David Klonoff 0:19

Welcome to Diabetes Technology Report . This is a podcast devoted to diabetes technology , hosted by me , David Klonoff , and by Dr . David Kerr , who will introduce our guest today .

David Kerr 0:34

Hello everyone , David Kerr , and a huge welcome to Lutz Heinemann . Lutz , we know you very well . Diabetes Technology World is very familiar with your work over the years , but perhaps there's some people out there who just want to hear a little bit about who you are and what you've been doing so far in this world .

Lutz Heinemann 0:53

So hello everybody , and thank you to David Kerr and David Klonoff for inviting me to talk with you a little bit about topics that are of my interest . So my name is Lutz Heinemann . I'm quite interested in many topics in diabetes technology . By profession , i'm an engineer and biologist . I've worked in the field of insulin pharmacology for many years . in the last 15 , 20 years , my focus was very much on diabetes technology and in this respect , i'm also the managing editor of the Journal of Diabetes Science and Technology , working closely with the two David's .

David Kerr 1:36

Thanks , lutz , it's great to see you . The topic we'd like to discuss today is a big one . It's about the environment and diabetes and the impact of diabetes on the environment . Why is this important now , in 2023 ?

Lutz Heinemann 1:55

So I think it's interesting to have different positions while talking about this topic . So I learned recently that , for example , the US healthcare system has such an impact on the global changes in climate that if the US healthcare system would be a country by itself , it would rank number 13 on a global level when it comes to greenhouse emissions and so on . So our aim to improve the healthcare , the diabetes treatment of patients with diabetes has an impact on the climate in itself . So , viewing it the other way around , from a patient position , the improvements that we have seen in diabetes therapy over the last 100 years are very much driven not only by insulin and other pharmaceutical achievements , but a lot also by technology achievements . Think about insulin pen needles or needles in general , about insulin pens , smart pens for blood glucose monitoring , continuous glucose monitoring , which now we have in the paenicular , achievement in the form of a system for automated insulin delivery . So these are tremendous achievements for patients with diabetes , enabling them a regular life . They are able to work , able to sleep and so on , like healthy subjects .

Lutz Heinemann 3:35

So I think , this is a big success . However , when there is a lot of light , there is also shade and shadow . So we also have to acknowledge that the usage of diabetes technology is associated with a lot of waste production , plastic and special . So that is one aspect . The other aspect , also for patients , is why is a changes where changes in the climate , where it is heat waves as an example , important for patients ? because not only the insulin might be degraded more rapidly , but also the function of the technology . We have to be careful if this works during a heat wave , like it does when the temperatures are in the normal range .

Lutz Heinemann 4:19

So I think it is of interest and , as David has highlighted , this is a big topic with many facets and many aspects that are interacting at the same time . So it is not easy to make a very straightforward statement let us do this , and that Most often , the simple solution is , from my point of view , too simple is to say , oh , the industries are manufactured should do this , and that , yes , that is one aspect , but that is it I was going to ask you about , david .

David Kerr 4:52

Is this something that people with diabetes should care about , or is it just yet another chore that , along with all the other things they have to do ? Is this important for people with diabetes ?

Lutz Heinemann 5:06

I believe , yes , i trust they have to understand that changes in the climate have an impact on their diabetes therapy for example , the storage of insulin , but also storage of blood test strips or glucose measurement and so on . So patients have to understand . okay , we as patients have a certain sensitivity to climate changes , to heat waves and so on , and this is something , do not get me wrong , but I assume also many physicians and nurses , and so I do not see as a topic on its own , so I see the awareness , the increase in awareness of such aspect as an important topic .

David Klonoff 5:53

What sort of activities do you think should be done ?

