The Diabetes Technology Society Green Declaration

Healthcare professionals, representatives of patient organizations, waste management experts, government agencies, and device manufacturers from the United States and six European countries (Belgium, Denmark, France, Germany, Ireland, and the Netherlands) met virtually to convene the Green Diabetes Summit (GDS) on July 21, 2021. The summit focused on various aspects of diabetes technology and waste. The purposes of the summit were the following:

1. To provide background on the complexity of diabetes device sustainability and waste management from a variety of perspectives.

2. To determine the feasibility and role of a coalition of stakeholders to address issues in sustainability and waste management of diabetes devices used in home care that no single stakeholder can resolve on their own.

Diabetes mellitus is one of the most common chronic medical conditions globally. According to estimates from the International Diabetes Federation, 463 million adults worldwide were living with diabetes in 2019. ¹ As technology to treat diabetes continues to develop, people with diabetes are increasingly using medical products in their at-home care; however, the amount of waste generated by used diabetes devices and their packaging is considerable. Accordingly, the disposal of diabetes devices, sharps, and blood waste generated at home (and also in practices and hospitals) can be overwhelming.

In 2021, Montoya and colleagues reported a study to examine and characterize current issues regarding waste disposal practices for diabetes devices. ² Of the 150 respondents, 64% indicated that they did not receive proper education on how to dispose of their diabetes-related waste, and around 40% indicated that they disposed of their lancets in common household trash. Many medical products used for diabetes monitoring and therapy contain multiple components, each constructed from a different material. Such devices require dexterity and effort to disassemble and sort into the appropriate bins for recycling. As a result, diabetes devices are normally left assembled and discarded with general household waste. This practice leaves the issue of appropriate disposal to local waste sorting facilities and puts patients, home healthcare professionals, and waste handlers at risk of injury or infection.

A declaration was developed by attendees of the GDS to affirm their support for new policies and practices to promote sustainability and sound waste management of diabetes devices used in the home setting. The aim of this declaration is to put forward a set of twelve programmatic goals, to which all involved stakeholders can aspire. Summit participants concluded that global and regional partnerships (“coalitions”) embodying cooperation among the interested parties will be vital to achieve these goals. If the stakeholders can effectively come together to determine barriers to progress, solutions, and priorities, then ways to overcome them will be addressed through detailed action plans to ensure achievement of the goals. Coalitions could inspire the necessary commitment for planning, execution, monitoring, and evaluation of the necessary activities.

We call upon people with diabetes, healthcare professionals, device manufacturers, government/regulatory agencies, and coalitions to commit to the following twelve principles that were discussed at the GDS.

People With Diabetes

As the stakeholder group directly responsible for the disposal of at-home medical waste, people with diabetes should take care of properly disassembling, sorting, and disposing of their diabetes device waste. We call upon people with diabetes to:

• Learn which medical products are associated with the least amount of waste and how to handle these appropriately with respect to recycling. They shall responsibly use sharps containers and return them to manufacturers or disposal facilities, or use customer mail-back programs, local sharps disposal kiosks, or other similarly responsible waste disposal programs.

Healthcare Professionals

As the stakeholder group dedicated to the health of patients with diabetes, healthcare professionals are responsible for educating their patients about the products used in their treatment with respect to waste handling. We call upon healthcare professionals (physicians, nurses, diabetes care and education specialists, and pharmacists) to:

• Provide patients with information about proper disposal methods and the potential dangers of needles and other diabetes waste when improperly disposed of.

Device Manufacturers

As the stakeholder group responsible for innovation, materials sourcing, production, and distribution of medical devices, we call upon device manufacturers to:

• Design and develop medical products for diabetes therapy that generate the least practical amount of waste, are easy to disassemble to enable recycling, and require only a limited amount of packaging, which can also be diverted to the extent possible from landfills.

• Develop and promote education programs to increase awareness of the waste issue and product-specific information for consumers and materials recovery facilities about how to safely disassemble devices and properly dispose each component of a device responsibly.

• Provide or support a mechanism to safely handle sharps sold to users.

Government/Regulatory Agencies

As the stakeholder groups responsible for establishing the legal and regulatory framework to allow medical products that are used for diabetes therapy to be optimized with respect to waste reduction and safe work conditions, we call upon government agencies, in collaboration with materials recovery facilities, to:

• Provide consumers with information about proper disposal methods and/or easily accessible waste collection or disposal options according to local ordinances.

• Standardize methods for medical waste and sharps collection and disposal (including deployment of medical waste and sharps bins in public spaces) to reduce mishandling and unsafe disposal of sharps and medical waste.

• Enact regulations aimed to divert disposal of sharps, medical waste, and associated packaging from landfills

• Provide grants and other incentives for device manufacturers that are willing to participate in sustainability and waste management initiatives.

Coalitions

If all stakeholders work together to create a coalition or coalitions devoted to sustainability and waste management, then much can be accomplished. The purposes of these coalitions would be to:

• Research how and why consumers improperly dispose of medical waste and sharps to define the current barriers that prevent proper waste disposal.

• Create medical device and sharps disposal programs.

• Educate the public regarding the medical device and sharps disposal process, by promoting such disposal programs on social media and building websites as a resource for device disposal.