Design Challenge Judge Daniel Crowe: One Cool Diabetologist Living with Type 1

Please welcome a brand new judge this year in the 2011 DiabetesMine Design Challenge, Dr. Daniel Crowe. He is Medical Director of the Diabetes Program at Southboro Medical Group in Massachusetts, and a long-time type 1 himself.

As a diabetologist who wears his very own insulin pump and CGM, Dan brings a unique perspective to this contest and the prospects of innovative diabetes tools:

DM) First off, can you tell us what it’s like to be a type 1 patient AND a diabetes doctor?

DC) Every day patients have the opportunity to learn that I too have diabetes, and they usually really sit back and say, “Wow, you understand!” That’s almost always what they say.

We also have a team of diabetics. My nurse practitioner is a type 1 on a pump, and her nurse is, too!

So when we have patients who are new to us and not sure if they want a pump, we say, “Do you want to meet some pump patients?” Then the three of us come in the room, and it’s really powerful.

What are your thoughts about being involved in this competition?

I keep switching hats, as I’m trying to understand it from a patient and a clinical world viewpoint.

As a patient, I’m very familiar with the daily frustrations with technologies not meeting the challenge. I’m excited to see some really innovative people coming up with things that will actually ‘shift the paradigm.’

As a physician, the issue everyone’s worried about as we get more and more data coming across our desktops is that at some point, we’re going to get saturated. We need something else!

From the patient side, how could better-designed gadgets and programs potentially improve your own life?

If we judge design by how easy it is to use (level of complexity), functionality (does it interface well with current diabetes technology?), and reliability (accuracy, precision, does it break down often, is there good customer service?), then design is critically important, and a well-designed innovation would potentially have a significant impact.

We definitely agree that complex data logging alone is not the Holy Grail…

We doctors already are inundated with data that’s presented in ways to try to “one-up” the competition but most still miss the mark.  What’s missing is information from the patient that allows much wiser interpretation.

For example, teleheath communication is being used for congestive heart patients, so cardiologists are getting loads of data too. There’s a tremendous potential for overwhelming the system. It’s all good stuff, but who’s gonna look at it?

With diabetes you have so many data points. If you download a whole month of data from an insulin pump, it’s overwhelming. If you then throw in patient-entered information like ‘I forgot a shot,’ ‘I exercised for 2 hours,’ – it’s just so much!

Also, patients don’t want to take the extra time to enter detailed diary-type information.

If data overload is the problem, then what characteristics do you think would make a “killer app” for diabetes care?

I like to think about different types of variation in terms of common cause – common things we do that can cause common variables.

If someone can think about a way to create statistical analysis that allows the interpreter to determine if BG variation is due to “common cause variation” – (carb counting errors, changes in physical activity, stress, sleep variation, etc.) versus “special cause variation” (insulin was exposed to excesses of temperature, incorrect code on meter, expired strips, illness, vacation, etc.), that would be incredibly helpful.

To date, ‘smart meters’ and pumps still are not used adequately by enough patients to allow these day-to-day variations to be categorized in ways useful for better data interpretation.

So… an app that was really easy to use that allowed both glucose/ insulin/ medication/ carb intake data entry along with fun ways to prompt for things that might fall under either ‘common cause’ or ‘special cause’ variation which then would analyze and interpret the data based on these variations would be phenomenal!

It could look for patterns that would prompt questions like “did you forget your glipizide/Novolog?” or “check to make sure strip codes and expiration dates are OK?” or “you may be consuming too many carbs at meals,” etc.

Is there any cool technology that you’re using in your practice?

I’m awaiting arrival of my new iPad 2 – though that’s not about the exam room {chuckles} But I was at a meeting at Brigham Women’s Hospital where they’re using it with patients while they’re in the waiting room while waiting for a physician to come in. These are COPD patients, and they answer a questionnaire on the iPad that helps the doctor decide whether they need a certain kind of test. That saves a lot of time…

There are gonna be all kinds of ways to incorporate this technology into the clinic. In a few years, it’ll be common practice for patients to use smart tablets of some sort during their wait time. This will be a very helpful way for clinicians to do initial screening.

But you know, the medical world is often one of the stragglers in terms of technology.

How do you define “success” for yourself and other patients living with diabetes?

Good clinical control (good, safe A1c plus low variability) plus a happy patient who feels they are in control (the diabetes doesn’t control them) without breaking the patient’s or the medical group’s budget.


We’re thrilled to have you as one of our this year.  Again as both healthcare professional and patient yourself, what would you most like to see materialize out of this contest?

I think something that challenges the industry to change a paradigm would be great.

Thank you, Dan. We hope you know that doctors like you are game-changers too!