Ever look at a diabetes product and wonder what the heck the developers were THINKING? People have to live with this stuff, after all! It’s even more interesting when they occasionally get it right…
Kim Blickenstaff, CEO of Tandem Diabetes Care, was unable to attend our DiabetesMine Innovation Summit event this year, but reached out to me to offer an inside view of how Tandem “got its groove on” to create the t:slim, the first-ever insulin pump that looks and feels like a slick consumer smartphone.
“How do you bring simplicity to something as complex as insulin pumping? By listening.’”
— Kim Blickenstaff of Tandem, on creating the t:slim
A Guest Post by Kim Blickenstaff, CEO of Tandem Diabetes Care
Diabetes does not run in my family. Growing up, I don’t recall any of my classmates having type 1 diabetes and I had certainly never seen an insulin pump prior to joining Tandem Diabetes Care. This is all a new world for me.
As I began to read the literature and talk to folks like John Walsh — whose book Pumping Insulin was required reading here — the only thing I could make out of it all was pumping insulin is hard work. Even with my limited experience at that time, I had already started to answer my own question of “Why do two-thirds of people with type 1 still rely on syringes for diabetes management?”
So we started talking to people. Many of you with whom we spoke may be reading this right now. The answers I heard were…”because it’s easier to use a syringe or a pen”….”there is so much to remember and do already that a pump complicates life even more”…. and, “even though better control can be achieved, a pump doesn’t seem worth the hassle.” We also heard that even people using pumps have a love-hate relationship with them. They love the benefits of pumping but hate the pump itself.
So we kept asking, and over the past five years have spoken with more than 5,000 people to help us get smarter. You told us pumps were hard to learn, hard to use, and looked like hospital equipment. You asked us to make your next pump cool to look at and simple to use. You took the time to share with us a ton of great ideas. Thank you.
(An early Tandem home screen design)
Simplicity. How do you bring simplicity to something as complex as pumping?
If you read the Steve Jobs biography, he was one of the first to realize that the touch screen could revolutionize the way we interact with our phones. Since then, touch screens have drastically simplified the consumer devices we all use. Our first generation of cell phones made texting so difficult that we had to create a whole dictionary of abbreviations to reduce the number of button pushes required to send a text. Ten numeric keys had to squeeze the entire 26-letter alphabet onto them. The touch screen, however, is infinitely variable. The interface is no longer fixed and mechanical but driven by software that can be changed and updated as new features and options are introduced. The simplicity that touch screens have allowed has made texting a new standard of communication. So it was obvious that to bring simplicity to an insulin pump, a touch screen was a must-have.
The second most important thing in making these devices simpler to operate was an intuitive user interface. One thing we knew about simplicity was that what might be simple for one of our software engineers who went to MIT, is not simple for me and may not be simple for you. Thankfully, with the emergence of all our digital media, “Human Factors Science” has developed to a sophisticated level, resulting in devices that are incredibly intuitive. We all know a good interface design when we use one. ATMs are a good example. We can get our money out without a user’s manual. It feels simple and intuitive and we don’t feel frustrated or make errors. That is a good design.
How do you design a good interface? There is a simple rule in the world of Human Factors Science – five interactions with a real user will point out 95% of all design flaws in an interface. By repetitive testing, you can design out the flaws that cause fumbling, stumbling, frustration and fear, and make what was a complex interface simple and intuitive.
Our t:slim insulin pump was designed through this process. Our goal was to design its interface so that anyone can use all of its features without referencing a user’s manual. The architecture of the t:slim interface is what is referred to as ”hub and spoke” – the home screen is the “hub,” and the “spokes” are all the other functions stemming from it that are just a touch away, rather than layers deep. It’s simple to get to the “spokes” like the Bolus Function or Insulin on Board. It’s simple to get back to the Home Screen with one touch of our “T” logo.
All the information and settings are arranged logically, to help people better understand their settings and feel in control. Advanced options like multiple basal profiles are easy to find, name and set up. All entries that affect dosing are presented one last time on a confirmation screen to help eliminate potential errors. And it’s one touch back to the Home Screen when you’re done.
(Tandem’s fully staffed t:slim pump production line)
Our first customers are telling us that we have achieved our goals. Our touch screen simplifies things dramatically, and displays more critical information at a glance. A third of our users are having their first experience with a pump, and they love it. Many users can figure out how to use it without a user manual. Everyone loves how it looks, its slimness, and its design.
I think sometimes it’s better to come to a problem with no prior experience or preconceptions. It forces you to talk directly to people to find out what they want and not start creating based on what you think they want. The t:slim pump was designed by you, for you, and we have enjoyed being part of that process. And you are continuing to help us innovate as we work to integrate the Dexcom CGM into our pump.
For everyone who has helped us over the last five years and who has given us hours of your time in testing, and hundreds of suggestions for improvement and changes, we are very grateful. We look forward to working more with the diabetes community to continue pushing the boundaries of innovation in diabetes technology. Working in Tandem with you, we listened.
