Upgrades to the insulin pen to improve disease management and prevent hypoglycemia due to overdoses are on the horizon.
There are some exciting developments on the horizon in terms of devices to help patients with diabetes better control their insulin administration and therapy management. These devices either attenuate currently available insulin pens on the market or incorporate insulin via cartridges into their delivery platforms.
Some may wonder what the attraction of these devices is for patients, but it all boils down to cost and patient safety. Take, for instance, the study by Budnitz and colleagues published in 2011 that analyzed what were the highest causes of adverse drug events in older Americans leading to emergency hospitalizations.1 They estimated that of the 99,628 hospitalizations that take place each year in the United States, nearly two-thirds were due to unintentional overdoses of medications, with the offending classes most often warfarin, insulins, oral antiplatelet and hypoglycemic agents. Now, factor in that diabetes is on the rise in the United States and insulin use is highly predominant, and one can see the argument for the creation and adoption of devices that not only improve therapeutic outcomes but reduce medication misadventures.
Below are some of the companies in this category and what they will be offering. Many of these products come from overseas, so the costs are mentioned in the countries' denominations. Some are also available in the United States.
Dukada Trio.2 This device is a cap like Timesulin but has more features like Insulcheck. It does not have a timer like the other 2, but it offers a time gauge that lights up to let patients know if they are within a timeframe for a dose that needs to be set up. The device, which costs about $47, also incorporates a penlight into the cap to help with the administration in poorly lit environments. Perhaps the most novel feature from Dukada of Denmark is that it has an attachment that can be popped out to help patients with shaky hands administer their insulin more easily.
ESYSTA.3 This product from Emperra of Germany is very much like the InPen, as it is a smart insulin pen that takes insulin cartridges, but it runs on the EYSTA platform, which allows those with a mobile phone to have an application to track data. Those who do not have mobile phones receive a home device that can export that data to an online cloud database for providers to have access to and use in patient care. It is a novel system and seems more clinically focused on patient management than the other products. The product is not available in the United States, however.
GoCap.4 Common Sensing of Cambridge, Massachusetts, is focused on creating smart devices, and the GoCap is its first product. The smart cap goes on the insulin pen, replacing the existing cap, like the InPen. The GoCap also tracks insulin dose and temperature, provides reminders and reports, and has an app to keep track of everything. The GoCap also keeps track of the amount of insulin in a pen. In addition, it has a sensor that monitors how much insulin is depleted out of the clear side of the pen that it covers. The GoCap is in Beta testing.
InPen.5 San Diego-California-based Companion Medical's sleek InPen uses insulin cartridges. The InPen, which costs $665, offers data reporting, a built-in temperature sensor, a dose calculator, and a dose reminder. All this is paired with an app for the patient to access. The InPen has received FDA approval and is only available in the United States. Patients need a prescription for the InPen to get it via mail, though some insurance plans may cover it.
Insulcheck.6 A similar device to the Timesulin, this product from InnovationZed of Ireland helps keep track of time between insulin administrations. But it has additional features, including a light that turns green within a safe time frame (eg, within several hours of the last dose) to alert patients if they are in their next dosing window. This also includes a temperature sensor that lets users know if the insulin pen is still within safe margins. The Insulcheck, which costs about $40, is clipped onto the back of the pen. It is battery-powered, so it needs to be charged every so often.
Insulog.7 The Insulog was launched on crowdfunding site IndieGoGo, raising more than $45,000. The snap-on device, which costs $199.99, goes on the end of the insulin pen and keeps track of how much insulin is injected. This information is paired with a mobile app and then serves as an electronic diary. The app can also incorporate data from other devices and data such as blood glucose levels collected from another platform.
Timesulin.8 This is probably the most straightforward product and definitely the cheapest. Sold in the United Kingdom, the device, which is about $27, essentially replaces an insulin pens cap but has a timer built in. So, every time a patient takes off and replaces the cap on the pen, the timer resets itself. The practical aspect of this product is to help patients who may forget the last time they dosed themselves with their insulin. In a way, it is a stopgap. Say that a caregiver or patient administers insulin but cannot remember a few hours later whether they did so. Checking the time will help keep a record and let them know. This is a basic solution, but that is probably the point. The product does not help dose insulin, does not keep a record of it, and does not offer an app. But it gets the job done and could be beneficial in some cases. This could be useful for patients who dose insulin multiple times a day.
All these insulin pens have pros and cons. It would be hard to imagine that the ones offered by companies outside the United States won't be available here in the future. Some are adaptable to insulin pens, while others use cartridges, which are not as commonly seen in the United States and have a limited amount of insulin types available. Several products required that patients choose the insulin pen carefully. This could be an issue at a time when multiple formularies are changing what insulin pens they may be supporting. That could leave some patients in the position of shelling out money for a product, only to find a few months later that it does not work because of an insurance change.
In terms of cost, the simpler devices are relatively cheaper, because they are standalone tools and not tethered to a smartphone. Nonetheless, patients who want to invest money in any of these devices should identify what problems they hope to solve with them. Those looking for a full tool to track and dose insulin should likely splurge. Finally, most patients who use insulin may have several pens (long-acting, short, rapid, etc.), which means that they may need several devices, which adds to the cost.
If patients could be identified as high risk, using an algorithm or previous hospitalization for insulin overdose, it would be worth the intervention of these tools to perhaps prevent an event or recurrence, as it would stand to reason that a hospitalization, in the long run, would be more expensive than one of these devices.
1. Budnitz DS, Lovegrove MC, Shehab N, Richards CL. Emergency hospitalizations for adverse drug events in older Americans. N Engl J Med. 2011;365(21):2002-12. doi: 10.1056/NEJMsa1103053.
2. Dukada. dukada.com. Accessed May 4, 2018.
3. ESYSTA. emperra.com/en/esysta-product-system/. Accessed May 4, 2018.
4. GoCap. gocap.me/index.html. Accessed May 4, 2018.
5. InPen. companionmedical.com/InPen/. Accessed May 4, 2018.
5. Insulcheck. insulcheck.com/. Accessed May 4, 2018.
6. Insulog. insulog.life/. Accessed May 4, 2018.
7. Timesulin. timesulin.com. Accessed May 4, 2018.