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Image via Diabetes Technology Society

If you live with type 1 diabetes (T1D), you probably know how wasteful it can sometimes feel. Constantly changing insulin pump sites, continuous glucose monitoring (CGM) sites, swapping out fresh pen needles, and the need for constant test strips, lancets, and syringes can feel like a lot of extra disposal plastic and materials that can add up over the years.

Information on proper recycling and disposal techniques for diabetes supplies is sparse, and with climate change reaching a peak, many know that more needs to be done.

Today, the typical person with T1D lives in a constant state of single-use supplies: lancets, syringes, CGM sensors, insulin pump cartridges, and insulin pens have all made our diabetes management easier, more pain-free, and more convenient, but they also come with a big cost to the environment.

The global issue of plastic waste is big: plastics are showing up more and more in the waters of our precious oceans, not only polluting the environment but also endangering wild species, such as whales, fish, and dolphins that have to live on our ever-more polluted Earth.

The question plaguing more and more people in the diabetes world is this: if CGM and insulin pump supplies must be plastic — much of it nonrecyclable — then why are we also using so much cardboard, fiberboard, bubble wrap, paper, and additional plastics on packaging, containment, and marketing, and what can be done about it?

A recent poll conducted by the nonprofit Children With Diabetes showed that nearly 50 percent of people throw all of their diabetes supplies away, while 22 percent are saving everything, but have no idea what to do with their leftover supplies. Only about 1 in 5 respondents to the poll say that they’re recycling everything they can.

There’s a lot of confusion on proper etiquette for dealing with medical waste in the diabetes space.

Dr. Jason C. Baker, assistant professor of clinical medicine and an endocrinologist at Weill Cornell Medicine in New York City, remarked in an interview with Healio recently: “Are [patients] 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 throwing sharps in the trash.”

Patients don’t want to do anything illegal, immoral, or unethical, but there comes a point when not recycling comes with its own set of guilt. One survey conducted in 2019 found that 64 percent of patients said they had never received instruction about safe sharps disposal as part of their diabetes education.

Shockingly, that same survey revealed that approximately one-third of T1Ds disposed of their lancets and insulin needles in an unsafe manner, not compliant with the current recommendations for safe disposal. Over 1400 needle stick injuries occur each year at material recovery facilities in the United States and Canada, resulting in $2.25 million dollars spent on treatment and monitoring. The number of used needles, lancets, and other sharps simply tossed into the household garbage nearly tripled from 2001 through 2011, and is only slated to increase.

Why is there so much waste in the diabetes space? How can we help educate others about the importance of recycling, without endangering the management of our T1Ds or waste-management professionals who have to deal with this daily?

How can we improve recycling practices, sustainability, and waste management techniques to lessen our impact on the Earth? How can we get others to listen?

In summer 2021, the Northern California-based Diabetes Technology Society (DTS) decided to do something about this. They held an international forum that was the first of its kind: The Virtual Green Diabetes Summit. For the first time, diabetes leaders from all over the world met and discussed key issues regarding diabetes supply waste and reuse management.

The DTS has a history of leadership in improved waste management and sustainability. In 2011, the organization’s official journal, The Journal of Diabetes Science and Technology, published the first special section in any medical journal ever devoted to diabetes and its impact on the environment.

At the 2019 DTS’s annual meeting in Maryland, the org’s leadership presented a talk on the disposal of waste from diabetes products, but the Green Diabetes Summit was their biggest initiative yet.

According to the summit website, the meeting sought to address two things: 1) the waste management of disposable diabetes devices and paraphernalia for home use, and 2) the design, manufacturing, packaging, and distribution processes of medical products throughout a product’s life cycle.

Twenty-three world leaders in diabetes, technology, and sustainability were in attendance. Amond them were Weronika Burkot, MFA, of the European grassroots patient org Type 1EU based in Brussels, Belgium; Dr. Andreas Pfützner of the Pfützner Science and Health Institute in Mainz, Germany; and Dr. David Weissman of National Institute for Occupational Safety and Health in Washington, DC.

Representatives from industry and government officials were also there, including from: Abbott, Dexcom, Roche Diabetes Care, Novo Nordisk, HealthBeacon, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), DASTRI French Health Industry Coalition for Sharps, and various local departments of health from the United States.

The summit was part of DTS’s larger Green Diabetes Initiative that seeks to promote conservation of natural resources and waste management processes for environmental sustainability.

A key goal is to help inform the public about the complexity of addressing sustainability-related issues, including waste management of diabetes devices from many different perspectives along a product’s life cycle stages.

The summit also aimed to develop key guidelines and educational projects to spread awareness and improve processes related to diabetes device waste and future sustainability options.

The focus was on diabetes devices that patients use in their homes, where there has historically been little to no legislative action nor guidance for proper recycling and/or waste management techniques aside from the occasional, “throw your syringes in a used milk jug!”, which isn’t very helpful for anyone.

Topics discussed included an overview of sustainability and product life cycles, an overview of diabetes sustainability and waste management, how patients dispose of diabetes waste, and the various roles that governments, industry, and coalition partners play in improving sustainability in the diabetes space.

Leaders spent the meeting discussing new technologies and policies that can reduce waste through redesign, reuse, and recycling of diabetes products, as well as ways to educate users of better waste management techniques.

They identified the resources necessary to achieve future safe and sustainable waste management systems for at-home diabetes supplies, such as lancets, syringes, and insulin pens and vials.

They also explored the idea of creating a coalition of stakeholders that would work find solutions in the design, use, and proper disposal of diabetes devices used in home care that no one stakeholder can resolve on their own.

