Living with type 1 diabetes (T1D) in the year 2020 comes with a variety of remarkable technology options to help you manage your blood sugars on a daily basis: pumps, pods, continuous glucose monitoring (CGM) systems, and closed-loop systems that automate some of the work. But for women, in particular, all this gear on the body can be quite burdensome, and challenge their comfort level with their own bodies.
“I don’t want to advertise my diabetes on my body,” says Kelly Close, founder of diaTribe, who wears the Omnipod tubeless insulin pump and Dexcom CGM. “I’m not embarrassed by my diabetes, but I also don’t like wearing any clothing that’s too-fitted because it just doesn’t look good over your diabetes gear.”
Close isn’t alone. When surveyed on Twitter, a large majority of women with T1D expressed their frustration about the lack of comfort and the negative aesthetics associated with wearing diabetes gear.
The question is: Are the shortcomings of today’s diabetes technology a result of functional design requirements, or is it related to the fact that there are far fewer women in the medical technology design field than men?
We posed the question to our DiabetesMine Twitter community: How often does your diabetes tech get in the way of your ability to comfortably wear dresses, skirts, tank tops, etc.? Here is a sampling of what we heard back:
- “I wear my Tandem pump in the sideband of my bra so that when my arms are down, it’s not super noticeable.”
- “I switched from a pump back to MDI (multiple daily injections) 85% because of this exact issue.”
- “A lot! There are styles I won’t even bother wearing because the tech is so obvious and then I’ll just feel self-conscious. Mostly dresses.”
- “Almost daily, hahaha.”
- “Yes!!! All the time. I’ve tried lots of different things but still not found anything I’m comfortable with.”
- “This is a lifelong problem that no endo warned me about.”
- “The wearability of diabetes tech is one of the most frustrating aspects, and can grind you down a bit, especially if you have other wardrobe-limiting issues to contend with…”
- “I wear mine shoved down the waistband of leggings and when out for a walk, they wriggle their way up and fall out.”
- “Dresses can be tricky since I don’t have enough room in my bra to be successful in that tactic, but I found a no-slip leg-garter with pockets that I use which helps most of the time. I use my abdomen for my sites, so tank tops haven’t been an issue.”
- “Every day! I love wearing dresses but I have no idea how or where to place the thing. My previous pump was smaller so it could fit easily in my bra, but this one is a little bigger and I’m super small so… adios to all my cute dresses.”
We noted that Omnipod users reported the fewest obstacles when it came to wearing and dressing around their diabetes technology:
- “Not at all with Dexcom and Omnipod on my upper arm. Albeit, I don’t wear tanks or skimpy tops.”
- “I wore a lot more dresses once I moved to a patch pump. Before, I just found it wasn’t worth the bother of figuring out where to stash the pump. The bra never worked well for me. But recently, I’ve been wearing bike shorts under dresses — great for carrying the RileyLink, phone, and keys.”
- “I’m on the Omnipod currently, so, never. Not having tubes is very helpful. In January I’m going on the TSlim though, so back to tubes for me, and I’m sure my answer will change. Going back to cutting holes in my pockets.”
- “Always struggled with my pump in clothing because of the tubing! Typically resorted to wearing the pump in my bra to hide it. Switched to Omnipod and life is so much better in terms of clothing! Dexcom never caused any issues for me.”
- “When I had a tubed pump, I’d put it in a baby sock, and pin it to the inside of my Spanx right at the crux of my hip-bend. Couldn’t see it at all. Now I’m on [Omni]pods and have no problems at all, and Spanx continue to smooth the bump of the pod if it’s on my torso.
- “Hardly ever a problem. I love my Omnipod!”
[You can read more responses on Twitter.]
While the number of women in medical technology design is inevitably growing, the overarching numbers over the last several decades paint a predominantly male picture.
“Just 18 percent of executive roles at the top 100 publicly traded medical device companies are held by women, and only three companies have a female CEO, according to an analysis of Medical Design & Outsourcing’s annual Big 100,” reported Medical Design & Outsourcing in 2019.
It continued: “Of the 969 leadership positions at the world’s biggest MedTech companies, only 172 are held by women. Nearly a quarter of the companies have no women in leadership roles and another 24 companies have a single female executive.”
The report also found that $2.7 million was given to 195 physicians in 2018 for medical research, and only 16 of those recipients were women, receiving a total of $322,000.
In March 2020, Medical Design Briefs reported that according to UNESCO UIS data, less than 30 percent of the world’s researchers are women. But they paint a more hopeful picture: “While women are still underrepresented in STEM [science, technology, engineering, and mathematics] fields, including the medical device industry, those who have chosen science and engineering as a profession are making a huge impact… They have broken through barriers to go on to develop transformational devices, fight diseases, and create revolutionary materials.”
Omnipod’s tubeless insulin delivery system appears to stand out as the easiest to adapt to physically, especially for women with varying types and styles of clothing.
Not surprisingly, Boston-based Omnipod maker Insulet also boasts a significantly higher percentage of women in their company.
