Stakeholders challenged to take action at first Green Diabetes Summit
A group of diabetes researchers, providers, government officials and representatives from device manufacturers and patient organizations are aiming to make the diabetes device industry more environmentally sustainable.
The advent of continuous glucose monitors and other advanced devices has allowed for improvements in diabetes self-management. However, these devices also use raw materials and produce medical waste, according to David C. Klonoff, MD, medical director of the Diabetes Research Institute at Mills-Peninsula Medical Center in San Mateo, California.
To further discussions on sustainability with diabetes devices, a group of stakeholders met at the Green Diabetes Summit on July 21 to discuss some of the biggest issues surrounding diabetes technology and waste, discuss the formation of a coalition to address sustainability, and draft a Green Declaration with 12 goals for patients, health care professionals, government agencies and manufacturers. A summary of the summit and the declaration were published in the Journal of Diabetes Science and Technology.
“This is the first declaration or initiative linking medical devices for any disease with the environment, and the disease example is diabetes, which affects more people and requires more measurements and more decisions on a daily basis than any other disease,” Klonoff told Healio. “This disease generates much waste in the form of insulin needles, lancets for blood glucose testing, syringes, and plastic, metal and glass from disposed devices and packing of various devices. In the future I expect to also see green initiatives regarding medical products used for other diseases besides diabetes.”
Healio recently discussed the summit and the Green Declaration with co-authors Klonoff; Lutz Heinemann, PhD, of Science Consulting in Diabetes GmBH in Kaarst, Germany; Edward P. Krisiunas, MT (ASCP), MPH, president of WNWN International Inc., a medical waste management company in Burlington, Connecticut; and Kevin Nguyen, BA, bioengineering administrator for Diabetes Technology Society in Burlingame, California.
Healio: Why was the Green Diabetes Summit convened and why is this topic important?
Heinemann: Nowadays, many patients are using continuous glucose monitoring systems, insulin pumps, insulin pens and systems with automatic insulin delivery — a lot of technology, which is great. However, when you have a lot of light, there is also shadow. In other words, you have to replace these systems over and over again, and many are made of plastic.
Think about the millions of patients nowadays using CGM devices over and over again. This is something we do not regard as waste because it has to do with disease treatment. Nevertheless, from an ecological global planet point of view, it doesn’t matter what the plastic generation background for it is. Therefore, we have to think in this direction to become aware of what’s going on here, what we can do, and what we have to do.
Krisiunas: Plastics, recycling, the circular economy are not new buzzwords, they are rejuvenated buzzwords. There is a lot of interest across the world looking at recovery, recycling, at what to do with these things. We know there are lot of these items being generated, and we know that they are posing a risk to solid waste workers.
It’s interesting across the board in so many facets of health care, there is more and more interest in recovering, reuse, recycling. This fits right into that just because of how ubiquitous it is in the world of diabetes care.
Healio: Do you believe people with diabetes and providers are paying enough attention to the environmental issues posed by diabetes product waste and sharps disposal?
Nguyen: From what I have observed, the answer would be no. I think the reason why there’s not enough attention on environmental impact is because it has never really been explicitly said whose role it is, so no one feels responsible for its resolution. It is not any one person’s role, and that’s what we are trying to say with the idea of coalitions. Everyone has a role.
Heinemann: I’ve gone back and forth between Germany and the U.S., and I am fully aware, also on a personal level, about the differences there. In Europe, the EU commission and high-ranking politicians are taking the waste issue and climate change quite seriously. For many Americans, this is not of relevance. I see a need to be more active here and to change the mindset.
Krisiunas: In the context of government and the public being aware of this, I think we’ve reached this plateau where some people are aware of it, there are programs in some parts of the U.S. that are better defined. There are places where they say this is important, and part of it is related to the community that is there. Areas where there are high instances of death related to opioids, you are going to see more people paying attention to needles, syringes and sharps.
