonard Nimoy in the original 1970s "Star Trek" series).</p>
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<p>DiabetesMine talked with Averbach-Katz just as Discovery's third season was coming to a close in early 2021, and he shared his love for everything Star Trek along with his own T1D story, how diabetes management helped shape his costume design, and his recent advocacy work with the <a href="https://www.t1international.com/insulin4all/" rel="noreferrer noopener" target="_blank">#insulin4all</a> movement.</p>
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<h3>DM: How did you first come to love Star Trek?</h3>
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<p>NAK: I was a "Star Trek" fan well before diabetes, so I was very much one thing as a <a href="https://memory-alpha.fandom.com/wiki/Trekkie" rel="noreferrer noopener" target="_blank">Trekkie</a> before I was another as someone with diabetes. It was always just a part of my life, thanks to my mom who was certainly a Trekkie going back to the 1970s. She watched the series growing up and for me, we watched "Deep Space Nine" and "Voyager."</p>
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<p>I think my own Trekkiness is built on "Enterprise," because that's when I was mostly at the prime TV-watching age. [My mom] would hold these Star Trek parties where my friends and I would all go watch the latest episode, and then she'd make a quiz of that episode and give out themed prizes. It was a lot of fun growing up.</p>
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<h3>How did your mom react to the news of you landing the role?</h3>
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<p>At first, she wondered if maybe I had a tiny part in a mask for 30 seconds in the background. I told her I had lines and a specific role to play. She started weeping, and then she ran into a closet and pulled out a model of the Next Generation Enterprise as big as a football, and she started flying it around the house in giddy excitement. And then she cried some more.</p>
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<h3>How did you first get introduced to Discovery?</h3>
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<p>As mentioned, I've been a Trekkie for most of my life. Mary and I met at Juilliard and started dating in our third year there, and we'd been dating for 3 or 4 years when she got the show. And I thought, well now we're definitely getting married... [<em>laughs</em>]. </p>
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<p>I was on set one time with her and was chatting with some of the producers showing them pictures of me at Star Trek conventions when I was younger. Someone at CBS was there and recognized me from a previous role of being on "The Good Fight" show that had aired on CBS All Access. The producer noted that I was a super Star Trek fan who actually had professional acting experience as well.</p>
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<h3>Weren't you going for the role of Spock?</h3>
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<p>Yes, I actually auditioned for Spock originally, which was awesome. It's funny because the character was code-named "Tom the Andorian" during the read, but I knew pretty quickly that this was a Vulcan not Andorian. They really liked my tape, though the role went to actor Ethan Peck. But they remembered me and a year later, I was with Mary when she was filming in Toronto and auditioned for this part. Then I was on set before I even knew it, as the actual Andorian character named Ryn.</p>
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<p>This was all a dream come true, and it's really been special to get to be part of this.</p>
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<h3>Can you share your first contact with T1D?</h3>
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<p>I'm the only person in my family diagnosed with type 1 diabetes. Being in eighth grade at the time, I had already been rapidly shedding my baby weight — down 30 pounds to a lanky kid — so my weight loss from the onset of diabetes wasn't readily apparent. There was a long period where things were off, going to the bathroom all the time and being thirsty — the classic T1D symptoms. I was at a family summer camp, and knew something wasn't right so told my mom we needed to go to the doctor. We came back from camp and the family doctor did tests, and he came into the office looking quite sad in telling us I had type 1 diabetes. I didn't know what he was talking about, but his face said "this is bad news," so I knew it wasn't good. That was the summer between eighth grade and my freshman year of high school.</p>
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<p>Rather than a family vacation planned to England that summer, we instead went to a diabetes family summer camp — which I was not happy about at all. This was supposed to be my big transition year between middle and high school, hanging out with friends at the movie theater drinking soda... but here I was, at a diabetes summer camp with my parents.</p>
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<h3>What was your diabetes camp experience like?</h3>
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<p>I do think diabetes summer camp was useful to my parents, in feeling prepared and talking to other parents. But for me, it solidified the fact that I couldn't be in control of what I was doing in life at that point. I was about to start high school and wanted to take control of my life in sort of every way a 13- or 14-year-old does. </p>
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<p>I remember thinking very clearly at the time, that I didn't want to be taken care of more than I need to be. I want to do as much as I can myself. That's continued throughout my life.</p>
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<h3>What diabetes technology have you used?</h3>
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<p>I was on a pump for awhile and then switched back to insulin pens, and was doing fingerstick testing before going to a Dexcom G6 CGM during the quarantine in 2020.</p>
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<h3>Have any Star Trek lessons helped shape your life with T1D?</h3>
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<p>What I've found is that the [Star Trek] community holds space for so many people with different perspectives or lives, for those who maybe don't belong anywhere else. I've found the response to the type 1 diabetes stuff that I put out there is so positive, not just from people who have diabetes or family with diabetes, but from the whole Star Trek community. </p>
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<p>It really does embrace that idea of a "Star Trek Utopia" where healthcare and medicine is free and available for everyone. And also, just because you have some [health condition] doesn't make you less of a person. Or that you can't participate in the creation of the world that you want to be a part of.</p>
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<p>Both in life and in Star Trek, I think perspective really allows people to see the world in different ways and allows them to bring different problem-solving abilities to the table.</p>
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<h3>What made you step up on diabetes advocacy recently?</h3>
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<p>Diabetes advocacy has always been on my radar, but I haven't really had any platform until recently. My forays into the larger diabetes organizations have been, I would say, less than stellar. Mainly because they're so big, they haven't seemed to need that volunteer, grassroots effort in the same way. As I got older and everyone has gotten more involved in politics, it's become more clear to me personally that with these larger groups taking money from pharma companies, they appear to be de-incentivized to follow what I consider the biggest problems — mainly insulin availability and affordability, particularly in the United States.</p>
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<h3>Is that how you got involved with the #insulin4all movement?</h3>
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<p>I'm lucky enough to have insurance and be able to afford my medicine, before and during the pandemic. But earlier in 2020 I came across a friend of a friend who'd lost their job, income, and health insurance because of the pandemic. That person had type 1 and couldn't afford insulin or supplies. I had some leftover supplies and reached out to that person, essentially black market giving them what they needed to stay alive a bit longer. It was worth it, so this guy didn't have to worry about being able to survive this pandemic. I wrote him a note along with that, offering some insulin pricing programs available. But in reading about these programs after the fact, these aren't designed to help people afford insulin; they seem designed to make the companies look good. That's infuriating but unsurprising.</p>
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<p>That is a roundabout way of saying I learned more, and got more involved in this issue on social media and seeing what everyone was thinking on this topic of insulin pricing. I landed on <a href="https://www.t1international.com/" rel="noreferrer noopener" target="_blank">T1International</a> and their <a data-id="https://insulin4all.tumblr.com/" data-type="URL" href="https://insulin4all.tumblr.com/">#insulin4all</a> movement because I felt they are really committed to making a change on a legislative level and they do have a worldwide focus beyond just the U.S. That's important in "Star Trek" because you have many fans in the UK and other places who also can't get their medications but don't necessarily face the same insulin pricing barriers we do here. That's a good reminder to people in the States, that it doesn't have to be the way it is right now.</p>
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<p>So I wound up supporting T1International because our interests are aligned, and they don't take pharmaceutical money which is a big deal for me. Because it's a smaller organization and grassroots, the money that I've raised makes a huge difference. I felt like I could make a difference, not only raising some money but also bringing visibility to the organization and this issue.</p>
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<h3>What has the response been from the Star Trek fanbase?</h3>
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<p>The response has been amazing. I'm certainly not famous by any means, and I'm in my own tiny little safe corner of the internet. I'm not famous enough to attract trolls, so the response has been great, and there's been very little pushback. People are really showing up, even if they can't give money. They have been retweeting and sharing this, and thousands of people — including my Star Trek friends and castmates — have shared it. </p>
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<p>Many of the comments have been "this has happened to me," or to an uncle or parent or someone they know. Seeing that outpouring of support and stories can help people contextualize this and see it's not just happening to a few people somewhere. This really impacts a lot of people, and those on the periphery like friends and family.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-920757" height="225" src="https://post.healthline.com/wp-content/uploads/2021/01/DM-StarFleetLogo.png" width="400" /><figcaption><br /></figcaption></figure>
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<p>One fan whose podcast I did saw that I'd put #insulin4all in my Twitter bio, and they made this really cool graphic of a <a href="https://www.startrek.com/article/starfleet-insignia-explained" rel="noreferrer noopener" target="_blank">Star Trek delta</a> (the symbol that Star Fleet characters wear on their chest) with a blood drop and #insulin4all logo on it. I reached out to T1International about this graphic, and I ended up building an <a href="https://secure.givelively.org//donate/t1international-usa/vials-of-life/noah-averbach-katz" rel="noreferrer noopener" target="_blank">open-ended fundraiser</a> around it. Some fans saw that and made a 3D design and printed some actual physical deltas. I'm hoping to sell, auction, or raffle some of those off to help the cause, maybe with an autograph. </p>
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<p>This all happened because of the Star Trek fans, and that's one thing that makes this Star Trek community so awesome.</p>
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<h3>How did your T1D impact playing the role as Ryn?</h3>
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<p>This was a very challenging experience diabetes-wise, compared to other roles I've had. At the time, I didn't have a pump or CGM. It was just pens and fingerpricks. That mask I was wearing is so restricting, intense, and massive, so I was very concerned about going high from having that sort of cage around my face. </p>
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<p>I didn't want to exacerbate that issue with anything else from a high or low. I was very careful of what I ate and was almost on a zero-carb smoothie diet, and almost didn't eat during the day when I was on set. I was hyper-diligent about it, and so there were no lows or highs that I remember impacting my acting. I spent a lot of time and energy in staying in range, in ways that I wouldn't do in normal life but because this experience was so important to me. I didn't want to feel like diabetes got in the way or impacted my performance.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-920832" height="225" src="https://post.healthline.com/wp-content/uploads/2021/01/DM-NoahRyn-HEADER.png" width="400" /><figcaption>Courtesy of Noah Averbach-Katz / StarTrek.com</figcaption></figure>
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<h3>Any wardrobe issues?</h3>
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<p>One thing that was interesting is that the actor Doug Jones who plays the character <a href="https://memory-alpha.fandom.com/wiki/Saru" rel="noreferrer noopener" target="_blank">Saru</a> must wear prosthetic gloves. Those are very challenging to take on and off, and I was worried that because I didn't have a CGM and needed to do fingerpricks. But my wife Mary told me to let the producers know because not having to wear prosthetic gloves would make a huge difference in managing my blood sugar. They were super accommodating, and that's why in all the scenes that Ryn is in, you can see he's wearing these black gloves that match his costume. Instead of making me wear huge prosthetics or painting my hands blue, and having to ruin the makeup as I touch my diabetes kit. It really made a huge difference.</p>
