We went ‘back to school’ on November 1-2 for our first-ever DIABETESMINE UNIVERSITY program held at UC San Francisco Mission Bay.

This two-day gathering of diabetes “stakeholders” (patient advocates, Pharma, entrepreneurs, regulatory and clinical experts) consisted of our annual DiabetesMine Innovation Summit, and bi-annual Fall 2018 D-Data ExChange technology forum. Read all about the participants and aim of our Innovation Days here.

Before we dig in with a play-by-play, some links from the event:

* Our DiabetesMine Patient Voices video, embedded in this post

* The event program here

* The event Slidesets on Slideshare (click around to explore)

* The event PHOTO ALBUM on Facebook

* diaTribe’s amazing detailed coverage of the #DData demo lineup

Rachel Kerstetter, a T1D advocate and our very own social media assistant and correspondent here at the ‘Mine, attended the event for the first time, and reports on the experience:

Day 1 kicked off with a welcome address from our own Amy Tenderich. She presented this year’s featured video that explaining the evolution of the DiabetesMine Innovation Project, and presented an award for “perfect attendance” to Ansley Dablo of Diabetes: What to Know, for attending every single #dbminesummit event since its inception in 2011! Amy also introduced the 2018 Patient Voices Winners who were to act as TAs (teaching assistants) for our Day 1 Workshops.

Day 1 (#dbminesummit18) was made up of two general sessions and three awesome workshops with interactive learning experiences for attendees.

The annual Innovation Summit always has a timely theme, and what could be more timely right now than the explosion of Digital Health? As Amy noted, we’re witnessing a burgeoning crossover of the traditional medical establishment with consumer health technology… so the core theme was exploring this new digital, consumer-driven world of D-care.

The ‘Consumerization’ of Diabetes

The first general session of the day kicked off with a keynote from Chris Bergstrom, Digital Health Lead of Boston Consulting Group, exploring the consumerization of diabetes. Chris’ first question to the room was, “Is diabetes management consumer friendly enough?”

The general consensus of the room was no. Chris continued to explain that the mission needs to be to leverage technology and resources to reach everyone with diabetes and improve outcomes. He took a moment to explore diabetes innovation over the years sharing some very telling slides comparing pumps, glucometers and insulin pens from the ‘70s to their counterparts today. Clearly progress has been made in these areas, but when we look at consumer electronics over that past nine years, the contrast is shocking.

Chris pointed to Amy’s Open Letter to Steve Jobs from 2007 as a milestone recognition of an obvious need to the user community that wasn’t obvious to the manufacturing community. Going forward, “digital and delightful” experiences are critical paths to consumerization. He noted that naturally, if we have innovation on the medical device and drug fronts but the payors aren’t on board, it creates friction and slows things down.

Chris then moderated a panel discussion among executives from leading companies in this space: Verily, Onduo, Samsung and Fitbit.

Some of the key takeaways from the panel included:

  • Verily, the healthcare arm of Google Alphabet, has a mission to make the world’s health information useful so that people can enjoy healthier lives
  • Onduo has chosen to start with the consumer experience and provide access to resources
  • 70% of Onduo’s users choose to text with their coaches
  • Samsung Healthcare is working on imaging and biosimilar development
  • Fitbit aims to create an experience that blends all of the data from diabetes and Fitbit devices

But what about costs?

An audience member asked during the Q&A session whether the goal of these new developments is to save people with diabetes money. The cost and coverage of technology were hot conversation topics between sessions and over coffee throughout the event. The panelists did a great job of explaining that the goals include helping people minimize medication need (Fitbit targeting type 2s), lower the burden on patients and improve outcomes (Samsung), and reinvent the structure to offset the “death by 1,000 paper cuts” phenom in healthcare by deploying resources more efficiently (Onduo).

The panelists’ companies are actively trying to collaborate with patient entrepreneurs as well through engaging with developers and open data platforms to promote innovation.