Thanks to Kim & staff at Tandem for taking a consumer’s viewpoint on a medical device, for a change!
When will it be connected to the Dexcom? Will the graph appear on the pump’s screen? Will the new delivery system eliminate my bubble problem? Can you change the insertion site without changing the reservoir? Will it be covered by insurance?
I was part of two focus groups that introduced the Tandem in the early days of talking about this pump. I’m looking forward to the development of this product so that when I’m ready for a new pump I can use this one.
I totally LOVE my T:slim. It is so user friendly and the staff at Tandem have responded to every question/need I have had. Connecting to DexCom would be a dream!
I for one have found the T:Slim a pleasure to use. As a vision-impaired PWD, it’s ease of use makes me WANT to enter BG’s and g of CHO and hear that little beep that tells me the bolus is done.
I’m a tech geek and I was able to set-up and hook up my T:Slim right away! IMO, it’s a great pump and I love it!
Thank you, Kim Blickenstaff, CEO of Tandem Diabetes Care, for pursuing and making this fine product!
My 13 year old recently got the the T- Slim, it is an amazing pump and he loves it. It is great to use and has so many fabulous features. However potential users should be aware that there have been a number of glitches that tandem is still working out. Initially there was a problem with numerous cartridge errors, Tandem did fix this problem. Now there is a problem where some pumps give false occlusion alarms. Tandem is not sure what the cause of the false alarms is and they are working to fix it. However it is an unresolved issue and I have been notified that it may take months to fix. While this pump is great, potential users when considering a switch should be aware that the “kinks” are not fully out yet and be ready for some potential issues such as false alarms. Potential apidra users should also be aware that the T-slim does not work with apidra.The good news at the management at Tandem is responsive and they seem .determined to work out the issue and fix the problem. I have my fingers crossed that they resolve it quickly!
It’s so simple to use t-slim. Its modern and friendly. I hope after this there will be more miracles for the treatment of diabetes.
I would like to know what the reservoirs cost. Some people use a lot of insulin a day and if they have to change their reservoirs every 2 or 3 days it can make managing their diabetes much more expensive. With occlusions the reservoirs will probably have to be changed out too. For me this is a bad design. I have the Onetouch ping and can change out the reservoir when I feel like it.
Let’s be realistic. Yes, the t:slim is slick and shiny on the outside. But other than that, it brings nothing new. Where is the closed loop?
Stefan, Please remember also, People are different. As one with one working eye and nearsightedness on it, The T:Slim is a game-changer for me and others like me. The touch screen and lack of having to scroll thru long menu-driven items to simply refill, The T:Slim, when it ‘sleeps’ wakes to where I left off, rather than having to start all over again.
Thank goodness YOU may not need assistive tech, but for ME it sure makes my pumping life easier.
As for the Closed loop, ask our friends at the FDA and those working on it presently.
@Jenny: in the today’s time and age, I expect every mobile device to come with a user-friendly touch screen. Any pump not providing this user experience (yes I’m looking at you Medtronic) is at least 5 years behind. Tandem is on par with today’s technology. Nothing more, nothing less.
Still, if you see well, this can give you definite “Picking rights’. At least T:Slim is ‘on par’ (I LIKE the “Looking at YOU, Medtronic” in your comment…. Agreed!) *I* for one am very happy I switched to the T:Slim. I see good things ahead from them, frankly.
Have a great Holiday
It looks like an interesting pump but the thing I dislike the most is the need to plug it into the wall to recharge. I enjoy backpacking and I don’t want to be worried about my pump running out of juice. I also would hate to worry about a power outage or natural disaster. I don’t want my pump to be like a cell phone when it comes to the battery.
Also IOB should be on the home screen. I look at it constantly.
Mophie and other companies offer rechargeable batteries 1,000-6,000 mAh and carrying one is of no consequence in a backpack. I have one for my iPad/iPhone, but this also works with my T:Slim and Verio_IQ as well as my iBGStar meter.
If you check out that HOME screen, Even without unlocking it, look to the bottom left. Your IOB is there, look to the right a bit & there is the duration too.
Thanks for insight into the design behind the t:slim. The fact that I can set basal rates to start at specific times is great. The same is true to insulin ratios, delayed bolus times, etc. No more 5, 10, or 30 increments, still learning how to best use this.
I look forward to future versions with CGM integration, much LOUDER alarms, a screen that gets brighter in sunlight, and software to download and store settings.
I wish the software had arrived with the pump, hopefully we won’t be waiting much longer for it. And please make it available on Mac also.
@Stefan I first heard about closed loop animal trials way over 10 years ago and have been waiting since. After listening to the FDA presentation at this year’s DiabetesMine Innovation Summit, I think we’ll see diabetes device approvals speed up even more, and hopefully the closed loop won’t be more than 5 years away.
@Bernard: we’ve been hearing about the “no more than 5 years away” promise for too long. The FDA isn’t what is stopping the closed loop from becoming reality. The algorithms simply aren’t there (yet).