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<h3>You mentioned starting on a CGM after filming this role?</h3>
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<p>Yes, I'm on the Dexcom G6 now. I hadn't been a huge fan of the CGM with the G5, because it was during my third year at Juilliard and I didn't have the energy or patience to deal with it. Not until early lockdown in April 2020, when I was sitting around not doing anything like I had been. So it was easier to adopt and integrate something new into my diabetes management. It was a good move, and I do think looking back that having the CGM would've been useful when filming those scenes during Discovery's third season.</p>
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<p>I knew, no matter what Ryn's fate might be, that this was going to be a temporary experience and one that I wouldn't have to make a permanent part of my diabetes management. I think I would have to find a different approach if this were a long-term role, and find new ways of making it work for me day-to-day. CGM is definitely something that I'll have going forward, in any future project that I may do.</p>
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<p>Overall, CGM has made a big difference — especially being married and sharing a house. One of my big symptoms when going high is mood swings, and I can sort of get lost in them. So having my numbers available and on Mary's phone makes a big difference and she knows when to let me ride those highs out in the basement.</p>
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<h3>Did you and Mary work together on the show at all?</h3>
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<p>We did a couple scenes together, and that was just amazing. I'd been around the set for almost 2 1/2 years at that point, so I knew the crew and the actors and it was just this electric feeling. Everyone knew I'm this massive Trekkie and how much this meant to me, and everyone was treating me like I'd been the kid on the bench the entire basketball game and finally got to go into the game. To do all of this, and be able to share that experience with Mary, was just so much fun.</p>
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<h3>Anyone else in the Star Trek universe you've met with T1D, too?</h3>
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<p>The boom operator or sound guy on Discovery has a son with type 1, and as a dad he's been figuring that out and we were able to connect there. It's always nice to have that, when they give a sort of nod in understanding what it's like. Someone who knows how difficult it is to manage your makeup and costume, the mask and the hair, your lines and the director and writer... and your diabetes on top of it.</p>
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<h3>Without any spoilers as to Ryn's fate, what's next professionally for you?</h3>
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<p>Right now, we're not in New York City but up in Toronto as Mary shoots season 4. I am taking it easy and enjoying my time on "Star Trek: Discovery" as long as I have before the sun sets on that, and basically trying to stay safe until the industry at large opens up again.</p>
<!--/wp:paragraph-->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-5094111549266893212021-01-13T16:58:00.013-05:002024-02-09T12:37:24.022-05:00Tidepool Loop App for Automating Insulin Dosing Now with FDA<p style="text-align: center;"><b>UPDATE:</b> Tidepool <a href="https://www.tidepool.org/blog/tidepool-loop-has-received-fda-clearance" target="_blank">received FDA clearance</a> on Jan. 23, 2023</p><p>Tidepool Loop, a first-of-its-kind app that will connect with a variety of compatible insulin pumps and continuous glucose monitors (CGMs) to automate insulin dosing, has been <a data-id="https://www.businesswire.com/news/home/20210107005324/en/Tidepool-Completes-FDA-510-k-Submission-of-Tidepool-Loop" data-type="URL" href="https://www.businesswire.com/news/home/20210107005324/en/Tidepool-Completes-FDA-510-k-Submission-of-Tidepool-Loop" rel="noreferrer noopener" target="_blank">submitted for FDA approval</a>.</p><!--wp:paragraph-->
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<p>This is big, Diabetes Friends, because new automated insulin delivery (AID) systems are the future of diabetes care, and because the <a data-id="https://www.tidepool.org/blog/tidepool-delivering-loop" data-type="URL" href="https://www.tidepool.org/blog/tidepool-delivering-loop" rel="noreferrer noopener" target="_blank">Tidepool Loop project</a> represents over two years of development work aimed at bringing do-it-yourself (DIY) "artificial pancreas" innovation into an official, FDA-regulated product that will be broadly available via the iOS app store.</p>
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<p>To date, the diabetes startup has focused on building a cloud-based platform that lets people collect and jointly review data from different glucose meters, insulin pumps, and CGMs. As of early 2021, that entails <a href="https://www.tidepool.org/devices" rel="noreferrer noopener" target="_blank">over 50 different devices</a> along with the ability to upload and interact with that data.</p>
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<p>The new Tidepool Loop innovation continues the mission, but takes it to the next level, says Tidepool founder <a data-id="https://www.diabetestechnology.org/ddc/bios/2018/look.html" data-type="URL" href="https://www.diabetestechnology.org/ddc/bios/2018/look.html" rel="noreferrer noopener" target="_blank">Howard Look</a>, whose inspiration is his daughter, who was diagnosed with type 1 diabetes (T1D) in 2011.</p>
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<p>"The vision is about creating an ecosystem, where you get to choose what's right for you as a person with diabetes," Look tells DiabetesMine. </p>
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<p>"This doesn't get us all the way there, but it's a big step in the right direction. This pushes everyone forward, to thinking about interoperability and interchangeability, and that makes for a better world for people with diabetes."</p>
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<h2>Why is Tidepool Loop a big deal?</h2>
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<p>Once referred to as "artificial pancreas" technology, new AID systems — also known as closed looping — essentially mimic what a healthy pancreas does: monitor glucose levels and deliver insulin as needed. It takes a lot of the guesswork out of managing diabetes and helps keep the user within a healthy blood glucose range 24/7.</p>
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<p>Medtronic and Tandem Diabetes Care currently have their own systems available, and more developers are building their own AIDs to launch in the coming years.</p>
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<p>But even before any commercial system was available, people with diabetes (PWDs) began creating their own homemade DIY artificial pancreas systems. DiabetesMine has been involved in encouraging this effort, rallied around the grassroots #WeAreNotWaiting movement.</p>
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<p>Thousands now use homemade systems called OpenAPS, AndroidAPS and Loop worldwide, but the downsides have held many people back: the complex build-it-yourself process; having to rely on older, non-warranty devices; safety fears; and the lack of an established tech support infrastructure beyond the open-source community.</p>
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<p>That's all about to change, thanks to open-data nonprofit Tidepool.</p>
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<p>Tidepool is building a first-ever commercial version of Loop that would do away with all of those downsides, while offering unprecedented ease of use via smartphone control. </p>
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<p>For those who use the original open-source Loop system, don't fret. That isn't going away. The DIY versions of Loop will still exist and continue to evolve even as this new Tidepool Loop option materializes.</p>
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<p>But this marks the first time a crowdsourced DIY diabetes solution will morph into an "official" FDA-approved product, that can compete with offerings from established vendors. </p>
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<p>This move essentially takes DIY tech that's been largely a "use at your own risk" proposition into the mainstream, allowing for a product that's not only FDA cleared but also one that healthcare professionals may be more comfortable prescribing and discussing with their patients. </p>
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<p>Also, users would now be able to easily use the Tidepool Loop app with any supporting insulin pump or CGM device they may choose — no more scrounging for outdated, used Medtronic models (still the only option for those who don't use the Omnipod).</p>
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<p>The hope is to gain FDA approval ASAP in 2021, to be able to launch the mobile app by year's end.</p>
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<h2>A quick guide to #WeAreNotWaiting diabetes terms</h2>
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<p>Since there's quite a bit of insider jargon here, let's begin with a refresher (primer?) on the #WeAreNotWaiting movement and the key components involved:</p>
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<p><strong>#WeAreNotWaiting: </strong>Hashtag <a class="css-1tpdbgp content-link" href="https://twitter.com/search?q=%23WeAreNotWaiting&src=hash" rel="noopener noreferrer" target="_blank">#WeAreNotWaiting</a> is the rally cry of folks in the diabetes community who are taking matters into their own hands by developing platforms, apps, and cloud-based solutions, and reverse-engineering existing products when needed in order to help people with diabetes better use devices and health data for improved outcomes. The idea is, "<em>We are not sitting back and waiting for the authorities to make these things happen for us</em>." Note that the term was actually coined at our <a class="css-1tpdbgp content-link" href="https://www.facebook.com/media/set/?set=a.10151790075828008.1073741829.56695563007&type=3" rel="noopener noreferrer" target="_blank">first-ever DiabetesMine D-Data ExChange gathering</a> at Stanford University in 2013. </p>
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<p>The DIY movement began most notably with <a href="http://www.nightscout.info/" rel="noopener noreferrer" target="_blank">Nightscout</a>, a tool for remote data-sharing via mobile app, website, and smartwatch. That was before any manufacturers launched their own products with these capabilities. Of course, interest in digital health tools has exploded over the past several years, with burgeoning closed-loop functionality at the center of that in the diabetes world.</p>
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<p><strong>iCGM: </strong>A <a href="https://www.fda.gov/newsevents/newsroom/pressannouncements/ucm602870.htm" rel="noopener noreferrer" target="_blank">regulatory designation the FDA</a> established in March 2018, to indicate CGMs that are designed to be interoperable with other mHealth devices. To date, only the Dexcom G6 has this designation, but it sets up a framework for future connective CGM devices to be approved via a simpler regulatory process. The end game is making it easier for PWDs to choose between the various devices we want to use, knowing they'll be able to "talk to each other."</p>
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<p><strong>ACE pump</strong>: An alternate controller enabled (ACE) pump is the <a href="https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-interoperable-insulin-pump-intended-allow-patients-customize-treatment-through" rel="noreferrer noopener" target="_blank">FDA designation</a> created in February 2019 for interoperable insulin pumps. Currently, the Tandem t:slim X2 is the only insulin pump with that label, but other manufacturers are working toward securing it for their future products.</p>
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<p><strong>RileyLink:</strong> D-Dad Pete Schwamb from Minnesota is the inventor behind this little box that's become a critical part of many DIY closed loop systems. It handles communication between the insulin pump (those older models) and the CGM. It's basically the radio bridge between the devices — speaking the Bluetooth LE language of the iPhone and converting it to 900Mhz frequency that the older Medtronic pumps use. That allows for communication with mobile apps, like Loop, used to control the insulin-dosing functionality via a smartphone or mobile watch.</p>
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<p><strong>Loop: </strong>A DIY automated insulin delivery algorithm app that operates as the "brain" of this particular homemade closed-loop system, containing the algorithm and user interface to control the insulin-dosing and AP functionality. As noted, to date this solution has been completely open-source and non-commercial. It's estimated that 10,000 to 15,000 people globally are using Loop. An open-source website called <a href="https://loopkit.github.io/loopdocs/" rel="noopener noreferrer" target="_blank">LoopDocs</a> contains the community-created and maintained documentation and instructions for building a DIY Loop system.</p>
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<p><strong>OpenAPS:</strong> Another <a href="https://openaps.org/" rel="noopener noreferrer" target="_blank">DIY closed-loop system initially developed by Dana Lewis and Scott Leibrand</a> that's one of the most visible examples of this homemade technology. Lewis, who lives with T1D, started creating it in 2013 and it's evolved with community input ever since. It also uses an algorithm to control the insulin dosing functionality, though unlike Loop where the algorithm is based on the phone app, OpenAPS uses a separate Edison mini-computer or related item to act as the brains of the system.</p>
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<p><strong>AndroidAPS: </strong>Stemming from Europe, this is a Droid-based version of the OpenAPS mentioned above. It works largely the same way, and its development has been mainly led by D-Dad <a href="https://github.com/MilosKozak/AndroidAPS/wiki" rel="noopener noreferrer" target="_blank">Milos Kozak</a>, a software developer from Prague, Czech Republic.</p>
