What happens when someone pulls the plug?
First came news that United Airlines issued a ground halt due to technical issues, next comes news that the New York Stock Exchange halted trading due to a technical issue. While it’s too early to tell whether these technical issues were the result of a cyber-attack or just internal system failures they raise some interesting question for the world of interconnected diabetes management (IDM). Namely what happens to IDM when there is a system failure?
For all the positives IDM has to offer we don’t hear much about what happens when the systems don’t work. What happens when the patient cannot access data or when information cannot be transmitted to the patient?
This is one reason Diabetic Investor has never been a huge fan of the quest to develop a true closed loop insulin delivery system. As we have noted on several occasions in reality such a system is collection of medical devices, most prominently an insulin pump and continuous glucose monitor. These devices are then combined with sophisticated software which transforms data into action. As whiz bang and way cool as such a system may be the fact is no system is foolproof, medical devices do fail or malfunction. This is huge problem given that when dosed improperly insulin is a lethal drug.
Considering this continued fascination with whiz band way cool technology not much thought has be given to what happens when this technology doesn’t work. The fact is as more patients and their physicians become dependent on this technology the greater the risk. Now Diabetic Investor is not trying to be an alarmist by any means but to just assume that these systems will never fail is foolish.
This is another reason we see the FDA becoming more proactive in the IDM space. As everyone knows there are host of diabetes apps most of which are not regulated by the FDA. These apps provide a wide range of information including insulin dosing recommendations. Well what happens if there is a glitch in the software?
Another cause for concern is many of these apps require a fair amount of patient interaction. It’s the patient’s responsibility to enter in information that is not collected via a device. Think for a moment about what could happen when say a glucose monitor captures and transmit an accurate reading which is then combined with inaccurate information which was entered by the patient. As we have noted time and time again diabetes management is more involved than just monitoring glucose.
Perhaps the best real life example is think about what happens when someone has a GPS system in their car. The driver enters into the GPS where they want to go and the system determines which route to take. Should the GPS fail the driver has a backup system and can use an app like Google maps to get the directions they need. If Google maps isn’t working the driver can always call their destination and get directions verbally. Even if there is no cell service the driver can always stop at a gas station and get directions. Simply put the driver has a host of backup systems in place should their primary system fail or malfunction.
The same cannot be said for a closed loop insulin delivery system or the many diabetes apps available.
Again we are not trying to be overly dramatic here but it’s about time someone starts asking what happens when these systems which are supposed to help a patient better manage their diabetes fail. What backups are in place? The harsh reality is medical devices fail or malfunction. And as everyone with a mobile phones knows there are times when service is not available. To simply believe these systems will work 100% of the time is not just foolish, it’s also dangerous.