At one point in the discussion, many of us got distracted by the Onduo representative’s comment on whether patients were “sick enough” to need more than primary care, but “not sick enough” to require seeing an endo. This unfortunate phrasing created a gnawing feeling in my own stomach, since many PWDs don’t consider themselves “sick” to begin with – and the fact that this virtual clinic is ranking people on levels of sick rather than on real-world needs for medication and coaching. I was not the only one bothered by this. Although Onduo tweeted an apology and clarification quickly thereafter.

Workshop: Humans, Diabetes Technology & Virtual Reality

Korey Hood of the Stanford Diabetes Research Center and Diana Naranjo of the Lucile Packard Children’s Hospital ran a workshop on how they are using virtual reality to research patients’ readiness and challenges using diabetes technology, moving beyond safety to look into the psychological side. They shared three VR video snippets of patient experiences wearing a closed loop system, including a scenario where the cartoon-like avatar looks into a mirror to see how noticeable the device is and handling an alarm in a social situation.

One aim is to explore how “patient preference” differs from patient-reported outcomes (PROs), the latter being what results after a patient has made the decision to use a device. They also reviewed some highlights from the INSPIRE Study looking at lived experience of closed loop for 294 participants. Learnings were that people tend to talk more about what they don’t want than what they do, and that if something can truly improve a health outcome, users are often willing to deal with the hassles it may bring.

Then in small group settings, we discussed our reactions to VR and its value for engaging patients, caregivers and physicians.

Patient Entrepreneurship and Health Design Hubs

The second general session of the day took a deep dive into patient Innovation and “Health Design Hubs” created specifically for students and designers to work hands-on with patients to discover practical new solutions to real-world needs.

These hubs are popping up at universities all over the country — San Diego, Humboldt State University, University of Minnesota, University of Arizona, Brigham and Women’s in Utah, and Ohio State to name a few. Not to mention a new health design center just established at Yale. Industry groups are also creating these hubs, both independent and big established organizations like Kaiser, which has already won awards for its efforts in this area.

What is the mission and value of these hubs?

Well, according to our friends at healthcare analyst firm Research2Guidance, there are more medtech Accelerators and Incubators than really good ideas for health tools in need of incubating… which is odd, given that healthcare has been called “a fixer upper.” It all comes back to – rather than focusing on engineers who know how to build things – focusing on the real-world needs of patients themselves. That’s what this growing wave of patient-focused health design is all about…

Aaron Sklar, co-founder of Prescribe Design, spoke about design as a team sport and led a panel of innovators that included:

  • Eric Hekler of UCSD Design Lab
  • Jonathan Cluck of JeffInnovation Design Lab
  • Samantha Gottlieb, a National Science Foundation researcher focusing on patient innovation

A few key takeaways from this panel:

  • People ARE empowered to shape the direction of their treatment
  • Patient-led design builds on the lived expertise of people with health conditions, and bring invaluable insights to build better tools
  • Patient-led design and business can coexist
  • The panel participant orgs are exploring the relationship between expertise and power, asking the question: ‘How do we get to the right space where knowledge from clinicians, industry and self-knowledge from patients are equal?’
  • There is a need for fine-tuning and feedback loops that offer checks and balances between patient insights/ideas and formal channels for research and product development

Workshop: Driving Social Media for Health Impact

Clearly, social media has changed the diabetes world, becoming a driver of both advocacy and market influence. (Read our just-published Journal of Diabetes Science & Technology research article on this topic for details.)

So it was exciting to have Thom Scher and Dana Howe of the powerhouse nonprofit Beyond Type 1 run a workshop on how to think about social media in these terms.

They presented a case study on Beyond Type 1’s Instagram strategy and success, and reviewed different tools and approaches that can be used to engage the online patient community and ways to measure and define success.

Then they walked us through creating a campaign for social impact, helping us think through the three-step process of Listen, Create, Iterate.