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<p><strong>FDA Digital Health Software PreCertification Program:</strong> In 2017, the federal agency launched a pilot program designed to speed up the regulatory process for health software by creating a "trusted network" system of developers. Tidepool was one of nine companies chosen to participate, and they're now part of regular meetings to determine the best protocols that can be used when making new apps or software. As part of this FDA pilot, Tidepool is working with regulators — and their new Tidepool Loop project is viewed as a potential "test case" that can be used for future DIY technology that may be brought into the regulated commercial space.</p>
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<p><strong>JDRF Open Protocols Initiative:</strong> Launched in late 2017, the JDRF Open Protocols Initiative aims to encourage device manufacturers to build products that are interoperability-ready. JDRF's goal was really to set a baseline for "plug-and-play" diabetes technology, for a world in which PWDs can pick and choose the particular devices they might want to use, and know that they will function well together. While Tidepool Loop isn't directly tied to this initiative, the efforts certainly overlap and the goals go hand-in-hand.</p>
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<h2>Overcoming hurdles, cracking open interoperability</h2>
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<p>Tidepool has long described the goal of Tidepool Loop as helping the D-community "overcome several challenges that prevent widespread adoption of these incredible projects." In the company's words:</p>
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<ul><li>For most people, their only option is to buy an old, used Medtronic pump. We think that’s just not right. People should be able to use officially supported and commercially available pumps. We shouldn't have to buy old, unsupported, out-of-warranty pumps on Craigslist, eBay, or Medwow to get great care.</li><li>Not everyone is comfortable building and maintaining their own DIY system.</li><li>Many people with diabetes are not comfortable using a system that isn’t FDA cleared or approved. And many doctors and Diabetes Care and Education Specialists (DCES) are not willing to recommend a product to their patients that is not FDA cleared or approved. The FDA would really love for there to be an entity that takes responsibility for support and tracking of safety and efficacy, including “post-market surveillance” (the fancy term for "gathering and analyzing data to make sure a pharmaceutical drug or medical device is<br />safe and effective after it ships").</li></ul>
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<p>Tidepool is tackling those barriers head-on.</p>
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<h2>Q&A on the details of Tidepool Loop</h2>
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<p>DiabetesMine spoke with the Tidepool team, including Look, following their FDA filing on Dec. 17, 2020, to get the scoop on this new app, the backstory, and how it will be supported. </p>
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<h3>How would you describe this 'iController' app?</h3>
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<p>Think of it like an equation: a compatible pump + a compatible CGM + controlling algorithm = a closed-loop system. While some systems currently available (like the Medtronic, Tandem, and upcoming Omnipod technologies) weave those smart algorithms into their systems, this new Tidepool Loop app will allow for a separate piece to work with the pump and CGM.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-962574" height="225" src="https://post.healthline.com/wp-content/uploads/2021/01/DM-TidepoolLoop-HEADER.png" width="400" /><figcaption>Conceptual rendering; not FDA-approved. Image courtesy of Tidepool.</figcaption></figure>
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<p>"What if instead of going to one or two companies for each piece of the system, you had a third party with an app allowing for that interoperability?" explained Melissa Lee, a longtime T1D advocate who is Tidepool's marketing and clinical training manager. "Those three pieces make up the system, and it's the (algorithm) piece that we're doing."</p>
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<p>The goal is to modify basal rates every 5 minutes. The algorithm will look at your insulin on board, current glucose reading, and entered carbs that you plan to eat, and adjust the basal rates to reduce or avoid high and low blood sugars.</p>
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<h3>Will this offer customizable glucose targets?</h3>
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<p>Tidepool has asked the FDA for adjustable glucose targets, something the agency hasn't before allowed. Compared to existing closed loop tech with fixed targets — Medtronic's 670G at 120 mg/dL and Tandem's Control IQ at 112 mg/dL — the Tidepool app submission proposes personalization for those settings. It's TBD whether the agency will OK that idea for Tidepool Loop's mobile app.</p>
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<h3>How exactly does it differ from the DIY Loop version?</h3>
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<p>While Tidepool needs to wait for FDA clearance before discussing specific features, they remind the D-Community about data from the <a href="https://clinicaltrials.gov/ct2/show/NCT03838900" rel="noreferrer noopener" target="_blank">JAEB Loop Observational Study of DIY Loop</a> to help support their submission. </p>
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<p>Any changes that Tidepool has made to the DIY product have been made in a way that they believe will be supported by the study data and Tidepool’s own usability testing data. The company says they look forward to publishing full submission documentation once the agency has had a chance to complete their review. </p>
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<p>Look says they also plan to keep the "DIY Loop experience" that many in the #WeAreNotWaiting community are familiar with, and that may include pizza-specific boluses that can be extended for longer-impacting meals like that. Fun features like including emojis may also remain a part of Tidepool Loop!</p>
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<h3>Which phones will it be compatible with?</h3>
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<p>At launch, it will work on iPhone and iPod Touch. Eventually, Android compatibility will be added as well.</p>
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<h3>What about connecting with smart insulin pens?</h3>
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<p>Look says: "That's a very interesting path. We have nothing to announce, but I'm a big believer in connected pens and it could be something we think about in the future."</p>
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<h3>How much will Tidepool Loop cost?</h3>
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<p>"We would really like Tidepool Loop to be as accessible, broadly and fairly and equitably, as possible. There are a lot of ways we can make that happen and we're exploring that, especially as we are a nonprofit," Look says. </p>
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<p>To date, everything Tidepool has offered (prior to Tidepool Loop) has been made available for no cost to the end-user. That's been possible through corporate sponsorships, JDRF and Helmsley Charitable Trust grants, as well as D-Community donations.</p>
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<p>"We are keenly aware that asking end users to pay for Tidepool Loop out of pocket would be a bad idea," Look said. "We'll keep the community updated as we work through device accessibility and insurance. It's too early to say at this point on how that will all go for potential users."</p>
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<h3>Will the company offer tech support for Tidepool Loop users having issues with their CGM or pump?</h3>
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<p>Look says: "I think it's fair to say we won't get into the hardware distribution business. We aren't going to be a single point of contact to get supplies or devices. To the extent that we can collaborate with our device partners to make it easier for people to get bundles, that is a great opportunity that we can look at."</p>
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<h3>How will you approach your own customer service for this app?</h3>
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<p>Tidepool's goal is to provide delightful and empathic support for our users, and this is where us having "pancreas in the game" matters. They understand what it's like to live with diabetes, and how important having good customer support is. </p>
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<p>"With Tidepool Loop, we'll have a wonderful opportunity to innovate on this because (users) will be holding the product — a mobile app — on their phone in their hand. So that allows us to provide some of the support on the phone directly, and we're exploring all of that," Look says.</p>
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<h3>Who are Tidepool's device partners?</h3>
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<p>Tidepool says it has a "dance card" that continues to evolve. As of early 2021, partners include Insulet with its Omnipod tubeless pump, Medtronic, and Dexcom. They will also likely work with the Tandem t:slim X2 down the road, given that device has an ACE/iPump designation. In the past, Tidepool has told DiabetesMine that they'd likely work with other pump and CGM makers involved in the JDRF Open Protocols Initiative: Roche, Sooil, SFC Fluidics, and Ypsomed.</p>
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<h3>How impactful was the JDRF Open Protocols effort on getting you to this point?</h3>
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<p>Tidepool says JDRF did the industry a world of good in establishing the Open Protocols Initiative. </p>
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<p>Coupled with the consistent advocacy from both JDRF and the Helmsley Charitable Trust to bring together device makers, regulators, and legal experts, the initiative gave credibility to the concept of device interoperability. Now the work lies with these many stakeholders to work out the details from a business and regulatory perspective, "but we couldn’t be pursuing it if the initiative hadn’t generated the momentum," Look says.</p>
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<h3>How does Tidepool view the competitive 'race' to get closed loop technology to market?</h3>
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<p>Look says: "We see it more as pieces of a puzzle coming together. We believe a rising tide lifts all boats. If our submission can help create pathways of innovation for new algorithm creators or existing large medical device companies, it’s the people with diabetes and their care teams who ultimately benefit."</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-962564" height="225" src="https://post.healthline.com/wp-content/uploads/2021/01/DM-Tidepool-PuzzleLogo.png" width="400" /><figcaption>Courtesy of Tidepool</figcaption></figure>
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<h3>Tidepool was hit hard by the pandemic and needed layoffs. How does that impact your work now?</h3>
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<p>"Practically, we've always been a remote organization and gave up our small San Francisco office in 2017. We've been completely virtual before it was necessary. So from that perspective, that switch wasn't a big impact on us. But the financial impact has been tough," Look says. </p>
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<p>"The pandemic hit a lot of nonprofits hard, including us. We had to reduce expenses, and that meant doing one of the saddest things we've ever done: <a data-id="https://www.tidepool.org/blog/the-future-of-tidepool-things-were-thankful-for" data-type="URL" href="https://www.tidepool.org/blog/the-future-of-tidepool-things-were-thankful-for" rel="noreferrer noopener" target="_blank">saying goodbye</a> to some incredibly talented and capable people, in order to get through this dark period. But we were able to hunker down and continue to execute on our mission."</p>
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<p>Look continued, "It's been hard, and I won't pretend I ever want to go through that again, but I'm thankful for every single person on board who helped get us to this point, as well as the people who are still on the team helping us continue on with our mission. I'm optimistic that the pandemic will end, fundraising will get back to normal, and then we'll be able to move forward."</p>
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<h3>How quickly do you expect Tidepool Loop to move through the FDA review process?</h3>
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<p>Being one of the first companies in FDA’s software pre-certification pilot program affords the company more frequent communication with FDA. They tell DiabetesMine that the FDA has been extraordinary to work with so far, and they don’t expect that to change. </p>
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<p>"What we can’t account for is the delay in review cycles that we’re seeing across industry due to the urgent focus for FDA that is COVID-19," Look says.</p><p style="text-align: center;">- - - - - - - - - - - - - - - - - -</p><p style="text-align: center;"><i>Originally published on DiabetesMine on Jan. 13, 2021</i></p>
<!--/wp:paragraph-->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-46226472545629951292021-01-12T16:26:00.015-05:002022-03-25T16:31:57.608-04:00Why Dr. Denise Faustman Isn’t Deterred by Skeptics of Her Type 1 Diabetes Cure Research<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTyep8yIZPPgoKXjN5GNf4d1GTIo13zzxx4e9k5Tc6BL98EGwuK0WPKRHaoWbpet8EhTwqaTU1XYkt8tzyetUyBqG_rRFTenx-0VsXILpyKpFyIHx-dLU0fmCoKlxeNyVDmmsKkXZSINUgm3J-P9DXdlFxu1tugo0U00owGIl2PG2LJIom_5qsnw-O/s1024/DM-Faustman-Research.jpeg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="683" data-original-width="1024" height="426" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTyep8yIZPPgoKXjN5GNf4d1GTIo13zzxx4e9k5Tc6BL98EGwuK0WPKRHaoWbpet8EhTwqaTU1XYkt8tzyetUyBqG_rRFTenx-0VsXILpyKpFyIHx-dLU0fmCoKlxeNyVDmmsKkXZSINUgm3J-P9DXdlFxu1tugo0U00owGIl2PG2LJIom_5qsnw-O/w640-h426/DM-Faustman-Research.jpeg" width="640" /></a></div><br />Dr. Denise Faustman is known in many circles as one of the most controversial figures in <a href="https://www.faustmanlab.org/current-research/" rel="noreferrer noopener" target="_blank">type 1 diabetes (T1D) cure research</a>. She's raised millions of dollars and waves of hope with her work but has also been effectively shunned by the research community. Yet she barrels forward with her innovative vaccine-based approach to a cure, never letting naysayers deter her.<p></p><!-- wp:paragraph -->
