The Other Cost of Diabetes
The current global prevalence of diabetes is estimated to be 463 million people, and it is expected to grow to 578 million people by the year 2030. Current financial costs are just as astounding: a 2015 study published by The Lancet estimated the global cost of diabetes to be 1.31 trillion USD, primarily stemming from direct medical care and costs incurred through loss of productivity. When I started thinking about these numbers in more context, I kept circling back to the daily management of the disease among such a large group of people, and another question came to mind: is there an environmental impact from diabetes monitoring that gets overlooked?
Commercial blood glucose monitors generally fall into one of two categories: self-monitoring blood glucose meters (SMBGs) or continuous glucose monitors (CGMs). SMBGs are probably what you think of when you think of diabetes management- a meter, testing strips, and a user pricking their finger to apply a small amount of blood. On the other hand, CGMs consist of temporary sensors that are replaced every 10 to 14 days, collecting information that is transmitted to a device for user engagement.
For those with insulin-dependent diabetes, it is generally recommended that their glucose levels are checked at least 8 times per day, meaning at least 8 test strips per day if they use a SMBG, and roughly two-thirds of this group do use these meters. For non-insulin dependent diabetes, opinions vary but it is generally recommended to test once per day. So what’s the impact of all these consumables on our environment? A rough estimate of SMBG user prevalence, about two-thirds of all people with diabetes, equates to approximately 308 million people worldwide. If each of these people tested their glucose even just once per day (an extremely conservative assumption), that would mean that 308 million test strips reach landfills every day. 308 million per day, 2.16 billion per week, 112 billion per year!
112 billion test strips per year, conservatively. That’s a difficult number to put in perspective (test strips are small, after all). A typical test strip measures 3cm in length. Laid end-to-end, all of those test strips would circle the equator of Earth 84 times. Every year. The width of a common test strip measures 0.8cm, meaning that its area is 2.4 cm2. Laid side-by-side and end-to-end, 112 billion test strips are enough to cover 3,765 football fields, or the entire land area of London Heathrow Airport. Twice. A stack of ten strips measures in at 1.2 cubic centimeters, which equates to over 13,400 cubic meters of test strip waste per year! That volume is equivalent to tossing 37 Toyota Corollas in the landfill every day. Or one Boeing 787 Dreamliner every month. And remember, these estimates are conservative- it’s likely that actual waste exceeds my calculations. I also haven’t figured in container, packaging, and shipping materials, which would increase the environmental impact significantly.
Studies on the time it takes for a single test strip to decompose are difficult to find, but if you’ve ever held one, you know that it’s a durable and resilient little creation (life hack: I’ve repurposed test strips for everything from cleaning dirty fingernails after a baseball game to tile spacers for a bathroom renovation project). The composition of a test strip is mostly consistent from brand to brand- layers of electrodes, adhesives, and hydrophilic materials held together and protected by two strong layers of plastic. In short, test strips give me that uneasy feeling of ‘if, not when,’ they will ever naturally decompose.
There are good reasons to be optimistic that the environmental impacts from diabetic consumables will begin to decrease in the not-too-distant future. There are many companies in the race to the holy grail of diabetes management: non-invasive blood glucose monitoring. One of the leaders in this race, DiaMonTech AG, plans to go to market with their handheld device, the D-Pocket, sometime in the second half of 2022. The D-Pocket would allow users to measure their glucose as often as they like without creating additional waste with each test. And, just as importantly, the ability to test frequently will create shorter feedback loops for the user, providing positive reinforcement of good behaviors or guidance for improvement, and leading to healthier outcomes.
