Debiotech's insulin "Nanopump" delivers the good stuff, stays out of sight
By Paul Miller 
posted April 26th 2007 7:02AM
posted April 26th 2007 7:02AM
Insulin pumps have come a long way in a few short years, all the way down to a pager-sized device diabetes patients can wear on a belt and keep out of sight for the most part, but Debiotech isn't content to stop there, and has teamed up with STMicroelectronics to bring a miniaturized insulin pump to market. The Nanopump is a disposable insulin pump, based on microfluidic MEMS tech (picture after the break), and is small enough to be worn as a nearly invisible patch on the skin, about 1/4 the size of existing pumps. The new partnership with ST brings this pump closer to the market, thanks to ST's silicon-based microfluidic manufacturing chops, and hopefully we should be seeing these not too long after the device clears regulatory hurdles, sans creepy butterfly. 
As exciting as this technology is, I can't get too worked up about it. I see too many patients (a lot of them late stage DM2) who might benefit from the continuous insulin therapy pumps provide, but who also can't afford them and have to rely on self-administration. Really, the problem is not that the insulin pumps are too big or unfashionable-- there's that story about the one kid who was kicked out of class because his teacher was convinced his pump was a pager or a cellphone-- it's that the pumps are too expensive for the majority of patients in this country.
Tell me when we can start handing these things out at the office like we do drug rep pens and I'll be excited.
I'm not sure what the comment about having to pay for the pumps or people not being able to afford them. In the US most carriers pay between 80 and 100%.
@stitifier: Bravo.
With todays tech you could make as small and easy to use as possible if you wanted to, if it never makes it to the patient because of a shitty American healthcare system then what is the point?
Well, there are the 6 billion non-US people in the world who also can use this technology, and for many of them the care for these kinds of conditions is provided by their government or insurance, and so access to these products is based more on need and less on the size of their wallet.
As a diabetic, I warmly welcome development in this technology. I've opted out of having a pump as I find the current models too cumbersome and limiting. A miniaturised artificial pancreas (combining the glucose meter and the pump) is one step closer, which will be a relief for many.
It's not just about the size or style, pumps allow better control which leads to fewer long-term complications that are the true killer in diabetes.
I do agree that affordability of the devices is an issue even for health authorities, but if a smaller package means better suitability for more diabetics, that will drive prices down eventually.
@TH: If you are one of the lucky ones to live in a country with great municipal health care then congrats, us American's suffering under corporate health care are extremely jealous.
I am interested in these new developments but I too as a diabetic feel that, at 17 years old, a pump is too cumbersome. This new thing might change my thoughts but at the moment Lantus is excellent especially considering it is on the PBS, albeit it took them forever to get it there.
http://www.health.gov.au/internet/wcms/publishing.nsf/Content/lantus_levemir-govtdecision.htm
Currently i think the inhaler development is looking good. Cheers all
I have Type 1 diabetes, wear a pump, and live in the US. I agree with the comments on the healthcare problem but I can still be excited about an advance like this. I welcome any and all advances in treatment. The point is to continue to advance towards a true artificial pancreas or even better a cure and to help improve the lives and control of diabetics.
I'd be interested in a survey of how many countries with national health care provide insulin pumps to diabetics as a routine procedure.
I'm guessing between 0 and 5.
Also, small as this pump is, where's the insulin reservoir? If the delivery system can't hold 2-3 days worth of insulin, it's not worth much.
Funny, that's not what the patients I saw at my preceptorship said. I guess they were misinformed. Or, maybe they didn't have insurance, those lazy bastards. It's clearly their fault.
I am a nurse educator and teach pumps as part of my job. So, yes I'd say they were missinformed...cant comment if they are lazy bastards.
I have a pump, and wouldn't live without it. I paid $500 of the $5000 and my insurance covered the other 90%. I've heard that the pump companies also have hardship assistant programs for people who truly can't afford pumps.
Now, time to be frank.
I waited a long time to be on the pump because of fear of the form factor. Lat's face it, when you're single and in your mid-20s you don't want a pump hanging off you if you meet someone special and some magic is about to happen.
My control has been an order of magnitude better since I got on the pump. If there was a more reasonable form factor such as this (or the OnmiPod for that matter) in my younger days, my control would have been this good much earlier in my life. Better control equals less complications.
Make it work, make it effective, make it convenient and you'll save lives, kidneys and people's vision.
After 45 years of type 1 diabetes, I am thrilled to see any improvements in diabetes care. Unfortunately, most people cannot afford the pumps even with the insurance paying 80 or 90%. We have once again found a way to separate the rich from the poor. I am still waiting for the cure. All the money put into developing new gadgets should go to finding that cure.