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<p>This is her story.</p>
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<h2>Motivated as a child</h2>
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<p><a href="https://cfmedicine.nlm.nih.gov/physicians/biography_108.html" rel="noreferrer noopener" target="_blank">Born in Royal Oak, Michigan</a>, Dr. Faustman now leads the <a href="https://www.massgeneral.org/endocrinology/diabetes/research/immunobiology-lab" rel="noreferrer noopener" target="_blank">Immunobiology Laboratory</a> at Massachusetts General Hospital (MGH) and Harvard Medical School in Boston. </p>
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<p>As a child, Faustman recalls how much she disliked her pediatrician’s general tone and approach.</p>
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<p>“He was really severe and didn’t talk much,” says Faustman. “I thought I could do a better job than this guy.”</p>
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<p>And so she set out to become a doctor, doing a great deal of research throughout high school and college. Over the course of a decade after college, Faustman earned her MD, PhD, and postdoctoral degrees, always fueled by a passion for research. </p>
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<p>She worked as a hands-on physician in a diabetes clinic for a number of years but tells DiabetesMine that she found the work to be filled with giving patients bad news, followed by “Debbie Downer” lectures on blood sugar, cholesterol, complications, etc. Eventually, she found her way back to research.</p>
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<p>“I liked asking questions, so I figured maybe academia was a good way to go,” explains Faustman, who began working at the Washington University School of Medicine in St. Louis with the legendary <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1603562/#:~:text=Paul%20Lacy%2C%20a%20pathologist%20who,at%20the%20age%20of%2081.&text=Lacy%20dedicated%20his%20extraordinary%20career,types%20within%20islets%20of%20Langerhans." rel="noreferrer noopener" target="_blank">Dr. Paul Eston Lacy, </a>known for pioneering islet cell transplantation as a potential treatment for diabetes. </p>
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<p>Lacy was also one of the first in diabetes research to identify and isolate the insulin-secreting cells from the pancreas of rats.</p>
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<h2>Early transplant work</h2>
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<p>“My work with Lacy was focused on making the islet cell ‘invisible,' moving the work forward to humans so we wouldn’t need to give patients immunosuppressive drugs after a transplant,” explains Faustman. </p>
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<p>By the time Faustman was leaving Washington University, they had performed the first islet cell transplant in 1989 with hopes that a cure for T1D was just around the corner. This research was also a significant contributor to the creation of the T1D-focused organization <a href="https://www.jdrf.org/" rel="noreferrer noopener" target="_blank">JDRF</a>.</p>
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<p>“It was the only place in the world that had isolated an islet cell,” Faustman says. “MGH and Harvard recruited me — they set me up in a lab to begin islet cell isolation and transplantation.”</p>
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<p>Faustman’s early islet cell transplantation work focused on putting islets in patients with T1D who were also undergoing kidney transplants.</p>
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<p>“We figured if they were already on the yucky stuff — the immunosuppressive drugs — for the kidney transplant, it was a good opportunity for an islet cell transplant.”</p>
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<p>Within a few weeks to a couple of months, Faustman and her team at Harvard would find that the islet cells were dead while the kidney was still performing well.</p>
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<p>“We probably did 8 to 12 transplants before we had a crystal clear bad answer,” recalls Faustman.</p>
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<p>Today, given what we know about the immune system’s ongoing attack on pancreatic cells, this result isn’t surprising. However, at the time — the late '80s and early '90s — diabetes researchers operated under the assumption that the immune system attacked only once, at the time of diagnosis.</p>
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<h2>Bucking the community</h2>
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<p>“After seeing so many failed transplants, I said, ‘Hey, wait a minute. There’s clearly an autoimmune issue still occurring here,'” recalls Faustman. “That was my first experience in bucking the community. They just assumed the autoimmunity was gone, but there were a few us raising our hands and pointing out that the autoimmunity was still a big issue and we were not very popular.”</p>
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<p>Sure enough, over the course of the next decade, the idea that autoimmunity continues in people with T1D became widely accepted. </p>
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<p>“When we started saying that islet cells weren’t the cure for diabetes, that’s when I should have learned the whole ‘keep your mouth shut’ if you’re going to go against where the money is going.”</p>
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<p>Faustman began her unconventional approach of focusing on the generic <a data-id="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139880/" data-type="URL" href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7139880/" rel="noreferrer noopener" target="_blank">Bacillus Calmette Guerin (BCG) vaccine</a>, due to its known induction of Tumor Necrosis Factor (TNF) and T-regulatory cells, which have the ability to kill the bad T-cells causing T1D.</p>
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<p>Her early results in lab mice created a lot of excitement, but since other researchers were unable to reproduce her results, skepticism among the scientific community began to spread. JDRF, a major funder of cure research, refused to back her. </p>
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<p>Nevertheless, she started the first immune interventional clinical trials in people with long-term diabetes, instead of just people with new-onset diabetes.</p>
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<p>In 2018, in an unprecedented move, JDRF and the American Diabetes Association (ADA) issued a <a data-id="https://www.healthline.com/diabetesmine/denise-faustman-research-pushback-ada-jdrf#1" data-type="URL" href="/diabetesmine/denise-faustman-research-pushback-ada-jdrf#1" rel="noreferrer noopener" target="_blank">joint statement warning the community</a> not to get too excited about her research. They noted her studies were very small sample sizes and “the findings prompt thought-provoking questions but not definitive answers” that are needed before her work can be broadly touted as a success.</p>
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<h2>Breakthrough or not? </h2>
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<p>But Faustman says if you look at many discoveries she and her colleagues have made over the years, they were often refuted at the time and then accepted 10 years later when other researchers caught up to speed.</p>
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<p>She provides a list of examples of early scientific dogmas that Faustman and her colleagues challenged — which later turned out to be true:</p>
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<ul><li>Identifying the immune system is still attacking insulin-producing beta cells long after the initial diagnosis</li><li>Identifying T1D results largely from changes to "miseducated" <a href="https://pubmed.ncbi.nlm.nih.gov/19111164/" rel="noreferrer noopener" target="_blank">CD8 cells</a>, in addition to the well-accepted role for CD4 cells</li><li>Confirming the hormone TNF can kill the “bad” CD8 cells and induce helpful regulatory T-cells</li><li>Identifying most people with T1D continue to <a href="https://pubmed.ncbi.nlm.nih.gov/14747294/" rel="noreferrer noopener" target="_blank">secrete varying amounts of insulin</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/24645775/#:~:text=Residual%20%CE%B2%2Dcell%20function%2C%20as,demonstrated%20to%20be%20clinically%20important.&text=Moreover%2C%20the%20model%20also%20implied,progressed%20to%20absolute%20insulin%20deficiency." rel="noreferrer noopener" target="_blank">C-peptides</a> for decades after initial diagnosis</li><li>Identifying <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6132734/" rel="noreferrer noopener" target="_blank">islet cells have HLA class-1 markers</a> that track to poor T-cell development and discovery of a "downstream intracellular defect in a TNF-sensitive pathway."</li><li>Showing BCG induced TNF, which reverses end-stage T1D in mice</li></ul>
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<p>“We’ve always tried to do innovative things,” says Faustman, who continues to forge ahead despite a lack of broader support from the T1D research community. </p>
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<p>“Almost every major breakthrough in the history of medicine started as a controversy. I don’t care what people say as long as it’s honest,” adds Faustman. “As <a data-id="https://www.vanityfair.com/news/2010/11/moynihan-letters-201011" data-type="URL" href="https://www.vanityfair.com/news/2010/11/moynihan-letters-201011" rel="noreferrer noopener" target="_blank">Daniel Moynihan</a> said, ‘Everyone is entitled to their own opinion, but not their own facts.’” </p>
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<p>Diabetes advocate and <a data-id="https://diatribe.org/author-advances-damaging-myth-about-diabetes" data-type="URL" href="https://diatribe.org/author-advances-damaging-myth-about-diabetes" rel="noreferrer noopener" target="_blank">author James Hirsch</a> summed up the Faustman controversy this way: "In the staid science world, she’s an unconventional thinker, she’s doing experiments that no one else is doing, and she’s devoted her life to the cause. She also ruffles feathers because she promotes her work and attracts publicity. Flamboyance is not admired in science, and some of the attacks against her have been personal and unfair. But her larger problem, and the reason the JDRF has rejected her requests over the years, centers around the reproducibility of her research and the overall soundness of her work."</p>
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<h2>Funding her work: An unexpected relationship</h2>
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<p>After billionaire <a data-id="https://www.nytimes.com/2019/07/02/obituaries/lee-iacocca-dead.html" data-type="URL" href="https://www.nytimes.com/2019/07/02/obituaries/lee-iacocca-dead.html" rel="noreferrer noopener" target="_blank">Lee Iacocca</a> lost his wife, Mary McCleary, to complications of T1D, he was determined to invest some of his wealth into finding a cure for the disease and started the <a data-id="https://www.iacoccafoundation.org/" data-type="URL" href="https://www.iacoccafoundation.org/" rel="noreferrer noopener" target="_blank">Iacocca Family Foundation</a>.</p>
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<p>Known largely for the development of the Ford Mustang, Iacocca was a successful automobile executive at Ford Motors and was also credited for reviving the Chrysler Corporation in the ‘80s.</p>
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<p>“One day, I’m in my office and this guy shows up,” recalls Faustman. It was George Cahill, a well-known diabetes researcher, senior leadership at Joslin Diabetes Center in Boston, and a past president of the Howard Hughes Medical Institute.</p>
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<p>“He said, ‘I’m really interested in your work and I like the fact that you’re interested in human immunology,” recalls Faustman. “He said he’d been selected [by Iacocca] to find young people doing innovative things.”</p>
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<p>The result was a small grant program focused on diabetic lymphocytes — and the Iacocca Family Foundation has been contributing financially to her research ever since, including a lump sum of $10 million towards her Phase I clinical trials. </p>
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<p>Between that and other private donors, the <a data-id="http://www.faustmanlab.org/wp-content/uploads/2018/05/DrFaustmanUpdate_Fall-2017.pdf" data-type="URL" href="http://www.faustmanlab.org/wp-content/uploads/2018/05/DrFaustmanUpdate_Fall-2017.pdf" rel="noreferrer noopener" target="_blank">Faustman Lab has raised</a> over $22 million over the years and continues to actively fundraise.</p>
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<h2>Getting started with the BCG vaccine</h2>
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<p>The BCG vaccine that is the focus of Faustman's diabetes research has existed for over 100 years, primarily known for its ability to protect humans from tuberculosis. </p>
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<p>Initially, using BCG to treat T1D was done with the hope that it would stop the immune system from destroying precious insulin-producing beta-cells.</p>
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<p>But back in the early 2000s, Faustman set her sights on utilizing BCG to boost levels of the hormone known as TNF. It’s well established that people with autoimmune disease are deficient in TNF. By increasing TNF, Faustman aimed to eliminate the T-cells killing off beta cells and increase the amount of T-regulatory cells, which would then help the pancreas produce new beta cells.</p>
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<p>At first, Faustman tried to find a pharmaceutical manufacturer to discuss producing a new source of TNF, but they found it to be too costly, lasting only minutes once administered in the human body, and potentially deadly if you received too much.</p>
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<p>“The BCG vaccine, on the other hand, is a simple drug used for vaccines around the world, so why are we trying to recreate this?” Faustman asks.</p>
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<h2>Faustman’s Phase I trial</h2>
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<p>In mice trials, the BCG vaccine was effective in near-death diabetic mice, so Faustman broke from a norm in diabetes research and chose people with long-term diabetes to participate in her Phase I trial that began in 2007.</p>