Workshop: Beyond Product Focus – Designing for the Diabetes Experience

This incredibly interactive workshop was run by Joe Cafazzo of University Health Network in Toronto and software engineer and advocate Thacher Hussain, along with members of Joe’s UHN Healthcare Human Factors team.

The workshop kicked off with a video of people trying to accomplish a goal on each of the primary insulin pumps on the market and it was maddening to watch – so many buttons to push and so much confusion! But they acknowledged that a great deal of progress has been made in improving product design.

Now it is time to turn our attention to designing better service experiences for PWDs, a deeper and more complex challenge than designing products. They explained that good services are: end-to-end, cohesive, coordinated and organized for context.

Each table then selected a scenario of a specific healthcare challenge (from camping with type 1 to appealing a denied health insurance claim) and filled out a “journey map” – a poster-sized template for recording moments of experience and corresponding thoughts.

It’s incredible to explore all of the parts of a seemingly simple experience. My table examined the journey of visiting the endocrinologist. We had to examine the big stages, fill in the detailed steps, capture feelings throughout, identify the high and low points and then generate ideas.

Day 1 ended with closing comments from Amy and a lively Networking Reception featuring an actual marching bandgo DMU!

Day 2 of DMU brought us the 11th DiabetesMine D-Data ExChange, a day of deep diabetes tech-talk.

The FDA mHealth Pre-certification Program: What it Means for Diabetes

Bakul Patel, the FDA’s Associate Director of Digital Health, took the stage to open the day by briefing us on the FDA mHealth Pre-certification Program, how it’s progressed in this first year and what the plans are going forward. The program is building a “feedback loop with regulatory science” that should be introduced in working model (v1.0) form by the end of the year, and will then be tested and refined with pilot participants throughout 2019. A working model (v2.0) should then go live at the end of the year.

Bakul shared the five principles upon which the FDA wants to build the program.

He was then joined by members of the pilot participant orgs Fitbit, Tidepool and Verily for an open dialogue on how the program is going and how other orgs can become involved.

Some key takeaways from the panel included:

  • There is still friction with the old-school regulatory mindset, which holds companies back due to fear of the FDA
  • Tidepool in particular has worked to change this, by “engaging with the FDA early and often”
  • The aim is to embed quality into medical software development from the get-go and shift from focusing on process to focusing on outcomes
  • Managing public expectations has been one of the main challenges of the program
  • The questions raised in a recent Open Letter from Senators Warren, Murray and Smith pressing the FDA on the oversight of digital health devices raised many of the same questions that the current trial phase is aiming to answer

Tidepool + Loop: Building an Interoperable Ecosystem

Howard Look, president, CEO and founder of Tidepool, stayed on stage following the FDA Pre-certification panel to present updates on #WeAreNotWaiting and highlight his organization’s exciting new partnership with Loop. Tidepool will help build this open source, closed loop tool into an established, FDA-approved product.

Howard reminded us how the #WeAreNotWaiting movement began in 2013 at our own D-Data Exchange, and ran through a great quick history of how far we’ve come in just 5 years. Then he shared his excitement about where it’s going, specifically as it relates to Tidepool and Loop: “We should be able to use great, on-the-market, in-warranty pumps” in an ecosystem that allows for true patient choice, he explained.

He was also able to announce the previous day’s big news: Insulet became the first pump company to partner with Tidepool as an official device working with Loop (!)

Blockchain in Healthcare: A Reality Check

Deepak Gopalakrishna, Director at Boston Consulting Group Digital Ventures, presented an informative review of blockchain technology and its potential in healthcare.

He reviewed the eras of technology and how we got to where we are, starting with the Hardware Era of the 50s and 60s, the Software Era of the 70s and 80s followed by the Networks Era of the 90s and 00s bringing us to where we are now: the Blockchain Era. This era is characterized by crypto-networks and open-source data.

What exactly is blockchain?

Blockchain unites the disparate disciplines of the following theories: game, cryptographic, computer networking and data transmission, and economic and monetary. When you boil it all down: Blockchain is about creating trust between two untrusting parties by intermediaries. Blockchain can replace key functions of validating identity and authenticity of transacting parties, verifying authenticity of assets and immutably recording their transfer, incentivizing counterparties to behave in certain ways and enforcing contractual obligations through algorithms.

