Frequently Asked Questions - Clinical

Is glucose control only important for diabetic patients in the ICU setting?

No. As it turns out, it is actually more important for ICU patients who do not have diabetes. The presence of diabetes and a chronic state of hyperglycemia provides some element of protection to diabetic patients against the extreme glucose fluctuations seen in the ICU setting. However, both the  ICU patients who do not have diabetes (70%), and those who do (30%) will benefit from safe and effective glucose control.

How does poor glucose control adversely effect ICU patients?

Poor glucose control causes impaired function of the infection fighting white blood cells and sets off some of the bodies’ inflammatory cascades, both of which can impair organ function including the bone marrow, kidneys, lungs and heart. These deleterious end organ effects explain why ICU patients have worse outcomes with ineffective glucose control.

Has the FDA already approved an artificial pancreas system for use in the ICU setting?

No. There are currently no approved closed loop glucose control systems (artificial pancreas) approved by either the FDA or European Union for use in either the ICU or non-ICU settings of hospitals.

What advantage does the EIRUS continuous glucose monitor have over other glucose monitors?

The EIRUS continuous glucose monitor works off of a microdialysis technique, which means it creates a filtrate of the blood via its specially designed central venous catheter that has a dialysis membrane attached to it. This filtrate is carried back outside the body to a glucose sensor, where the glucose level is measured and reported to the FUSION system every 1 minute.  This glucose measurement method is more reliable than other methods that rely on aspiration of whole blood across a sensor positioned outside the body. The EIRUS continuous glucose monitor has already been shown to be reliable and accurate in clinical studies, and has  achieved a CE mark, meaning it is available for use in the European Union.

How does the FUSION glucose control system actually work?

The EIRUS continuous glucose monitor provides a stream of glucose data to the artificial intelligence (AI) based glucose control software inside the FUSION system. The AI software takes in this glucose data and makes adjustments to the infusion rates of insulin and/or glucose under its control, in order to bring safe and effective glucose control to the ICU patient. By making adjustments to these infusion rates every 5/10 minutes, the AI software is able to keep up with the very dynamic glucose state of ICU patients, thus avoiding  both hypoglycemia and hyperglycemia, while at the same time minimizing glucose variability.

Why is it important to minimize hypoglycemia, hyperglycemia and glucose variability?

These three glucose measurements have been shown to have direct correlation to ICU patient outcomes. In a large study on hypoglycemia performed on almost five thousand ICU patients, it was shown that patients who experienced even one hypoglycemic measurement (< 81 mg/dL) had a 46% higher mortality rate. In a large study on hyperglycemia on over three thousand ICU patients, it was shown that patients with a mean glucose level greater than 180 mg/dL had a 400% higher mortality rate than those with a mean glucose level of 100-140 mg/dL. In a large study on glucose variability on over two thousand ICU patients, it was shown that patients with glucose variability in the highest 25th percentile had 400% higher mortality rates.

Can the FUSION system avoid both hypoglycemia & hyperglycemia, while minimizing glucose variability?

Yes. In our simulation study, we modeled 126,000 ICU patients and had an overall hypoglycemia (<70 mg/dL) rate of 0.09%. When we asked our FUSION systems AI based glucose control software to control the simulated patients to a range of 100-140 mg/dL, we had a zero rate of hypoglycemia. The FDA accepts simulations as a valid means to test glucose control software, and in fact used the results from this simulation study to determine that the FUSION system is a Breakthrough Medical Device. In this same study our overall rate of hyperglycemia (>140 mg/dL) was 2.1%. Our glucose variability rate, as measured by coefficient of variation, was 11.1%. Clinical studies have shown that variability rates this low can lower ICU mortality rates two fold (e.g., lowered from 20% to 10%).

Can the FUSION system be used to treat diabetic patients who are not in the ICU?

Yes. However, Ideal Medical Technologies current plan for the FUSION system is to first seek an indication for use from the FDA for treatment of hyperglycemia in the ICU setting. Once the FUSION system has been proven to be safe and effective in the ICU setting, and the FDA approves an interstitial based CGM for use in the hospital setting, our plan is to expand its indication for use to diabetic patients admitted to a non-ICU setting. This will require additional studies to determine that the FUSION system is safe and effective in this patient population, and of course FDA approval of this indication for use.  The ICU version of the FUSION system will have built in hardware capabilities to use an interstitial CGM (e.g., Dexcom G6) as a glucose measurement source, thus the FUSION system will only require a software update prior to being deployed into the non-ICU setting. 

Does improved glucose control lead to better outcomes for diabetic patients in a non-ICU setting?

Yes. Studies have shown that safe and effective glucose control in diabetic patients in a non-ICU hospital setting lowers their rates of post-operative wound infections, pneumonia, length of stay and mortality rates. 

