If the Times account of the study reviewed here was good, and WebMD’s was bad, then this write-up is just ugly. Misleading description of the experiment. Sensational terms. No independent perspective. They might have served readers better by simply posting a link to a more detailed press release about the study.
Advances in technology could help ease the burden of managing insulin for individuals with type 1 diabetes, and the study covered here is an important step forward. That being said, journalists aren’t doing anyone any favors when they fail to ask tough questions about a study and overhype its results.
If we’re far enough along to determine that that the "artificial pancreas" was better than conventional techniques at managing glucose, we’re far enough along to start talking about what this approach may cost.
Many patients with type 1 diabetes are not using currently available pumps and sensors because of the high cost of these devices. It seems likely that this new treatment, if it ever becomes widely available, will be as expensive or more so than the current pump and sensor technology.
The story cites study data showing that the system increased the amount of time the study participants spent with normal blood sugar levels and that it "halved" the amount of time blood sugar dropped to "worrying or dangerous levels." Saying that the system "halved" time with low blood sugar suggests a big effect, but absolute rates were 4.1% for the experimental group and 2.1% for the control group — a 2% absolute difference. The true clinical significance of these differences may not be another matter.
The story gives no sense of what could go wrong if this technology malfunctions and delivers the wrong dose of insulin while someone is sleeping. The consequences could be fatal.
The story misstates what happened in this experiment, giving the impression that the "new system" automatically monitored and adjusted patients’ insulin throughout the night, when in fact there were nurses adjusting the patients’ insulin pumps based on the calculations made by an algorithm. It might not be that hard to develop a device that would handle these adjustments automatically, but we won’t know for sure until we see the study proving it. The story also should have done more to call attention to the small size of this study and what kind of conclusions we can draw from an experiment involving only 17 patients. Although there are some cautionary notes sounded in an interview with one of the investigators, the claim made in the headline — that "the new device works better than conventional treatment"– is not well supported. It will take much larger and longer studies with patients living at home (and using an actual device that hasn’t been built yet) to show whether this new technololgy is safe and manages glucose better than conventional methods.
The description of type 1 diabetes in this story is a bit sensational. If type 1 diabetes is left untreated, the story states, "blood vessels and nerves are destroyed, organs fail and patients die."
While this is technically true, patients with type 1 diabetes are treated and their experiences with the disease, while often frustrating and frightening, are not well-represented by this overly dramatic one-sentence description. We’ll flag this one for disease-mongering.
The story cites one interview with a study researcher and provides no other independent perspective. It does not inform us that this source had financial ties to one of the study sponsors.
The story doesn’t describe how type 1 diabetes is currently managed and why new automated systems might be an improvement. An important benefit would be the prevention of nighttime episodes of hypoglycemia. The story doesn’t make this clear.
The story suggests that it will be several more years before the "new device" supposedly tested in this study will be available on the commercial market. But as the competing story in the New York Times makes clear, the researchers in this study did not test a "device" per se but rather an algorithm that could hypothetically be used to link up a glucose monitor and an insulin pump to create a new device for automatically managing blood glucose. The suggestion that there is a device already in testing exaggerates the level of progress that has been made and will give readers a false sense as to how close this product is to becoming a reality.
The story says that medical device makers have been working for years to develop a so-called artificial pancreas. While this is perhaps enough to satisfy the criterion, the story could have mentioned that some of the most important features that an "artificial pancreas" might provide can already be found on commercially available products. A Medtronic Insulin pump can suspend insulin delivery when it gets a low blood glucose reading from the continuous glucose monitor to prevent hypoglycemia. This pump is not available in the U.S. because it doesn’t have regulatory approval–something that is also likely to take a long time for an "artifical pancreas."
Because there are no independent perspectives in this piece, we can’t be sure of the extent to which it may have been influenced by a news release.
Systematic, Criteria-Driven
Monday at #ADA2021, an infectious disease epidemiologist, a journalist, and a researcher shared perspectives on communication of risk in the era of COVID-19: http://ow.ly/ROfR30rMeE7 @AstleyCM @garyschwitzer @berthahidalgo @ADA_DiabetesPro
Shoutouts to @susan_bewley @drkevinknopf @MichaelBaum11 in this call for more than fawning coverage from press releases for these kinds of stories.
Also, linked history inside goes back 5 years just on Grail apparently trying to become Holy Grail. https://twitter.com/garyschwitzer/status/1408849696416841731
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