Non-invasive CGMs - The one to watch

Last week I had the pleasure of meeting up with some fellow bloggers and a team from C8 Medisensors, the company bringing to the market the much-anticipated non-invasive continuous glucose monitor somewhat catchily named, 'the HG1-c'.  I mentioned them briefly after happening upon their stand at the ATTD earlier this year and last week provided an opportunity to get some waffley blogger-types together in a room to discuss the Hg1-c, the company, the history and the future. It's all bright, by the way.

In a nutshell this investigational device (not yet CE approved) consists of a small box, around the size of today's smart phones or an insulin pump, which is held in place around the midriff by a neoprene belt.  Here it measures the amount of glucose in the fluid beneath the skin using Raman Spectroscopy technology. For those of you who - like myself - don't speak 'medical journal', Raman Spectroscopy is effectively shining a light through the skin.  This light reacts only with glucose molecules and can therefore identify how much glucose is present.  It then feeds this back to an app on a smart phone (Apple version in the pipleine) for you to keep a near real-time eye on your glucose.  Ingenious, I think you'll agree.

So far the benefits of the system include being vastly cheaper than the current traditional CGMs available such as the Navigator, the Enlite and everyone's favourite, Dexcom.  The price of the unit is approximately £2500 which although still a very large outlay, is a drop in the ocean in comparison with the traditional CGMs.  In fact over the anticipated 4 year lifespan of the device, that is a saving of approximately £10,000.  Imagine how much diabetic chocolate you could buy with that!

Other benefits include being non-invasive and therefore painless, having no expensive parts to replace, it is relatively discreet (although perhaps not underneath any negligee when preparing to seduce the husband/wife!) and the accuracy is comparable with the current systems.  CGM accuracy rates currently range anywhere from 75-89% and the information we were presented with clearly showed that for trend information allowing you to make better self-care choices, this system performs as well as any of those above.  

There are a few drawbacks to mention.  For all those parents out there thinking how fantastic this will be for your little ones, we were categorically told that this device will only receive CE marking for adults.  So alas if you are interested in this, using it on children would be considered 'off-label'.  

It is also - in my opinion - rather on the 'chunky' side at this point thanks to being worn on a girdle style belt and the need for a battery pack alongside the monitor. But for me, this is a trade up I would make for the sake of more affordable, reliable and non-invasive CGM.  I have tiny marks all over my abdomen from the many cannulas I have worn over the years, so the idea of a monitoring device that doesn't even pierce the skin, is wonderful. 

It also isn't waterproof so no skinny dipping while wearing your C8 girdle, because you can't return it if you wreck it, OK? And due to the need for no movement between the skin and the laser for it to work without interruption, it isn't recommended during exercise at the moment.  

That said, if you are looking for a more affordable, reliable CGM system that is up and running in 15 minutes, is close to the 'gold standard' of glucose monitoring and is run through your phone meaning no extra devices to carry around, then I strongly suggest you make your own enquiries about this system.

The plan at the moment is to roll out in the EU imminently, followed by Switzerland, Norway and eventually, Iceland.  So to the Norway readers I discovered a while back - you know who you are - keep your eyes peeled.

The message really is keep your eyes on this company.  If they can get CE approval then they may well have version one of a contender for the likes of the market leaders who have become such a household name in the diabetes community.  We are bombarded with information about how beneficial CGM can be.  Well, maybe C8 are about to bring us the first step closer to CGM being a routine part of our care in the UK.

Watch this space.

I've attached some photos of some very engrossed-looking bloggers for your entertainment...

The Advanced Technologies and Treatments for Diabetes conference 2012

The 7^th -10^th February 2012 saw the arrival of the international event known as the Advanced Technologies and Treatments for Diabetes (ATTD) conference, which I was lucky enough to be able to attend as a representative of INPUT and funding from Dexcom to assist INPUT in the work they do. The ATTD is a worldwide conference where research outcomes at the very forefront of technological advance are presented. Being only 5 years old it is still in its fledgling years, but growing noticeably each year. Although I was not at last year’s event, I am informed that there were around 1000 attendees. This year, there were 1600 and I’m sure there are many more who would have attended given half a chance. It is aimed at diabetic professionals (or professional diabetics, in my case) mainly being consultants, nurses and diabetes educators, although the odd advocacy service pop up here and there too!

