Tuesday, April 27, 2010

Wednesday Three: News Worthy of Sharing

A few interesting news items, along with my unbiased opinions, as my reader's have come to expect.

LCT Gets A $500,000 Grant From the Juvenile Diabetes Research Foundation (JDRF)

First, of particular note is the fact that Living Cell Technologies (better known by it's acronym LCT) announced today that it has received a grant of US $500,000 for its ongoing Phase II clinical trial of DIABECELL® in New Zealand from the Juvenile Diabetes Research Foundation International. From my perspective, I would dare say that the actual investment from JDRF may be less critical for the company from a financial perspective (but the grant is certainly welcome), because as a publicly-held company listed on the Australian Securities Exchange as well as in being listed in the U.S. (ticker symbol: "OTCQX"), the company already has access to worldwide capital markets making it easier for them to obtain financing than many privately-held firms or nonprofit organizations. More important, I think this grant effectively gives the technology the imprimatur of this important diabetes organization, which in my humble opinion may be worth far more than the actual financial investment from JDRF itself.

For those of you who aren't familiar with the company, LCT is an Australia-based company that has developed a method of encapsulating (using a material derived from seaweed) transplanted islets and enables them to function while simultaneously protecting the islets from the body's immune system which caused type 1 diabetes to occur in the first place. Islets could then be implanted without requiring ongoing immunosuppression. The company is also pursuing treatments for diseases other than type 1 diabetes using similar or related technology, including degenerative diseases of the nervous system including Parkinson's disease, Alzheimer's disease, Huntington's disease and stroke, as well as a treatment for hemophilia. The idea is that healthy islet cells would be encapsulated and transplanted into the body to produce insulin and regulate blood glucose levels in a completely physiological mannner, quite unlike any other treatment for type 1 diabetes. The capsules ensure that the cells are not recognised as foreign by the patient, so no immunosuppressant drugs will be needed.

That sounds nice, but there's a massive shortage of islets derived from human cadavor pancreata, so the company is proposing a form of xenotransplantation, using islets derived from pigs (which are guaranteed virus-free due to the source from an isolated island in New Zealand) and the undisputed similarity of porcine insulin to human insulin, which actually is MORE similar to human insulin than such widely-used "modern" insulins as insulin aspart rDNA origin (brand-name Novolog/Novorapid), insulin glulisine rDNA origin (brand-name Apidra), insulin glargine rDNA origin (brand-name Lantus), and insulin detemir rDNA origin (brand-name Levemir), and insulin secreted directly into the bloodsteam would not require any manipulation because the time-activity profile would be measured in minutes rather than hours for any subcutaneously dosed insulin.

However, until recently, xenotransplantation of any form has been all but banned, prohibiting trials from conducting human clinical trials in any developed nations, which has raised some skepticism among the Western medical establishment and regulators alike. Russia, on the other hand, allowed the trials, so the company completed it's Phase I human clinical trials in that country, and those trials were regarded as meeting the research goals, this enabling the company to proceed to Phase II human clinical trials. The Russian Phase I trials, however, followed well-established Western medicine scientific protocols, and were closely monitored by a Boston-based contract research organization. Because of this, the early phase trial was therefore instrumental in convincing Parliament in New Zealand to enable Phase II human clinical trials to take place in that country. The New Zealand Ministry of Health has authorized clinical trials in NZ and patient enrolment has already commenced, with the first implant taking place last October (October 2009).

According to Professor Bob Elliott, Medical Director and one of LCT's founders, early results from the clinical trial, which began in October 2009, showed that the cell implants eliminated hypoglycemia unawareness in one of the trial participants -- a complication that occurs in as many as 2 in 10 people with long-term type 1 diabetes, and can be fatal.

As the company addresses the Phase II trials, and heads towards the final phase III human clinical trials, many eyes are on LCT as a possible curative treatment (in spite of the American Diabetes Association's move to stop the use of the word "cure" altogether, catch their 2009 "consensus" statement on that here) as fancier regenerative and autoimmune treatments proceed as well.

Afrezza Claims to have Met Clinical Endpoints

As I wrote in January, at least two new insulin products are now pending approvals, with more likely in coming years. One of those is Mannkind's Afrezza, the rapid-acting inhalable insulin.

According to a two-year study presented at the American Association of Clinical Endocrinologists 19th Annual Meeting in April 2010 (see here), Mannkind showed that Afrezza provided glucose control similar to standard insulin therapy (along with weight loss and reduced incidence of hypoglycemia) in patients with Type 1 diabetes and poorly controlled blood sugar levels. That much was required to submit Afrezza for FDA approval, but nagging questions on lung-function persist.

Mannkind discussed pulmonary function test results (PFTs) in patients treated with Afrezza at the AACE meeting, where the company claimed that follow-up measurements were similar to PFT results observed in patients receiving standard insulin therapy (see here).