Lutz Heinemann 5:59

So the diabetes technology society , david Klonoff and myself and some other colleagues , we had an event already two years ago was the Green Diabetes Summit , where we had also come along with a declaration that try to highlight and really come along with very pragmatic suggestions for each and every group that is involved in diabetes therapy , what they can do to improve the situation . And I think , david , you asked me for what can be done . I think it is impressive to see that manufacturer of devices , for example , insulin-pandem manufacturer and so on , they are trying to improve the situation by establishing recycling procedures and so on . So the industry , for a little bit , is spare headed in Europe , because the pressure , also by the political system , is very much higher , to my understanding , in Europe than in the US to make changes when it comes to disposable pens and so on , or to insert us of CGM systems why can they not use multiple times and only once , and so on . So there are very clear opportunities to improve the situation .

David Klonoff 7:28

Do you see the opportunities more in how products are manufactured or more in how they are disposed of ?

Lutz Heinemann 7:39

As I tried to indicate , david , i think we have to handle all aspects . For example , in Europe , in France , there is a new initiative driven by the political system , the Gastry , and they , for example , now have established a system that is able to separate the different compartments of a given patch pump . So this helps them to recycle all the relatively easy to separate parts of a patch pump metal , electronics , batteries , plastic parts and so on And this can then be recycled . So this is a very pragmatic approach And this I think we have to consider , and we have also considered the cost factors and so on . But there are opportunities for us , for the industry , for the users , for the physicians , to make changes .

Lutz Heinemann 8:42

And probably the last point , david , we that means some colleagues of mine in Germany we have performed a study , in a sense , in which we asked patients with diabetes to collect their diabetes waste over a period of three months . One of the first observations is it is impressive what kind of volume , really big bags of plastics , bags you have filled up with paper coverage , plastic coverage and instructions for use you name it that are used by patients that are using diabetes technology and other treatment options in daily life . And the other point is that I found very interesting is how much of patients are interested in the topic and are interested in reducing the waste generation . they see , they really see and could carry it . they are doing well treating their disease .

David Kerr 9:49

Yeah , David kind of mentioned this , but I'm wondering do you think it's got a station where people with diabetes , as consumers , are going to start making decisions about which products to use based on the greenness or lack of greenness ? Do you think that's going to be part of the decision making process ?

Lutz Heinemann 10:11

Absolutely , David . We have performed a survey , a relatively small survey , with 2000 patients in Germany , asking them about their opinion on race-race generation .

Lutz Heinemann 10:23

And again , let me really highlight the patients are aware of what they are doing there And this is probably not early days , but they are starting to make the decisions , also on the ecological footprint of the product they are using Currently , and something also for David and David for us to do . I tried to find data about the ecological footprint of diabetes slash diabetes technology , which I was unable to find , so if we would provide patients with the clear information if you take this CGM system or this pump or whatever , this is the ecological footprint of this product in comparison to another product . this might be something patients slash diabetes teams are really interested in .

David Kerr 11:17

So we might come to a day when , as well as reporting the MIRD on the accuracy of the glucose sensor , we might actually have a score on their ecological footprint .

Lutz Heinemann 11:30

That's pretty interesting , i'm fully with you and you have reported about such a scoing , and I think this is what we need , taking all aspects into consideration .

David Klonoff 11:41

Well , it's one last question . Where do you think this field will be in five to 10 years ?

Lutz Heinemann 11:51

You know there's a million dollar question , david , and most often people like myself in five years have to say , oh , we were unable to think big enough . But trying to answer your question , i think what we would see is the usage of AID systems . so the systems for automated insulin delivery be practically all patients with type one diabetes , but also by a number of patients with type two diabetes . So there is a great future for diabetes technology , to my understanding . But at the same time we have to handle the ecological aspects of diabetes technology more carefully . We have to have this as one of the driving factors in the development And keep in mind to develop a new product take years , so in other words , you have to do something now . to have a different product is a hopefully improved ecological footprint in four or five years in our hands .

David Klonoff 12:59

Well , Lutz , thank you for being interviewed by David Kerr and me today . This was the first in a series of podcasts about diabetes technology , and we will be posting this podcast on the Diabetes Technology Society website , and the podcast will also be available on major podcast sites such as Spotify and Apple . So , David Kerr , thank you for participating . Lutz Heineman , thank you for being interviewed .

Lutz Heinemann 13:32

Thank you for having me .