If there’s one thing we here at the ‘Mine can get behind, it’s innovation in diabetes technology. After all, Amy did launch the DiabetesMine Design Challenge four years ago after her popular Open Letter to Steve Jobs post was published. So that’s why we were excited to see that this month’s DSMA Blog Carnival challenge is all about diabetes technology, especially after spending weeks looking at all the wonderful submissions to this year’s contest. We have a lot to say about diabetes technology (though, really, when do we not have a lot to say about anything related to diabetes?). Here are Allison and Amy’s respective answers to this month’s DSMA question:
“What improvements or adjustments would you make to current technology?“
Allison’s Answer:
When it comes to improvements to current diabetes technology, I have to admit, I think about it mostly as a digital native. A few weeks ago, I was giving a presentation on the “patient’s perspective” on health 2.0, and as an example, I held up my insulin pump for the entire room (filled with non-D folks) and I said, “What does this look like?” One guy in the front suggested, “A pager?”
“Right,” I replied. “And when was the last time you saw a pager? 1993?”
We’re in the 21st century! Land of iPhones, laptops, flat-screen TVs, BlueRay players, and wireless Internet at 35,000 feet, and innercontectivity like never before. So why is it that the only thing I wear everyday looks like a piece of technology that about 1% of society actually uses? And do you know who uses them? Doctors!
When I look at modern diabetes technology, my main beef with it is that it doesn’t look modern. It looks old. It doesn’t fit in with the other products that I use. It doesn’t fit in with the aesthetics of my life, and that makes it uncomfortable to use. It’s clunky and outdated, and it makes it unappealing. Logically I know that an insulin pump is my best chance for living a healthy life. But it also seems logical that medical device companies would want it to be as appealing yet functional (like an iPhone, for example) as they can to help folks be more inclined to use it to its full advantage. We are in an age of the sleek, of the touchscreen, of the wireless transmission. If medical device makers don’t keep up with consumer demands, they might find it difficult to survive in the era of “digital natives” like me!
Amy’s Answer:
Clearly, improving on diabetes technology 
is a personal passion for me. Even with the DiabetesMine Design Challenge gaining national attention, it never ceases to amaze me how engineering- and clinically-driven the design of many our health devices remain.
On the Expo show floor of this year’s ADA Conference, I spent a little time looking around with Brennan Cassidy of the sports group Insulindepence. As two adults with Type 1, we had some very practical questions for some of the device-makers, who seemed surprised that we wanted to know things like: “What do you do when the 10-test cartridge runs out, and you don’t happen to have a spare drum with you?” or “Why isn’t there a container included to hold the used test strips?”
After a few minutes, Brennan surveyed the exhibit hall, and then looked at me and said: “You know what’s wrong with all of this stuff? It wasn’t designed by diabetics!“
BINGO, Brennan!
It is a personal passion of mine to get patients — the people who live with this technology day in and day out — more integrally involved the conceptualization and design of this stuff. To that end, we’ll be hosting a Diabetes Innovation Summit event on Stanford campus in the fall, bringing together a select group of patient advocates, entrepreneurs, design experts, and pharma industry leaders from the marketing, R&D, legal and regulatory sectors to explore new ways to achieve truly “patient-centered” solutions.
Here are the tenets of what I personally believe to be necessary to improve diabetes technology as it stands today:
Aesthetics – most of this stuff has a long way to go to measure up to Apple products, for example. I was amazed at how angular and plain some of the new pump designs were that were shown at ADA this year.
Life Functionality – any medical device designer should ask him or herself: would I want to wear this thing stuck to my belly 24 hours a day? Does it pinch when I lean over? Beep me awake all night with harsh alarm tones? Or fit into a pocket or belt clip holder without making me look like an idiot? Etc.
Interoperability – for God’s sake, the data is of no use unless it can be shared. Why do you think Google, Facebook, Twitter and other sharing-based technologies have been so wildly successful? And people’s lives don’t depend on most of the stuff shared there. At the recent Roche Social Media Summit, we practically begged JDRF CEO Jeffrey Brewer to push the diabetes industry on interoperability standards (well I did, anyway). This is what will make new closed-loop and mobile apps truly viable options for patient use.
In case you need some inspiration on Point #3, Industry Folk, allow me to revisit the Diabetic Data Cloud entry from the 2009 DiabetesMine Design Challenge:
Viva la innovation!
