COVID-19: Today’s diabetes therapy is tomorrow’s outcome data

Reading through the latest COVID-19 diabetes statistics  from the UK/NHS , I’m reminded that I’m in a much stronger position today with my blood glucose levels than I was two years ago.

Thanks to DIYAPS.

I”m not about to kid myself that I’m invincible – far from it – But it’s sobering to realise that if I do get COVID-19, I’ve got a better chance of not dying from it than I would have, had my blood sugar levels remained the same as they were two years ago.

HbA1c last 14 years
Impact of CGM + Nightscout + OpenAPS, Loop & AndroidAPS

Reflecting on the breakdown of COVID-19 mortality by age in type 1 diabetes, I realise a lot of those in the older age groups that are dying at a greater rate from COVID-19, spent the first decade or two of their diabetes without access to blood glucose monitoring. They relied on urine testing. Compared with BG monitoring it was a blunt tool.

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Type 1 and Type 2 diabetes and COVID-19 related mortality in England: a cohort study in people with diabetes (Holman et al, 2020)

I can remember how blunt a tool it was because a Clinitest tablet in a test tube of urine is what I used to measure my glucose for my first year with type 1 diabetes in 1980. It was part of my therapy, along with one shot a day of long acting insulin.

Apparently my paediatrician loaned us a BG meter for a month when I was thirteen. I asked my mother how the data from this loan period was used. “The doctor told us your blood sugar was high,” she said. I guess he increased my daily dose of insulin when I went to see him at the end of the loan month.

There was a bit of resistance to the idea of patients having their own meters back then. “What would they do with the information?” was a question that was often asked, and some worried about the danger inherent in allowing patients to make their own treatment decisions.

Blood glucose monitoring had a major impact on long term outcomes for people with type 1 diabetes. And this impact can be seen now in the NHS stats.

There’s so much luck in when you were born, where you were born and what resources you have access to.

The latest data is a reminder that diabetes is a generational, historical phenomenon. And that the current moment is ripe with possibilities.

Closed loop systems for type 1 diabetes should make long term side effects of diabetes pretty much negligible. For closed loop people need access to affordable insulin, loopable pumps and CGM.

The solution is actually right here, now. It just needs funding.

Let’s speed the process up. Let’s close the gap in those graph lines.

People with diabetes deserve a healthy future.

Ypsomed partners with Dexcom, promises future closed loop using TypeZero algorithm

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Medtronic paradigm (522) & Ypsomed

Ypsomed and Dexcom have just announced their partnership (4 May 2020) and say a future version of the Ypsomed pump will loop with the TypeZero algorithm, the algorithm used in Tandem’s ControlIQ.

This partnership is a step forward for a company that says it is committed to patient choice and interoperability.

Because this is a non-exclusive agreement with Dexcom, Ypsomed is also open to future integration with other CGMs.

Dexcom G6 data in mylife app

From October/November 2020, it’s expected that Dexcom G6 readings will be integrated into Ypsomed’s mylife app.

Although G6 readings can be used for dosing calculations through the app’s bolus calculator, people with the current version of the Ypsomed pump will still need to manually enter the bolus into their pump.

Next pump will enable bolus from phone

The next version of the Ypsomed pump, which is expected to be available in the first half of 2021, will enable bolus from phone.

The company says people using Ypsomed pumps will be able to automatically upgrade to the bolus from phone version of their pump, for no charge. Apparently this version will not need to go through the therapeutic goods administration approvals process in Australia.

This 2021 upgrade will not be the TypeZero looping version however.

TypeZero loop

The looping version of the Ypsomed pump will need to clear the regulatory approvals process, which can be lengthy. I look forward to hearing updates on this timeframe.

Also, it is unclear whether users of current or interim (bolus from phone) Ypsomed pumps will be in a position to upgrade for free to the TypeZero compatible pump, or whether additional costs will be incurred. It will be great to get more information on this too.

Discreet pump, open protocols

I’m not usually in the business of writing product endorsements. But Ypsomed does interest me because:

  1. They were one of the first companies to sign up to JDRF Open Protocols initiative, which indicates a commitment to creating systems that are interoperable and give maximum choice.
  2. It’s a tiny pump with a 160 ml reservoir. This will not suit everyone unfortunately, but as I use around 25 units of insulin per day, and I don’t have pockets in a lot of my clothing, this tiny pump is the first one I’ve found that I can slip into my my bra without a noticeable bump.

