Travel Insurance and Diabetes - shop around!

Travelling with diabetes is not always easy or straightforward - that is why we set up VoyageMD.com. One recurrent complaint we hear from people living diabetes is the cost of insurance for travel. As we mentioned in a previous post, for the insurance companies the main consideration is the cost of dealing with an unforeseen medical incident whilst the traveler is abroad. Some countries are notoriously expensive when it comes to medical care especially the USA but even within Europe the costs can also vary by huge amounts.

Although there are very many companies selling insurance, when it comes to travel, the majority use one system to work out the risk for an individual traveler by asking a set of standard questions (http://www.healix.com). For diabetes the questions relate to age, insulin or no insulin, recent hospital admissions (without specifying the reason), smoking history, presence of diabetes complications and whether or not the applicant has to take medicines for blood pressure or cholesterol (nearly everyone with type 2 diabetes!!). The interesting finding is what is NOT asked - the insurance companies do not appear to be interested in hypoglycaemia risk, HBA1c levels any aspect of glucose control. This seems surprising especially as hypoglycamia and problems with maintaining good control of blood glucose levels are two of the commonest problems related to travel and diabetes.

The variation in the price of insurance premiums related to diabetes is surprising. As an example, VoyageMD used a well known comparative website (www.moneysupermarket.com)  and compared the costs of buying insurance for a person living with type 1 and type 2 diabetes and compared the costs if the traveler had been in hospital recently: single male traveler with diabetes planning a single 2 week trip in December the quotes were:

Travelling to France
Type 1 diabetes with no recent hospital admissions     £10.60 - £37.88
Type 1 diabetes with a recent hospital admissions       £14.36 - £85.47
Type 2 diabetes with no recent hospital admissions     £11.36 - £15.05
Type 2 diabetes with a recent hospital admission         £14.36 - £95.48


Travelling to Spain
Type 1 diabetes with no recent hospital admissions     £10.60 - £37.85
Type 1 diabetes with a recent hospital admissions       £21.25 - £96.27
Type 2 diabetes with no recent hospital admissions     £12.66 - £79.78
Type 2 diabetes with a recent hospital admission         £30.77 - £95.46


Travelling to the USA
Type 1 diabetes with no recent hospital admissions     £31.69 - £120.32
Type 1 diabetes with a recent hospital admissions       £51.75 - £202.20
Type 2 diabetes with no recent hospital admissions     £25.99 - £147.04
Type 2 diabetes with a recent hospital admission         £66.00 - £231.97

The take home message is (a) shop around and (b) the insurance companies need to talk to people living with diabetes and  their diabetes teams to gain a better insight about the risk and realities of travel and diabetes so that people living with the condition are not unfairly penalised.

This is going to be one of the major campaigns for VoyageMD in 2013.

Happy New Year

VoyageMD and the House of Lords

Last week VoyageMD had the honour and privilege of meeting with a small number of members of the House of Lords in London. The meeting was organised by the Association of British Healthcare Industries (ABHI) (http://www.abhi.org.uk/) and took place at the House of Commons. The ABHI is the industry association for the medical technology sector in the UK, aiming to facilitate the adoption of medical technologies to ensure optimum patient outcomes for the UK and beyond. This UK industry has more than 3000 companies, employing over 64,000 people with a turnover £15 Billion. 

Following last year’s publication of the NHS Chief Executive’s review of innovation uptake in the NHS, entitled ‘Innovation, Health and Wealth’, and at a time when the NHS is expected to make considerable efficiency savings, there are opportunities for the technology industry to help improve patient outcomes and at the same time reduce the financial burden for the NHS

Unsurprisingly the main topic of discussion focussed around technology and diabetes and a number of themes emerged:

