What do diabetes clinical trials and vacation plans have in common? Staying at comfortable Airbnb homes across the country, as it turns out!
The reason may not seem apparent at first, but Airbnb is becoming an important tool helping researchers test new diabetes technology with patients in “real-world settings.”
Taking groups of patients to a vacation rental home where they can cook and eat together, and even participate in activities like bocce ball and swimming while they’re being monitored is a modern spin that’s making these studies more accessible and user-friendly as we wrap up this second decade of the 21st century.
Being in a clinical study has surely never been so much fun! But this approach also helps solve some serious issues in research science.
Traditionally, clinical trials suffer from low participation and many who do enroll often end up dropping out for any number of reasons -- including travel challenges and the inconvenience of staying over in a clinic for research purposes. The Airbnb method has the potential to change that. And it allows a much more holistic view of how blood sugar control systems work for patients in day-to-day settings.
Diabetes closed loop studies at Airbnbs
Diabetes researchers around the country appear to be using this method increasingly often -- from big research centers at Yale and University of North Carolina, to the Barbara Davis Center in Denver and other smaller sites around the country. One of those using Airbnb sites the most is Dr. Bruce Buckingham at Stanford Diabetes Research Center. He's been using Airbnbs on a semi-routine basis going back to roughly 2014, and a clinical trial happening this week marks the 23rd time they've used Airbnb locations for study participants.
The studies focus primarily on new closed loop systems, aka Artificial Pancreas technology, that connects an insulin pump and continuous glucose monitor (CGM) with a smart algorithm to automate insulin delivery. These are nuanced systems requiring oversight both during the daytime and overnight.
The off-site locations provide a great transition between studies in clinical settings, where patients are typically hooked up to hospital-grade equipment, to attempting to follow patients out in their actual homes and workplaces. In an Airbnb, people can move around, watch TV, snack, and socialize much as they would in their normal lives – all while being in close proximity to researchers monitoring how the closed loop technology is reacting to their fluctuating blood glucose levels.
Most commonly, Buckingham says they have 4-5 people participating at a time in one of these Airbnb trial sites so it’s easy to manage. Those who’ve stayed range from young kids to adults in their 70s. They have found some nice four or five-bedroom houses that present good options so the participants can have group interaction, but still have their privacy.
“It allows for a home base to do not only these activities, but for more remote-monitoring at night.” Buckingham said. “It’s closer to a real-life situation where they’d be using this device at home, and it’s certainly cheaper than a hospital, research center or hotel. This is just more friendly, and each one is unique and brings a different attitude to what you might think of in being part of a clinical trial.”
Better than hotels
While they’ve used hotels and even diabetes camps in the past, Airbnb offers less expensive and more convenient location options for the research, Buckingham says.
“The hotels are tough because people are in their rooms behind locked doors. If we’re remote-monitoring someone and we need to check on them in the middle of the night, we’d need to knock on the door. That’s not convenient and wakes other people up. And it wasn’t as much real-life.”
Airbnbs allow people to leave bedroom doors unlocked and easily accessible, while also offering a common room and kitchen where study participants can congregate. Researchers can station themselves in the common area, in close proximity to the individuals they’re monitoring.
It’s also significantly less expensive for the research clinic to pay for compared to a hotel, which in California and especially the Stanford University area of Palo Alto typically start at $250 a night for just a single room.
Trial organizers can simply go online to the Airbnb site, key in specific dates and number of bedrooms plus whatever other parameters might be needed, and they're able to find an array of existing Airbnb homes that would work.
Many of the locations they’ve used are also near parks and other areas for outdoor activities, and include amenities like trampolines and billiards that can become part of the research trial experience. In testing these AP systems and monitoring the participants, groups have played sports like soccer, basketball, or even laser tag. and the participants’ resulting blood glucose data is weaved into the research. Some of the homes have nearby hiking trails, or one home used by Stanford even had a zipline going into the nearby woods.
Besides Airbnb, they’ve also used rented condos in some places like around ski camps, where they’ve done research trials on various devices. It all depends on the needs of each particular study, Buckingham says.
Assuring legal protection
To be clear, this isn't a formal program or even officially endorsed by Airbnb. Researchers have turned to the home rental service on their own.
Of course, it all goes through the proper IRB (Institutional Review Board) protocols, that govern how scientific research studies should be set up ethically and responsibly. So there shouldn’t be any liability concerns using the Airbnb sites.
Buckingham explains: "We always disclose that this is a research study for type 1 diabetes, that we'd have these medical devices used and medical staff on site to monitor. Most (renters) have been willing to have us there, and have welcomed us to come back anytime.”
He says that of the nearly two-dozen Airbnbs Stanford has requested to use as research sites over the years, only one host has declined consent.
Airbnb’s connection to medicine
While this use of homes for on-site patient studies is unique, Airbnb is stepping up to help people with medical challenges via its new Medical Stays Program that offers free or low-cost lodging near hospitals or clinics for people traveling to those locations for treatment. That program launched in March 2019 in New York, with the goal of housing 100,000 people in medical need by 2022.
The Medical Stays program is part of Airbnb’s Open Homes initiative to help find temporary housing for vulnerable communities around the world. According to the company, “the idea for the platform originated after Hurricane Sandy hit New York in 2012, with hosts opening their homes for free to those evacuating from the storm. It expanded in 2017 to help refugees around the world resettle, and last September to critically ill patients and their families traveling for medical treatment or respite.”
The admirable tagline for this program is “share your space for good.”
When it comes to staging type 1 diabetes studies at Airbnb homes, clearly convenience and cost-savings are the biggest benefits. But using these venues also allows more thorough tracking of closed loop systems, meaning better research being accomplished to help people with diabetes.
It’s a great example of "out of the box" thinking in medicine, just the kind of thing that can help real-life data revolutionize clinical trials.