Source:

Healio interviews

Disclosures: Baker reports he is a speaker for Dexcom. Heth reports she is an employee of Abbott. McIntosh and Taylor report they are employees of Dexcom. Healio was unable to confirm relevant financial disclosures for Hughes before publication.
April 22, 2021
5 min read
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Plastics, sharps diabetes waste require conscious disposal

Source:

Healio interviews

Disclosures: Baker reports he is a speaker for Dexcom. Heth reports she is an employee of Abbott. McIntosh and Taylor report they are employees of Dexcom. Healio was unable to confirm relevant financial disclosures for Hughes before publication.
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Among the burdens of managing diabetes is responsibly discarding all the packaging, test strips, plastic and sharps. Manufacturers of new technologies are working to reduce waste, but concerns about disposal remain.

Lucille Hughes

According to Lucille Hughes, DNP, MSN/ED, CDCES, BC-ADM, FADCES, director of diabetes education at Mount Sinai South Nassau in New York, the advent of continuous glucose monitoring has lessened some of the trash generated by finger sticks, and CGM manufacturers have worked to cut down the amount of plastic used with each new generation to reduce waste further.

Source: Adobe Stock

“I commend those companies because [the environmental impact] is something that they are aware of,” Hughes told Healio. “They convey that not only through their product, but through their messaging to the provider that they’re always looking to improve.”

Disposing of diabetes materials is a multipronged issue. On top of reducing the amount of plastic used to make the devices is the proper disposal of the supplies themselves. This includes used sharps, something providers said is a big concern for patients.

Jason C. Baker

“Where there is a lot of confusion, especially among patients who are newly using these devices, are what to do with sharps,” Jason C. Baker, MD, assistant professor of clinical medicine and an attending endocrinologist at Weill Cornell Medicine, told Healio. “Are they supposed to get a sharps container? Where do they discard it? There’s a lot of concern with what to do with those things and being socially responsible and not throw sharps in the trash.”

Less waste in diabetes supplies

In more than 30 years of working in the diabetes field, Hughes has seen many changes in the supplies and devices used to manage the disease. She said the advances have led to a drastic reduction in waste.

“We probably have less plastic now because of these devices,” Hughes said. “The sensors go for a longer period of time. You now wear a sensor for 14 days, not less than that. Less use of that product, still less finger sticks. In [insulin] pump therapy, you have this plastic wire for some of them, or you have a plastic device, but they’re staying on for 3 days.”

Advancements may have reduced the environmental impact in recent years, but Baker said some people with diabetes are still concerned about the amount of waste they generate, particularly with the amount of plastic used.

“It definitely is something that comes up with most of my patients,” Baker said. “As it relates to pump supplies and sensors, it is a very common comment to say, ‘My goodness, how much waste is generated with these things,’ and ‘I wish there wasn’t so much waste generated.’ It doesn’t cause the person not to use the product, but it certainly makes them not happy about the plastic that’s being used.”

Reducing waste in devices is not easy — manufacturers need to create products that are functional and easy to use in addition to having a low impact on the environment.

“It’s not as straightforward as only the environment,” Hughes said. “Is it easier for the patient to use? Is it less product? The less things you have teach someone to manipulate, the more likely they are to use it. Then of course, they are smaller, smaller means comfort, discreetness, but also less waste.”

Some environmentally conscious people with diabetes have gotten creative with trying to recycle items such as the Dexcom G6 applicator. Baker said he knows of a few users who take apart the applicators, separating the sharps components from the plastic and putting the plastic into the recycling.

“If they can do it safely, I think it’s a great thing if they can take out the plastics that they know can be recycled,” Baker said. “It’s a really thoughtful thing they are participating in.”

A simple way to dispose of sharps

Baker and Hughes acknowledged recycling the plastic in CGM devices is not the primary concern for most patients. The questions they hear most surround sharps disposal, which seems to mystify many.

Bruce Taylor, senior director of government affairs, access and policy for Dexcom, said used sharps disposal has been a challenge government and health officials have tried to tackle for many years. States have regulations for disposing of sharps, but not enough has been done to communicate these rules to patients, Taylor said.

“You can pass a law and say you can’t put it in your household trash,” Taylor told Healio. “But unless it is communicated to the patient and the patient understands — how do you safely dispose of sharps, how do you containerize it, how do you safely dispose of it — legislation is going to be completely ineffective.”

This realization led to the founding of SafeNeedleDisposal.org, a website dedicated to helping people safely dispose of used sharps. The website is owned and managed by NeedyMeds, a nonprofit organization serving as an information resource for health care financial assistance programs. Nine health care companies are part of a coalition supporting the website and its mission.

SafeNeedleDisposal.org features a map that users can click to find out the proper way to dispose of sharps in their area. The website advises people to place used sharps in either a sharps disposal bin or a used laundry detergent bottle. Disposal methods are listed for each state, and visitors can put in their ZIP code to find the nearest disposal locations.

Taylor said organizers of the website recognize providers have a limited amount of time and may not be able to initiate a conversation about sharps disposal. To assist with this, the website includes materials that can be downloaded, printed and placed in waiting rooms or handed directly to patients.

“The patient wants to do the right thing,” Taylor said. “And if they’re informed, they do the right thing.”

Creating less wasteful devices

Reducing the amount of plastic in diabetes devices continues to be a focus for manufacturers. Abbott and Dexcom both said reducing their environmental footprint is something they are concerned about.

“To protect a healthy environment, we’re working across our operations and with key suppliers to reduce our environmental impact of our product packaging and minimizing waste across our broader operations through reuse and recycling approaches,” Jennifer Heth, senior manager for public affairs for Abbott, told Healio. “One example: We designed our new FreeStyle Libre 3 product to be more sustainable for the environment with a smaller and more discreet sensor, and a one-piece applicator, reducing the total volume by more than 70%. The new sensor design uses 41% less plastic and requires 43% less carton paper than previous FreeStyle Libre systems. We are also exploring a pilot energy program for users.”

James McIntosh, senior public relations manager for Dexcom, said the company has explored creating a recycling program for its G6 applicator, but guidelines for the disposal of medical waste have made the process challenging. Nevertheless, Dexcom has also worked to reduce the amount of plastic in its devices.

“Looking ahead to our next-generation CGM, we have reduced the volume of plastic in our G7 system and packaging by more than 25% when compared to G6,” McIntosh told Healio. “In the long term, Dexcom is committed to being good stewards of the environment while providing the best possible products for our customers.”

Hughes said she is not surprised Abbott and Dexcom plan to reduce the volume of their next generation of applicators.

“That’s phenomenal,” Hughes said. “Again, I’m not surprised, because that’s what they do. They have dedicated staff for that reason to look at these processes.”

With different regulations across states and even down to the local level, communicating how to recycle devices can be difficult. Providers advise patients to follow the instructions included on the device’s packaging and to educate themselves about the rules surrounding recycling and sharps disposal in their area.

“It is unclear to the providers as well as the patients as to what is the perfect way,” Baker said. “But I always tell people that no matter what you choose to do with them, the bottom line is you want to protect other people from your [medical] waste.”