If anything, there is interest around the world at different levels. The French actually have a very strong program for collection of sharps in the community. Then you have variations of it throughout Europe. You won’t see it in some of the lower- and middle-income countries.
Healio: What are some of the biggest barriers to making improvements with medical waste recycling and sharps disposal?
Nguyen: As devices get more advanced, it becomes harder for people to get rid of device waste. For example, an insulin infusion set is essentially a tube, which is relatively easy to dispose of. However, we want medical products to become increasingly more technical because technology is able to provide better, more convenient diabetes management.
For example, consider a subcutaneously inserted CGM sensor. It is not easy to disassemble, and for patient safety, maybe it shouldn’t be easy to disassemble. But when it is thrown into the trash and sent to a waste management facility, do the people working there know how to disassemble it? Most of the time, these more complex devices are just disposed of as a full unit and not broken apart. That is where we see an opportunity for device manufacturing that takes into account being able to disassemble it, being able to separate it into its components, then sorting those components into the correct place for proper disposal.
Krisiunas: If I’m sitting in corporate America, what’s in it for me? They have shareholders. I have dealt with some hospitals that had incredible sustainability programs, recycling programs, taking anything and everything they could. Then financial issues come up and what was the first thing cut? Sustainability. It was a “nice to do,” not a “need to do.”
Everybody is looking at it from different levels, but they are still looking at the bottom line of what is this costing. That is the biggest challenge, and I think technology is going to help us get over that hurdle with these companies.
This talk wasn’t around 10 years ago. Markets are a little bit different; I don’t know if it is the younger generation pushing this. Certainly, the European Union with their circular economy, they’re ahead of us. They discuss this much more.
Healio: This movement requires a collaborative effort between all parties, correct?
Klonoff: We think that all of the stakeholders need to be involved, that includes patients, health care professionals, industry, government and nongovernment organizations. We would like to see them all come together, and we think that a coalition of these stakeholders can accomplish more than any one group, organization or company. We see that there are individuals or groups or companies or organizations that are working on this. We’re happy, but we think they can accomplish more through a coalition.
Healio: What message did you want to get across with the Diabetes Technology Society’s Green Declaration?
Klonoff: We want to raise consciousness that will lead to new attitudes and new behaviors toward sustainability and waste management. Diabetes is a disease where there are a lot of products that use a lot of materials where there is room for better design and production, so that there can be better resource management. Many of the diabetes products have to be disposed of, and it’s not clear to health care professionals or patients what is the best way to dispose of them. Not only do they create a waste product, but many of them are sharp, and then that creates risk for waste handlers and home health employees, such as visiting nurses.
Krisiunas: It is important to see that companies are coming together, the providers are working together with them hand in hand, and now we need some additional people coming into that group. It’s one thing to have a company that makes it, it’s another to have those who are actually using it and talking about it. Now, to bring in the waste recovery sector, the recycling sector, we’ll really have a dynamo here. You’ll have interest across the continuum.
The thing we’re talking about is, let’s make this greener. We’re having some collaboration there. It’s not like we’re waiting for someone to come on board, it’s happening, but it has to be scaled up bigger. Starting off with just diabetes is fantastic because of the breadth of the disease around the world.
That is the key message: We’re here, we want to be successful, we want you to have less of an impact on the environment.
Heinemann: At the end, it’s a personal thing. We have a global responsibility, but we as human beings, we can make a difference. Will it be a big difference? I don’t know. But if you don’t start at a given point with such a declaration, then we’re in trouble.
- Nguyen KT, et al. J Diabetes Sci Technol. 2021;doi:10.1177/19322968211049800.
- Nguyen KT, et al. J Diabetes Sci Technol. 2021;doi:10.1177/19322968211051721.
For more information:
Lutz Heinemann, PhD, can be reached at firstname.lastname@example.org.
David C. Klonoff, MD, can be reached at email@example.com.
Edward P. Krisiunas, MT (ASCP), MPH, can be reached at firstname.lastname@example.org.
Kevin T. Nguyen, BA, can be reached at email@example.com.