Access: In the area of access to insulin pump therapy the UK has an unenviable reputation. Insulin pump therapy has been around for a number of years, has a solid evidence base and has been approved by the National Institute for Health and Clinical Excellence (http://guidance.nice.org.uk/TA151) yet access to this form of insulin delivery is not equitable across the UK. It still depends on where you live! In a nutshell there are still a number of specialist diabetes centres in the UK that "don't do pumps" or have a limited number available. VoyageMD suggested that it may be an option to consider developing supra-regional pump centres that can offer assessment, pump initiation and on-going follow up for the first 12 months with the use of web-portals and other forms of digital communication to support on-going care once a patient returns to their usual point-of-care. Basic and high level training would also be offered by these centres. Controversially their Lordships were interested in whether this model would allow more patients to continue to have their care managed in the community.

Evaluation of New Technologies: The UK should be the gateway to Europe for new companies and established companies with new devices. The idea would be to create an environment whereby industry could have access to clinicians and patients at an early stage to facilitate device development especially the user "experience" - in other words make devices that (a) work (b) produce benefit and (c) patients will keep using. Their Lordships also touched upon the need to consider better regulation as recently suggested by the European Association for the Study of Diabetes following the PIP breast implant scandal.

Partnerships: A number of headlines in the media have highlighted deficiencies in diabetes care as well as the continued growth in the number of people developing the condition. Technology has an opportunity to promote behaviour change, encourage self-monitoring and provide "big data"  - the so-called quantified self philosophy (http://www.guardian.co.uk/science/2011/dec/02/psychology-human-biology). However to achieve progress there will need to be more partnerships between clinicians, patients and industry. Their Lordships appeared to be particularly interested in creating training programs for clinicians to provide training end expertise in clinical medicine, scientific methods and business - the latter giving insights into taking an idea, developing it and bringing it to market. More information on the UK Governments views on this are about to be unveiled in the forthcoming Life Science Strategy publication.

The discussion also covered other topics including the role of social media to improve diabetes care,  funding for the NHS in general and the need for new approaches to deal with increasing number of elderly people living with multiple chronic medical conditions.

A great deal was covered in the 3 hours and VoyageMD was delighted with the level of interest shown by the peers in encouraging more technological solutions for diabetes and other conditions. There was no sense of politicising the discussion for the benefit of one party or another rather a sense of "we are in this together". Further discussions are planned and VoyageMD will keep you up to date.

World Diabetes Day

In anticipation of the forthcoming World Diabetes I was asked for some thoughts about diabetes for the people at Timesulin (http://timesulin.com/blog/). 

Endocrinologist Professor David Kerr was one of the first supporters of Timesulin, particularly because of his passion for smart technologies to help make life for people with diabetes easier. Professor Kerr and his endocrinology team have launched the fabulous www.VoyageMD.com, which provides very relevant advice for those of us who have to travel and maintain good diabetes control. Thank you for taking the time to share your love of shiny things with us, David! You can follow Professor Kerr on Twitter by clicking here.

I don’t have diabetes but I come across many thousands of people who do and who have to live with it every day of their life. Living with diabetes is certainly not easy especially the day-to-day juggling of insulin and I can completely understand how difficult it is to nail the HBA1c to the target range but at the same time avoiding the beast that is hypoglycaemia.

I do like shiny thing things and on World Diabetes Day I want to make sure that the scientists, engineers, boffins and money men understand that technology has an enormous potential to help the millions of people with diabetes. However, when they are thinking about new ventures and new designs they need to talk to their customers at an early stage to make sure what they create is of value to both people living with diabetes and healthcare professionals like myself.

I also need to make sure my colleagues working in health understand that diabetes – especially Type 1 diabetes – is for life and it is not easy. I did think of using the tag line “life is made up of moments” but that has recently been high-jacked by a major brewery!! Nevertheless it hasn’t stopped me thinking about how we can help to reduce the burden of diabetes by using future technologies.

