Who is Diamesco? And Why Should We Care?

Several readers queried me recently on a Korean pump manufacturer by the name of Diamesco. This company apparently exhibited at last summer’s ADA conference, and has discussed plans to introduce its BEST LIFE insulin pump in the US market some time later this year.

“My understanding is that it delivers only meal-time boluses, basal dosing requires a separate injection. On the other hand it is supposed to be easy and comfortable to insert because of a ‘soft wing’ and it delivers precise insulin dosing,” one reader writes to me. “What do you know about the company? Are they considered reliable in Korea? Any regulatory or PR problems you may have heard about?”

Great questions, My Friend. I’m afraid the company’s web site is a bit cryptic and half-baked. Which may be a function of language issues and pre-market status. But it makes evaluation difficult at this point.Best_life_with_cradle_3

From what I can tell, the BEST LIFE pump comes in several varieties, including one that is programmed for bolus dosing only. The most information is available at this link, which details their special features: the BEST LIFE pump communicates to your computer via a cradle (pictured), allowing you to actually program the pump via your PC screen. It features extra-simple battery change, and a big, bold readout that uses icon designs “so old people can easily use it without taking pains.” Diamesco also boasts Swiss-designed micro-controlled motor parts for ultimate precision and reliability.

“But it’s just another standard pump with tubing. These are all just bells and whistles — all cosmetic improvements, not functional improvements. The technology itself is nothing revolutionary,” D-industry analyst David Kliff tells me. I turned to him yet again for some industry-insider feedback.

“One of most misunderstood aspects of the pump market is that everybody foolishly believes that making the pump itself is the difficult part. It really isn’t; it’s not brain surgery,” Kliff says. “The big challenges are more pulling together a strong sales team that can sell the product. Then you need insurance reimbursement. Then tech support. And all the incremental advancements your competitors are making…”

A real revolution in pump therapy comes with something entirely new and different, like what Insulet did with the OmniPod, Kliff says. They were the first to separate the controller and insulin reservoir and make it a wireless system.

What he’d like to see — and I couldn’t agree more — are smaller pods or “patch pumps” that could be worn longer than 3 days running. Although the 3-day limitation is about protecting the skin at the infusion site — rather than an insulin delivery issue per se — wouldn’t it be wonderful to change your set less often and waste less insulin all around?

In terms of reducing the profile of those pods (ie making them flatter) this will likely become possible by employing higher-concentration insulin, Kliff says. The current standard we all use is called U100 insulin, or a concentration of 100 units of insulin in 1 mL of solution. But there is also such thing as U200 and even U500 insulin, which has 500 units of insulin in 1 mL. This type of insulin is rarely used, mainly for people with severe insulin resistance.

[A spokesman for Eli Lilly tells me that Humulin® U-500 Regular sales amount to only 5 percent of the company's overall Humulin sales, but use is rising along with the epidemic of obesity and Type 2 diabetes.]

According to Kliff, Insulet is experimenting with using this higher concentration insulin in its pods with some of its OmniPod patients now.

“Imagine if you could wear a pod longer, or have a much smaller profile pod. With U500 it could be smaller profile AND maybe you could wear it for 5 or 7 days. That’s the kind of pumping improvement that matters to someone like me,” Kliff says.

Amen, Buddy!

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12 Responses

  1. Michelle
    Michelle April 2, 2008 at 7:13 am | | Reply

    unfortunately, going to higher concentrations of insulin won’t benefit children at all. :( Many kids actually have to dilute insulin in their pumps. We need child centered pumps, pediatric pumps, which hold teeny bits of insulin of insulin and are teeny tiny. We shouldn’t have a one size fits all pump market.

  2. barbara
    barbara April 2, 2008 at 10:26 am | | Reply

    yes, but U500 is still short acting insulin, not rapid acting. Sounds like we need more development in producing U500 rapid analog.