Adults with diabetes who participated in any of the four controlled clinical trials of Afrezza were invited to participate in this follow-up trial. Patients were followed for a total of up to three months with PFTs assessed at the end of the parent trial and one and three months after completion of the parent trial. Of the 649 patients in the study, 315 subjects received Afrezza and 334 subjects received usual teatment regimen without Afrezza during the parent trials.

While these results were still greeted with legitimate skepticism considering patients will be expected to use the product over a lifetime, the company is trying to present as much data as it can at this point in time, but until the company has FDA approval, skepticism among healthcare professionals remains high, and long-term safety will remain a key question because long-term usage results cannot be measured in a clinical trial, unfortunately for the company.

One thing that kind of irritates me is the fact that Mannkind refers throughout it's press releases to "antidiabetic therapy" rather than diabetes treatments. Ummmm, remember when Pfizer conveniently ignored the type 1 audience in it's marketing and just look what happened to Exubera. Well, note to Mannkind and Alfred Mann: stop calling treatments for this disease "antidiabetic" -- there's no such thing, they are treatments FOR the symptoms of diabetes, but they aren't supposed to be anti-patient, and that terminology is more than a bit offensive. Watch your language, or it may come back to bit you in the @$$ -- just ask Pfizer, whose marketing folks once told me before Exubera launched that by changing the dosage amounts in "blisters" they were trying to change the diabetes treatment paradigm to be more "intuitive" and less rigid. Yeah, we all know where that ended up ...

Bayer Launches Didget: A Combination Handheld Videogame & Glucose Meter Aimed at Kids With Diabetes

Yesterday, to much fanfare, Bayer Diabetes Care announced the introduction of the DIDGET(TM) blood glucose monitoring system in the U.S. It was billed as being the only blood glucose meter that connects directly to Nintendo DS(TM) and DS Lite gaming systems to help kids manage their diabetes by rewarding them for building consistent testing habits. One feature of this thing I absolutely did NOT like was the fact that the device was also designed to reward kids for "meeting personalized blood glucose target ranges". Bayer claims the DIDGET meter is now available for purchase in the U.S. through CVS.com, Drugstore.com and Walgreens.com. There's a video here you can have a look at:

Personally, I have mixed emotions about this thing. In some ways, I really like the idea, and anything that rewards kids for establishing good testing habits is probably a good thing. But as Amy Tenderich noted, toys generally do have a more transient nature. While video games have longer lives due to the ability to continuously add new games to the mixture, kids do eventually outgrow those, too, otherwise I'd still be playing games on my Atari 2600!

My only real concern is the notion that we should somehow reward kids for "being in target" rather than simply rewarding the notion of testing regardless of the result. That's a big mistake that may cause kids to cheat or lie about results, rather than rewarding the act itself. There are no "good" or "bad" results, it's merely a tool to help guide your next actions. Instead, I think this should reward the idea of testing regardless of the result, because the information from the test can be used for valuable purposes regardless of the result.

My other gripe is the hefty sticker on this device. Bayer gains by selling more devices and test strips, so why do they need to price it at a premium? They ideally should be giving this thing away given the long-term financial benefit they stand to gain if the kids test more. But if parents of kids with diabetes like the idea, there's no reason not to offer a device like this. They might outgrow it, but be ready to replace it with Bayer's Contour USB meter (catch my post on that here) when the fascination with video games start to fade!

Sunday, April 25, 2010

A Tribute & Embracing My Inner ABBA

Just as my friend Kelly decided to honor the fab 70's Swedish band ABBA on Friday by noting that Friday was National Take a Chance Day, which really had very little to do with ABBA's #1 disco classic "Take A Chance", but did lead in nicely into her blog post for Friday, I've decided to do something similar.

Today, I'd like to honor a TV legend who passed away a year ago today: Bea Arthur, best known for her groundbreaking roles on television as Maude and Dorothy Zbornak on The Golden Girls, although her career began decades earlier on Broadway (actually, off-Broadway). Part of my reason for this is because just last week, an organization that she was an honorary director of, in this case PETA (People for the Ethical Treatment of Animals), began running some new ads featuring the late actress which called attention to one of the nation's largest buyers of chicken for it's antiquated (and cruel) slaughter practices, which aren't even within the current USDA standards.

As TV Guide wrote, the campaign may be taking a page out of Nike and Tiger Woods' advertising book. The ads target McDonald's chicken-slaughtering practices, and the new ad features a shot of her — with her trademark glare — and the headline: "McCruelty: It's enough to make Bea Arthur roll over in her grave." Incidentally, The New York Times reports that the ad does have the approval of Ms. Arthur's children, and it's also worth noting that the actress left some money to PETA in her will to continue its mission.

The print ads are interesting, but the video spots are even more shocking, which is the intent -- to shock the viewer to consider what really happens. Have a look:

McCruelty: I'm Hatin' It--Learn More.

