Adding to the options for MDI users – part one: What’s out there?

Over the last twelve months or so, connected devices have been the bywords for Diabetes treatment, and this isn’t just related to pumps and CGMs. This presents enormous opportunities to provide treatment advice and decision support tools in relation to the use of MDI, which has long been available to pump users.

We’ll start in this article by looking at a range of the options in terms of connected devices, including glucose monitors, insulin pens and pen add-ons (although this isn’t supposed to be an exhaustive list, and I could easily have missed some), and in the second of this two parter (my first ever!) we’ll look at how decision support tools are being enabled to use these devices and what they perhaps could do in the future. 

Let’s get started…

Standard Blood Glucose Monitors

On the Fingerprick front, the Contour Next One has been loudly promoted by Ascensia, with its app and bluetooth connectivity, providing a more useful dataset than a monitor alone, and it isn’t on its own.

In addition, the iHealth system has been around for sometime (although I found it to be rather unreliable when I tested it back in 2016), and we also have systems from:

Accuchek – the Aviva Connect

Dario (which I also tested):

And a couple of others out there, including OneTouch:

These all make reviewing your data a lot easier, but rely on manual entry for meals and insulin dosing. One of the huge benefits of using pump and integrated CGM, whether in a DIY system or a 670G is that all your data is aggregated and stored in one place, so that the reports and trend spotting is made much easier.

Connecting Insulin pens

If you’re on MDI, there have been very few options in this area, however, this is now changing.

Novo Nordisk

Late last year, Novo Nordisk announced their new, connected, pens for their insulins, the Novopen 6 and Novopen Echo Plus.

These have Bluetooth connectivity to apps on smartphones, as well as integration with products such as Diasend from Glooko, and MySugr from Roche. They were supposed to be being rolled out right now, however, I’m not aware of anyone using one, and would love to hear from you in the comments if you are.

In addition, Novo and Abbott issued a joint announcement about integrating the output from their pen into Abbott’s LibreLink and LibreView software, allowing better review of dosing data in relation to the glucose data. 

Companion Medical InPen

Aside from this, there is the Companion Medical InPen, which is currently only available in the US and only works with NovoRapid and Humalog.

This provides a bolus calculator, bolus reminders, various reporting and also a temperature sensor to warn you if your insulin is getting too hot or cold.

Pendiq 2.0

Similarly, Pendiq provide the Pendiq 2.0, which integrates with the Dialife app.

 

This is compatible with penfill cartridges from the following manufacturers:

• Lilly^®
•  Sanofi-Aventis^®
• Berlin-Chemie^®
• Novo Nordisk^®

Its main features are 0.1u microbolusing, a motor driven injection mechanism and it’s rechargable via USB.

Emperra Esysta

Another connected pen, that’s apparently reimbursable in Germany, that uses a modular approach to provide the ability to use most penfill cartridges.

That seems to be its unique selling point as the application is mainly a data recording device. 

Honourable mentions can be given to Bigfoot and Lilly, who have both announced connected systems, although the details of what is available are not easily found.

There may be others out there, but these are the easiest ones to find details on, and demonstrate that third parties have generally been ahead of the insulin manufacturers in providing connected solutions. 

Smart Adapters for Dumb Pens

A quick google search reveals that there are many pencaps out there. Some smart, some dumb. Some that are available now and some that are products that have been protoyped and may be already backed and going into production. They all follow a familiar pattern. 

“Pen data + App = Better data management => Better diabetes management”

Which is the same story as the connected pens.

I’ll separate this into items that are available to purchase now, and those that appear to be “forthcoming”. As with the previous two sections, there are likely to be items I miss, for which I apologise in advance.

Currently available smart adapters

There are currently very few smartcaps available on the market right now, and not all of them are available in all countries. In my digging, there appear to be only two that you can buy, and that are currently in the hands of real people with Type 1 in the real world. 