To lighten up the thread for a sec: For a second i thought the manufacturer of this pump was diebold.. oh the hilarity that would insue at the next election! Wireless vote tampering technology!
@stitifier :
i understand where you are coming from, but are you suggesting just because you can't "hand pumps out" that this isn't promising news? let me ask you a question : are you a type one diabetic? do you wear a pump?
Cure? What cure?
You can't permanently fix everything, no matter how much you might want to. The closest we'll probably get to a "cure" would be an artificial pancreas, which requires us to have a machine capable of synthesizing insulin, plus a glucose meter, all in a device roughly the size of a human pancreas.
Even then, it needs to be powered by something, so you're looking at changing batteries instead of reloading on insulin.
(And even then, it's not generally a good idea to just cram MORE insulin into people who don't respond to it well, it's better to first make them respond to what they've got, and then make up the difference. There are drugs for that, and sure, it's a huge market with incredible demand, but it's a bit naive to assume that there's some vast pharmaceutical conspiracy.)
The reason that there's no cure isn't that they're lazy, and similarly, the reason that the pumps cost more isn't because they're greedy. It's because you need money to make up your losses in R&D. For every working pump design out there, there's dozens of failed designs, and ultimately, millions lost in those prototypes. Every new design has to pay off its R&D budget while the patent is still valid, and then it's time to release something smaller, more accurate, and more bearable, thus continuing the vicious cycle.
In the long run, of course, yesterday's revolutionary pump is today's low-end pump, and that's STILL better than setting an alarm on a wristwatch and carrying a load of syringes at all times.
As a contrast, my kid sister is on daily injections of fairly expensive meds, and she started off with nasty, uncomfortable needles. Now it's dispensed via a computer-controlled pen that drops a predefined amount via an intramuscular injection, since that's what the insurance now covers. Huzzah. In a few more years, some other kid will probably be on a weekly patch that does the same damned thing.
but the issue is that this isn't a post about rich vs. poor, it's a post about a medical advancement for diabetics. As a Type 1 diabetic I would love nothing more than to see a cure, but it would be crazy to say stop inventing things to improve our lives and use all of that money and funding to just search for a cure. These things are seperate issues.
There are advancements being made on several fronts from better insulins to injecting islet cell in the liver.
Personally I've always been reticent about pumps. Needles are intimidating enough without having one there constantly. Fortunately I'm not really brittle enough for that level of monitoring, adjusting and medicating.
I've gotten my type 1 under reasonable control using once a day time released insulin(Lantus) and the right medication and diet(of course). Hopefully there will be improvements made where I only have to do it, say once a week or longer. I feel I've come a long way since the days I used R,N & NPH and combos thereof, 4-5 times a day.
When these pumps advance to a very low maintenance with less implants I'd be in.
should be:
"When these pumps advance to a very low maintenance implants I'd be in."
@Bill : Respectfully . . . you do not have a needle in you when you wear a pump . . . it is a small tube which i can honestly tell you that you don't feel. I was just like you before I got my pump. I felt like I had decent control just using needles etc. and then I finally took a chance and had a nurse come to my office and put one on me. She said "Ok wear it for the weekend and tell me what you think". I was shocked (had saline in it of course). I was even more shocked when I forgot the thing was on me by the end of the weekend. After that weekend I never looked back. The flexibility and benefits you get from wearing a pump are tremendous. Having said all of this, I certainly respect your decision to not get one. But I will say that a lot of people who say that don't want them are not educated to how they work or have ever even tried one. Besides, if you try one and don't like it . . . you can always go back to needles!!!! Cheers.
According to the UK's NHS, the US with its private health care system has a rate of usage of insulin pumps among Type 1 diabetics of 20% (the highest in their study). Contrast that with their own admitted rate of less than 1% overall and among children less than 0.1% who use an insulin pump under their government health care system. Money was a primary reason for the NHS not offering the best care for their patients.
Quote: "While countries across the world, notably the USA, continued with pump development, the UK appeared to move away from CSII, following concerns about efficacy and safety, and the potential financial burden on the NHS." Source: http://adc.bmj.com/cgi/content/extract/88/11/949
Here's a link to the NHS report with a chart listing the rate of pump use in several countries:
http://www.dh.gov.uk/prod_consum_dh/idcplg?IdcService=GET_FILE&dID=134718&Rendition=Web
"Not too long after the device clears regulatory hurdles..." Where have we heard that before? When you have diabetes, again and again! Often these things take 5-10 years to get to market, and longer still for healthplans to start covering them. Here's hoping this one's on the fast track!
See this Open Letter to Steve Jobs from the diabetes community:
http://www.diabetesmine.com/2007/04/an_open_letter_.html