This campaign calls attention to the manner in which industrial-food operations exempt themselves from current U.S. Department of Agriculture guidelines. One of the best ways to avoid this kind of thing is to buy foods sourced locally, the same way suggested in the groundbreaking movie "Fresh", and also along the lines of the type of movement being promoted in Jamie Oliver's Food Revolution. When you can visit the source for your food, there's much less chance this kind of behavior can occur, and you can actually talk to the farmer(s). But when your food comes from an industrial operation based thousands of miles away, you have no idea what happens.

Some simple steps everyone can take include growing your own garden, or if that's not feasible, visit your local farmers' markets or farm stand and buy some veggies, fruits, eggs, dairy products, meats, seafood, bread, herbs, honey and baked goods. You can visit LocalHarvest.org to find nearby markets, and you might even meet the farmers who raised and/or harvested your foods. Not only will they appreciate the business, but you'll be closer to the source of your food!

As I noted, a year ago today, Bea Arthur passed away at age 86. She had been suffering from cancer, but reportedly died with family. Prior to TV, one of her best known shows on the Great White Way was as the boozy Vera Charles co-starring with her lifelong good friend Angela Lansbury in Mame. Incidentally, Arthur also played that Broadway role in a 1974 big-screen production of Mame co-starring with none other than the legendary Lucille Ball, which is available on DVD. But her acting career also included sharing the stage with such legendary actresses as Tallulah Bankhead, whom she would later go on to lampoon in her one-woman show which I was fortunate enough to have caught in New York back in 2005 after missing the original, and was glad to have seen it in person, which was one of her last stage performances that I am aware of, so it was awesome.

To close on a slightly higher note, I think it's appropriate to feature a great clip of Bea Arthur who was featured as a guest on the last episode of the first season of the 1990's TV show "Malcolm in the Middle" (which IS available on DVD, although I haven't had any luck finding them on the NickatNight or Hulu websites). That episode is entitled "Water Park" because the family visits a water park, but has to leave Dewey at home with a babysitter. I have captured a clip featuring Bea playing babysitter Mrs. White and Dewey (played by actor Erik Per Sullivan) singing the awesome ABBA song "Fernando". I've downloaded the Flash video clip permanently, but for the moment, I found it and it also appears here (for the moment, anyway, but the embedded video below isn't going anywhere).

Wednesday, April 21, 2010

Running With ScissorsSyringes?

A Possible Shadow In My D-Life Closet

I hope you'll pardon my not-so-great Photoshop skills. To understand this post, you'll need some background on my family (something I seldom write about, as I started this blog to write about diabetes research and the business of diabetes which provides plenty of content, not my personal life, but hey, I can write about anything I want!). I'll try to tell the story in an entertaining manner. I should note up-front that there IS a diabetes theme to this -- I promise!

Widows and Early Latchkey Kids

My maternal grandmother -- I'll avoid sharing surnames outright, but let's just say that if you ever watched the 1970's TV show "Eight is Enough" and you know the last name of that TV family, then you can figure her last name out pretty easily. Anyway, she was a pioneer of sorts. I adored my grandmother, without ever realizing that she pioneered the world of career women and single-parent families, paving the way for women in the late 1960's and 1970's to do the same thing en-masse. When I was growing up, I didn't really care -- how many grammar school kids really care about things like this? She was widowed in the early 1950's, and was effectively forced into becoming a working woman to support her family. This occurred in an era when life in America resembled the life of TV's June Cleaver of "Leave It To Beaver" far more than it did Ann Marie of "That Girl" or Mary Richards of "The Mary Tyler Moore Show" who came along in the late 1960's and early 1970's. At that time, there wasn't the same social acceptance of working women, nor did the local school system even attempt to be accommodating to working parents, so there were certainly challenges. My grandmother's career also impacted her children, who were among the earliest latchkey children, and each child was affected by the experience differently.

My mother is the youngest of three children. She has two older brothers, the oldest of whom she remained pretty close with in spite of him being older and having left for college, then joining the Peace Corps and another organization called IVS (International Volunteer Services) and working in Pakistan, India and Vietnam (he felt those were a superior alternative to joining the military and going to war in Vietnam to kill people) before ultimately moving from the East Coast to the Pacific Northwest (not far from Seattle, Washington, to be exact). He fits easily into the mold of what is viewed as the baby-boomer stereotype. Over the years, including the very summer I was diagnosed with type 1 diabetes, I have spent time at his place in Washington, so in spite of the distance, we've been pretty close.

On the other hand, my mother's other (younger) brother (I guess I can call him my uncle) fell in with a bad-boy crowd at a very young age, getting tattoos (before they became trendy among youth) and starting an addictive drinking habit at age 16 (even though the drinking age was 18 in the U.S. at the time, he was STILL underage) and also developed a pack-a-day smoking habit for Camels (without filters) long before that brand had been resurrected by RJ Reynolds in the 1990's, all while my grandmother was trying to bring home the bacon. My mother, as the only girl in the family, assumed some responsibilities of cooking and housework to help out. She later married and went on to have a family of her own (including me). Because of my bad-boy uncle's many issues, I have never been very close to my uncle.