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<p>“At the time, we were concerned that we would not have the budget to recruit new onset patients,” says Faustman.</p>
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<p>In the end they were able to use the BCG vaccine to treat T1D in 9 participants — all of whom had lived with the disease for 15 to 20 years. The early results were underwhelming. </p>
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<p>At 22 weeks, there were no changes in <a href="/health/type-2-diabetes/ac1-test" rel="noreferrer noopener" target="_blank">A1C results</a> or insulin production. Faustman did find small changes in biomarkers, like T-regulatory cells and C-peptide cells. Regardless, she says these findings wouldn’t feel like much of a victory to those living with the day-to-day burdens of T1D.</p>
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<p>Around the same time, research using the BCG vaccine in new onset multiple sclerosis patients was published, and it was impressive.</p>
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<p>“That data showed that BCG was preventing relapses, showing in MRI scans that lesions [on the brain] were not progressing, and some were even reversing,” recalls Faustman. “And these findings were occurring after year two and year three of starting treatment with BCG. BCG is halting the disease and producing brain recovery.” </p>
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<p>This research led Faustman to re-open her own BCG study, which closed after the planned 22-week trial was complete. </p>
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<p>“We looked at our data and thought, ‘Why would we think we’d see clinically meaningful data at 22 weeks?’ We realized we needed to reopen that study and look at the longer-term results.”</p>
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<p>Sure enough, when they brought every participant back three to four years after BCG vaccinations, they found notable changes.</p>
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<p>“We started by looking at their A1Cs,” explains Faustman, “and it was not a subtle finding.”</p>
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<p>Three years after receiving BCG, every participant experienced anywhere from a 10 to 18 percent reduction in A1C, and their insulin needs had decreased by at least a third.</p>
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<p>She says many people questioned her choice to include long-term patients instead of newly diagnosed. Her response: “There’s a belief that once you get the disease, and have had it for years, it’s too late. But isn’t that what the public wants: A treatment for the people who’ve had diabetes for years and years?”</p>
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<p>The other point of criticism was the sample size of just nine patients. "When you see a small study with huge statistical significance, it means that everybody responded to the treatment," she says.</p>
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<p>Also, Faustman and her team waited a year to publish <a data-id="https://www.sciencedaily.com/releases/2011/06/110626145244.htm" data-type="URL" href="https://www.sciencedaily.com/releases/2011/06/110626145244.htm" rel="noreferrer noopener" target="_blank">results of their Phase I trial</a>, and later did a more comprehensive five-year followup, published in 2018. She says they "resisted publishing the findings until we could better understand what led to the stable and long-term corrections in blood sugar levels and a one-third drop in insulin needs."</p>
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<h2>Exploring her own results</h2>
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<p>“We’ve looked closely at what the pancreas is doing by administering glucagon and drawing blood. There was only a little blip in insulin secretion. No way that this little amount could explain a drop in A1C from 8.5 to 7.0 percent,” explains Faustman. </p>
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<p>“Was it a change in insulin resistance?” recalls Faustman of their next speculative guess.</p>
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<p>An expensive thing to test, they sent patient serums to <a href="https://www.metabolon.com/" rel="noreferrer noopener" target="_blank">Metabolon</a>, a unique lab that analyzes biochemistry, genetics, and more. </p>
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<p>The results: no significant changes in insulin resistance when evaluated for metabolites consistent with this metabolic change.</p>
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<p>What they did find, however, was a huge increase in “purine metabolism.” Purines are uric acid that accumulates in the blood — but why would BCG affect this?</p>
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<p>“When we looked deeper into understanding this, we became acutely aware that at baseline, [people with diabetes] had a metabolic effect that hadn’t been described before,” explains Faustman. “People with type 1 diabetes using more oxidative phosphorylation than glycolysis for energy.”</p>
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<p>Oxidative phosphorylation uses no sugar for fuel compared to glycolysis, which uses tons.</p>
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<p>“This is a defect in white blood cells,” explains Faustman. “We looked at the lymphoid system in the participants before they started BCG and they were not using much sugar for energy. Then we looked after BCG and glucose was now their primary source of energy. The BCG treatment was flipping lymphoid metabolism to become a regulator of blood sugar levels.”</p>
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<p>Recalling that BCG is actually a live but weakened strain of tuberculosis, it is known that when you develop tuberculosis, it switches energy metabolism in the same exact way. </p>
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<p>“Our best result was an outlier,” says Faustman of the participants. “His A1C is at 5.5 percent, he can go off his insulin entirely sometimes for a few months. Then he might see his blood sugars start to rise again and he goes back on a small amount of insulin.”</p>
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<p>Faustman adds that, strangely, when his blood sugar levels do start rising he does not produce ketones. </p>
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<p>“We monitor ketones in all our participants. We think the reason he isn’t going into ketoacidosis is because the pathway that leads to the use of oxidative phosphorylation starts right after the production of ketones.”</p>
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<p>If BCG is preventing the process of oxidative phosphorylation as the primary source of energy, ketones aren’t occurring either.</p>
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<p>“We realized on a systemic level that we were able to change sugar metabolism. Participants also experience fewer low blood sugars because their insulin doses have decreased so much.”</p>
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<p>Faustman adds that while they know BCG can reduce a person’s A1C level by 10 to 18 percent, they haven’t tried the treatment on the more extreme cases with A1Cs above 10 percent. </p>
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<p>“This is such an individual disease. Could the results of this treatment mean some people end up just taking some basal insulin while others might choose to just do insulin for meals? We don’t know yet," she says.</p>
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<h2>Phase II: Faustman’s research today</h2>
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<p>Today, Faustman and her team continue to follow patients who have been involved in multiple BCG trials at the lab, including the 150 patients in the double-blinded <a data-id="https://clinicaltrials.gov/ct2/show/NCT02081326" data-type="URL" href="https://clinicaltrials.gov/ct2/show/NCT02081326" rel="noreferrer noopener" target="_blank">Phase II clinical trial</a> that kicked off in 2015. The estimated completion date for that study at the <a data-id="https://clinicaltrials.gov/ct2/show/NCT02081326" data-type="URL" href="https://clinicaltrials.gov/ct2/show/NCT02081326" rel="noreferrer noopener" target="_blank">ClinicTrials.gov site</a> is July 2023, a surprisingly long timeline.</p>
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<p>“We are building a large and well-controlled data set,” explains Faustman. “Pending approval by the FDA, we hope this year to start a multi-institution pediatric trial.”</p>
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<p>To date, she says more than 236 patients have been involved in the BCG trials either completed or enrolled and 143 have been treated with BCG. </p>
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<p>Skeptics believe that Faustman may be dragging her feet on completion of next-round trials. And given the JDRF and ADA's <a href="https://www.jdrf.org/blog/2018/06/25/joint-statement-from-jdrf-and-the-american-diabetes-association/" rel="noreferrer noopener" target="_blank">joint statement</a> urging caution on interpreting her Phase I results, some believe that standing up and supporting Faustman could pose a conflict-of-interest for other experts in the community whose research is funded and supported by the JDRF. </p>
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<p>But who knows? This pushback may eventually help her gain more support from the research community, not unlike what happened with <a href="https://www.pbs.org/video/story-cancer-emperor-all-maladies-dr-bernard-fisher/" rel="noreferrer noopener" target="_blank">Dr. Bernard Fisher’s revolutionary work</a> that challenged norms in the treatment of breast cancer.</p>
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<h2>BCG’s growing popularity in other research</h2>
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<p>Meanwhile, using the BCG vaccine to treat other conditions has been growing in popularity remarkably.</p>
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<p>“One of our biggest challenges was not just that we had a lot to learn about type 1 diabetes, we had a lot to learn about BCG,” explains Faustman. </p>
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<p>“As part of a <a href="http://www.bcgworkinggroup.org" rel="noreferrer noopener" target="_blank">global coalition of BCG researchers</a>, we have fundamentally changed our understanding of how BCG interacts with the immune system, how long it takes to work, and how long it lasts,” she says. </p>
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<p>“I get a call at least once a month from someone working on <a data-id="https://www.healthline.com/health/fibromyalgia" data-type="URL" href="/health/fibromyalgia" rel="noreferrer noopener" target="_blank">fibromyalgia</a>, allergies, autoimmunity, Alzheimer’s, and other conditions that might benefit from BCG. There’s a global interest, especially in Europe and Australia. There are even some very interesting data sets showing that the right strain of BCG, at the right time and sequence, can delay the onset and possibly prevent type 1 diabetes.”</p>
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<p>There are also 22 global trials using the BCG to prevent or lessen the impact of COVID-19. <a href="https://www.faustmanlab.org/wp-content/uploads/2020/04/BCG2-pagerC-19.pdf" rel="noreferrer noopener" target="_blank">Faustman details BCG and COVID-19 research</a> in her own work, noting that multiple studies have shown there are fewer COVID cases in areas where the BCG vaccine is universally applied. Dr. Faustman is a co-principal investigator on a <a data-id="https://trialsitenews.com/massachuesetts-general-hospital-to-commence-trial-investigating-the-correlation-of-bcg-vaccine-to-covid-19-health-improvements/" data-type="URL" href="https://trialsitenews.com/massachuesetts-general-hospital-to-commence-trial-investigating-the-correlation-of-bcg-vaccine-to-covid-19-health-improvements/" rel="noreferrer noopener" target="_blank">multi-center BCG/COVID-19 trial</a>.</p>
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<p>Of course, as BCG’s popularity rises and the data continues to expand, Faustman has found new and interesting allies, such as health insurance companies and large employers, who understand the value of an inexpensive intervention with limited dosing. </p>
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<p>“I’m a lot more popular now. I have a lot of new friends!” she notes with amusement considering the flack she’s taken over the years. </p>
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<p>“There has been interest from big pharma, too, just not so much in BCG,” says Faustman. “They know we have identified a novel pathway and are starting to think about new ways to attack it. It will be interesting to see what they come up with.”</p>
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<p>As for her trial participants, they never miss an appointment.</p>
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<p>“I have participants who rent an RV in Montana and drive to Boston just so they don’t have to worry about COVID-19 interfering with their appointments,” says Faustman with gratitude. “Our participants are all very educated in their disease and grateful to be involved. It’s a real privilege for our nursing staff.”</p>
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<p>The interest from others with T1D continues to grow, too.</p>
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<p>Faustman has a lengthy waiting list of patients who would love to enroll in the next study — if only it were that simple.</p>
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<p>“Everybody should register. You’ll get the newsletter once a year with updates, and notified of upcoming trial opportunities. But our trials are very narrow with specific details about how long you’ve lived with type 1 and other factors that mean not just anyone can participate," she explains.</p>
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<p>People with T1D can e-mail <a href="mailto:DiabetesTrial@partners.org" rel="noreferrer noopener" target="_blank">DiabetesTrial@partners.org</a> to register and stay up-to-date on Faustman’s work.</p>
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<p>As for the critics, Faustman intends to continue ignoring them. </p>