The concept is simple – create a library of “Diabetes Moments” where anyone can take one of these moments and find practical information of how to make their life easier from a diabetes perspective. The first one is already available for people with diabetes who need to travel (www.VoyageMD.com) and we are about to launch our first app specifically for people with painful neuropathy caused by diabetes. We are also working on using the experience from the computer gaming world to look at making monitoring easier and more understandable. Future ideas will be around pregnancy planning, driving, hypoglycaemia detection etc.

Diabetes sucks – but that should not stop us from thinking laterally and creating new technologies to help, We also need to keep hearing from the people that matter – those living with diabetes. On World Diabetes Day I would like everyone with diabetes to look at what they do everyday and come up with one idea that could and would make a difference. A great example is the Timesulin device – simple idea fulfilling a real need – I wish I had thought of it!!

Pumps, Sensors and Airport Security

Travelling through Airport Security with an Insulin Pump and Glucose Sensor

A recent case published in the medical journal, Diabetes Technology & Therapeutics (2012, Volume 14, pages 984-5) highlighted the potential problem for people with diabetes using and insulin pump or glucose sensor when faced with the demands of airport security.

When an insulin pump (continuous subcutaneous insulin infusion - CSII) or glucose sensor (continuous glucose monitoring system-CGMS) is passed through airport security equipment there is the potential for the motor in the devices to be affected by electromagnetic fields. It does depend on the device. In a nutshell, insulin pumps and glucose sensors can pass relatively safely through airport metal detectors (these have low magnetic energy). However the airport body scanners is, in fact, a low energy X-ray system and can cause interference.

At a practical level the advice is to remove the devices if the traveller has to pass through a full-body scanner or alternatively request a pat-down by the security officer. The only exception is the Omnipod insulin pump (Insulet Corp, Bedford, MA, USA) which is made in such a way (no direct current motor) making it safe from electromagnetic fields.  

For more information on all aspects of travel and diabetes go to our main website at www.VoyageMD.com

Radical Thoughts on Funding Diabetes Care

Published first in Diabetes Digest, 2012, Vol 11, No 3, page 126

Many a small thing has been made large by the right kind of advertising.” Mark Twain

The so called “black art” of marketing is a ubiquitous feature of modern life, and daily examples such as television commercials can reach levels of supreme irritation. Fortunately, when it comes to marketing pharmaceuticals and medical devices, official regulations are in place to prevent advertising overload and to control the way in which marketing can be used to attract potential prescribers. However, we should bear in mind that marketing is not a straightforward exercise, nor is it easy, with companies often having to maximise benefit from a small amount of data. But, as Mark Twain noted, “many a small thing has been made large by the right kind of advertising.”

At a time when the wind of austerity blows through the NHS, there is increasing pressure on drug and device spending. This is taking many forms and disguises, and the reality is that the days of enthusiastically embracing new (and invariably expensive) therapies and shiny technologies based on “feel-good” factors alone are over. However, universal adoption of this rationing approach must also be cautioned against as it can lead to people with diabetes being denied equitable access to beneficial new treatment approaches. This has been seen over recent years with insulin pump therapy, for which rates of uptake have been determined by “geography” – the UK still lags significantly behind most of Europe in terms of insulin pump provision.

To borrow a phrase from the lexicon of Tony Blair, perhaps there is a “third way” when it comes to the provision of new therapies and medical devices? This concept is simple and based on purchasing “outcomes” for people with diabetes. For new drugs, the NHS would “buy” treatment outcomes based on evidence yielded from clinical trials. If the drug is then offered to the target population and treatment achieves pre-determined outcomes (over an agreed pre-determined time), then the funding of this drug would continue. However, if pre-determined outcomes are not met, assuming that it was used appropriately, the NHS would receive a rebate.

The advantages of this approach would be as follows: (a) the clinical trial subject participants would need to reflect the background population for whom the drug is being considered; (b) clinical trial outcomes would need to be relevant to the tax payers; and (c) the pharmaceutical industry would be encouraged to act as more than simple purveyors of medicines by providing support to optimise the benefits of their products. The caveat would be to take into consideration factors such as treatment compliance, but the onus would be on the pharmaceutical companies to help develop new approaches to this perennial problem.