Can the FUSION system be used in the operating room to control blood glucose during surgical cases?

Yes. However, it will be limited to use in major surgical cases where the patient requires placement of a central venous catheter as part of their surgical procedure, and when the patient will be treated in an ICU setting at the end of the surgical procedure. 

Will the FUSION system lead to improved nursing efficiencies?

Yes. The current methods of glucose control in the ICU setting take up to 2 hours per day per patient. Ideal Medical Technologies estimates that the FUSION system will only take 5 minutes of nursing time per patient per day to use. On start up the only required inputs are the patients weight and physician prescribed glucose range. After start up the only ongoing nursing input will be daily changes of the intravenous bags of insulin and glucose used by the system to maintain glucose control. This means that the nurse will be able to spend more time monitoring their patient, which should help to improve patient outcomes and patient satisfaction.

Will hospitals benefit from the FUSION system?

Yes. Hospitals in the U.S. receive fixed reimbursement rates from the government/insurance companies based on the diagnostic related groups (DRG's) of the patient. This means that the various conditions the patient has, such as congestive heart failure, diabetes, pneumonia, etc determine how much the hospital receives to care for the patient. Hospitals increase their net revenue when they can improve the quality of patient care and shorten the patients length of stay. Multiple studies have shown that glucose control in the ICU setting can save from $1,500 - $4,000 per patient, which would be realized by the hospital as an increased profit margin. Given that each FUSION system could be used up to 90 times per year, hospitals may see their net revenue increase by at least $135,000/year for each FUSION system they use.

Frequently Asked Questions - Business

Does Ideal Medical Technologies plan to sell the FUSION system outside of the U.S.?

Yes. Once we have successfully launched our FUSION system into the U.S. market, we will expand into the European Union. After that, we will then consider expansion into the rest of the world, depending on the demand.

Does Ideal Medical Technologies have intellectual property protection for its FUSION system?

Yes. Ideal Medical Technologies has been issued patents in both the U.S. and European Union for its complete glucose control system. The U.S. patent rights run through 2031, and the European Union patent rights run through 2028. We feel this length of patent protection should be long enough for our FUSION system to become the market leader in glucose control in the hospital setting for the two largest medical device markets in the worlds - the U.S. and European Union.

Does Ideal Medical Technologies plan on manufacturing its own FUSION systems?

No. Ideal Medical Technologies will be working with a contract manufacturer that has a proven record of engineering complex medical devices such as the FUSION system. This manufacturer will be ISO 13485 certified, meaning they adhere to international standards for a quality management system for medical devices. In addition, they will be FDA certified to manufacture class II medical devices such as the FUSION system.

Does Ideal Medical Technologies plan on setting up its own distribution network?

No. Ideal Medical Technologies will be working with a contract manufacturer who also has the capability to distribute the FUSION system to hospitals throughout the U.S. and European Union. By working with a manufacturer with distribution capabilities, Ideal Medical Technologies should be able to shorten the time it takes to bring the FUSION system to market, and fulfill the demands of the market.

How will Ideal Medical Technologies approach marketing and sales?

Ideal Medical Technologies plans on using a direct sales force for the U.S. market. For the European Union and rest of the world we will explore the possibility of partnering with a larger corporation that already sells medical devices to hospitals throughout the world.

Will the FUSION system cost more to use than the savings it produces for the hospital?

No. We anticipate that hospitals will realize net savings of at least $1,500 each time they use the FUSION system, even when accounting for the cost to use the system.

What is Ideal Medical Technologies' business model for the FUSION system?

We will make money through sales of the consumable goods needed to run the FUSION system (central venous catheter, glucose sensor, and intravenous tubing). In addition, we will make money by either selling or leasing the FUSION medical device to hospitals. 

Will the market size for the FUSION system increase over the next 10-20 years?

Yes. The ICU market will increase as the majority of patients admitted to adult ICU's are older than 65 years of age, and the worldwide population of individuals older than 65 years of age will increase as a percent of the population in the coming decades. Currently around 9 percent of the worlds population is older than 65, however this percent will increase to 17 percent by 2050.   This will lead to more than a doubling of ICU admissions by 2050, when accounting for the projected  25 percent increase in the worlds population by 2050.

Around 9% of U.S. adults have diabetes at this time (95% type 2), however this percent is expected to more than double to 20% by 2050. This increase, combined with a projected 20% increase in the U.S. population by 2050 will lead to a 240% increase in hospitalized patients with diabetes.

Both ICU patients and diabetic patients admitted to a non-ICU setting will benefit from the safe and effective glucose control provided by the FUSION system. This safe and effective glucose control will lead to decreased morbidity/mortality rates, shorter lengths of stay, and overall reduced cost of care.