Having been looking at insulin pumps for about a year now, it’s plainly obvious that there are different standards in operation globally regarding healthcare sign off, but equally, different manufacturers have targeted different features for different audiences. There is, however, one truism about the insulin pump.
What it does is, very simply, pump small increments of insulin, continuously, via a subcutaneous cannula. Once you get beyond that, the functionality becomes about how you can apply variations and “cleverness” to make managing that process much easier.
With my pump having been my best mate for only a month, I’ve already drawn a few conclusions about what I like about it and what I’d like to improve.
Likes:
- Remote control
- Integrated blood glucose monitor
- Simple to use
- Variety of usable transfer systems thanks to Luer Lock
Improvements:
- Connectivity to Diasend
- Pump interface
- Size
- No CGM interface
Now I know I’ve not had a pump for long, but there are some things I’d like to see in a pump, so I thought I’d create a list. I asked my friends over at the DCUK forum what they thought and I’d love to know what readers think should be in a pump.
So here’s what we’d like to see:
Standard Pump Features
- Full remote control
- Multiple Basal Rates (minimum five)
- Standard, Extended, Multiwave and Super Bolus modes
- TBR in 5% intervals
- Minimum increments 0.01u (but customisable)
- Open bluetooth protocol
- CGM integration for Medtronic Smartguard like application
- Upgradeable CPU ROM to allow for BiAP future-proofing – if it has to last four years I’d like to have Artificial Pancreas capabilities
- Basal Rate maintenance on pump (allowing for remote to be placed elsewhere)
- Smartphone integration
- All data uploadable to a standard platform not a manufacturer proprietary platform – a standard platform can be something industry standard, not necessarily an open platform, although I’d like to thing that the manufacturers could get together and create “Dia-FIX” so that they all used standard protocols for communication
- Customisable alerts so that different sounds/pulse patterns can be used for different things
Tubed Pump customisations
- Uses standard insulin penfill cartridges (and can be adapted to different manufacturers cartridges)
- Luer Lock connector (nothing proprietary thanks)
- Clips designed so insulin comes from bottom of reservoir, not from the top where the bubbles are
Patch Pump customisations
- Max 200u reservoir (as a patch it needs to be relatively small)
- Angled or perpendicular cannula
- Can be used as a patch or tubed pump (similar to the Cellnovo model)
Remote control
- Full pump control system (similar to Combo or Insight, not just bolusing like Medtronic)
- Smartphone performance level, i.e. base it on something like Android with a custom skin but a decent battery
- CGM integration
- Blood test meter (preferably using the cheapest available NHS strips to make them easily accessible, e.g. SD Codefree) which should be able to test blood ketones
- Data reports including BG trends, variance, etc and overlays with carb and bolus values integrated with existing food databases
Fundamentally, it should be a system that can communicate with either of the pump hardware options using a standardised remote/software package, so that you have the possibility of using either.
Additional Thoughts
While I’m not a pump designer, I’m a user and technophile. One comment from a pump user I read was that “It should be easy to use without constantly having to refer to a manual” and I think that sums it up well as well.
It also adds an additional criteria. I like to be able to fiddle, play and see what is going on. I like to understand the technology and the algorithms involved. Most people don’t, so offering the pump in both an Advanced and Basic format would also be a good idea. Given the mechanical design doesn’t really change, this would be a software difference. The combo already offers something similar in the “Menu Options” available to the user.
There’s also the challenge of making them look, if not spectacularly nice, at least a bit less like a functional device and more aesthetically pleasing.
Finally, cost. The upfront cost of the pump should be made cheaper. Do they really need to last for four years with warranty? We design other things with a lot shorter obsolescence built in, and the cost is therefore factored in. Patch pumps, perhaps, are different in this respect, as by necessity the consumables are more expensive.
Summary
So there’s a list of requirements. All pumps fit some of them. None that I am aware of do it all. I’m sure this isn’t exhaustive, but what have I missed that we, as end users, would like a pump to do, in addition to all of this? It feels like an amalgamation of a number of technologies that are already out there rather than the creation of anything new. Do any of the pump manufacturers have plans to pick up with any of these things, or do we need to open source the requirements and develop our own specification that we can put into production? The floor, as they say, is open!
One criterion, several criteria.
Otherwise, good points, exept: an artificial pancreas isn’t feasible!
Stefan
Thanks for the feedback. If you’ve read the rest of the site, I would hope you’ve changed your mind as Automated Insulin Delivery is very feasible and has been in use for some time.
Haven’t you noticed how small the improvements are in all published studies? Yet they are always exaggerated (but you have to be good at statistics to realize that). And CGM data are low-pass filtered so that tops and valleys get smaller.
With the one approved and widely used commercial system that’s out there, yes I’d agree that the improvements are not earth shattering. Likewise, the DIY systems don’t tend to show massive improvements in Hba1C or Time in Range indication, although many of the people using those start from an already pretty impressive position.
What you’re failing to take into account is the other benefits that people see, namely in relation to reduction in hypoglycaemia, which does tend to show much better results, and also in quality of life. When using CGM alone, waking up in range, day after day with no overnight alerts for lows is not that easy. Both the DIY and commercial systems do allow for this to happen, and these are the factors that people find most refreshing about them.
We often focus on clinical outcomes to the detriment of quality of life/psychological ones, and those are where much of the benefit can be found.