The “third way” approach to treatment provision in the UK would also be appropriate for the adoption of medical devices, for example for insulin pump therapy. It would make more sense to “buy” a pre-determined number of days of continuous subcutaneous insulin infusion with the cost including the device, consumables, insulin and blood-glucose monitoring as well as established outcomes around hypoglycaemia risk reduction and improved quality of life. The same would apply to glucose-sensing devices where people would purchase days of sensing rather than the device itself, therefore passing the risk from device failure onto the device manufacturers. The advent of outcomes-based risk-sharing schemes has seen some progress being made, but there is still much to do.

The polarisation of views on new approaches to therapies and monitoring devices in diabetes care is, I doubt, helpful nor is it reassuring for people living with the condition. Furthermore, the high-profile cases of unhealthy relationships between the industry and the professions have changed this particular landscape forever. The need now is for lateral thinking and avoidance of a siege mentality.

For the NHS, change is not often easy nor is it straightforward, but to quote Steve Jobs from his 2005 commencement speech to Stanford University graduates, “If today were the last day of my life, would I want to do what I am about to do today?”

New Thinking on Paying for Diabetes Innovations

In the UK, improving access to new medicines and medical technologies is not always straightforward and in these current harsh economic times, the costs of innovation are the major concern.

For new medicines and devices, a novel approach might be to consider passing some of the risk back to the company by "buying outcomes" rather than the drug or technology per se. For new drugs, this would mean buying outcomes based on research evidence from clinical trials so that if a new drug achieves the pre-determined desired outcomes over a fixed period of time then it would be continued to be funded. However if it did not achieve this there would be a rebate for the healthcare system. This is equivalent to having a warranty on a new car. The advantage of this approach would be (a) clinical trial subject participants would need to reflect the background population,  (b) the outcomes of clinical trials would need to be relevant to the payers and (c) industry would be encouraged to act as more than simple purveyors of medicines by providing support to optimise the benefits of their products.

The same approach could be used for new medical devices so with this in mind we are sending this request to the companies that manufacture real-time continuous glucose sensors for people with diabetes.

Re: Real-time glucose sensors

As you are aware we are very enthusiastic about the role of technology in helping to deliver excellence in diabetes care. This includes continuous glucose monitoring systems. Although the latter systems.

In 2011, many of our patients benefitted from the data provided by CGMS and for 2012-13 we would like to develop this further. Recently barriers to accessing technologies for diabetes care were discussed at a All-Parliamentary Committee at the UK House of Commons.

Therefore rather than adopting the traditional cost model of purchasing up-front systems and equipment that offers blocks of days of sensing at a time, we would like to explore a new approach to funding CGMS for patients with diabetes.

Consequently we are writing to the 3 main sensor companies (Medtronic, Abbott Diabetes Care and Dexcom) to ask them to provide the costs of delivering 500 and 1000 days of real-time continuous glucose monitoring data which includes all hardware, any equipment failures as well as VAT (tax).

We will let you know the response???

15/10/12

Dexcom: No response
Abbott Diabetes Care: No response
Medtronic: Very interested in developing this idea

 

VoyageMD reviews: www.glooko.com

At a medical meeting in 1956, Dr Priscilla White of the Joslin Clinic asked: ‘Do you think patients should learn to do their own blood sugars?’ This was greeted with laughter from the audience who clearly regarded it as an outrageous idea. Nowadays, self monitoring of blood glucose levels has become a routine activity for the vast majority of people living with diabetes. Traditionally,  the recording of achieved blood glucose levels has been with a pen and paper –the ritual handing over of a messy, blood stained log of hundreds of random numbers at each clinic visit. However, changes in consumer electronics have altered markedly methods of communication.