Clipsulin

Clipsulin, by Diabnext, clips over your pen’s body and records the doses as you turn the wheel. It’s supposed to be compatible with most pens (except half-unit ones). Based on the description on their website, I assume it uses the sounds of the pen clicking to calculate doses, as it states that it has a very high accuracy rate, but you can adjust using the +/- buttons. The associated app can take data from connected glucose meters and track the two sets of data together.

Clipsulin is compatible with both disposable and reusable pens from Novo, Sanofi and Lilly. 

 

 

Insulclock

A relatively new entrant to the market, Insulclock attaches over the pen’s twisty bit and monitors how much you turn it. Insulclock was an Indiegogo, crowdfunded, start up, which offered their device at a significant discount to the current retail price.

As with the Clipsulin, the app integrates with multiple bluetooth meters, and provides an automated dosing diary, information relating to which insulin you are using, a temperature sensor, pen “find-me” functionality and various reminders, including notification if a child hasn’t taken an expected dose. Unlike Clipsulin, there doesn’t appear to be an on device mechanism for adjusting the dose that is recorded.

Based on what’s available in the shop, it only works with the disposable pens from Novo, Lilly and Sanofi.

Smartcaps in development

Whilst there aren’t that many devices that “smartify” an existing pen, there are a whole lot more that are currently in development. Will they make it to market? Who knows, but it would be good to see additional competition in the smart adapter world. 

Go-Cap

Go-cap from Common Sensing is not yet available to buy, although it has been used in trials with Joslin Diabetes centre. This is a cap replacement that detects insulin used, presumably using some form of optical sensing tech, uploads the data to an app, and allows you to aggregate all your data in the app. It also has the ability to detect temperature and warn when the temperature is out of range. 

 

PenPal by Adelie Health

PenPal is similar to many of the other smartcaps, in that it consists of a mechanism for detecting delivery and an app, plus things such as reminders. It’s not yet available to purchase. Compared to the other “in development” products listed, this is from a new company, Adelie Health, so may have a better chance of coming to market. 

 

Insulcheck Connect

I’ve placed this in the “in development” group as it reflects the current state of the product. Insulcheck timer caps have been available for a while, however, in 2017, they announced that they were running a trial with 300 NHS patients. The trail goes a little quiet there though. What is available suggests a Cap, an app, and the ability to share information, so no surprises! 

Mallya (also known as Easylog) by Biocorp

Another Smartcap that has gone through marketing and development, but doesn’t seem to have reached the market yet, the Mallya from Biocorp does everything that every other smartcap does, or if it will ever be available. Last commentary seems to have been late 2017, early 2018 time. Sanofi have supposedly been discussing integrating this technology into their pen devices. 

Bigfoot “Inject”/Timesulin next gen product

Timesulin was probably most well known, provider of replacement pencaps that tell you when your last dose was. They announced a future bluetooth connected product in 2016, and then went on to be acquired by Bigfoot in 2017, leading to the impression that whatever the next gen product was, it will be the Bigfoot “Inject” product. This will include software that gives bolus advice and is interchangeable with the Bigfoot pump within the system.

Apps and Compatibility

What you’ve probably noticed from all of these items is that they pretty much all come with their own apps, and the compatibility of these apps is, well, difficult to determine. While some, such as Novo, have clearly stated that they’ll work with MySugr and Diasend, few seem to mention Tidepool (indeed, InPen seems to be the only product in this list to do that). 

When you compare this with what happens with glucose monitors, there’s a stark difference. Now this may just be because it’s a very young marketplace, but I would have expected that upload to an existing cloud service would be a part of the solution, especially when you consider just how little the closed ecosystems of pump manufacturers are liked. But it looks like we’re re-inventing the wheel here.

And of course, they all rely on manual entry of meal data. While this isn’t an issue if that entry results in a bolus recommendation, few of the apps that come with any of these devices include that, suggesting that the likelihood of complete recording of meal data in relation to using these systems is going to be a challenge.

But that’s where we go with the next part of this discussion. Watch out for part 2…