What’s been going on???

When someone asks you how you are, and mentions that it’s been a while since they’ve seen any new posts on your website, it makes you take stock, and also look back.

The last time I wrote, NICE had announced a consultation period on the provision of Flash and CGM for all those with Type 1, with additional access to monitoring for those with type 2. We’re now at the end of that consultation period, and excitement is brewing, in England and Wales at least, as to how this will be implemented, and what people will have access to? Initial indications, however, suggest that both Libre3 and Dexcom will fall under the new guidance, which raises some interesting questions for users and healthcare providers, but let’s consider those in the context of what’s changed in the past four (yes, four) months. I can’t quite believe it’s been that long. So what have I missed?

Plenty of announcements

We’ve seen announcements that Libre 3 will come to the market in the UK, that Dexcom’s G7 finally has its CE mark and that the Omnipod 5 (née Horizon) is, definitely, coming.

Out of all these things, the 30 minute warm-up on the G7 with the ability to start a new sensor so that you have no break in readings are perhaps two of the most interesting features. That we also have an official Automated Insulin Delivery System for a tubeless pump is also a major positive. However, that still has to come to market, where the two new CGMs are either here in large parts of Europe, or will be here soon.

Then of course there is the interplay with the NICE announcement of the above two products. If Libre3 is the same price or cheaper than Libre2, and Dexcom G7 is priced at the same level, then the new guidance makes it very clear that user preference, amongst other factors, becomes one of the most important decision points. I know what I’d be arguing with my healthcare professional about if that turns out to be the case…

But what of other things that have taken place? In the “You may have missed it” news, CamAPS recently announced compatibility of the Ypsopump with the CamAPS system. That’s an interesting one, as we know that myLife has been working with the AndroidAPS team as well to try an improve compatibility there, and it’s a nice little pump that picks up the mantle of the discontinued Insight very nicely.

And of course those that use Medtrum have seen some interesting developments from this company. They’ve quietly gone about releasing their Nano product suite, which includes a much smaller CGM and Pump, complete with predictive low glucose suspend, although I’ve yet to see reports of use of this. We know that they’ve talked about an automated insulin delivery system in the past, but given the integration with a phone based app now, it might be interesting to see whether they’d be open to allowing access with AndroidAPS. The new pump certainly appears to be a vast size improvement over the old one.

Then let’s also not forget the approval in the UK of the Ogluo GLucgon pen, the first room-temperature, ready prepared, stable Glucagon format that doesn’t need a user to mix it up and can just be injected if required. In theory at least, this should make administration of glucagon in an emergency a lot easier, if you can get one. The cost is eye-watering, at more than £70 for a single use pen, that contains 1mg of glucagon. It’s starting to rival insulin as one of the most expensive liquids on the planet…

In the apps world, there’s also Diahelp, which takes peer support to an interesting place. Originating out of Croatia, it’s a way of finding out about local peers also using the app who may be able to provide assistance in the even you need help. In many ways it’s similar to some of the facebook groups like “Help we forgot our T1 kit”, but it operates in a more confidential way, meaning that the only people you share the information with are those within the radius that the app can reach. I know the developers personally, and think this is a great idea, indeed, I agreed to share the details with senior UK healthcare professionals, as I think it plays into the peer-support channels that are being set up in UK diabetes care.

And what of the #WeAreNotWaiting world?

If you’d missed it, AndroidAPS v3 appeared. Key components of that were the first AID system to support Omnipod Dash, plus the Dana-i and Diaconn pumps, GUI changes and some major upgrades under the covers to improve the database and coding.

With the launch of the Dash in AndroidAPS, we’ve also seen it appear in the Loop-dev branch.

For the US and Europe, these are interesting developments, because it relegates the Rileylink for Omnipod to an “obsolete” status. I wonder, when Pete developed it, whether he realised how long the Rileylink would hang around for?

And of course, there are other things that have been going on…

One of the reasons I’ve been so quiet has been the work to bring DynamicISF to life. For those who don’t know what it is, there’s an image of the readme below. This takes the age old model that we’ve all used, where we give more insulin when we have higher glucose levels, and attempts to codify it. Chris Wilson (Glucose Genius on Twitter) has developed an algorithm that describes insulin sensitivity in terms of blood glucose and total daily dose of insulin, and I’ve implemented it in AndroidAPS. It’s currently available in the nighscout repo dev branch as a plugin, and we’re working to refine it.

I’d describe this as the validation process, and it’s proving to be an interesting journey.

Alongside this, I’ve continued to try and develop Boost, an insulin-only fully closed loop using oref1 as the base and taking advantage of the Dynamic ISF work. My thoughts on that will follow in a separate post, but after 9 months of trying, I think it’s become very apparent where it works and where the addition of something to allow handling of falling glucose levels is important. Stats that provide for >80% Time in Range with around 5% time below range, an Hba1C that’s estimated at 6.1% in my case, and other users seeing 3% time below range are really quite impressive.

So what’s next?

Now we head into conference season. ATTD has been postponed twice and will end up taking place in Barcelona, and sadly this year, I am unable to attend, so I look forward to hearing all about it from those going in person. The Diabetes UK Professional Conference has also just finished in London, with announcements about the DexcomONE coming to the UK (and being on the new NHS Tariff related to the NICE guideline) alongside noise about the GlucoRX Aidex system potentially also being part of the model (the latter having a very low price for consumers purchasing it privately).

What are we expecting at ATTD? Hopefully we’ll see some exciting new developments somewhere in the Diabetes Tech world, but if we’re honest, the last 12 months feels like we’ve seen the fruition of a lot of well laid plans, but not much in terms of new and exciting innovation (aside from the WeAreNotWaiting work). It feels as though we’re through the questions as to whether AID systems work, and now into the realm of how we roll them and the CGM components out more widely.

So with that, it’s time to repeat the calls that I and many other have made consistently over the past few years. With ATTD coming up, wouldn’t it be great to see:

• manufacturers providing interoperable systems, so that we, the users, have a choice instead of a lock-in;
• the removal of four year lock-ins that make no sense in a world where technology updates happen far more quickly;
• making diabetes technology affordable, both on the access front and the price front;
• take advantage of the peer-support networks to assist in wider roll out where possible.

Only a few small asks.