With this in mind, VoyageMD has recently had an opportunity to review the Glooko Logbook app and Glooko Metersync cable (http://www.glooko.com/). The concept is very simple - plug the Glooko MeterSync Cable into most standard self-monitoring blood glucose meters and sync it with a variety of iOS devices (iPhone, iPod Touch) to create a digital logbook of readings. The advantages are (a) being able to create an instant error free logbook  (b) recording carbohydrates, insulin doses, medications, when they happen (c) accessing nutritional information from the integrated food database and reviewing trends with the integrated meter readings and notes. The results can then be summarized as a pdf, exported to a spreadsheet or emailed to a doctor or nurse. The Glooko MeterSync Cable is very easy to use and compatible with a number of exisiting meters:

       ACCU-CHEK^® Aviva, ACCU-CHEK^® Aviva Nano, ACCU-CHEK^® Compact Plus, ACCU-CHEK^® Nano

      Bayer’s Breeze^®2, Bayer’s Contour^®

      FreeStyle Freedom Lite^®, FreeStyle Lite^®

     OneTouch^® Ultra^®2, OneTouch^® UltraLink^®, and OneTouch^® UltraMini^®

On a negative side the system lacks the ability to create custom graphs and images but hopefully these will come with later versions. More significantly, this is a device which adds some value but misses the opportunity of being a truly disruptive technology which will radically improve the lives of people living with diabetes.

At VoyageMD we would like to see device manufacturers include tools that will:

Enable patients to act on their blood glucose results by translating blood glucose test result into usable information and advice for diabetes management and also including bolus and basal insulin calculators for insulin users

Assist with interpretation of glucose data by adding software for pattern recognition of high and low blood glucose levels including prompts about potential reasons for these events occurring (e.g. wrong time of administration of a bolus dose, or insulin stacking due to too frequent dosing)

Create a structured approach to testing for specific needs, e.g., the use of paired pre-meal and post-meal testing to help with weight management

Develop web and mobile phone applications to take into account an individual’s achieved level of numeracy and literacy in addition to native language, culture, and age

An additional approach would be to create technologies based around common “life events” for individuals living with diabetes such as travel, shift work, or in-hospital care, where it may be possible to predefine frequency and timing of testing to maximize benefit and reduce risk and costs. It is also anticipated that future technologies will be personalized to current treatment regimens.

By adopting new, actionable monitoring technologies, we believe people will be enabled to self-manage their condition better and, in the longer term, potentially reduce the burden of diabetes on the individual and society.

Report for the 2012 Diabetes Technology Society Clinical Meeting

Website: http://clinicaldiabetestechnology.org/

This year’s clinical DTS meeting was held at the Omni Hotel in downtown Los Angeles on April 20^th-21^st. Unlike the large annual meeting of the Society in the Autumn, this one focuses on clinical aspects of the role of technology for diabetes care. As well as the formal meeting, the other benefit of attending is to network with fellow scientist-clinicians, educators and high-level industry attendees. Unsurprisingly, the audience was overwhelmingly US.

As well as discussing the current state of the art in relation to diabetes technologies, there were many glimpses into the future. So what were the take-home messages?

Self-monitoring of blood glucose

The debate about acceptable levels of accuracy for test strips continues but the general impression was that the level of accuracy depends on the patient group – for example better accuracy is needed for those at greatest risk of hypoglycemia.

The hot topic, as far as the audience was concerned related to preventing serious infections in care homes and hospitals (now known as assisted blood glucose monitoring) in relation to the lancets but also the meters per se. The US regulatory authorities are increasingly turning their attention to this topic and industry will have to deal with this.

Fantastic presentation and discussions around structured blood glucose monitoring for people with diabetes not using insulin highlighting the importance of thinking about the timing and frequency of testing and most importantly making sure that clinicians as well as people with diabetes know what to do with the results! This is especially relevant when working out the cost-effectiveness of self-monitoring. 