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<p>“Discovery is always a disruptive process,” says Faustman. “I am not here to confirm what people want to see.”</p><p style="text-align: center;">- - - - - - - - - -</p><p style="text-align: center;"><i>Written by Ginger Vieria and originally published on DiabetesMine</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-68964716462743510472021-01-08T12:59:00.005-05:002023-11-14T13:04:34.268-05:00The Big 100th Anniversary for Insulin<div class="separator"></div><div class="separator"></div><div class="separator"><figure class="wp-block-image alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><figcaption class="wp-element-caption"><br /></figcaption></figure></div><p>2021 marks the 100th anniversary of the most important and impactful event for many in the Diabetes Community: the discovery of the life-sustaining liquid that would transform this condition from a death sentence into a manageable condition for millions worldwide.</p><!-- wp:paragraph -->
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<p>Insulin was discovered in 1921 by Drs. Frederick Banting and Charles Best. But marking a century since that amazing development involves more than honoring these pioneers. </p>
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<p>In fact, the <a data-id="https://definingmomentscanada.ca/our-story/bios/" data-type="URL" href="https://definingmomentscanada.ca/our-story/bios/">Defining Moments Canada</a> Insulin 100 team leading this historical initiative is adamant that a <a href="https://definingmomentscanada.ca/insulin100/timeline/">series of events</a> from 1920 to 1923 actually mark insulin's brightest initial moments, leading to where we are now.</p>
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<p>The ironic and unfortunate reality is that today, many people can't afford the lifesaving insulin they need. </p>
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<p>Some are forced to ration, even to the point of death. It's a fact that would no doubt have Banting and Best rolling over in their graves.</p>
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<p>“It’s all very emotional, especially this year,” said Rebecca Redmond in Ontario, who has lived with type 1 diabetes (T1D) for more than two decades and happens to be a distant cousin of Banting. </p>
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<p>“Every single person I meet or story I hear hits me in a place I cannot quite articulate. There are no words when you are directly connected to so many people who share your plight and the man who’s co-responsible for your being present,” she said.</p>
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<p>Still, the Insulin 100 group is marking this centennial with multiple <a href="https://insulin100.com/">conferences and virtual events</a> meant to appreciate and celebrate the advent of insulin, even as we recognize how much still needs to change.</p>
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<h2>New Google Doodle for Insulin 100?</h2>
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<p>To garner global attention, there's a renewed push for a Google Doodle to mark insulin's centennial.</p>
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<p>It may seem like a long shot, but remember it happened before: Diabetes advocates spent years lobbying Google before the company actually created an insulin Doodle to honor World Diabetes Day on Nov. 14, 2016. (That date in November marks Banting’s birthday.)</p><figure class="wp-block-image size-large" style="margin-left: 1em; margin-right: 1em;"><img alt="" class="wp-image-1109005" height="270" src="https://post.healthline.com/wp-content/uploads/2021/03/DM-GoogleDoodle-2016.png" width="479" /></figure><p></p>
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<p>It was pretty remarkable to see that diabetes artwork displayed at the top of Google’s global search page, generating awareness and likely getting millions of views that particular day.</p>
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<p>Google did not respond to queries from DiabetesMine for this story. But who knows, it may be on the horizon.</p>
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<h2>Celebrations led by the ‘birthplace of insulin’</h2>
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<p>The historic Banting House in Ontario, Canada, is particularly invested in marking this centennial. </p>
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<p>It's a historic site converted into a museum to honor the “birthplace of insulin,” where Banting lived at the time he came up with the idea leading to insulin’s discovery. </p>
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<p>Located at 442 Adelaide Street in London, Ontario, the site is run by the Canadian Diabetes Association.</p>
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<p>It was in an upstairs bedroom of this house where Banting woke up suddenly in the middle of the night on Halloween 1920, scratching notes that led to his important research that cracked the code for insulin’s use to treat diabetes.</p>
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<p>The rest is history, of course.</p>
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<p>Banting House initiatives for the Insulin 100 campaign include: </p>
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<li>a telling of the history of diabetes and diabetes research through stamps collected by one collector over the course of 40 years</li>
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<li>a new in-person exhibit opening July 2021 relating the story of one person's journey from the <a data-id="https://bantinghousenhsc.WordPress.com/2016/07/29/before-banting-treatments-for-diabetes-in-the-pre-insulin-era/" data-type="URL" href="https://bantinghousenhsc.WordPress.com/2016/07/29/before-banting-treatments-for-diabetes-in-the-pre-insulin-era/">Allen “Starvation Diet”</a> — an early draconian measure to keep people with diabetes alive — to insulin treatment</li>
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<li>social media campaigns throughout the coming year marking significant historic dates for insulin’s discovery leading up to October 2023, with a commemoration of Banting and Best's recognition for insulin, earning Canada’s first Nobel Prize</li>
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<h2>Augmented reality for museum visitors</h2>
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<p>Roughly 4,000 people visited the Banting House from 85 countries in 2019 before the pandemic began. </p>
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<p>Only a fraction of those were able to visit in 2020 when the museum was closed during lockdowns. It was only open for 6 weeks between October and December 2020.</p>
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<p>With new limited hours starting in March 2021, the museum hopes to see more visitors later in the year once COVID-19 vaccines are more widely distributed and as international travel resumes.</p>
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<p>Meanwhile, a <a href="https://techalliance.ca/banting-house-celebrates-100-years-since-insulin-discovery-with-new-ar-attraction/">new augmented reality (AR) app</a> offers a way to virtually visit the historic house.</p>
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<figure class="wp-block-image size-large"><img alt="" class="wp-image-1109006" height="225" src="https://post.healthline.com/wp-content/uploads/2021/03/DM-BantingAR.png" width="400" /><figcaption class="wp-element-caption">Photography by Banting House</figcaption></figure>
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<p>While the app is free and available on both iOS and Android, it’s unfortunately only for people who actually travel to the birthplace of insulin in Canada and take the tour.</p>
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<p>“With COVID restrictions limiting the hours we are open to the public, this experience will provide an outdoor activity to add to their current routine and provide an enjoyable and educational experience,” said Grant Maltman, Banting House curator.</p>
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<p>“Museums are about the stories behind the objects. Our hope is that these vignettes will encourage participants in the experience to visit the museum after or even later having had a taste of what we have to offer,” he said.</p>
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<p>For people who visit and can access the app, there are five experiences to choose from while standing in Banting Square:</p>
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<li><strong>Bedroom.</strong> Visitors can walk through a virtual door and stand in Banting's bedroom. His statue comes to life and recites the events of October 31, 1920, from his memoir. He then walks over to the "Dear Dr. Banting" exhibit and reads a number of letters that were left for him in the room.</li>
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<li><strong>Artwork.</strong> A selection of Banting’s artwork “floats” in the square, and you can walk up close enough to view them as if you were standing in the gallery inside.</li>
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<li><strong>World War II service.</strong> Banting served in the Canadian military and died in 1941, during his military service. His funeral is recreated through the reading of his eulogy and a series of images highlighting his military medical research contributions, each with a voice-over explanation.</li>
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<li><strong>Flame of Hope.</strong> A video of the kindling of this memorial flame by the Queen of England in 1987 is shown, as well as other imagery and stories related to its significance as a symbol for the diabetes and medical research communities.</li>
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<li><strong>Commemorative bricks.</strong> You can experience standing in the upper garden, watching the commemorative bricks rise from the ground around you and then dissolve. At the end there's a link to purchase your own commemorative brick.</li>
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<p>Maltman said this AR experience offers excellent detail, maybe even better than a live tour. For example, he said the eulogy isn’t included in the in-person tour because it’s too long.</p>
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<p>We're hoping that Banting House will choose to eventually make this mobile AR experience more widely available to the public. That’s a sentiment echoed by at least one Banting relative as well.</p>
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<h2>A word from Banting’s distant cousin</h2>
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<p></p><p style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" class="wp-image-1109003" height="200" src="https://post.healthline.com/wp-content/uploads/2021/03/DM-Banting-RebeccaRedmond.png" width="200" /></p>Redmond, who is a second cousin three times removed from Banting (through her father’s grandma), said she’s disappointed to see that Banting House isn’t offering a virtual experience for people who can’t visit in person — especially during these pandemic times when travel is so restricted.<p></p>
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<p>Diagnosed with T1D as a teenager in 1999, Redmond reflects on the history of insulin and how it’s so important to her survival.</p>
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<p>“Growing up I was aware of Banting's remarkable discovery but always found connection through art, as I too am an artist,” she told DiabetesMine. “However, that connection shifted and became more intimate when I was diagnosed at age 17.”</p>
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<p>Though Redmond has had many chances to visit Banting House, and her son has written notes to their famous distant relative researcher in that historic bedroom, she wishes more people had the opportunity to visit virtually during this centennial year that’s still gripped by COVID-19 and its aftermath.</p>
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<p>“I wish they were open to offering the world a glimpse inside,” she told DiabetesMine. “I know it's what my cousin would have wanted.”</p>
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<p>Indeed, it's <a data-id="https://bantinghousenhsc.WordPress.com/2018/12/14/insulin-patent-sold-for-1/" data-type="URL" href="https://bantinghousenhsc.WordPress.com/2018/12/14/insulin-patent-sold-for-1/">famously reported</a> that Banting said “insulin belongs to the world, not to me.” </p>
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<p>He gave half his Nobel Prize cash award to one of the co-inventors responsible for insulin's purification, who had been overlooked. He also sold the original patents for insulin to the University of Toronto for $1 each.</p>
