The Choice is yours…

… and Amazon hopes you get your medical devices from the Choice brand. Why? Because they own it – and everything else. Amazon and the Arcadia Group announced the launch of an “Amazon-exclusive” brand of consumer-use medical devices for diabetes and hypertension management. According to Arcadia’s CEO, “Our products are best in class and very affordable. Over time we intend to incorporate voice-driven measurement interpretation as well as individualize wellness recommendations. This is all possible with Alexa and will provide patients with a wellness experience not available until now.” Great, soon Alexa will also tell me I’m fat. To see some of the worst and best choices on The Price is Right go here. The last 2 minutes are priceless. Pun, intended.

Hacks that help

In a more positive biohacking story, a group of diabetics and hackers are using vulnerabilities in their medical devices to make their lives easier. Diabetes is notoriously annoying to monitor, sometimes making patients or their caregivers wake up at night to check glucose levels and dose insulin accordingly. To avoid that, patients are willing to cobble together their own artificial pancreases using hacked insulin pumps, glucose monitors, a small Bluetooth-connected computer with open-source code, and a smartphone app. The system works in concert to automatically deliver a calculated dose of insulin from the pump to moderate glucose levels. To be very clear, this is not regulated in the slightest. But it’s cheap. And it shows that if these the market isn’t addressing these patients’ needs, they’re happy to circumvent it.

American Society of Plant Biologists

We didn’t make that up, the ASPB is an actual thing. Before you start in with your favorite Little Shop of Horrors plant references, you might want to wait. Some background: montbretin A (MbA), a natural compound with the potential to treat type-2 diabetes, was discovered in the ornamental plant montbretia 10 years ago, but it couldn’t be produced on a large scale until its biosynthesis was understood. Scientists have now discovered genes and enzymes responsible for MbA biosynthesis and demonstrated the potential for metabolic engineering of wild tobacco to produce this promising drug candidate. Seeing that the 2016 global diabetes drugs market was valued at ~$31 billion and is estimated to reach USD ~$45 billion by 2021, the question is, who will license the technology? Our guess, Novo Nordisk.

Money, meet Mouth

In a move that InsightCity writers believe will become more popular in the coming years, Medtronic announced it’s putting its money where its mouth is for their MiniMed 670G insulin pump system (not for the popular BBC antiques television show). Already well established for the treatment of type 1 diabetes, Medtronic is looking to take a larger part of the larger type 2 market. According to the announcement, “with this guarantee, Medtronic will provide flat-fee reimbursements up to $25,000 per pump over 4 years for qualifying diabetes-related inpatient hospitalization and emergency room admissions for eligible in-network patients in the United States.” These outcomes-based pricing models have been in play for a bit and they are evolving. Italy has used them with limited success since 2016, according to this Wall Street Journal article. We’re just sayin’, we hope it works.

Precision medicine + diabetes

Time to break down diabetes into more subtypes than the amount of Wilford Brimley parodies there are on YouTube. Ok that might be an exaggeration because there are a TON, but Swedish & Finnish researchers are making an argument that we should probably have more than just the current two subtypes. They propose keeping Type 1 as its own thing, but expanding Type 2 into four clusters that are more descriptive of their causes. The basic breakdown is: Cluster 1, severe autoimmune (the former Type 1;) Cluster 2, severe insulin-deficiency; Cluster 3, severe insulin-resistant; Cluster 4, mild obesity-related; and Cluster 5, mild age-related. According to researcher Leif Groop, this is “a real step towards precision medicine. In the ideal scenario, this is applied at diagnosis and we target treatment better.” Increasingly patient-centric approaches will always get a thumbs-up from us.