Continuous Glucose Monitoring

There were detailed descriptions of the role of CGM in certain situations including pregnancy and for children with diabetes and discussion around interpretation of sensor data.  Perhaps there is a need for the creation of a platform for sensor downloads to be more widely available and in a more understandable form for education purposes? The recent findings showing value of CGM in type 2 diabetes were also highlighted.  There was also an update into the potential appearance of implantable glucose sensors. The bottom line – CGM can add value to diabetes care and needs to be more widely available in health-care systems but the costs need to come down! The patient panel eloquently highlighted the good and the not-so-good aspects of sensor technology and their insights would be well worth recording and posting for others to hear.

Insulin Delivery Systems

In a nutshell, everyone is waiting to access smaller patch pumps and the race is on from at least two new companies entering the commercial arena as well as the usual suspects. Key requirements seem to be (a) better connectivity and (b) an absolute requirement for a bolus button on the patch pump. For pens can we have new technologies that date and time stamp the insulin injections and ones that can be downloaded? Experience and data are increasing on the use of CSII in type 2 diabetes – this could have important economic consequences for any healthcare system though! An excellent talk on software guided systems for insulin delivery made the important point that this approach should be more widely sued in Critical Care Units but the real difficult nut to crack remains glucose control elsewhere in the hospital.

Other important take home messages from the meeting were:

1.     Inhaled insulin may still have a future - http://www.mannkindcorp.com/

2.     Telehealth for diabetes care continues to develop and there is increasing interest in using this approach for discrete diabetes monitoring.

3.     Dealing with exercise and insulin remains a difficult challenge but a great deal can be gained by learning from the approach used by elites athletes and their diabetes teams

4.     Work on the artificial pancreas continues to bear fruit – it is likely that a system for overnight closed-loop control will be the first to be widely available although the exact timing is still not clear.

Given that I gave the presentation it is probably no surprise that one take-home message from the Clinical DTS meeting is that social media has the potential to add enormous value to diabetes care although it is still in its infancy. Traditional research funding bodies will need to re-evaluate their approach and methods to allow imaginative trials in this space to happen.

So what next?

From both formal and informal discussions there is a clear need to offer more practical training for whole diabetes teams for common  (and often evidence free) clinical scenarios. With this in mind we are exploring developing this for next year so please keep following developments on http://www.VoyageMD.com

Back to a rain and wind swept UK now!!!

March 2012 and VoyageMD goes to the next level

Hoorah, finally we have the flight calculator on our site for travellers with diabetes (http://www.voyagemd.com/). The idea is very simple - simply type in the departure and arrival airports and the date/time of the flight and the journey will be mapped out in terms of when to check blood glucose levels and when to give insulin.

The calculator is mostly geared for people with diabetes using multiple daily injections of insulin but we also provide guidance for those using insulin pumps or drugs such as Byetta (Exenatide) or Victoza (Liraglutide). This extra information is in addition to the regular advice about dealing with airport security, helpful travel phrases, malaria prevention etc etc.

So what next?

Once everyone is happy with the flight planner, we will create an "app" for the smart phone so that people with diabetes can plan their journeys anywhere and at any time. We also want to provide space on VoyageMD.com for travellers with diabetes and their friends and families to post their stories, tweets and photos. We will also be increasing our restaurant and hotel reviews.

Having said all of this, our core aim is still the same. We want to persuade all aspects of the travel industry to do more, nothing very complicated, but just ask them to think about the needs of people with diabetes when they travel. In previous blogs we have listed some very simple and practical things that airlines could and should do.

Finally, our experiences with VoyageMD and diabetes have taught us a huge amount and we will shortly be turning our attention to other situations where travel is not always straightforward for people with medical conditions. Watch this space!!!

Breakfast with VoyageMD

VoyageMD is for travellers with diabetes. Although we cover the more serious aspects it is important to remember that sometimes travel can be so much fun. One of the great aspects about travel is sampling the local cuisine. However sometimes it is not simply about the food but the place where the meal was enjoyed. This is nothing to do with calories or carbohydrates but is all about pleasure.

