Thursday, November 29, 2012

Stuff Changes In The Diabetes World

I was diagnosed with diabetes 6 years and 3 months ago, which means I've been diagnosed 5 years fewer than the average American diabetic (including T2s). Even though that seems like a short time to me, a lot of things have changed.
This post, more than most of mine, is very much US centered. There are insulin pumps, CGMs, and insulins for sale in other parts of the world that I am not discussing and the products available here aren't available everywhere else.

-The only insulin pump that was for sale in the US when I was diagnosed, that is still for sale in the US now, is the Accu Chek Spirit. When I was diagnosed, the insulin pumps for sale were Cozmo, Minimed 522 and 722, Animas 1250, and Accu Chek Spirit.
Cozmo has gone out of the insulin pump business. Now for sale are Omnipod, Minimed Paradigm Revel, Animas One Touch Ping, Accu Chek Spirit and Spirit Combo, and the new TSlim. Omnipod is the only insulin pump without a cord (unless we count the V-Go, which I don't), the TSlim is the first with a touchscreen and also the first one that needs to be recharged, the Revel is the only American pump that can double as the receiver of a CGM, the Spirit is cheapest, the Ping inaugerated the whole remote to the pump thing (although the combo works as a remote and I believe the Revel has a remote too).

-The year I was diagnosed, animal insulins went off the market in the United States. Exubera, the first inhalable insulin to go on the market, came out a few months after I was diagnosed, and is no longer for sale. Apidra was introduced after my diagnosis. And the new newest insulin is degludec, which is being sold as Tresiba. Neither Apidra nor Tresiba has been shown to make a real difference in diabetes control compared to other insulins. Novolog, Humalog, NPH, Regular, Lantus and Levemir were on the market then and still are now.

-The year I was diagnosed, the glucowatch biographer was still for sale. Dexcom and Medtronic were both earlier versions of their CGMs- Dexcom had just gotten approval for the Dexcom STS, which could only be calibrated by using the One Touch Ultra meter, which plugged into it (that was part of why I went with Medtronic for my first CGM), has sensors approved for only 72 hours of wear, and had transmitters that would last only six months (oh, that sounds familiar, you say?). Medtronic already had the Guardian RT out when I was diagnosed, although that is a slightly different version than the Guardian Real Time. The pump-acting-as-cgm-receiver didn't get released until the year I was diagnosed, 2006.  Abbott's Freestyle Navigator was not yet on the market when I was diagnosed; its brief foray on the US market started and ended during the period since my diagnosis. Two versions later, the Navigator is still selling in much of Europe and Asia, but not here in the US.
Insurance companies rarely covered CGMs then.
Here is a Dexcom STS user guide:

-The year I was diagnosed,  the ADA still had the reasonable position statement that diabetes could not be diagnosed by A1c alone, and that normal range for A1c went up to 5.9%. TnZ8 antibody tests weren't being done in a clinical setting. Bone marrow transplants for new onset diabetes weren't being done in the US (anywhere), and islet cell transplants were brand new. Nobody'd heard of Faustman, much less been disappointed in her data.

- The year I was diagnosed, the smallest insulin pen needles were still 5mm (now they're 4mm), and they still made reusable insulin pens for Lantus, and they sold Regular in cartridges (they still do that outside the US). There were four companies selling jet injectors to private individuals (there's one left).

When I was diagnosed, I figured that one of the perks of diabetes was going to be that I was going to try all sorts of products I never would have thought of. I've tried to change something every year, and mostly I have. I have tried a lot of things. I have used one NovoFlexPen (one was enough), Novopen Jr, Novopen 3, Novopenmate, an Inject-Ease, seven I-Ports, vials of Novolog and vials of Lantus, Solostar pens, Opticlik cartridges (since discontinued), a few versions of Bayer's syringes with 8mm needles, five sizes of pen needle, a bunch of meters (but only the Aviva as my primary- although its on its second type of test strip), the Guardian with Sof Sensors, Dexcom 7+, NPH, Novolog, Novolin R, and Lantus (in the morning, in the evening, and twice daily).
For me, changing stuff around makes everything more interesting.

In the immediate future, I expect to see some changes in the diabetes products available. In particular, I expect the Enlite sensors for Minimed to become available; hopefully the Veo too. I'm somewhat hopeful that the Animas Vibe will reach these shores in the near future. There are at least three insulins in clinical trials and I bet we'll have another one on the market sooner or later. I am interested to see if C8Medisensors turn out to work, and I'm hoping that bone marrow transplantation as a way of heading off type 1 diabetes will become safer and more effective with new methods.

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