Earlier this week, I read with interest the guest post from our friend and fellow type 1 John Sjolund about diabetes devices sorely needing simplification, i.e. integration and easy ways to make the data more accessible. His points struck a chord, as these themes have been on my mind a LOT lately:
I want solutions that take away some of the necessary steps, instead of adding to them! Ultimately, I want to have to think less about my diabetes care — not more.
We don't need more data, more cables, more apps, or complicated calculators. We do need to be able to make more sense out of the data we already have!
We conduct our share of product reviews and device trial-runs here at the 'Mine, but we often get behind... wishing we could do more on that front but struggling to keep up because honestly, despite the great stories behind these gadgets and apps, most are plagued by the very problems that John described in his post. They are too much hassle, despite claims to the contrary about how they are supposedly "simplifying" our diabetes lives. Many of us have written at length and advocated loudly about the ridiculous number of connection cables required to "simplify."
Take for example the recent launch of ShugaTrak, another blood sugar tracking app that allows for Bluetooth-enabled connectivity between certain meters and some smartphones so that blood glucose results can be viewed in an app online and sent by text message or email. Without a doubt, ShugaTrak has a tremendous personal D-story behind it. But sadly, in using this device and app briefly, I found it quickly became too much hassle and just wasn't worth it for me.
NEWSFLASH: FDA Clears Dexcom Share Direct
Dexcom gets regulatory approval of its 'on-the-go' mobile apps for CGM data-sharing.
Snail Uses Insulin to Poison Fish
New study shows these slow-moving creatures use toxic form of insulin to capture prey.
A New Square Patch Insulin Pump
TouchéMedical's new Bluetooth-enabled patch pump is supposedly the world's smallest and cheapest.
What Were Your Numbers?
ShugaTrak was created by John Fitzpatrick in Connecticut, after being inspired by his wife Sandra who's been living with type 1 since her adult diagnosis in March 2009. About two years ago in November 2011, when Sandra was pregnant with their first child (their son Ryan is about 2 now), John was wondering how he could utilize his background in biology and neuroscience to create a startup tech business that would "put diabetes data together" -- to help his wife and other people manage their diabetes more easily.
John created ShugaTrak, allowing users to grab the past 25 hours of readings from a meter and send those to a phone using a separate Bluetooth adapter. During Sandra's pregnancy, John says her insulin needs tripled and that added a huge extra burden -- especially once they had a young son and went through a second pregnancy. Sandra would use ShugaTrak to share her blood sugar results with her husband, and before a low blood sugar, she could text him first to let him know that all was OK. She would then re-check 15 minutes later and the result would again be sent. While it never happened, John says that if he saw a low reading and she didn't respond to his texts, he could call or respond accordingly.
Parents who've used ShugaTrak have responded positively, John says, and he's heard from many who say it's even helped eliminate arguments because they don't have to keeping asking kids "What were your numbers?" any longer.
"Texts aren't all that exotic, but diabetes is unrelenting and this is one less thing you have to do yourself," John says. "It's a little peace of mind."
Next up for ShugaTrak is being ported to iPhones, and then connecting to more meters including those that might have USB connections or even Bluetooth capabilities built in.
Too Much Hassle?
For one, the ShugaTrak app uses a Polymap Wireless adapter that hooks into the audio jack of your meter and then wirelessly communicates with your Droid phone. But not just any Droid phone -- only one of the approved versions, which wasn't the one that I carry, so I needed a whole other phone to just trial-test this device. Then there's the fact that it's only compatible with certain meters, including the one that I use, so I had to revert to an old meter and buy an extra set of strips just to use it. So, more and more to carry...
Then there was the whole notion that once everything did connect, it took 30 to 60 seconds or more after the blood sugar result displayed to see that number sent to the ShugaTrak app and then text message. So more time built in to your daily D-tasks... And what do you end up with? A scrolling list of results, that looks nicer on the web-based account you can use for free but doesn't integrate with other software, devices or logging apps. Instead, ShugaTrak is really creating another silo of information that doesn't really go beyond its own walls and create actionable data for PWDs to use.
It's a shame, because I really want to like this app as much as I like the foundation for how it came to be.
After using ShugaTrak briefly, I decided it would be easier to go back to the smartphone I use every day and just take the extra 10 seconds to send my wife a text message showing her my latest blood sugar result. In the end, she had the exact same ability to track my blood sugars and respond, or engage me, and there was less hassle on my end.
