This is the 9th in our series of interviews with the 10 advocates chosen as 2015 Patient Voices Winners, who will be joining us for this year's DiabetesMine Innovation Summit at Stanford in a few months.
Today, we're happy to share the story of fellow type 1 Dmitri Katz, who's originally from the California Bay Area but has been living in Germany for more than a decade. Dmitri was diagnosed as a teenager 35 years ago, and of course a lot has changed in diabetes care since then.
He works in diabetes research at Open University, the largest undergrad university based in the UK, studying mobile health technologies for diabetes. So naturally, Dmitri has many insights on the whole mHealth world to share with us here at the 'Mine.
DM) Dmitri, we always like to begin at the beginning, with your your diagnosis story...?
DK) I was diagnosed in 1980 at age 13, and was displaying all the signs. I had lost weight, extreme thirst, going to the bathroom often at night, the usual. My mother was a nurse, and I think she had it pretty well figured out. I was lucky to go to UCSF Medical Center, which was very forward-thinking in diabetes education and self-management.
When I was first diagnosed, took a little walk in the hallway to think about what it meant to me, and decided right there that my life had changed a bit, and that I would just cope with it. That was in the early 80’s, and I had an Ames Dextrometer, which had to be plugged in, and constantly recalibrated.
How did you cope in those early years?
I had always been a bookish kid, small and not very athletic. When I entered high school, I started running cross-country, which sort of became my public identity for the next few years. I was the first person in my family to do an organized sport. I ran a marathon when I was 16, which really proved to myself that diabetes didn’t have to hold me back. I have been active through the years, which I think has helped me stay complication free. I have never felt that diabetes has prevented me from doing anything in life, though it has make me be a bit more risk averse at times, which is probably a good thing.
Where do you live now, and what do you do professionally?
I grew up in San Francisco and moved to Berlin, Germany, in 2002. I still feel like a foreigner, and miss SF at times, but there is much to be said for Berlin. We have a reasonable social system, and a vibrant startup scene. I went to art school, and after graduation starting using graphics programs. I then worked in multimedia, photography, advertising production and at a number of startups.
At a certain point, the lack of deeper meaning was too much, and I started to wonder if I could contribute to diabetes research. That led to my entering the graduate computing department of Open University in the UK. My PhD research focuses on the use of mobile connected technologies to support diabetes self-management, with a strong emphasis on user experience. This is a very exciting time due to the rapid adoption of the smartphone and lowering costs for connected personal devices, such as continuous glucose monitors. I am very hopeful that in the coming years these technologies will support better control and better quality of life, not only for diabetics, but for healthcare in general. I am starting to do some consulting work with a diabetes startup here in Berlin, and have some other diabetes-related projects in I am hoping to get going as well.
You’ve done research specifically on mobile diabetes apps, right? What have you found?
It is no secret that long-term engagement and evidence for significant benefits is a huge challenge for diabetes apps. Most T1 people I have talked to are interested, but have found current products not helpful enough to justify continuous use.
Current products largely depend on the act of entering data to promote engagement, which has some value, but it's something most people don’t want to do. The whole landscape will be shifting quite a bit as automated data entry changes the paradigm.
Are these apps just tech toys then, or do you see real value for disease management?
I am personally extremely optimistic that in time apps can play a major role in helping people with diabetes, but we are still in the beginning stages.
What were the most encouraging advancements in diabetes technology and innovation since your diagnosis?
The first big change was the convenience of small, battery-powered BG meters, which can be seen as a very early ubiquitous computer. In a way we diabetics have led the way in using portable computing in daily life. These devices made a tremendous difference in my life in terms of immediate feedback and flexibility in scheduling. The CGM is clearly the future, and I look forward to the German insurance companies realizing this. The ability to connect all our devices together and have them share data offers enormous potential for decision support and error prevention, and I expect to see more devices adopting these technologies.
What about progress towards an Artificial Pancreas?
I am holding off on my opinion of the closed loop system. It is no doubt a game-changer for many people, but will not necessarily address many of the lifestyle issues, which are crucial for long-term outcomes. My research on why people don't use diabetes apps more often speaks to that.
What else should entrepreneurs be focusing on in terms of diabetes innovation?
All in all, I think this is an incredibly exciting time, and that technology is allowing huge democratization. Almost anyone can now develop an app, and a huge number of people have the skills to at least prototype a new device. We no longer have to wait for the industry to deliver new products. We have the basic tools we need, the insulin and BG meters work. It is in lifestyle management and decision-making that we all need help.
Hopefully more companies will embrace open standards, which will make it easier to move personal data between devices. Our relation to technology is one of the big issues of our time, and diabetes offers us a great opportunity to understand it in a very immediate way. I really hope that we can use this as a chance to support individuals in their personal goals, rather than to control and restrict.
We need big visions and the willingness for investors to back promising diabetes startups, especially in the hardware area. Hardware is difficult, but it seems there is tremendous potential in the personal hardware/software space. And once again, we always need to be carefully considering the social and psychological effects of new technologies in people’s lives.
Tell us a bit more about the life hack (or hacks) you submitted as part of your Patient Voices Contest entry?
I submitted a 2.5-minute video talking about some very practical 'hacks' of mine, like carrying cash in your running shoes for emergencies, using a discarded Coke bottle as an interim sharps container, and always bringing a compact second set of D-supplies when you travel. But the real life hack for me has been taking the initiative to get involved in the diabetes world, in some way beyond just living with this illness.
It all stems back to a bit of a health scare I had a number of years ago, which made me realize that I had to make my diabetes control a bigger part of my life. Contributing to diabetes research has not only greatly enhanced my personal motivation to take better care of myself, but has also allowed me to be in contact with a broader community. Hopefully we will be helping many others as we help ourselves.
Sounds like a whole paradigm change more than a hack there... So that led you to enter our Contest for an opportunity to attend the DiabetesMine Innovation Summit?
Yes, I have been a regular reader of the DiabetesMine ever since I started my research, and I am very excited to have the opportunity to meet the conference attendees. Developing better technologies demands considering the viewpoints of so many stakeholders -- from caregivers, the industry, payers, hardware developers and most importantly the user. This event seemed like an amazing opportunity to be part of this movement.
What are you most looking forward to at the Summit?
Meeting fantastic dedicated people, and hearing more about what they are working on. Of course it would be great if I found some potential collaborators for our academic research and the Berlin-based diabetes startups I am currently involved with.
We look forward to including you, Dmitri, and thank you for your work on improving mobile health for people with diabetes!