Memories can last a lifetime especially holiday ones and as January is the traditional time for people to book a new vacation now is also a good time to think about previous holidays and some of the meals associated with them.

We would like to hear about the place and the meal in less than 100 words and we will will publish the results on VoyageMD.com. If you have a photograph then even better...For the best entry we will buy you breakfast - not saying where that will be at the moment just to make it more interesting.

Send you entries to me at david.kerr@VoyageMD.com

Meanwhile here are some of our favourite places where we have had memorable breakfasts  - in no particular order:

1. The Queen Mary 2 on entering New York Harbour
2. Puente Romano bridge at Ronda in Spain
3. Captains's club, Christchurch, Dorset, UK
4. Grand Anse beach, Grenada
5. Sausalito, California

Predictions for 2012 - new technologies, diabetes and beyond

I first published this in the the medical journal BMJ on January 4th 2012.

January is the month that heralds the end of procrastination. The New Year is traditionally the time that individuals and organisations look ahead and plan for the future. Among the usual resolutions to do more, eat less, and be more productive, there is also the ubiquitous past-time of predicting the near future. For healthcare the future seems to be focused increasingly on the development and application of technology with a blurring of the distinction between consumer electronics and medical devices.

In their review of more than 1600 posts during 2011 focusing on technological innovations in medicine, Medgadget highlighted various technologies that will make a difference not just to individuals but also the way medicine is practiced. These include lab-on-a-chip technologies for HIV and Syphilis testing, robots that could replace theatre scrub nurses, brain-controlled prosthetic arms, in-car health management, and further evidence that the iPad is now a must-have medical technology given the huge number of medical apps available. Elsewhere, the next year is predicted to see the creation of artificial intelligence systems located in a computer “cloud” that any healthcare provider can access to help with interpretation of lab data or review of radiological images. There is also the potential to use apps to diagnose rashes or to assess a mole, thereby perhaps reducing the demand for dermatologists. You can now order your personal genomic sequence online at a fraction of the cost compared to a few years ago. Given the advances in wireless sensing, artificial intelligence, and the lab-on-a-chip, there is the opportunity to take self-diagnostics to a completely different level. There is even a prize (worth $10 million) for the inventor of the first functional “tricorder” for non-invasive sensing and analysing human data and making an instant diagnosis—first used by Dr Bones McCoy in the 1970’s series Star Trek.

In my own area of diabetes, the next year will bring increasing use of established technologies such as insulin pump therapy but with significant user preferences to use the smaller “patch” devices, a drive to have continuous glucose monitoring devices approved for use by the NHS, and a renaissance in self-monitoring of blood glucose using a more structured approach perhaps incorporating some of the methods used by the computer gaming industries to encourage testing. More patient education will be available online and web portals will be created to smooth the process of care between primary and secondary care providers and patients. The focus will be on outcomes that matter to people living with diabetes such as risk of severe hypoglycaemia rather than surrogate measures such as HbA1c levels or average glucose level.

The other prediction for 2012 is that social networking will have an even more prominent place in medical practice especially in the public health space with the potential to change behaviour more effectively and with less financial costs than traditional approaches. Communication between patients, their peers, and healthcare providers will be less hierarchical and the new social media could be also a hugely powerful driver for change in the area of new drug and device development as well as running clinical trials. Trail participants would be able to provide immediate feedback on a new drug, support training in the use of a new medical device, and importantly capture adverse events in “real-time.”

The caveat of all of this is to make sure that the technology innovators engage with clinicians so that the devices and technologies will actually be used by the target population. In my own speciality, many people with diabetes are from backgrounds where using a smart-phone or computer tablet to help with their healthcare is not a top priority even if they have the numeracy and literacy skills to use them and can afford the cost