Diabetes Technology and Waste: A Complex Problem Piling Up!

Today we live in a world of endless products that come to us in many shapes, sizes, applications, and packaging. Medical products used by patients with diabetes fits into that world quite well. After unpacking a continuous glucose monitoring (CGM) system, a patch pump or an insulin infusion set, the patient has the actual product into his hands; however, this comes along with a considerable amount of waste.^1,2 Many of us are aware of the global issue of plastics waste, including such waste floating in the waters of Pacific or washing up on beaches of Southeast Asia.^3,4 In the context of diabetes care technology waste (DCTW), the actual diabetes care product may only be 10% of the total weight and volume that was delivered. The remaining 90% are cardboard, fiberboard, diverse plastic materials, bubble wrap, paper, and so on. All this might find its way to a waste can or—hopefully—to a recycling bin. The question is, does this packaging effort have to be so great and can it not be otherwise? The irritating and disturbing feeling is that when we buy food today, for example, we naturally, or aided by legislation, use recyclable bags. Why is there so much plastic waste when it comes to DCTW products, and what can be done about this? While there are a number of studies looking at life cycle assessment and environmental impact of a wide range of pharmaceuticals, there seems to be limited data related to DCTW. Authors of an editorial published in India about this topic have stated the need for “green diabetology” but the context relates specifically to waste management practices in India.⁵

When the first ready-made insulin pen came onto the market from Novo in the 1990s, a return campaign was launched as a result of the burning discussion of waste; the pens were allegedly recycled for the production of park benches. Today, pens are produced and used in much higher quantities; however, the subject of recycling pens (and other diabetes technology products) is not a topic anymore to our knowledge! Could the packaging (and the product, see below) be recycled?

Single-use insertion devices are often used for placement of the glucose sensors of CGM systems or the cannulas of insulin infusion sets. These small masterpieces of engineering make these procedures considerably easier; they also considerably reduce the pain associated with them. However, these advantages come along with the expense of various grams of plastic each and every time that go directly into the waste. As such, products are produced and used millions of times each day; this adds up to a considerable mountain of plastic waste. We must ask ourselves where a better balance is to be found here; however, packaging and recycling is a complex story with many different aspects.

The use of plastics visibly improves presentation and appeal of a given diabetes technology product (we are used to this from all other products), while protecting the product during transport and storage. In hospital and clinic settings, protection from plastic enclosures after use of lancets and syringes is essential for health care personnel. There are guidelines for how such medical products must be packaged, for hygienic reasons, among others. Nevertheless, one wonders what the hurdles are to reduce the amount of packaging and how this might differ. What are the hurdles for recycling of medical products taking all safety aspects into consideration?

Both packaging and recycling are in the truest sense of the word multilayered issues, complicated by the wide range of plastics (and other materials) used and the highly complex ways in which they are combined. This makes it extremely difficult or even impossible to separate them by type. Plastics such as polyethylene, polypropylene, polyethylene terephthalate, polystyrene, polyamide, and others are used for packaging and plastic housings for the products. Furthermore, the plastics are often mixed with additives prior to processing. These can be paints, but also flame retardants or processing aids. Exactly what is used is often hidden from the public as a trade secret. Disposal of the actual medical devices is complicated by the fact that CGM systems, pens, or patch pumps are made not only of plastic, but also of electronic components (including batteries and circuit boards with some new ones), contaminated cannula that pose risks, and possibly also contain residual insulin.

There is some progress being made in the broader context of packaging and the circular economy.⁶ How this impacts diabetes care remains to be seen. The question is, are there not new “plastics” made of “biodegradable” materials not derived from oil that can be used for packaging, as well as the products themselves? Could redesign minimize size? These are probably more expensive than the plastics used so far, which are produced comparatively cheaply in huge quantities, while ignoring their environmental costs. However, if we are prepared to switch from cheap plastic to much more expensive paper or metal straws, what about medical products? Perhaps more than we think or better said than we know. Which one of us has dealt with this topic before, what is our awareness of it?

The aspects briefly discussed in this editorial are clearly issues for manufacturers of diabetes technology products; however, until now there has not been open discussion about such topics specifically related to diabetes technology to our knowledge. Presumably, when designing and manufacturing such medical products, more thought needs to be given to their disposal and overall impact on the environment.