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Automated glucose control is already available via wearable insulin pumps combined with CGMs in a 'closed loop' system.

by jamesgill 1mo ago

ijustlovemath 1mo ago
None have been approved for hospital use as of yet, which is the next frontier.
- lokar 1mo ago
  Why is hospital use so important?
  - ijustlovemath 1mo ago
    If the large studies are to be believed, you could save hundreds of thousands of lives and many billions in excess expenditure, because stable blood glucose shortens length of stay. People with diabetes alone account for 60% of hospital expenditure, so improving their care improves the system in a big way.
    - disillusioned 1mo ago
      >People with diabetes alone account for 60% of hospital expenditure That number seemed too large to be true, and I think you might be conflating some numbers... The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states: >For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself. Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications. Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related. Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here. [1] https://pubmed.ncbi.nlm.nih.gov/37909353/ https://pubmed.ncbi.nlm.nih.gov/37909353/ [2] https://www.diabetes.org.uk/about-us/news-and-views/cost-complications-highlights-urgent-need-transform-diabetes https://www.diabetes.org.uk/about-us/news-and-views/cost-com... [3] https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytics-medical-expenditures-of-diabetes-related-hospitalizations-in-the-united-states-august-4-2020/ https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytic...
      - deleted 1mo ago
        [deleted]
      - ijustlovemath 1mo ago
        oof, that's what I get for commenting late! I was thinking of that 23% number.
        nerdsniper 1mo ago
        In fairness, that’s still massive.
      - mchusma 1mo ago
        Wild numbers. I already thought GLPs were huge but this makes me think it’s even larger.
    - ButlerianJihad 1mo ago
      Why should hospitals be motivated to shorten stays and reduce expenditures when those stays and expenditures mean that their profits will increase? Why don't they want to maximize profits from the suffering of sick people?
      - xethos 1mo ago
        Outside America, profit does not push every other motivation to the bottom of the pool to drown Though for the more terminally American founders here: reception filling in intake forms and charging one-time admission and diagnostic fees for new patients may have better margin than doctors charging billable hours
deleted 1mo ago
[deleted]
terminalcommand 1mo ago
Minimed 780g user here, it is not perfect. For a true closed loop we need a system that can give glucagon as well. The current closed loop only gives you insulin to lower your blood glucose. When it gives too much it wakes you up and asks you to treat it. You also have to accurately count carbs of meals you eat, enter when you exercise. The sensors are also not quite reliable so sometimes it freaks out and you calibrate and go manual. For a closed loop we need insulin and glucagon in conjunction to keep the bg stable without user intervention.
- jamesgill 1mo ago
  All closed loop systems require human action--maintenance,filling reservoirs, changing sites, dealing with the inherent variation of CGMs, estimating carbs, etc. even if glucagon delivery were on board (it's being worked on). But most are generally providing insulin delivery in real time, based on CGM data. Also, I agree--glucagon would be a useful thing onboard for T1d, but not really for T2d, because (as you know) the essential problem there is highs, not lows. And I definitely agree about CGM accuracy: most people don't know that there's a significant margin of error in all CGMs. It's 'close', but not precise. I'm a parent of a T1d kid.

Automated glucose control is already available via wearable insulin pumps combined with CGMs in a 'closed loop' system.

ijustlovemath 1mo ago

None have been approved for hospital use as of yet, which is the next frontier.

lokar 1mo ago
Why is hospital use so important?
- ijustlovemath 1mo ago
  If the large studies are to be believed, you could save hundreds of thousands of lives and many billions in excess expenditure, because stable blood glucose shortens length of stay. People with diabetes alone account for 60% of hospital expenditure, so improving their care improves the system in a big way.
  - disillusioned 1mo ago
    >People with diabetes alone account for 60% of hospital expenditure That number seemed too large to be true, and I think you might be conflating some numbers... The NIH study about Economic Costs of Diabetes in the US in 2022 [1] states: >For cost categories analyzed, care for people diagnosed with diabetes accounts for 1 in 4 health care dollars in the U.S., 61% of which are attributable to diabetes. So, 25% of health care (not hospital) dollars in the US are apportioned to people with diabetes, and in 61% of those cases, the cause is directly attributable to diabetes itself. Similarly, an NHS study [2] revealed that 60% of overall diabetes spend goes towards diabetes-related complications. Finally, this presentation [3] states that: "hospital stays involving patients with diabetes contributed almost $83 billion or 23% of the total hospitalization costs in the United States," and, of course, not all of those were directly diabetes-related. Obviously that is still a staggering amount of money spent on diabetes every year, and represents a huge burden on our healthcare system. But 60% for all hospital expenditure just doesn't track from my cursory Google-ing here. [1] https://pubmed.ncbi.nlm.nih.gov/37909353/ https://pubmed.ncbi.nlm.nih.gov/37909353/ [2] https://www.diabetes.org.uk/about-us/news-and-views/cost-complications-highlights-urgent-need-transform-diabetes https://www.diabetes.org.uk/about-us/news-and-views/cost-com... [3] https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytics-medical-expenditures-of-diabetes-related-hospitalizations-in-the-united-states-august-4-2020/ https://www.bu.edu/csmet/2020/08/04/healthcare-data-analytic...
    - deleted 1mo ago
      [deleted]
    - ijustlovemath 1mo ago
      oof, that's what I get for commenting late! I was thinking of that 23% number.
      - nerdsniper 1mo ago
        In fairness, that’s still massive.
    - mchusma 1mo ago
      Wild numbers. I already thought GLPs were huge but this makes me think it’s even larger.
  - ButlerianJihad 1mo ago
    Why should hospitals be motivated to shorten stays and reduce expenditures when those stays and expenditures mean that their profits will increase? Why don't they want to maximize profits from the suffering of sick people?
    - xethos 1mo ago
      Outside America, profit does not push every other motivation to the bottom of the pool to drown Though for the more terminally American founders here: reception filling in intake forms and charging one-time admission and diagnostic fees for new patients may have better margin than doctors charging billable hours

deleted 1mo ago

[deleted]

terminalcommand 1mo ago

Minimed 780g user here, it is not perfect. For a true closed loop we need a system that can give glucagon as well. The current closed loop only gives you insulin to lower your blood glucose. When it gives too much it wakes you up and asks you to treat it. You also have to accurately count carbs of meals you eat, enter when you exercise. The sensors are also not quite reliable so sometimes it freaks out and you calibrate and go manual. For a closed loop we need insulin and glucagon in conjunction to keep the bg stable without user intervention.

jamesgill 1mo ago
All closed loop systems require human action--maintenance,filling reservoirs, changing sites, dealing with the inherent variation of CGMs, estimating carbs, etc. even if glucagon delivery were on board (it's being worked on). But most are generally providing insulin delivery in real time, based on CGM data. Also, I agree--glucagon would be a useful thing onboard for T1d, but not really for T2d, because (as you know) the essential problem there is highs, not lows. And I definitely agree about CGM accuracy: most people don't know that there's a significant margin of error in all CGMs. It's 'close', but not precise. I'm a parent of a T1d kid.