I've read similar reactions from others in the community, including D-parents, who simply use straightforward texting to keep in touch with school nurses, administrators, and health care professionals about diabetes management at key times -- without adding another device to carry, plug in, or enter data into.
Please be aware that it's really tough for me to write this. Really! Because I can't speak highly enough of the creativity and innovation in this Diabetes Community, and people like John and Sandra who saw a problem and created a solution to address the issue. For them, it's been great. And there's no doubt that ShugaTrak will do wonders for many people who choose to use it. It's just that I have to be honest about not seeing the benefits at this time with all the extra steps and hurdles it adds to my BG checking process.
This isn't an isolated example, by any means. Lots of other current apps and tools end up adding to our burden instead of relieving it. I wrote about the Glooko and Ditto systems earlier this year, and after trying them out came to the same conclusion: that I just don't want extra cables and devices in my world, on top of all the chargers and cables I'm already forced to live with. Do I appreciate the fact that many of these are USBs and easy to connect? Of course. But that doesn't make it worthwhile to bother with every day, to me.
In a Nutshell
Recently, we were delighted to learn about at least one new app that seems like a realistic way to truly simplify diabetes management! It's called Nutshell, being developed by Tidepool, a non-profit aimed at creating an open source platform for diabetes devices and tech. Tidepool's CEO presented at our DiabetesMine Innovation Summit this year, and Nutshell was showcased at our first-ever DiabetesMine D-Data ExChange event too.
Since I missed those presentations myself, I was excited to talk about Nutshell with Brandon Arbiter, a fellow type 1 diagnosed about two years ago, who recently joined Tidepool as VP of product and business development. Previously, Brandon worked for New York-based online grocer Fresh Direct, described as the "Netflix of grocery stores" and one of the largest online grocers in the world. Running data management for Fresh Direct, Brandon said his life was so full of data and moving it between systems that he eventually started to see potential in an idea revolving around food patterns and how people interact with different categories of food.
He went out to lunch at a Mexican restaurant one day and ordered a burrito, and when it came to the table he asked himself that all-too-familiar question: How much insulin do I need for this? Brandon counted the carbs as best he could the way he was taught, and as he bit into that burrito he realized that he'd had that exact same lunch three weeks earlier. Being active on Foursquare and checking in everywhere he goes, he found the exact time and date he'd last been to that restaurant and went home to look at his pump and glucose meter data for that time period. He discovered that he'd bolused exactly the same amount and, just like last time, his blood sugar had gone above 300 mg/dL. He realized he could learn from past trial-and-error data to "solve" any particular meal.
"I made that same mistake twice. But with the data we've got in all these tools, you don't have to make the same mistake more than once. We can make these data-driven decisions more easily," Brandon says. "Whether it's spaghetti night or Taco Tuesday at home or at the movies, you can pull Nutshell out of your pocket and see what decisions to make -- all the info you need, in a nutshell."
A key to Nutshell is being able to integrate data from other D-devices, and not adding cables or extra steps aside from what you'd normally be doing in your life. Brandon says that in his experience, if people have to manually enter data from other devices or even just plug extra steps into their otherwise "normal" routine, there's a lower chance of long-term use. In the medical world, that might be seen as "a drop in adherence." So Brandon is committed to getting data to move between devices seamlessly.
For now, Nutshell exists in an early prototype form for both iOS and Android platforms (!) that's being tested in New York and California to get feedback on user interface and functionality. But it's not yet ready for general availability, Brandon says, and more functionality should be materializing during the next year.
As we've reported previously, Tidepool's work goes beyond the Nutshell app to creating an open platform across the industry -- to encourage diabetes device makers to help figure this out, and move the ball forward.
They are looking for teachable moments, where they can look at different devices and say "this is what was done wrong and how we can learn from it."
"A lot of this is not rocket science," Brandon says. "The real impediment to all of these apps reaching their potential is not having access to the data. This process becomes very complicated, and we have to un-complicate it."
Totally agreed, Brandon. We're on the exact same page, when it comes to eliminating connection cables or being able to just merge data between devices: the easier the better.
This is where the future's at, and our Patient Survey underscores the need.
Hopefully, we're getting closer to this hassle-free tech every day, and will soon have Standards making it a reality -- rather than yet another diabetic pipedream.