“In every European country, the approach to diabetes waste disposal is very different. Some of them have special programs, some are aware of the issue and are trying to find the solution, some are completely ignoring the topic,” patient advocate Burkot told DiabetesMine.

“Problems usually come from a lack of a unified system, no education/awareness on the topic of diabetes waste, or a lack of interest from the local diabetes associations… Fortunately, the European diabetes community is more aware of the diabetes waste problem and pays more attention to sharps and diabetes equipment waste. Even if there are serious barriers, they are trying to segregate waste the best way they can. One of the successful movements in Europe and beyond was a Reduce Diabetes Technology Waste Campaign conducted by my community, Type1EU,” she said. “We need to raise awareness together and make changes on a political level to create effective programs for patients.”

One important outcome of the summit is the DTS Green Declaration, the first-ever international call to action for improved sustainability and waste management techniques for any specific disease state, let alone diabetes.

The Declaration was signed by attendees from the United States as well as Belgium, Denmark, France, Germany, Ireland, and The Netherlands.

The Declaration calls upon government entities, industry, healthcare providers, and patients to commit to key principles that support sustainability and improved diabetes device waste management. The Declaration was published in the Journal of Diabetes Science and Technology on October 15, 2021.

“This is the first declaration or initiative linking medical devices for any disease with the environment and the disease case is diabetes, which affects more people and requires more measurements and more decisions on a daily basis than any other disease,” Dr. Lutz Heinemann, summit attendee and managing editor of the DTS’s academic journal, told DiabetesMine.

“Diabetes therapy generates much waste in the form of insulin needles, lancets for glucose testing, syringes, and plastic/metal/glass from disposed devices and packing of various devices. Multicomponent devices require careful handling to separate the used components to dispose of each element effectively.”

He noted that when the DTS launched the Green Diabetes Initiative, it changed the color of the organization’s logo from red to green in honor of the project.

“In the future, we expect to also see green initiatives regarding medical products used for other diseases besides diabetes,” Heinemann added.

The DTS believes it is past time to develop strategies for the minimization, collection, separation, treatment, and disposal of diabetes device waste, and concurrently to address legislation, regulation, and education.

They’ve developed the waste hierarchy of the five “R’s”:

  • Reduce
  • Reuse
  • Recycle
  • Redesign
  • Re-educate

The five “R” strategies are intended to provide easy, practical benefits while generating the minimum amount of waste.

Manufacturers, such as Dexcom, Abbott, and Medtronic are increasingly interested in life cycle analysis of devices to avoid unnecessary generation of waste. For example, Abbott’s new Freestyle Libre 3 product will be more sustainable for the planet with a smaller sensor and one-piece applicator, reducing the total volume by more than 70 percent. The new sensor uses 41 percent less plastic and requires 43 percent less carton paper than their earlier systems.

Likewise, Dexcom’s much-anticipated G7 system coming in 2022 will use 25 percent less plastic volume and packaging than the G6. The company had for years explored the idea of creating a recycling program to return used CGM sensor supplies, but that was never implemented.

Omnipod-maker Insulet had a popular recycling program for their insulin pump pods starting in 2009, but that was discontinued for the United States in 2018 because it wasn’t used enough to be efficient. Insulet continues that program in Canada and the United Kingdom, though.

At the time that Omnipod recycling program was introduced, the former president and chief executive officer Duane DeSisto said, “People with diabetes shouldn’t have to choose between taking care of their health and taking care of the environment.”

Furthermore, Medtronic has also committed to implement up to a 25 percent decrease in plastic use by 2025, and a 35 percent decrease in paper by 2027.

Many physicians and patients alike are hungry for knowledge on how to properly dispose of their diabetes devices. SafeNeedleDisposal.org, a site created by the national nonprofit NeedyMeds, is a helpful resource dedicated to educating people on the proper way to get rid of their used sharps, including diabetes syringes.

The website features a map that users can use to find out the proper way and place to dispose of their sharps close to home, using their zip code to find appropriate disposal locations. The website advises people to utilize a sharps disposal bin or used laundry detergent bottle when collecting sharps at home.

As noted, safe disposal means not only helping to prevent buildup in landfills, but also preventing waste handlers from encountering dangerous needle sticks and exposure to blood and other bodily fluids.

Local and federal regulatory agencies have been tightening up restrictions on medical waste, however, household waste is traditionally excluded from government regulations, and that is the category in which the majority of diabetes device waste falls.

Per the Environmental Protection Agency (EPA) regulations, “household wastes” are excluded from the definition of “hazardous waste” subject to regulation under the Resource Conservation and Recovery Act. Since 1991, medical waste has been primarily regulated by state environmental and health departments, where laws and enforcement vary from state to state.

Part of what the DTS hopes to do is to help change government approaches to medical waste.

The problem may seem overwhelming, but just know that a lot is being done behind the scenes. Industry is responding to people with T1D who want less plastic, fewer paper inserts, and smaller packaging for their diabetes supplies. Redesign is possible. Using biodegradable materials in place of plastic is possible. Devices getting smaller and less wasteful is possible.

Physicians and nonprofits are working to educate the public about proper diabetes devices and sharps disposal, as evidenced by SafeNeedleDisposal.org.

Local, state, and the federal government will respond to their constituents, if you make your voice heard. Reach out to your elected officials and ask what their plans are to improve environmental and medical waste.

The DTS plans to convene their Green Diabetes Summit again next year, and is continuing to engage the public for input with the hope that their initiative will encourage the diabetes tech industry, healthcare providers, government officials, and partners to practice sound material and waste management, pass policies to protect the Earth, achieve sustainability, and take care of both people and the planet at the same time. For more information, follow their efforts here.