Lutz Heinemann on the Sustainability of Diabetes Devices and the Green Diabetes Initiative

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.