Once every two to three days, I throw away a piece of medical technology that is necessary for my survival. I have type 1 diabetes (T1D), and the device in question is a smart, disposable insulin pump called an Omnipod. Omnipods can communicate via Bluetooth with other medical devices I use to manage my T1D and use machine learning to adapt insulin delivery based on my body’s needs. These devices are extremely sophisticated and complex, essentially like tiny computers that I adhere to my skin. They’re made of a host of copper components, a printed circuit board (PCB), mixed plastics, mixed materials, and three small button batteries. Their components are precious, toxic, and far from environmentally benign, and yet I am meant to throw them away every three days.
The process looks like this: I rip the plastic-coated paper backing off the plastic container that holds my Omnipod. I then use a disposable plastic syringe to inject insulin into my Omnipod. Finally, I rip the plastic backing and paper covering off the pod to adhere it to my skin. I repeat this cycle, on average, 122 times over the course of a year. This process of disposability is common for people living with T1D, particularly those who use insulin pump therapy or continuous glucose monitors (CGMs). According to industry estimates and research organizations, approximately one million Americans living with T1D use either a disposable insulin pump or a CGM (or both) to manage their T1D. It’s critical to explore this waste issue because it’s not going away, and it is likely to grow. T1D is an autoimmune disease that prevents the pancreas from producing insulin, a hormone that regulates blood sugar in the body. Over 1.6 million people in the United States live with T1D, and diagnoses have increased 30% since 2017.
There is no cure for T1D, and thus I, and all others who have been diagnosed, will have to administer insulin to manage our blood sugar for the rest of our lives. While there is no cure for T1D, management technologies have improved and proliferated rapidly in recent years. Devices like continuous glucose monitors and insulin pumps are associated with better patient outcomes, including mental wellbeing and blood sugar management, and are becoming the new standard of care for type 1 diabetes. All these advanced technologies have significantly improved the quality of life and ease of care for people living with T1D, but it has come at an environmental cost.
In what follows, I explore the social and environmental cost associated with the waste of disposable diabetes technologies. This work draws on research I conducted from June - August 2024. During this time, I conducted a survey of T1Ds and parent caregivers of T1Ds (n=40) to explore the amount of disposable diabetes technology waste they generated, how that waste was managed, and the impact that wasting had on respondents. To better understand the lived experiences of participants, I conducted follow-up, semi-structured interviews (n=6) with survey respondents. I also interviewed professionals in municipal waste management, waste stewardship, and sustainable diabetes management roles to explore potential solutions to the problems associated with disposable diabetes technology. I draw on this research to argue that there are social and environmental costs associated with diabetes technology waste and that stronger policies should be put in place to steward these materials throughout their lifespans.
While there are a range of insulin pumps on the market for T1Ds, Omnipod (made by Insulet) is unique because it is currently the only automated tubeless pump on the market for T1Ds. An Omnipod is about the size of two matchbooks stacked on top of each other. It adheres to the skin for up to 72 hours and is able to withstand submersion in water for up to an hour while providing a continuous delivery of insulin to the wearer. In short, this is a rugged, complex, and smart little device. It’s also very difficult to classify as waste because it is both medical and technological in nature. Because it sits at the intersection of e-waste and medical waste, there is currently no legislation or direct guidance on what to do with these devices, both from local governance and the producer itself.
Lacking specific guidance on how to dispose of wearable diabetes technology, some users quite literally break the devices down into their component parts for recycling. This strategy is problematic, however, because most of the device components are not accepted by waste systems in the United States. Waste experts that I spoke with as part of my research indicated that the broken-down components of Omnipods are too small, too dispersed, and lack viable infrastructure for their processing. In the absence of strategies to recycle or otherwise divert these devices from the waste stream, I estimate that we throw away approximately 1,183 tons of Omnipod components in the United States annually. These are precious materials, produced at significant cost to the environment and to human health. We must be able to do better.
Social Costs: Frustration & Guilt Around Wasting
The lack of guidance and systems for how to properly dispose of these medical devices is frustrating for many users and their caregivers. My survey indicated that 57% components of these devices ended up in the trash, compared to other methods of disposal like recycling, medical/hazardous waste streams, or a different method of disposal. Respondents appeared to care about this, too–70% of respondents were extremely or moderately concerned with the amount of waste produced by their disposable diabetes technology. When asked in the survey about their concern, one respondent explained their guilt about the waste, saying, “the waste upsets me but I feel bound to it. To protect my mental health, I try to focus on the necessity.” In a follow-up interview, one parent exclaimed, “This diagnosis has treatment options, and the technology is awesome, but it comes at [an environmental] cost” (Interview, 7/13/2024).
One caregiver of a child with T1D described how they try to manage waste by holding onto all of the waste from each pump and CGM change until there is a better way to dispose of them. The frustration and guilt associated with constant wasting seemed to exhaust some of the people I spoke with. One interviewee described this feeling, saying that “I have to go seek out that information, and I should. Why didn't I look into that in the last three years? Because, well, I've been managing a kid with diabetes. You know? Like, I've had other things on my mind” (Interview, 7/12/2024). Managing T1D is time-consuming, stressful, and never stops. The added burden of waste on top of the daily care needs seemed to overwhelm some T1Ds and caregivers. Despite the guilt and frustration expressed by interviewees, there was also an acknowledgment that these devices save lives, provide a high standard of care, and contribute to the wellbeing of T1Ds and their caregivers. Understandably, users I spoke with were not willing to sacrifice ease and quality of care to achieve environmental goals. As one parent pointed out, “I would not pick a treatment based off waste or materials or anything like that. It would be more considering what's best for my daughter with her input” (Interview, 7/13/2024). This interviewee broke down into tears, explaining, “I want the best for my daughter---to let her live her life without too much thought involved, and Omnipod provides that” (Interview, 7/13/2024). Another survey respondent pointed out, “I am not going to feel bad about the waste produced by this since we have to use them.” There was a clear tension for participants, who both recognized the value of disposable diabetes technology and felt the burden of managing its waste.