My Bad-Boy Uncle

Anyway, the bad-boy uncle's life is the kind of story that is often parodied in television and movies, and he became the very definition of a redneck. While my Mom and other uncle suspect that he may have been dyslexic as well as had some form of ADHD (Attention-Deficit Hyperactivity Disorder) which lead him to quit school without a high-school diploma, he was never declared to have a learning disability, he was instead said to have "behavior problems", which apparently was quite common until the late 1960's. He was pretty abusive when he was drinking, and he even hit my mother a and uncle few times while under the influence, thus sewing the seeds for a relationship that was anything but close. He ultimately got a job with the Department of Sanitation in another town as a trashman, which paid reasonably well even if it was anything but an aspirational career path. His first of three marriages was to a woman -- let's just call her Elle (the names have have been changed) -- who was, to put it kindly, a tramp (I could hardly call her an aunt considering I barely considered her husband my uncle) as she was married to him for such a short time and I had only met woman the woman 3 or 4 times in my entire life.

Meet My Cousin "Augusten"

But Elle had already parented 2 children whom she had willingly discarded/abandoned (she handed custody of those children to their father, and luckily for them, he was a stable parent) before meeting my uncle. If I'm not mistaken, it was around 1972 when my bad-boy uncle and his first wife had a son (I'll call him "Augusten", which is not his real name, but I think you'll understand why in a paragraph ahead). Not surprisingly, their marriage ended a few short years later, and while the details on what exactly lead to the divorce were never disclosed, it's safe to conclude that my uncle's alcoholism, occasional visits to jail and various other brushes with the law no doubt played some role, but equally as important, I suspect Elle's unfaithfulness and other lovers just gave my uncle a convenient excuse to drink in the first place. Anyway, given my uncle's inability to care for himself, let alone my cousin, the State granted custody of my cousin to my uncle's first wife, Elle.

Elle also worked, and since it was the 1970's, working women were becoming increasingly more commonplace, and her career advanced quickly (it's unclear whether this was due to her skills, or her willingness to "give it all" to her career, often at the expense of her son, by working "after hours" so-to-speak, or some combination thereof). Then, in a move that really resembles what happened to Augusten Burroughs in his memoir "Running With Scissors" (or the movie by the same title which was based on the same title, which incidentally, was produced by Ryan Murphy, also the producer of "Nip/Tuck" and now "Glee"), Elle actually signed custody of my cousin who was maybe only seven or eight years old to a family she was paying to babysit him while she worked. How any parent could relenquish custody of their child to a complete stranger defies reason in my mind, but remember, this woman had already abandoned 2 children from a previous marriage, so this was merely a continuation of what was becoming a well-established pattern. The family legally changed his last name, which he later would have legally changed back once he was legally emancipated. It's really a mere coincidence that Augusten Burroughs lived in Western Massachusetts, while my cousin lived in Northwestern Connecticut -- both places are in New England in the Berkshire Mountains (in Connecticut, they're probably more like foothills, but I digress). But the similarities pretty much end there, as Augusten Burroughs would go on to receive a college education, and then go on to work for the advertising industry before becoming a well-known author, while it's unclear to me whether my cousin actually received a high-school diploma, much less go on to have a successful career.

My grandmother, before she passed away, frequently visited my cousin Augusten and was among the few semblances of family the poor kid ever knew -- both his mother and father had completely abandoned him. When I was young, we did visit my cousin in his newly-adopted family for an occasional birthday party, although the family who adopted him had as many kids as an orphanage, and in hindsight, I believe most were probably adopted to collect ADFC (Aid to Families With Depedent Children) payments. How much of those payments were actually allocated to the poor children they were supposed to benefit was unclear, but truthfully, my mother and family essentially lost touch with my cousin after that. He lived a good distance from where we lived, and my mother was busy raising her own children, and she did not need threats from an abusive and unstable brother whose everyday language consists to this day of every profanity known in the English language.

A few years later, my uncle remarried, and we even attended the wedding. It was a very strange occasion, as the reception was held in an Odd Fellows Hall which are sometimes described as being similar to the local VFW Halls which dot the country (not exactly the most high-brow event), and there was lots of country Western music at the reception, along with a wierd cast of attendees, and the parking lot was full of pickup trucks with Confederate flags (mind you, this was in Northwestern Connecticut, an area better known for genteel living, with large Colonial homes that have been snapped up by Manhattan execs looking for a country home in the state's bucolic Litchfield Hills, a few ski areas and pristine lakes, not to mention numerous wineries). My cousin lived in a place best known as home to Kimberly Clark's largest Northeastern U.S. manufacturing site -- where workers make Huggies diapers among other things, a town that's something of an anomaly in an otherwise very sparsely populated county -- hopefully that helps to paint some picure.