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<p>That spirit of community and caring is certainly something to celebrate as well.</p><p style="text-align: center;">- - - - - - - - - -</p><p style="text-align: center;"><i>Originally published on DiabetesMine</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-32044984431611609642020-12-24T01:04:00.000-05:002020-12-24T01:04:00.405-05:00A Writer's Pen<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim95ncKuc6nEy6q82Rxw5qv02kYRIVgUXWrKzIv1IQTJJCUoJ2Q-sd6L0281P7R11BqSnA1eX0bEgvIp6ncMA-xGRtntss2SXsdDX9zmbZq3O7vXVNKk1cVAesDTvnNUhiNf6T0iYXPgc/s2048/Mike-Pen.jpg" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" data-original-height="2048" data-original-width="1725" height="400" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEim95ncKuc6nEy6q82Rxw5qv02kYRIVgUXWrKzIv1IQTJJCUoJ2Q-sd6L0281P7R11BqSnA1eX0bEgvIp6ncMA-xGRtntss2SXsdDX9zmbZq3O7vXVNKk1cVAesDTvnNUhiNf6T0iYXPgc/w338-h400/Mike-Pen.jpg" width="338" /></a></div>A writer carries a pen.<p></p><p>That is the way it is.</p><p>For as long as I recall, that's how it has been. Moments have appeared, of course, where that vow failed. Where I did not have a pen to write with. Where the pen was in my hand, but it didn't write.</p><p>Moments in history are marked by the written word. Journalists know and live this truth*.... (<i>yes, truth matters. Facts matter. Alternate versions of both do not</i>**.) ... [<i>the fact that we have to emphasize this in 2020-21 is ridiculous, but the reality exists</i>].</p><p>I carry a pen. Because I'm a writer. Because the written word matters. Because facts and details matter. Context is everything. Painting a picture with my words is what I've done, professionally and personally, for so long.</p><p>Words have painted a picture, opened a portal into the heart and mind. I've read what others have written with their own pens, even if those pens aren't physical but mental and those words have materialized from digital tools. The idea of what the pen provides has been a backbone of my existence, and for so many it shapes what we know.</p><p>So when 2020 began, that was the way it was.</p><p>And then, the year became what it did. COVID-19 became a common household term, one capturing attention and headlines and passions and grief so often. Each day, it was something new. While also some of the same.</p><p>Words mattered. And yet, too often, they did not. Truth wasn't truth, facts were not facts, and reality seemed to exist on multiple planes simultaneously.</p><p>And yet, I carried a pen. As writers do. Even when they write most of their words by keyboard. By mobile device and MacBook, When signatures and the written word, actually written, aren't as important as they once were when a virtual-everything is the reality.</p><p>In 2020, my became something more.</p><p>A global pandemic arose for the first time in a century, and with it precautions and safety protocols that limited our actions. Changed our mindsets. Made us hesitate before going out, and if we did made us mull how we interacted with others and navigated this world safely. Germs might exist in everything we touch, everyone we interact with physically, every air we breath without a facemask.</p><p>Touchscreens became a hesitation, at gas stations and liquor stores and grocery hubs and beyond.</p><p>Our "new normal" manifested itself in both brutal and subtle ways, from the people around us to the "clean pen" baskets atop our local brewery counter.</p><p>And so, my writer's pen took on a new meaning.</p><p>To write, of course. But also to tab the keys on the touchscreen.</p><p>In a time when we must grapple with the simple act of human connection and what it means to "social distance," this pen of mine became so much more than it had before.</p><p>With it, I chronicle my life and the history from this corner booth of the world. But also, I protect myself and others in health.</p><p>And tell the story for my fellow humans to read. Written words, transcribed by a pen, that I hold in my hand. No matter the amount of hand sanitizer and hand washing, this pen travels with me.</p><p>To tell stories, because words matter.</p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com34tag:blogger.com,1999:blog-5690084467070242215.post-7347716296525677332020-12-22T02:32:00.004-05:002020-12-22T02:44:17.874-05:00Look to the Stars<p> </p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVyDZ-A8_AB_nfqAwCdWSvrOsFdCQTyjzbK6WE05KSmdkhWFfYbznQeS5dnWd9_vIUFFUXB0JWbohiVp8kHQb0su92Ypwh5GMfuZMa08rvKtGo0wsuJ-3xMQGWIkNYdCFVkoeNzsvpHi8/s985/NASA-stars.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="591" data-original-width="985" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVyDZ-A8_AB_nfqAwCdWSvrOsFdCQTyjzbK6WE05KSmdkhWFfYbznQeS5dnWd9_vIUFFUXB0JWbohiVp8kHQb0su92Ypwh5GMfuZMa08rvKtGo0wsuJ-3xMQGWIkNYdCFVkoeNzsvpHi8/w400-h240/NASA-stars.jpg" width="400" /></a></div><br /><p>Human beings look to the stars. We always have, always will.</p><p>That becomes clear even more in a year like 2020, when the world is caught up in a pandemic that's reached global health crisis levels. We have what's dubbed <a href="https://www.nasa.gov/feature/the-great-conjunction-of-jupiter-and-saturn" target="_blank">"the great conjunction" of 2020</a>, when Jupiter and Saturn are closer than they usually are and can be seen by the human eye. While these large planets align and near each other every 20 years, they aren't often this close and even less often are they able to be viewed by the naked human eye.</p><p>Sure, this happens every 20 years to some extent. But before 2020, the last time the two planets were this close was in 1623... and even then, that alignment wasn't visible to the human eye. It was way back in 1226 the last time this happened and could actually be seen.</p><p>Think about that for a moment... almost 800 years.</p><p>That's simply amazing.</p><p>Think back eight centuries ago, to March 4, 1226. This was during the <a href="https://en.wikipedia.org/wiki/High_Middle_Ages" target="_blank">High Middle Ages</a> period, about a decade after the Magna Carta had been signed. The Crusades were ongoing, with the Sixth Crusade just about to start in order to recapture Jerusalem.</p><p>Hell, that's remarkable to think that before 2020 the last time we experienced a similar celestial event would've been back then, so many centuries ago...</p><h3 style="text-align: left;">Family History Reflections</h3><p>Looking at this from a genealogical POV, my own Hoskins and Hoskyns lines weren't even born yet with those surnames. Chances are my long-ago ancestors were then known by the surname Osekin, which historical accounts note came after the Norman Conquest of 1066 when some of my ancestors were a part of that.</p><p>They went on to become the Hoskyns, were associated with Robert the Bruce of Scotland and all that good Braveheart lore. And so on into Herfordshire England, eventually leading to Bartholomew who changed the name to Hoskins in coming to the New World in the 1600s.</p><p>Roughly four centuries ago in 1623, the last time this "great conjunction" happened like this, that was before America. Pre-colonial times, just a few years after the famed Pilgrims made their way to the New World and settled here in Jamestown. My own genealogy tells of Bartholomew Hoskins, the first-ever American immigrant who came from the prominent Hoskyns line in England and was in his early 20s at the time.</p><p>Did he look up at the night sky on that July 1623, thinking about the entirety of the cosmos and how we're all connected worldwide? That despite the challenges and horrors of those early years in this new land, how he had survived and was starting a family?</p><p>Then again, the "great conjunction of 1623" wasn't even visible to the human eye... so it's not even something that could be seen, if Bartholomew had wanted to look up and had known to be looking for something special.</p><p>Who knows what ancestors from the 1220s were doing at that time, and if they happened to look up at the stars to reflect on everything larger than ourselves... it may have been cloudy that night back in 1226, for all we know.</p><h3 style="text-align: left;"><b><u>Keep the faith</u></b></h3><p>Thinking on all of this, the phrase "keep the faith" comes to mind. While the Bon Jovi tune by this name is a good one, it's not what I'm referring to here. No, instead this is based on Christian faith.</p><p>This celestial event may have been what's referred to as the "<a href="https://answersingenesis.org/christmas/the-star-of-bethlehem/" target="_blank">Star of Bethlehem</a>" in the nativity story from the Book of Matthew.</p><p>In my own Bible readings, that passage has so many interpretations that it's difficult to not look at it now, in the 21st century, with a combination of both astronomical fact and human faith factored into the interpretation.</p><p>Could the "Star of Bethlehem" been in the sky on Dec. 21, 2020? Even though it was cloudy here in Southeast Michigan without any visibility, does that mean an experience 800-years in the making was ruined? Does it mean one can't find their own faith, their own beliefs, their own fears and hopes and loves and reflections, in the mind beyond those clouds?</p><p>Maybe we can see what this "Christmas Star of 2020" is guiding us toward, just like it was guiding those Three Wise Men way back when. There's endless speculation and belief on what the Bible says and whether that "Christmas Star" as a real astronomical event or a God-offered vision... but if it were up to me and my Bible reading, I'd go for a mixture of both.</p><p>That star alerted the magi to the birth of Christ, prompting them to make the long journey from the East. But whatever may have happened back then, the symbolism and guidance for our own lives now can be a deeper meaning.</p><p>Despite all we've endured in 2020 collectively, there is a cosmic light in the sky. It can guide us toward something, even if it's physically clouded in the sky and can't be seen with our own eyes. We can feel it, we can focus our heart on what it's leading us toward.</p><p>That hundreds of years after this last appeared as it does in the sky, we are connected to each other -- past and present, and the future. Our planet has lived this long, and it's our duty to ensure it lives on so that future generations can experience these astronomical events — and reflect on them, in whatever ways they choose.</p><p>It's our duty as humans, being the descendents of those in the 1600s and 1200s and before then, to continue our life on this planet. We must guard Earth, and not self-destruct.</p><p>Those are the lessons I take from this "Christmas Star of 2020," even if it was too cloudy in my corner of the world to physically see it.</p><p>I can look to the heavens, use my mind and heart, and know where it's leading me. And us. Together.</p><p><br /></p>Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com2tag:blogger.com,1999:blog-5690084467070242215.post-74632851339853499652020-11-26T10:42:00.013-05:002022-03-25T10:45:30.926-04:00A New Maple Cream Designed for Low Blood Sugars<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_y6HC6VQTWCNiwQdyxrfZ7Ux4TSSmfMRwERqKybHLWevCcrFED1X90QHbByUdkIGLg57aPW1lcNY9R6TfaUo0tRSK53fB-CFAhnb3-y55P4h9eHmRzYw776XJrTViID88CJf1-2MpVrl1v1dQ7xKWZ6Wak2n_T539k2gtcZTLXsdLXN0rDWMWOXzb/s1296/DM-MapleRise-HEADER.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg_y6HC6VQTWCNiwQdyxrfZ7Ux4TSSmfMRwERqKybHLWevCcrFED1X90QHbByUdkIGLg57aPW1lcNY9R6TfaUo0tRSK53fB-CFAhnb3-y55P4h9eHmRzYw776XJrTViID88CJf1-2MpVrl1v1dQ7xKWZ6Wak2n_T539k2gtcZTLXsdLXN0rDWMWOXzb/w640-h360/DM-MapleRise-HEADER.png" width="640" /></a></div><br />Maple syrup is an American favorite, given its North American origins and delectable sweetness, and many find it to be the perfect complement to holiday feasts. But if you live with diabetes, maple may seem taboo.<p></p><!-- wp:paragraph -->
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<p>Thankfully, 20-something Darren Celley in Vermont is working to challenge that notion.</p>
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<p>Embracing his family heritage in the maple syrup business, he is fundraising to launch a new product geared specifically toward people with diabetes (PWDs): <a href="https://maplerisevt.com/" rel="noreferrer noopener" target="_blank">Maple Rise</a>, a spreadable maple butter that can raise low blood sugars quickly and more pleasantly than powdery glucose tabs, juice, or large mouthfuls of candy.</p>
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<p>Diagnosed at age 12 in 2008, Celley is proud to be bringing a diabetes twist to the traditional concept of maple syrup and its spreadable offspring, maple cream.</p>
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<h2>What is maple cream?</h2>
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<p>Maple cream is simply whipped <a href="/nutrition/maple-syrup" rel="noreferrer noopener" target="_blank">maple syrup</a>, that turns out more condensed than syrup in the production process. It is heated, cooled, and then mixed until a "rich, creamy consistency is reached," Celley explains, and then it's jarred and ready to serve.</p>
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<p>For the most part, it looks like peanut butter when it's all stirred up and ready to consume. Maple Rise is all-natural, without any additives. Just like the maple syrup and maple sugar his family makes, the only ingredient is 100-percent pure maple from Vermont, Celley notes.</p>
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<p>Maple Rise is currently <a data-id="https://maplerisevt.com/" data-type="URL" href="https://maplerisevt.com/">being sold</a> in a 1/2- or full-pound jar ($12 and $20, respectively), and can be enjoyed on its own, on toast, in coffee or tea, on ice cream, as a glaze for cupcakes, or in a myriad of other ways. </p>
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<p>The proceeds from those sales are going toward the diabetes twist on the product: New, small, portable 1-tablespoon packets of Maple Rise that Celley plans to begin marketing as a treatment for hypoglycemia (low blood sugar) in 2021.</p>
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<p>"This product is aimed at addressing the lack of effective, durable, and health-conscious remedies for low blood sugar," he notes on the company's website.</p>
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<p>Each pouch contains 17 grams of pure sugar for a quick glucose boost. This is the ideal amount according to the long-held "<a href="https://www.diabetes.org/diabetes/medication-management/blood-glucose-testing-and-control/hypoglycemia#:~:text=The%2015%2D15%20rule%E2%80%94have,it%20doesn't%20lower%20again." rel="noreferrer noopener" target="_blank">Rule of 15</a>" for treating hypoglycemia (eat 15 grams of sugar, wait 15 minutes, check blood glucose, treat again if still low).</p>
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<p>Given that maple cream is supposed to be refrigerated after opening, you might wonder if the packets hold up. Celley says they will last quite a while at room temperature, but for longer-term storage, packets can be kept in the freezer. </p>
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<h2>How does it work for low blood sugar?</h2>
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<p>DiabetesMine received a small sample jar of Maple Rise to try. I found that it tastes great, making me imagine warm pancakes with maple syrup. That was a nice feeling, one that I don't typically get when consuming glucose tabs or a quick orange juice.</p>
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<p>For both of my lows, I was hovering in the 50s or 60s and consumed a heaping tablespoon that boosted me up to about 150 both times — though it took noticeably longer than the quick action I'm used to with glucose tabs or juice. I watched my blood sugars rise on my <a href="/diabetesmine/what-is-continuous-glucose-monitor-and-choosing-one">continuous glucose monitoring (CGM)</a> graph for about an hour afterward, before leveling off and then gradually dropping as the maple cream started leaving my bloodstream.</p>
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<p>Practically speaking, scooping it out of the jar was not ideal, because it was difficult to gauge that ideal tablespoon serving for the 17g carb count. This will, of course, be solved with the pouch format. </p>
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<p>I also learned that maple cream separates after it sits for a bit. The dark syrup portion rises to the top, while the whipped part that resembles peanut butter settles below. This means you may need to mix it (or knead the packet) before use — which could be a downside if your low is urgent.</p>
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<p>Outside of a low, I did enjoy some of this maple cream on a piece of toast in the morning and found that a thin layer combined with wheat toast had a very manageable impact on my glucose.</p>