I’m not trying to sell anyone on this product. This is a very non-descript pump. I’d love to see something funkier. But…

I’ve been waiting for a tiny pump that will allow me to use either its ‘own’ algorithm or an algorithm of my choice. There are no guarantees here, but at the moment, I’m wondering if Ypsomed could be a good bet.

Non-exclusive agreement

The non-exclusive agreement with Dexcom means Ypsomed is also open to partnerships with other CGM companies such as Abbott/Libre.

The contract covers both the G6 and G7 (future version) of Dexcom CGM.

Already, in Australia at least, Ypsomed has had deals offering six months free supply of Freestyle Libre sensors for new users of Ypsomed pumps, so this relationship seems to be in place already.

I’m guessing there may well be an announcement for integration with Libre 2 sensors at some point.

Will future Ypsomed pumps loop with DIYAPS systems?

This is a good question. I believe the Baker Institute in Australia will commence a trial this year using a bluetooth-enabled clinical trial version of the Ypsomed pump with AndroidAPS.

Meanwhile, Tidepool has a mission to create Tidepool Loop, an approved version of the DIY Loop app, to be available in the App Store for iOS users. I sincerely hope Tidepool and Ypsomed are talking. This would seem to fit with both Tidepool and Ypsomed’s interoperability/maximising patient choice imperatives.

So, I guess, it’s a case of “watch this space”…

New Mio-like sets

Ypsomed has just been granted therapeutic goods administration approval for a new type of set that is essentially the same as the Medtronic Mios (and discontinued Animas Inset II).

The sets are produced at the same facility as the Mios but have their own special Ypsomed proprietary connector.

These new sets are expected to be listed on the national diabetes supply scheme (NDSS) in Australia as subsidised pump consumables in the near future.

360 degree clip

A major consideration for me in any new pump commitment is wearability. My next pump has got to be able to slip into my bra and also clip onto my waistband. And if it’s on my waist I want it to be super grippy.

Ypsomed is a light weight pump, and although the 360 degree clip is not as grippy as Medtronic’s old slim waist clip for their 22 and 54 series pumps, it does rotate which could be useful, and it did pass my rigorous ‘going to the loo quickly without falling off’ test.

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Data visualisation, sharing with healthcare providers

Pump and CGM data will upload to the cloud any time the mylife App is open. Data visualisation is available through mylife Cloud software which also allows people to share their data with their diabetes clinic.

User reviews

It’s always worth checking real life user reviews of pumps before buying them. I’ve never used this pump myself.

Here is a snippet of feedback from one person I queried about Ypsomed about six months ago:

“I’ve only been using this pump for three weeks, so my opinions are still forming. So far, I quite like it. It’s very small and lightweight. I love the bright screen and large icons and fonts (I’m legally blind, so this is one of the main reasons I went with this pump).

I like the infusion sets, and in particular having an inserter available for steel sets, which I use. The tape on the infusion sets seems good and so far they cause me much less irritation than Contact Detach sets used to.

I also enjoy using the app to calculate boluses and log events and I love having the ability to pre-fill cartridges weeks in advance to store in the fridge. The cartridge-change process is the most simple and fastest I’ve had on any of my pumps. It takes 30 seconds and you’re done.

I do wish that the pump stored insulin on board on the pump itself (it stores it in the app), and the basal rates are a little annoying to get an overview of when changing (because you can only see one hour at a time). But those are fairly minor complaints.

The only big issue I’ve had is that I’m trying to use the pump with Fiasp and it appears to cause occlusions often in the tubing and infusion set. I’ve had five occlusions over the past three weeks, which is probably more than I’ve had in my years of pump experience. The good news is that the occlusion alarm works well!! I’m going to be switching to NovoRapid so fingers crossed tha t solves the problem. I’ve read that Fiasp causes occlusion issues with other pumps, so I think this is more of an issue with Fiasp than an issue with the pump.

Good luck to everyone on making the decision on your next pump in this crystal ball gazing era we find ourselves in.

Looking forward to hearing about more companies taking an open protocol pathway and maximising algorithm and CGM options for people with diabetes.

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Ypsomed, Tandem TSlimX2, Medtronic 522