Policy Solutions
Waste has long been an individualized problem. Producers often tell consumers to be responsible in discarding, and many consumers try to oblige by carefully separating and handling waste. Even in the disposable diabetes technology world, there are avid YouTubers who demonstrate how to crack open and deconstruct Omnipods and CGMs, suggesting that if individuals only tried hard enough, they could be “responsible” with this waste stream. Over the summer I broke down an Omnipod to examine its components. The process took nearly an hour, required a suite of tools, and resulted in a small heap of materials that had no clear place in any waste stream. Given the fact that users cannot easily navigate their waste systems to better properly dispose of these devices, whose responsibility is it to create better pathways for disposal?
T1Ds and their caregivers that participated in my research wanted better solutions for their disposable diabetes technology – options that didn’t involve these products going straight into the trash. An overwhelming majority of survey respondents (94%) said they would be extremely likely or likely to utilize an option to recycle disposable diabetes technology if given the opportunity. This is not a theoretical suggestion. Insulet, Omnipod’s parent company, says that it is “always thinking about waste, and we're always thinking about how to reduce it across the board” (Interview, 7/12/2024). Insulet has established takeback programs in fourteen countries worldwide and is currently running a pilot takeback program in Massachusetts after a previous nationwide program in the United States was shut down in 2018. Although many survey respondents were eager to do something better with their disposable diabetes technology than throwing it in the trash, some interview participants indicated that solutions needed to go beyond checking off boxes and seemed skeptical of company-initiated solutions that weren’t transparent. As one interviewee explained, “If we're checking a box for corporate sustainability or responsibility, they can go to hell” (Interview, 7/12/2024). Additionally, there is some mistrust about how the company would handle the takeback program and if that would be the best solution since, as another interview participant put it, “I would prefer a system that had built-in sustainability in mind versus a take-back program because I've heard that it ends up just going into waste anyway” (Interview, 7/10/2024).
While frustrated with the status quo for disposable diabetes technology waste, my research participants also indicated that they wanted to see transformative systems change that would change the way products were made and distributed. One potential avenue for finding a better waste solution is extended producer responsibility (EPR). EPR policy, which has become more widespread in recent years, involves placing increased responsibility for the end-of-life management of a product onto the producer, putting pressure on them to bear the burden of funding, creating, or expanding the recycling infrastructure of their product. This means that the company would be responsible for the end-of-life management of their products instead of placing that burden on individuals or municipal or county waste systems. There are various types of extended producer responsibility with a range of involvement from the company. EPR policy can involve companies being held individually responsible, or it can require the formation of producer responsibility organizations (PROs), which are third party groups developed to help with the management and implementation of EPR on behalf of regulated companies. While there are mandated takeback programs for some medical equipment (specifically, medical sharps in some states), there is no EPR legislation proposed or in place that relates to disposable medical devices like Omnipods and CGMs. According to Erin Victor, a PhD candidate at the University of Maine studying EPR packaging policy in North America, “Omnipod would probably be a good fit for extended producer responsibility, because it's a more set (material) stream” (Interview, 7/10/2024).
The main obstacles to overcome would be crafting the legislation, as this would be the first of its kind, and deciding whether to focus on a specific device, such as the Omnipod, or on medical device waste more broadly. Additionally, EPR policy has received pushback in many states, with many citing the potential rising cost of the product for consumers as companies may put the cost of stewarding their device into the ticket price. Companies themselves often push back against EPR because after municipalities and taxpayers have already covered this cost of disposal for so long, this shift in responsibility is, as Victor puts it, “a threat to business, business interest, and profit margins” (Interview, 7/10/2024). Whether or not the per unit price of these devices would increase as a result of EPR legislation is unclear and remains highly contested within the EPR policy sphere, as studies have shown varying results. Yet, EPR policy involving diabetes devices, whether it be specific or broad, could be a good potential avenue for alleviating some of the environmental stress these devices cause, as well as the emotional burden of constant wasting for users and caregivers.
Conclusion: Sharing the Burden of Waste
The environmental and social cost of disposable diabetes technology is important to understand as we face increasing T1D diagnoses and as more patients opt for treatment that involves disposable diabetes technology. We can and should do more to circularize our economies so that valuable materials can be recovered instead of discarded, and so that the individuals and families who already do so much to simply live with T1D are not also burdened with the responsibility for all the waste on their shoulders. T1Ds and their caregivers should not be forced to choose between quality of treatment and waste, as one interviewee described to me when they noted that “the benefit (for my child) far outweighed the waste that we are producing” (Interview, 7/10/2024). Policies like EPR can ensure that producers are pushed to consider reuse, remanufacturing, and recycling in their design processes, rather than relying on users to bear the burden of disposal.