)
Hmmm… I, too, love technology. I have an iPhone, a Mac, a PC, and a MM pump (blue.) Tried the OmniPod (in my opinion the most modern-looking of the pumping devices, with the coolest PDM.) Unfortunately, it didn’t work for me as well as it does for Amy. Anyway, having just celebrated my 39th, complication-free, Diaversary, I am SO thankful to have a pump/CGMS and meter (for God’s sake!) I spent the first 10 years after diagnosis with NO meter, doing urine glucose tests in test tubes with Clinitest tablets, was SO happy when the color-coded test strips that you put blood on and wiped it off and waited to see what BG-range the color was, AND living with injections of primitive Regular and NPH insulins that made my blood glucose plummet at least 4 times a day, that I’m not terribly upset that my pump looks like a pager! On the other hand, I can hardly wait for the iBGStar meter (seems I’ve been waiting a year already, and I guess the FDA is holding it up)!
I’m not really a diabetes technology person — I wore a pump for a period a few years ago and gave it up (willingly) when I’d capped my durable medical equipment limit and the warranty expired, but I think the questions you pose are excellent, and SHOULD also be a regulatory requirement (hmmm, there’s an interesting idea; a lay review committee for the FDA … maybe we can lobby for it!). The new smartphones and the like are cool, but bridging the gap between those and medical stuff seems like a monumental challenge. When I attended the Roche Social Media summit in June, I told the product development folks at the company to consider adding a compartment to their meter cases for USED test strips, which as we all know, end up all over the place. That seemingly simple idea had not occurred to them, but I was told that they liked the idea, so maybe someone … the right person … has heard?!
What I do not like is that phone application used to monitor your blood sugar. It is so lame how could a device like a phone monitor your blood sugar level? Heartbeat yes, but diabetes is all in the blood. One needs to have those blood sugar monitors. They save lives.
Well written article, great information. Thank You
Amy, as well as pushing Jeffrey Brewer I’ve also talked to someone from the devices section of the FDA. I was trying to persuade them that lack of interoperability is a safety issue. If I can’t use a single piece of software to give me an overall picture of my diabetes that includes: insulin basals; insulin boluses; meter readings; CGM readings; weight; etc, what chance do we have of making any sense of it all.
As more people use CGMs, and newer CGM devices arrive, this situation will get worse. We’ll have even more data that cannot be transformed into information that we can use.
One of the things I find most infuriating about my own diabetes technology is the @$&)@#( infrared port for uploaded one’s data from the Animas Ping. It always takes 10 minutes of fiddling and repositioning (and then holding my breath when it finally does connect) to upload my data! Leaving aside interoperability concerns (which I also agree should be a top priority), it’s hard for me to PHYSICALLY get my data off the device! (Infrared data transfer is so 10 years ago, as well. Palm Pilot anyone?)
I love my omnipod, but the pdm annoys me immensely. Its huge. I have to bring a messenger bag with me everywhere because theres no way to fit it in my pocket, atleast without having this giant bulge. I’m excited for pancreum since it finally fixes this problem by using a smart phone as the controller. I always have my phone with me, but then I need a giant pdm and a giant dexcom receiver.
Careful what you ask for. Having everything super connected is a security risk. I actually prefer the IR data/Config method as it is more secure. I am going to be talking about this very topic at a conference next week (https://www.blackhat.com/html/bh-us-11/bh-us-11-briefings.html#Radcliffe).
Great post!
Design is key to making great products, but I think there are other issues that need to be considered.
All of our products, and I would assume most of our competitors, are in fact designed by teams that include people with diabetes. Even at a small company like ours we have several people who deal with the very issues you talk about and provide first hand feedback on our products.
Non-PWD’s are required to use a glucose monitor for a period to learn “first-finger” what it’s like to deal with diabetes. The more adventurous have also worn saline pods and CGMS sensors to get an even better understanding.
Regarding your comment about strip storage, we actually filed patents on 4 different designs back in 2005! Designers at all the big companies have lots of great ideas, but we face some serious roadblocks including: Retail distribution, Insurance Coverage, Regulations, Economics, etc.
We all want to make great products as much as you want to use them, but we need your help. We would love to participate in this summit in the fall and share what we’ve learned and ideas about how we can improve the system!