Being an insulin pump user, a diabetes advocate and a bit of an inquisitive old lass, it is always of great interest to me to see where this diabetes technology beast is heading. We hear terms like ‘Artificial Pancreas’ and ‘non-invasive glucose monitoring’ thrown about on an almost daily basis now and yet many people in the diabetic community feel these are creatures of myth and seem to hold a ‘that’ll be the day’ attitude towards them. So to be involved in a conference where this research is being presented was an honour and frankly, somewhat of an eye-opening occasion for me. .

Clearly it would be impossible to go through each of the presentations, symposiums and workshops in detail. Not in the least because my less than scientific mind would never be able to recall all the details for you. But perhaps giving you an idea of the things that caught my eye would be of use.

One of the stands in the exhibition which I kept circling in a slightly cautious way, was that of C8 Medisensors. In case you haven't heard of them (I hadn't), they are bringing to market a non-invasive glucose monitor that uses Raman Spectroscopy technology which for those of you who don't speak 'medical journal', is effectively a light that shines through the skin and identifies how many glucose particles there are in the interstitial fluid. Phew, mouthful ay. Well, according to early tests they are showing promising results, although the last test only involved 6 people. I would need to see a significant higher amount before I would be convinced it would rival the likes of Dexcom 7+ and Medtronic Enlite. Now we all remember the success of previous non-invasive systems such as the Glucowatch, the remnants of which remains burned on the skin cells of countless diabetics who had the misfortune of using it. But this was impressive. In its current form it is a bit on the 'chunky' side, and is held around the midriff with a tight neoprene band. But for those parents out there who hate the feeling of piercing their children's skin with countless needles they have to face, I think this could be a contender. If, and only IF, they come good in clinical trials. Watch this space.

For quite some time I have been aware that in order to avoid post meal spikes I need to bolus 30 minutes before each meal, otherwise those spikes just creep in a couple of hours later. But we also know that each diabetic is different and we are told all the time to find our own way. So I was very interested in a lecture about bolus times in children using insulin pump therapy. In the results being demonstrated to the audience, the message was that 15 minutes was the optimum pre-meal bolus time to avoid those spikes. In addition to this the study, called “Fine Tuning of Insulin Pump Therapy in children with type 1 diabetes: The importance of bolus timing and type” demonstrated that making the most of dual wave boluses and separating correction boluses and meal boluses, would make all the difference. They found that with mediterranean food for example, boluses were split 70% straight away and 30% over 4 hours, while Pizza was 30% straight away and 70% over 6 hours. They also highlighted that the results of their study showed that when blousing for a meal, any correction bolus being included with the meal bolus, should be separated by 15 minutes, and that this would bring glucose down to normal via the fastest route. Fascinating stuff for me, someone who has always struggled to get my head about a dual waver

One of the key lectures for us to attend included INPUT’s very own Lesley Jordan taking to the stage. Lesley has been involved in a pioneering project to trial the Accu Chek Diaport, an intra-peritoneal (goes into the peritoneal cavity in the abdomen) infusion site which is permanently fixed (as long as the host wants it, that is). It is surgically implanted and regularly maintained and allows for insulin to be much faster acting (see number 3 on my list), removes the worry of hitting a bad site and means much better control. It may not be for everyone as it is surgically implanted but for those with site problems leading to frustration and poor control it provides a very useful tool in helping achieve control over their condition and maintain use of an insulin pump effectively. Lesley has been one of the Diaport 'guinea pigs' and thanks to feedback from her, the new and improved second generation is ready to launch.

There were also stands demonstrating the Omnipod, the Accu-Chek Combo, the Medtronic Veo and my particular favourite of the moment, the Cell-Novo. I had the chance to catch up with some old friends from Medtronic, meet new ones at Roche and Cell-Novo and had a chance to thank Dexcom for supporting INPUT and in a round about way, helped me attend such an inspiring event.