“It’s definitely 50/50,” Dr. Trang Ly, senior vice president and medical director of Insulet, tells DiabetesMine. Ly, a seasoned pediatric endocrinologist, leads the program to develop the next-generation Omnipod Horizon Automated Glucose Control system.
Overseeing product development — from conception to product testing — Ly feels that Insulet stands out largely because of female-led teams.
“We do things a little differently at Insulet because we do have a lot of women involved in our process,” explains Ly. “We do a lot of user experience research with people with diabetes, and this is led by a female engineer who does all the market research.”
Over half of this research team consists of women.
“We don’t develop in a vacuum. We develop with a lot of user interaction,” adds Ly. “The FDA has really increased the importance of user experience.”
The CEO and medical director of Omnipod is also a woman — Shacey Petrovic.
“With several women leaders in our company… We have a very different perspective. It’s absolutely valuable to have females in your organization. We are geared differently. We think differently than men. It’s critical to have both perspectives represented, and minorities as well,” Ly says.
She recalls a former lead design engineer who came from a very privileged background. The company soon realized that this person did not recognize that many people with diabetes are not fully resourced and do not have adequate access to healthcare professionals and healthcare, in general, and that many people across the country (and the globe) do not have a college degree.
“With diabetes, it’s so important to understand that it affects people from all walks of life, and to consider what their needs are,” Ly explains.
Close, for one, still feels the Omnipod is too thick to wear over fitted clothing.
“I wish it was smaller,” she explains. “It fits 200 units of insulin but I only use 22 units per day so I don’t need that much room for insulin — just 66 units in 3 days, not 200 units. It could be smaller. I wish they had options so people who use less insulin could choose a smaller pod.”
Ly emphasizes that the team at Insulet is indeed constantly thinking about how to make the Omnipod smaller and slimmer without losing functionality.
“Our motto is ‘simplify life’ — I don’t think about ‘how do we make our insulin pump deliver with finer degradations?’ I think about ‘what’s the next innovation that will help reduce the burden for people living with diabetes?’”
The research team often polls both current users and potential users, asking them, “What would make your life with diabetes better?”
They review the answers and determine which are feasible, and which are not.
Surprisingly, though, Ly says the biggest request they receive when polling their customers is not about size, but about connecting the pod to their smartphone so users no longer need to carry an additional PDM (personal diabetes manager), a controller unit the size of a cell phone.
The PDM is a touchscreen device that manages the pod’s programming of insulin delivery. In a world where you never go anywhere without your cell phone, it is an extra responsibility to make sure your PDM goes everywhere with you, too, and remains charged and functional.
Ly says they hope to deliver the newest closed-loop Omnipod system with smartphone control in the first half of 2021.
When it comes to pod size, Ly says they actually get requests on both ends of the spectrum — some asking for the pod to hold more insulin because they run out of insulin after 2 days, and some asking for it to hold less so it can be smaller.
“Electronics are getting smaller and smaller, so we are thinking of ways to even further miniaturize our product, which would further support the needs of women trying to accommodate clothing styles. We know it’s an ask from our customers and it’s on our list.”
Many users may not be aware of these efforts to gradually improve the wearability of the product, Ly says, and her team is also often making small improvements that may not be visibly noticeable to the user.
“We redesigned the cannula so it had better insulin dispersion under the skin, for example,” explains Ly. “This came out last year. It led to a massive reduction in occlusion rates (insulin blockages), but a design change like that doesn’t make headlines.”
Over the last 20 years, a remarkable number of companies have popped up creating accessories to make diabetes devices more comfortable and appealing for women to wear. These outfits are often founded by women with diabetes, or mothers of children with diabetes, and offer everything from fashion carry cases to “device skins” to specialized garments.
Some of those diabetes-focused clothing and accessory companies include:
What challenges does a fashion designer face when creating with diabetes technology in mind? DiabetesMine interviewed Anna Sjöberg from Sweden about the creation of the “AnnaPS” line of tank tops, bras, shorts, and bikinis with special pockets to accommodate diabetes gear.
“I had support from the biggest suppliers of insulin pumps, healthcare professionals, and pump users, but my biggest challenge was to secure the functionality and the quality of the garments — and at the same time, making a sustainable fashion line. And making products that look good!” says Sjöberg.
She emphasized that the physical positioning of the pockets to carry an insulin pump is critical; making sure the openings of these pockets are within exact measurements requires several additional layers of sewing.
In early designs, Sjöberg discovered that the material where any pump is going to be clipped or held needed to be significantly more reinforced and stronger than normal clothing would require. Waistbands on underwear, for example, required a more reliable elastic material and careful seam placement to ensure it could handle more weight and force than regular underwear.
“There was a really hard battle to teach the factory to produce these garments,” she says. “It took much more time than I could have imagined. Of course, this cost me a lot of money and a huge amount of hours working for free, but I was determined to make clothing that makes it easier to carry an insulin pump.”
Barring the redesign of the devices themselves, Sjöberg remains committed to making the best possible accessories for women with diabetes.
“My dream is to help all with carrying any medical equipment, making it convenient to wear and invisible,” she says.