Suffice to say, my uncle's second wife, I'll call her Katie, was also from the wrong side of the tracks. Katie was an interesting character; she weighed significantly more than my uncle did (let's just say she was BIG girl), and apparently her brother was arrested for manslaughter (so that should tell you something about her upstanding family). But Katie was also a very tough woman who did not tolerate abusive behavior from my uncle, admitting that she had hit my uncle over the head with a cast-iron frying pan when he went after her in a drunken stupor, knocking him out cold, something that would happen on more than a few occasions. My cousin, to the best of my recollection, did not evern attend their wedding, since legally at least, he was then part of another, wierd family. I can only guess what ever became of his mother, but no doubt, she took good care of only herself, as if she didn't already have 3 children from at least two previous marriages already.

Post-Mortem: Augusten's Adult Life

Anyway, my cousin "Augusten" has not lived a good life by any stretch of the imagination. He had two parents who had completely abandoned him, and I would learn later that his adoptive family was abusive, both physically and mentally. I don't even know if Augusten got a high-school diploma, truthfully. Some years later, when he was old enough to figure out that he was entitled to contest his custody arrangement, and he would then locate his father, who had bought a home with his redneck wife and was living a more or less stable life, aside from his occasional run-ins with a cast-iron frying pan! My cousin Augusten, now in his teens, would move into my uncle's dysfunctional home until he was 18 or so, when my uncle caught him stealing the television, VCR, stereo, etc. As my uncle told it, which may very well be a complete lie, my cousin needed money for a gambling debt or for drugs, so my uncle, ever the understanding parent, kicked the kid out permanently, not that he'd done much of anything to support him over the years. To the best of my knowledge, he returned to his adoptive family for the remainder of his high-school years.

So, You're asking, that's somewhat interesting, but What the HELL does this colorful story have to do with diabetes, or anything else, for that matter?

Well, my cousin Augusten, eventually married and had a daughter (or fathered a daughter, and then later married). It was at that time when he began to try and piece together contacts with family, if for no other reason than to have some information to share with his own daughter. Eventually, he located my mother and reached out to her. My mother agreed to meet with him and tried to answer his questions about family, etc. including what had become of my grandmother -- she had moved to Washington, DC in the early 1980's after reconnecting with a college classmate whom she married shortly after. Unfortunately, she passed away a few years later at the age of 77. My mother also provided him with some photos, which I believe he really appreciated, and gave him directions to the cemetery in Boston where my grandmother is buried. At some point, my uncle from Washington was visiting, and he also met with my cousin Augesten, along with Augusten's daughter and wife. Augusten's daughter is a cute little girl, but my cousin Augesten had become obese and ultimately, was diagnosed with type 2 diabetes (the obesity, as recent research has revealed, does not cause type 2 diabetes, rather it protects the body from the impact of the calorie-dense diet that has become so commonplace in the U.S. today). That wouldn't be particularly noteworthy, as both my sister and I have lived successfully with type 1 diabetes for decades so it can certainly be dealt with, but we had the benefit of adequate medical care, appropriate diabetes and nutritional education, so we are examples of individuals who have thrived in spite of having diabetes. For too many people, healthcare is not even available, and for anyone who claims it is not a right, I would dare you to say that to the faces of people who are denied it. My cousin is an example of what can happen without that basic life necessity.

My cousin Augusten, unfortunately, did not have the same benefit of sufficient diabetes care that me and my sister had; while I may complain about my doctors growing up, at least I had ready access to them. Aside from a dysfunctional childhood, to the best of my knowledge, Augusten has never received any sort education on diabetes whatsoever. If I had to guess, I believe his family doctor may have told him he should loose some weight, and prescribed some type of oral meds without explaining much beyond taking the pills regularly, and that was the extent of his diabetes care and education. In the years that followed, Augusten quickly suffered the consequences of poorly-managed diabetes. He developed neuropathy in his feet and legs, which resulted in abscesses forming on one of his feet, which spread to a leg which ultimately had to be amputated. He now lives with a prosthetic. To top matters off, he has lost most of his vision on one eye, and has limited sight in the other, but these things have impeded his ability to find meaningful employment, with a physical disability and lack of much education has limited his ability to find anything.

Evidently, Augusten' wife recently threw him out, so it appears he's now living with my uncle and his THIRD wife. My uncle's third wife is a very kind woman who frankly deserves better than my uncle, but that's a separate story. My mother does not speak to her brother anymore, although she does speak with his wife, as she's lived in my hometown forever, and we've known the family for many years. My uncle, however, is in poor health and now has metastatic lung cancer (frankly, given his smoking habits, the big surprise was that it did not happen sooner), and if I had to speculate, I would guess his time on this earth is pretty limited. I cannot help but wonder what will become of my cousin if my uncle should pass away; he has no assets to speak of, no education and two major disabilities, plus my uncle's wife has no legal obligation to care for my cousin -- she's doing so mostly out of kindness (and for my uncle).