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<p>I'd certainly recommend it on taste, and the quick-grab packets, when ready, should make a nice alternative for those who might want an all-natural, delicious option to treat hypos. </p>
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<h2>A maple syrup family (plus diabetes)</h2>
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<div class="wp-block-image"><figure class="alignright size-large is-resized" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img alt="" class="wp-image-801514" height="217" src="https://post.healthline.com/wp-content/uploads/2020/11/DM-DarrenCelley.png" width="217" /><figcaption><br /></figcaption></figure></div>
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<p>Being from Vermont, the state that produces more than half of the country's maple syrup, it's no surprise that Celley has grown up with that in his veins.</p>
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<p>His sister and brother-in-law own their own maple farm and his dad also had one before selling it. "It's one of those cultural things that most people in Vermont experience either through friends or family," he said, noting that he worked for his sister selling their syrup in Massachusetts farmer's markets while in college. And he did an internship at the farm while getting his business degree.</p>
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<p>That was the genesis of Maple Rise, he tells DiabetesMine.</p>
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<p>"Maple syrup was always convenient for me to use as a blood sugar booster because of how accessible it is in my area, so I would generally use that when I felt the lows," Celley says.</p>
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<p>Growing up playing soccer, Celley remembers forcing himself to drink juice or eat a granola bar when playing sports and how that wasn't always convenient. That experience and his inside knowledge of the maple syrup industry helped him build his own business plan around maple cream.</p>
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<p>He began forming the idea for Maple Rise and pulling it together in 2019 before launching in early 2020 — just as the COVID-19 crisis was turning into a global pandemic and turning the world upside-down. </p>
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<p>Celley's full-time job is at a life insurance company as a data classification specialist but every other weekend he attends a local farmer's market to sell his Maple Rise and related syrup products, which include a coffee sweetener.</p>
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<p>"I'm very fortunate to be able to work full-time from home with the pandemic still happening. (It) allows me some extra time to also focus on Maple Rise," he says. "The market debut was a success, despite happening in the middle of a pandemic. I'm excited to see where everything goes from here."</p><p style="text-align: center;">- - - - - - - - - - - - - - - - - - </p><p style="text-align: center;"><i>Originally published at DiabetesMine on Nov. 16, 2020</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0tag:blogger.com,1999:blog-5690084467070242215.post-13420834847367587762020-11-13T15:55:00.016-05:002022-03-25T15:58:55.101-04:00Sierra Sandison: Beauty Queen with Diabetes Turned Advocate and Engineer<p></p><div class="separator" style="clear: both; text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5ajwxmj_z6KY8aWFpIhnofm3oUcdKyAVkuud-sya2gxEWAJCz-T9is2kOzyqEpyTrVB6IbCH4EkO5V_GY8bLz5lQOBNdM41zFYYTvJEcUCFqbXHfgb6OF-z6ZPVRTRo6tr3-pHdj8r9KIIawBblBPSvtNLIb4cg02zuolwnrjGcMUeKW-q-PFq1ae/s1296/DM-Sandison-HEADER.png" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="728" data-original-width="1296" height="360" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi5ajwxmj_z6KY8aWFpIhnofm3oUcdKyAVkuud-sya2gxEWAJCz-T9is2kOzyqEpyTrVB6IbCH4EkO5V_GY8bLz5lQOBNdM41zFYYTvJEcUCFqbXHfgb6OF-z6ZPVRTRo6tr3-pHdj8r9KIIawBblBPSvtNLIb4cg02zuolwnrjGcMUeKW-q-PFq1ae/w640-h360/DM-Sandison-HEADER.png" width="640" /></a></div><br />You may remember her as the Miss America beauty pageant contestant famous for <a data-id="https://www.npr.org/sections/health-shots/2015/07/30/427711228/how-a-beauty-queen-with-diabetes-found-her-sugar-linings" data-type="URL" href="https://www.npr.org/sections/health-shots/2015/07/30/427711228/how-a-beauty-queen-with-diabetes-found-her-sugar-linings">wearing an insulin pump</a> on national TV during the swimsuit competition, but fellow type 1 Sierra Sandison is so much more than that.<p></p><!-- wp:paragraph -->
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<p>The Idaho-based 20-something is now finishing her degree in mechanical and biomedical engineering and has been a force behind diabetes advocacy lobbying to lower insulin pricing in the United States. </p>
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<p>Years after her 2014 Miss America run, she recently put her name back into the beauty pageant arena with the aim of empowering women who might want to enter the fields of <a href="https://www.ed.gov/stem" rel="noreferrer noopener" target="_blank">Science, Technology, Engineering and Math (STEM)</a>.</p>
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<p>We talked with Sierra recently about all that she's accomplishing these days, and where her advocacy is leading.</p>
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<h2>Who is Sierra Sandison?</h2>
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<p>Diagnosed with type 1 diabetes (T1D) at age 18, Sandison struggled at first and even pretended she didn't have it in hopes that "it would just disappear," she told DiabetesMine. That led her to be discouraged, not knowing if she could accomplish her dreams.</p>
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<p>But then one day in church, Sandison learned about <a href="https://www.nicolejohnson.com/meet-nicole/" rel="noreferrer noopener" target="_blank">Nicole Johnson</a>, who was crowned Miss America in 1999 and the first contestant to ever wear an insulin pump while competing. Sandison, a pageant hopeful herself, found something she didn't even know she was looking for.</p>
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<p>"I immediately realized how silly I had been to think that wearing an insulin pump would make me any less beautiful," Sandison says. "If any of my peers had a problem with me wearing a medical device, then their opinions weren't really worth worrying about anyways. I slowly realized that this was true for every 'flaw' I saw in myself."</p>
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<p>She would go on to earn the Miss Idaho crown in June 2014, wearing her Tandem t:slim insulin pump on stage clipped onto her bikini. That spurred the viral hashtag <a href="#ShowMeYourPump" rel="noreferrer noopener" target="_blank">#</a><a href="https://twitter.com/hashtag/showmeyourpump" rel="noreferrer noopener" target="_blank">ShowMeYourPump</a> on social media that helped Sandison win the title of People's Choice in the Miss America 2014 competition.</p>
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<p>Six years later, Sandison re-entered the pageant world participating in the Miss Iadho USA competition in September 2020, once again wearing her t:slim and earning first runner-up. Despite not winning, Sandison said she feels that her messages of empowerment are taking on a broader scope.</p>
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<p>"One thing I've learned over the years is that this wasn't just inspiring to little girls scared of wearing their insulin pump, but to all genders and ages," she says. "As I was preparing for the recent competition, I wanted to get outside of just the diabetes box and this condition."</p>
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<p>Now in her late 20s, Sandison says she is more concerned about affording her own health insurance once she is off her parents' coverage. That realization has led her to be more attentive to, and critical of, diabetes organizations that don't address these affordability issues directly.</p>
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<h2>Calling out diabetes orgs</h2>
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<p>After the initial #ShowMeYourPump excitement years back, Sandison published a book titled <a href="https://www.bookdepository.com/Sugar-Linings-Sierra-Sandison/9781514369722" rel="noreferrer noopener" target="_blank">Sugar Linings</a> about her experiences, and embraced the public speaking circuit at diabetes conferences around the country. She even <a href="https://beyondtype1.org/bike-beyond/">biked across America</a> with <a href="https://beyondtype1.org/about-beyond-type-1/" rel="noreferrer noopener" target="_blank">Beyond Type 1</a> (BT1) in 2017.</p>
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<p>Despite her early advocacy with a variety of diabetes companies and groups, Sandison has more recently become a vocal advocate for the <a data-id="https://www.t1international.com/insulin4all/" data-type="URL" href="https://www.t1international.com/insulin4all/">T1International #insulin4all</a> movement, which is categorically critical of organizations that accept money from the pharma industry. </p>
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<p>That led her to resign from the advisory board of BT1 in early 2020 after she learned the details of a funding policy change that the group made public in early 2019.</p>
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<p>"I have seen how that money influences what they do, and I was disappointed that I hadn't heard about this... from them, but rather from 'Twitter trolls' online."</p>
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<p>She's also been questioning potential conflicts of interest with other diabetes advocacy orgs as of late.</p>
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<h2>Females in engineering</h2>
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<p>Through it all, Sandison has maintained her focus on her education in engineering. In fact, she believes her own T1D led her to this field.</p>
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<p>"If you've ever heard me speak, I have this one line in my speeches about starting pageants and a friend asked me about the particular talent I'd demonstrate... I made a joke about solving a calculus problem to music," Sandison says. "And that would prompt people to ask me if that was because of diabetes math, or if I was pursuing STEM. After getting that question so many times, I wondered why I wasn't majoring in that."</p>
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<p>Now she is one of the only females majoring in engineering at Boise State University, with a major in mechanical engineering and a minor in biomedical engineering. At one point — as a former beauty queen — walking into an engineering classroom full of young men she felt like the character "Elle Woods" of the Legally Blonde movies walking into Harvard Law School. (<em>"You got in here?!"</em>)</p>
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<p>All of those experiences — from her sometimes frowned-upon beauty pageant participation to speaking around the country at diabetes conferences — led her to a strong desire to empower other women to enter STEM fields, she says.</p>
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<p>"I know who I am, what I believe, how I want to make a difference in the world," she says. "I want to be a message, and not just for girls who want to wear pink in their engineering classes, but any girl who feels they need to 'tone down their personality' to be taken seriously in a male-dominated field. My tagline: I want to inspire girls even when it's difficult, and to love themselves, medical devices, and all."</p>
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<p>Sandison says that when little girls don't see female engineers, that limits their imaginations of what is possible. That is one thing she'd like to see change.</p>
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<h2>Fun science goals</h2>
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<p>While Sandison isn't yet clear exactly where her ambitions may take her career, she has some tantalizing ideas. With her biomedical engineering minor, she's considered working on medical devices by perhaps joining a company like insulin pump maker Tandem Diabetes Care. </p>
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<p>She's also tempted by the ultra-creative and fun sides of STEM. Currently, she is working as an engineering intern at a toy company founded by <a data-id="https://www.idahostatesman.com/news/business/article59599691.html" data-type="URL" href="https://www.idahostatesman.com/news/business/article59599691.html">Caleb Chung</a>, who created the famous talking robot, Furby, in the 1990s.</p>
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<p>And she's fascinated by a New Mexico entertainment group known as <a href="https://meowwolf.com/visit/santa-fe" rel="noreferrer noopener" target="_blank">Meow Wolf</a>, which Sandison describes as a "discovery center meets escape room meets psychedelic Disneyland." It's an art museum where all the art is interactive and requires engineering skills to build.</p>
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<p>She also loves the idea of starting her own Boise-area franchise that could not only help inspire kids to become engineers but bring in elements of diabetes and medical devices.</p>
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<p>Her ultimate dream, she says, is possibly becoming the female engineering counterpart of <a href="https://billnye.com/" rel="noreferrer noopener" target="_blank">Bill Nye the Science Guy</a>, appearing regularly on Netflix or YouTube to talk about the field. That type of project could also involve setting up a maker space, with 3D printers and different technology displayed.</p>
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<p>"That would be so awesome, to have a visible woman engineer in front of kids showing the cool machines you can build," she says. "I want to help people understand what engineering is and what it can be used for. There are so many exciting things, and no one as a kid connects engineering with those exciting career options."</p>
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<p>No matter what Sandison decides, it is clear she will continue to inspire.</p><p style="text-align: center;"><i>- - - - - - - - - - - - - - -</i></p><p style="text-align: center;"><i>Originally published on DiabetesMine</i></p>
<!-- /wp:paragraph -->Mike Hoskinshttp://www.blogger.com/profile/06551066714605052991noreply@blogger.com0