Let Us Make Diabetes Care Greener Free

Every individual with diabetes is affected by environmental and climate changes. We have witnessed a remarkable success story with diabetes devices in recent decades. However, these devices consist of plastic, metal, needles, electronics, and batteries. They also come with packaging materials and printed instructions for use (IFUs). After use, these devices and their packaging can end up in regular waste instead of being recycled. Our planet is filling with discarded medical waste, and diabetes devices play a role in this waste problem. Thus, the use of diabetes devices also impacts the environment, underscoring the need to reduce diabetes-related waste.

The (relatively) small amount of medical waste might appear insignificant compared with the overall amount of plastic waste generated; however, the study by Tian et al. (1) published in this issue of Diabetes Care demonstrates that the amount of waste generated from diabetes devices is substantial. Our colleagues from the Diabetes Technology Society (DTS) collected data from several individuals with diabetes who were using various therapies. In a separate study performed in Germany by a different group of researchers, 80 individuals with diabetes were asked not only to note which products they used but also to collect the products used over a 3-month period (2).

What can we do to reduce the waste generated by diabetes therapy and devices specifically? Let me state right away that this requires us to step outside our comfort zones. Regarding concrete activities, one provocative self-reflecting question arises: Is there still a need for printed medical journals (like Diabetes Care)? Most of us will discard such journals, which represent a lot of paper, immediately, hopefully into the recycling bin. Nowadays, when searching for a certain publication or topic, we use search tools to find the respective PDF. We should also consider how the annual diabetes congress can become greener.

In general, the answer to the question raised is to use fewer resources and to recycle resources whenever possible, which is referred to as supporting the circular economy (Fig. 1). I see three steps that can be initiated by device manufacturers and three steps by individuals with diabetes, governments, and nongovernmental organizations to change the situation. The latter are organizations with a track record of working to reduce the waste problem (such as the DTS and the German Diabetes Association [DDG]). The DDG recently established a working group and published a position paper on this subject (3). This working group has also established a roundtable for open discussions among all relevant manufacturers.

The most important step the manufacturer can take is to design products with less plastic and a small number of different plastic materials to ease recycling (4,5). It is acknowledged that creating and developing eco-friendly devices takes time; however, in my discussions with diabetes device manufacturers, they were quite receptive to such ideas. Many companies have initiated programs to reduce the carbon footprint associated with manufacturing and the products themselves. One solution for reducing plastic waste is reusable inserters for glucose sensors in continuous glucose monitoring systems. The inserter allows for simple, pain-free application of the sensors; however, each time an inserter is discarded, over 70 g of plastic is wasted. Given the high volume of glucose sensors currently used worldwide and their increasing annual use, why not switch to inserters that can be used multiple times? I am aware of design hurdles and regulatory barriers, but we should consider alternative options. Another option could be to implement a recycling program for the inserters (and the glucose sensors).

A straightforward measure would be to create a recycling program for single-use insulin pens. These commonly used devices likely generate the largest amount of plastic waste among all diabetes devices due to their volume and prevalence. In recent years, initiatives have been started or established in Brazil, Denmark, and France. In Brazil and France, federal laws mandate these measures. France has a recycling program for insulin pens and insulin patch pumps (6).

Many diabetes devices, such as glucose sensors, patch pumps, and smart pens, contain electronics and batteries. Recycling glucose sensors is far more complex than recycling insulin pens (7). The next generation of glucose sensors should be designed to enable easier disassembly and recycling of the different parts. Used batteries can be recycled quite well (8).

If you unpack an insulin infusion set, seeing how small the product is related to the package is impressive. One reason why the package must have a specific size, at least in Europe, is that IFUs must be included in the packaging of every medical device product (9). Again, I assume that in most cases, individuals with diabetes discard the IFU along with the packaging immediately. If they have a specific question or want to learn about the product's function, they will visit the manufacturer's homepage for a PDF or look for a video online. There is an initiative in the European Union to transition to electronic IFUs (10).

We tend to focus on the manufacturers of diabetes devices regarding activities to reduce waste; however, I believe we should also consider our own contributions. Please remember that the most critical players in this game are individuals with diabetes. The publication by Tian et al. indirectly addresses the care of people who have diabetes. When considering modifications to diabetes treatments (recall the title of this journal), the authors argue that until recently, we have not adequately focused on the environmental impact of waste from diabetes devices. In a prior attempt to identify initiatives by medical associations and organizations dealing with the environment and diabetes, we were unable to identify any such initiatives (11). I believe many people with diabetes are frustrated by having to dispose of the waste generated by their therapy in regular trash; however, no large-scale campaigns have been launched to educate them about proper waste disposal (2). However, until now, these concerns have not influenced their decisions. For younger individuals with diabetes, this issue has become increasingly urgent. Patients seek guidance on effectively managing diabetes-related waste, which should be included in their training. Why not provide recycling boxes for diabetes devices in every practice or hospital to support recycling efforts for people with diabetes? Furthermore, we should clarify what eco-friendly products are and why accessible waste disposal and recycling programs are essential.

This commentary emphasizes waste; however, heat and heat waves significantly impact the effectiveness of diabetes devices and glucose-lowering drugs (12,13). I urge you not to dismiss this commentary as a distant concern that “somebody” will address. We must act now and integrate this knowledge into our daily work and lives. Effective change is imperative at all levels, from patients and hospitals to medical practices, manufacturing, and storage. In Europe, political initiatives like the EU Green Deal are poised to reshape perceptions of climate change and reduce plastic waste, potentially transforming the medical device industry (14).

It is crucial to establish clear and defined goals. Specifically, what level of plastic waste reduction associated with diabetes devices do we aspire to achieve? The Green Diabetes Declaration outlines ambitious targets for all stakeholders involved (15,16). Together, we can collaborate to ensure that diabetes care meets medical standards and remains environmentally sustainable. Let us take this critical step for our health and our planet.