Although I am no way responsible for my cousin's life -- indeed, I hardly know the guy (most of what I know has been shared with me from my mother and the uncle I have always been close with), but I also feel somewhat guilty for being fortunate enough to have received adequte healthcare growing up which has enabled me to meet some amazing type 1 (and type 2) diabetes dynamos we have here in this fantastic, supportive diabetes blogging community, and have the ability to adequately care for myself. When someone does not have this, the horror stories become real.

I feel somewhat strange when I write or talk about my cousin, in part, because I really don't know him at all except what a crappy life he had growing up and how he's suffered not from diabetes specifically, but from a complete lack of information on how he can best protect himself from diabetes complications. It never ceases to amaze me how the U.S. healthcare system will readily remove one or more limbs, but will make it difficult (if not impossible) to get the basic care necessary in order to avoid them. Mind you: I had almost no part of my cousin's health issues, and I haven't even seen him since I was a child, and he has only half of my DNA. I did remember being told I couldn't eat his birthday cake when I was a kid and thinking it was a raw deal, only to see that as a good thing decades later. All I know is my mother was caring for me and my siblings (including my older sister with type 1) and she absolutely didn't want her brother to cause any problems so she pretty much avoided all contact with him.

Besides, there was really very little we could have done to help Augusten anyway. But today, my cousin has paid a terrible price due to a lack of knowledge on how to effectively manage his condition, which an afternoon or two with a good diabetes educator and or nutritionist could have helped prevent. I also don't think he gets much spousal support, as his wife told my uncle that she had sneaked a Big Mac into the hospital (he didn't like hospital food, but then again, who does?) for him after his amputation -- hardly what the doctor ordered. But I would caution my readers against blaming his wife -- realize that she was just trying to comfort her husband after traumatic surgery in the best (maybe the only) way she knew how -- this was well before she threw him out. Truthfully, his wife knew even less than Augusten does when it comes to diabetes, even though everyone can benefit from eating well, including their daughter. About the only thing I can say is that I hope that he will not suffer from further complications, and that he deserves to get appropriate care, not only for himself, but also his daughter. Whether healthcare "reform" has come in time for him is unclear, but I would hope his daughter has the benefit of adequate healthcare that he so obviously has never had the benefit of.

But it's NEVER too late to get adequate healthcare!

Wednesday, April 14, 2010

Happy Birthday To Me With A Bayer Contour USB Meter

On April 1, it was my (dare I say it?) 41st birthday. Because I don't have kids and I'm at an age where I can pretty much buy whatever I want whenever I want it, I'm well beyond the whole "I want that for my birthday" phase of life because I don't really have to deny myself all that much (the one possible exception being vacation time, and that's an employer issue, not really a personal option). So when I was asked what I wanted for my birthday, I actually chose something that many people might say was kind of inappropriate for birthday gift: the Bayer Contour USB blood glucose meter. I wanted one because it looked kind of cool and had some neat features, but I did not like the price-tag (although most brands are covered by most insurance companies ... except the brand I'd like to use AgaMatrix WaveSense meters because of their accuracy, but they aren't on many insurance formularies, which I told my contact at the company ... they claim to be working on it, but it's tough to do without giving the product away to insurance companies), but wasn't willing to spend $75 for a trial device.

I certainly didn't NEED the Bayer Contour USB meter because I already have another brand I use all the time (I test around 14 times per day, so companies should be lusting after my business AND willing to give me a free meter -- even a costly one) as well as an estimated 5 different backups (those I keep in the glove compartment of my car, in my office desk drawer, a second one, a backup I carry with me in my bag, etc., etc., etc.). But I also wouldn't even think of going out and spending $75 on a glucose meter, so I figured this might be my only opportunity to try it. I must disclose that the manufacturer (Bayer) did NOT give me ANYTHING (not even an offer!) to try it (if they want to, they can locate me or leave a comment on my blog, I'd welcome some free strips to extend my trial!), so I am 100% objective and completely unbiased in my review of the product. Nothing against my peers (such as Chris who was very forthcoming about the fact that the company sent him the device at no charge) who have gotten free samples - I wouldn't mind getting one like this! But truthfully, I don't exactly make it easy for manufacturers to reach me because I don't publish my contact information (that's by design), although it CAN be done -- and has been. I generally pride myself in not having been a recipient of any "blog-ola" as it's come to be known, which I view as a plus when it comes to my objectivity in providing an objective review.