  3. elizabeth joy
    elizabeth joy April 2, 2008 at 12:46 pm | | Reply

    I totally agree with Michelle. I’m on the OmniPod, and I take only about 20 units of Apidra/day. I always end up wasting insulin–Not much, because you only need to fill a pod with 75 units, but still, I’m a total cheapo, and that 15 wasted units gets to me. (I inevitably leave the pod on for more than 3 days, and after 3 days + 8 hours it ends up screaming at me in the middle of the night.) For people like me, the pod’s three times bigger than it needs to be. Why haven’t they come out with OmniPod for smaller adults or children?

    Knock-knock, Insulet, you there??

  4. AmyT
    AmyT April 2, 2008 at 1:18 pm | | Reply

    Elizabeth,
    Who says they aren’t coming out with a smaller pod? That’s exactly what this post is getting at. I’m quite sure a smaller profile is on the short list.

  5. Doug
    Doug April 2, 2008 at 6:39 pm | | Reply

    Perhaps what is required is a pump design that holds a small amount of insulin but somehow allows refilling. e.g. like replacing small little batteries, you pop out the near empty 20 unit “battery” and replace it with a new one. Perhaps an insulin manufacturer could premake these??

  6. hyip
    hyip April 2, 2008 at 9:50 pm | | Reply

    I also agree with Michelle and Barbar

  7. JasonJayhawk
    JasonJayhawk April 2, 2008 at 10:24 pm | | Reply

    As U200 and U500 insulin concentrations become more popular, so will errors in overdosing by simple oversight. I doubt we’ll see anything higher than U100 insulin become mainstream for a very long time because of concerns of overdose.

  8. Andy
    Andy April 3, 2008 at 4:13 pm | | Reply

    I think this is standard procedure. At first you make product and then you slowly make changes… smaller pods, higher concentractions of insulin… This pods seem, like they wouldn’t be good for me… I am on pen now, and I use total of 74 units of insulin a day… I know that with use of pump your total amount goes down, but it seems to me, that I couldn’t use it for 3 days… So I would need more higly concentrated insulin…
    Andy

  9. camille johnson
    camille johnson April 4, 2008 at 5:14 am | | Reply

    Bottom line: the MOST important “gadget” is the CGM, the Continuous Glucose Monitor — which, of course, most insurance companies won’t cover because they are “still in development” but they really just don’t want to pay for them. A CGM is ESSENTIAL to good control, then — and only then, should one consider a pump.

  10. ewald christians
    ewald christians April 4, 2008 at 6:38 pm | | Reply

    I spoke with an OmniPod rep recently about the size issue and she mentioned that one of the main obstacles to smaller pods is the fact that insulin delivery mechanism simply work best with cylindrical containers and that the ones being used in the device now where the smallest they could get to work at the time.

    That said, this is one of the most common complaints and Insulet is — according to the rep — listening.

  11. Dennis
    Dennis April 4, 2008 at 10:01 pm | | Reply

    Big Question? Just need a Pump to deliver Novalog Over nite..to keep Levels Down.. Vs using Levemir and getting up 2 hrs after bed to test and take correction bolus..and yes, have tried various Doses, etc..to no avail.. daytime ave ? 90′s
    any suggestions? Thanks

  12. Melissa
    Melissa May 9, 2008 at 8:44 am | | Reply

    Kliff may be overly optimistic when he says, “With U500…maybe you could wear it for 5 or 7 days.”

    Infection risk is why pumpers who have low insulin requirements must still change an infusion set after 3 days even if a full insulin cartridge lasts them longer. This infection risk is attributable to how insulin interacts with the body’s immune system at the level of the skin.

    Studies in 1989 and 1990 showed that people using insulin containing the preservative m-cresol (aka metacresol) vs the
    preservative methyl p-hydroxybenzoate in their pumps had a higher risk for infection when all other variables were controlled for, but both preservatives reduced the body’s ability to fight infection at infusion sites:
    http://care.diabetesjournals.org/cgi/content/abstract/12/2/153
    http://care.diabetesjournals.org/cgi/content/abstract/13/1/71
    Leukocytes are the white blood cells that fight infection; when
    m-cresol interferes with them infection becomes a bigger risk.

    From my perspective, it would be fantastic if the insulin manufacturers were to consider reformulating the rapid-acting insulins to reduce their effect on the skin at the infusion site.

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