Let me begin by noting that I honestly don't believe there's anything materially different in terms of the underlying technology between the various meters & test strips from Johnson & Johnson's Lifescan/One Touch, Abbott's Freestyle, Roche's Accu-Check, or Bayer's Contour meters in terms of underlying technology. In fact, the FDA seemed to validate this assumption a while back by issuing a warning that applied to ALL electro-chemical meters (the old, color-based test strips were exempt from the warning) about over-the-counter medicines that could impact test results -- the warning was not specific to a particular brand. None of them are any more or less accurate, because they all pretty much use the same electro-chemical reagents to generate an electrical charge that results in a meter reading. All of the competition (the notable exception being AgaMatrix, which just signed a deal with drug giant Sanofi-Aventis, which could get that more-reliable technology on formularies for many insurance companies that don't presently cover AgaMatrix Wavesense testing supplies today) use very similar technology.

Nowadays, manufacturers pretty much market testing supplies largely with lame-ass gimmicks, such as unsubstantiated claims of smaller samples that's supposed to translate into less pain (since they all require the same lancet, I fail to comprehend those claims), or else faster results -- nice, but considering the average is now about 5 seconds for the major brands, I wonder when they'll get to a point when the meter GIVES me time?! The most recent gimmicks have come down to such things as petty designer colors, as if they were selling nail polish to tween-aged girls or something. But Bayer appears to have done some homework, and based on my initial trial, I think they've scored VERY well on several accounts, which I'll address just ahead in this post.

Marketing of blood glucose testing supplies today is either by aggressive sales forces who work to get the product on every single insurance company formulary (that's tough unless they negotiate big price breaks), and/or via annoying salesmen/women who pester doctors all the time, thereby detracting them from actually treating us as the patients. If they want to call on doctors, I think they should do it at a time when the doctors aren't seeing patients.

Anyway, I've been using the J&J One Touch Ultra for a while now, and although I'm not crazy about their meters (but I DO need to use some brand), there really hasn't been much to get me to switch brands. I really believe that J&J completely takes my business for granted -- I'm only loyal to the brand because of inertia, and nothing else.

Over the years, I have tried many different brands, and I'd switch from my current brand if there was something fundamentally different about the products but mostly they're just variations on the same theme. That was until this Bayer meter came along, which has built-in software, it's very compact, yet has a full-color display screen, a lighted test-strip insertion location (if needed), huge storage capacity, and it recharges from the USB port on your computer (or from a wall outlet if you're away from a PC).

I tried Abbott's Freestyle product (back in the day, I had a Freestyle Tracker that worked with my Handspring Personal Digital Assistant/PDA -- that company was later acquired by rival Palm) a number of years ago. While it was nice having my appointments, contacts, and meter all in a single device, that was really more of temporary route to today's smartphones, which are really tiny computers. With smartphones assuming that role today, and product development and new product timelines for the handset business being months, the molasses-slow FDA approval process has prevented similar types of technologies from emerging ... yet.

As I already noted, I absolutely hated Abbott's Freestyle test strips. I also think Abbott's claims about the world's smallest sample size is a complete lie. That leaves Roche's Accu-Check, which I must admit was the very first meter brand I ever used back in the mid-1980s when self-monitoring blood glucose meters were still brand new. When it comes to advertising that brand, I'm not sure the patriotism theme in their advertising really speaks to me, even if they are the only strips still made in the U.S. because Roche is actually a Swiss company. I cannot document all of the corporate ownership changes for the Accu-Check brand over the years, but I seem to recall the Accu-Check brand when I first began using it belonging to a German company named something like Boehringer Mannheim (or maybe it was Boehringer Ingelheim) at the time, not Roche, but for all I knew, that might have simply been a U.S. distribution partner.

At this point, I really just need a compelling reason to switch brands. Truthfully, the mere fact that the Bayer has Nick Jonas' endorsing the product works against them in my opinion, because I view as a tween boy-band largely merchandised by Disney's Robert Iger, yet to be proven without the Disney dollars behind him as celebrity endorsements which really don't work in medical devices. Nick Jonas talking about Bayer's "Simple Wins" campaign simply doesn't speak to me. Ironically, Bayer isn't using the Disney-created type 1 tween to promote the Contour USB. From what I can tell from Bernard Farrell's review of the Contour USB meter, the initial target audience was twenty-somethings, and I don't really think that age group is the prime audience for the Disney Channel's JONAS show either, so they abandoned the celebrity pitch for the Contour USB meter.

Smart Advertising for Contour USB

I actually think Bayer's advertising for this meter is actually quite slick -- it's suggestive (the woman in this ad's face isn't even visible!) without being as overtly sexual as, say, commercials for certain shampoo brands are (anyone seen commercials for Clairol's Herbal Essences?). I can't really say this ad is gender-neutral, as I don't know if it's going to appeal directly to women (or gay guys for that matter), but I think everyone can see an ad that's smart and creative. By comparison, most ads for testing supplies today is either offensive (pain-free?), irrelevant, stupid or some combination of all these things. My one complaint: why must meter companies ALWAYS feature non-diabetic readings in their ads? After all, someone without diabetes has no need for these devices, so let's see a reading of 363 mg/dL or 45 mg/dL in the ads for a change (catch my previous diatribe on that subject here). But you can catch the smarter commercial spots now running for Bayer's Contour USB meter here:

Bayer Contour USB's Features

For some basic background, I won't attempt to cover the all of the basics because others do that much better than I do, and I'm still testing it. Bennet from YDMV first broke news about this new meter here. Fellow D-Blogger Bernard Farrell whose focus is on diabetes technology does a really great job reviewing it with more details on, well ... details on the meter, so do catch his post here for more ... details! Another writer, this one The Wall Street Journal's Walter Mossberg wrote about it in December 2009 here and even better, did a video which you can catch right here:

Diabetes bloggers from around the world have written about this new device, too. For example, one Swedish blogger I follow wrote about it here and here, and thanks to my speedy Google Chrome browser and a built-in "extension" application, all I have to do is push a button to provide instant Swedish-to-English translations. For those of you who don't have that technology installed, fear not, just visit Google Translate at http://translate.google.com/ and then enter the blog posting URL (such as http://www.dinabarn.se/forsta-blodsockermataren-med-usb-anslutning-lanseras-idag) and then select translate FROM Swedish TO English, press the translate button, and voila -- a functional (although not perfect) translation (note: it cannot translate photos or words in images).

My Meter Function Desires

My needs and desires for a meter are actually pretty simple. The Contour strips are code-free, meaning there's no need calibration code with each new container of strips. That's nice, but not a huge deal for me, but collectively, these little things add up, in my humble opinion. I really want a fast meter that uses a small sample I can see being drawn into the test strip -- Bayer's Contour does fine on that. I have always wanted a small sized meter that fits into my pocket, not some clunky device that takes up more space than a cell phone. I also want mega-memory (supposedly, you can also use the Contour USB as a flash drive as well), and the ability to download results to my computer, not some clunky proprietary software program like Johnson & Johnson's horrendous One Touch software, or having to buy some stupid $40 cable to download the results. Ideally, I'd like the ability to import the results into a more open-format software, such as a Microsoft Excel spreadsheet (or Open Office's Calc program, Google Docs Spreadsheets, and similar programs), SugarStats or some of the other innovative tracking programs written by people WITH diabetes. I also appreciate not having some weird kind battery that has to be found in a place that carries 200 different battery varieties for hearing aids and the like. On that score, the fact that Contour USB is rechargeable from either a wall-outlet OR a USB port on a PC, so it does great on that.

I'm less enthused with the pre-designed graphs and the other "diabetes" management functions that aren't unique to Bayer's software; I'll do them myself if I can easily import the raw data into a much more dynamic program. Down with proprietary data formats -- let's have comma separated values that any program can read from! Some people find the ability to code each meter reading with "pre-meal", "post-meal", or some other tags -- but I like the ability to skip this coding if I choose, because not every test is event-driven, and some programs force you to enter a value when there isn't one (J&J's program does this, for example). Sometimes I test because I think it might be running high or low, but that doesn't mean it's pre-meal or post-meal. Assigning event codes to test results based on time of day is another no-no that serves little purpose and should have the option to be non-coded. Bayer's software does let the user create their own notes which could double as event codes, if only they could be entered that way. I am still finding the Bayer Contour USB menus a little bit clumsy to use after only a few days, but with time, I'll have those down so I can do them in my sleep. The documentation for this meter is also very verbose and features few graphics to make it easier to read through.

Another feature I LOVE: this meter does have a light similar to Abbott's Freestyle Flash meter, that illuminates the test strip itself if you're in a poorly-lit area (e.g. a movie theater, or if you're in bed at night and don't want to wake your partner by turning the lights on). I've borrowed the following photo from Bernard Farrel to demonstrate this feature, because it's one I really liked in the Freestyle Flash meter, but the other brands seem busier selling pink and purple colored-meters!

You know how tough it can be to get the strip into the meter and a sample on the strip; I often use my cell phone to light the meter up if I want to test at a movie theater. To operate this function, you click the power button at the top of the meter (it's not visible in these photos) twice before inserting the test strip, and then the area to insert the strip lights up. I couldn't find this function in the manual, although I'm not sure in what section it might appear, so it may be there someplace. But I like the attention to details, which suggests that Bayer may be the market share under-dog, but aims to grab share from the current leader: Johnson & Johnson.

I Think I'll Be Kissing Johnson & Johnson's One Touch Goodbye!

Based on my initial trial, I think I'm going to bid adios to Johnson & Johnson's One Touch Ultra family of testing supplies. I'll have to buy a few backup meters consisting of the regular Bayer Contour meters, and Bayer does offer online coupons for those (they SHOULD). I'll also have to exhaust my supply of One Touch Ultra strips, and I have about 90 days worth to use up, but I think this new product looks like a winner!