Blockchain does have the potential to change industries, however Deepak cautions that it is currently has some “terrible” drawbacks that include:

  • Slow
  • Low storage
  • Not private
  • Bad user experience
  • Expensive
  • Lacks governance structure

Despite all that, “We are looking at a shift in where value will be generated,” he said. We are currently at an inflection point and will begin to see these problems solved, along with scaling. Blockchain’s applications in healthcare could aid in anti-counterfeiting in the pharmaceutical industry, telemedicine and more.

An International View of Diabetes Innovation

Dr. Niti Pall, Medical Director of KPMG Global Healthcare, presented on fascinating diabetes and healthcare initiatives around the world involving new players and new business models.

Her examples included:

  • The YMCA’s U.S. community outreach for diabetes prevention as a case study on financing in healthcare based on results
  • Tonic, Bangladesh’s health ecosystem of 5.2 million people, which is a subscription healthcare service that costs just $11 per person / per year
  • ClickMedix, a mobile health service that provides virtual consults to rural and vulnerable patient populations across three countries
  • Pro Mujer, a program in Mexico that offers integrated health and financial services to low-income women, which has been able to offer screenings for diabetes

In many of the countries Niti discussed, spending the money to see a doctor can mean not eating that day for the family. Innovations in access, micro insurance and affordability are crucial for these populations.

She also discussed Diatravellers, an online platform enabling people with diabetes to meet others with the condition across Europe; and Yourah, a youth platform for the International Diabetes Federation in Europe.

Machine Learning 360 Seminar

With Artificial Intelligence and Machine Learning (ML) becoming so widely discussed and employed in the diabetes tech world, the #DData program included a rapid-fire seminar approaching the topic from the three very different viewpoints of:

  • DIY Patient Community
  • Established Industry
  • Market / Regulatory Outlook

DIY Diabetes Takes on Machine Learning

D-Dad Marius Eriksen presented on a system he developed based on ML called TinyAP. He told the story of utilizing machine learning models to provide better living with type 1 diabetes specifically for his young daughter.

TinyAP learns carb and insulin curve parameters and sensitivity based on the time of day, along with many other factors. Marius actually used the list of 42 Factors that Affect BG created by Adam Brown of diaTribe as parameters to train the machine learning in TinyAP.

How Machine Learning Fuels D-Industry Solutions

Lane Desborough of Bigfoot Biomedical presented an enthralling “20 assertions in 20 minutes” on machine learning and data science. Diabetes is truly a data disease, and one of the most powerful slides he shared was a graph of 304 different responses his child’s blood sugar had to a juicebox with 16 grams of carbs.

Bigfoot chose to also share Lane’s presentation on YouTube, and it’s packed full of interesting #Ddata info.

On FDA Regulation & the Promise of Machine Learning

Bill Evans, CEO of Rock Health, approached machine learning from a different angle: investment. Rock Health exists to fund and support entrepreneurs working at the intersection of healthcare and technology. He discussed the reasons to believe that another “AI winter” is not on the horizon due to four machine learning accelerants: better algorithms, more infrastructure, faster processing and more health-related data.

He shared the top value propositions for AI funding which included R&D, population health management, clinical workflows, health benefits administration, diagnosis and monitoring of diseases. However, he put into words what many of us have known for a while: Money isn’t in prevention.

Note that Bill and his team at Rock Health are working directly with FDA to help the agency develop regulatory guidelines for ML tools in healthcare.

Creative Tensions: Discovering Your Stance on Machine Learning

This session led by the world-renowned design firm IDEO was perfectly timed for when we all needed a break from sitting. Everyone was asked to get out of their seats and play a game. IDEO presented questions and one side of the room represented one view, the other wall the opposite view; we were asked to walk to the point between them where our own views fell. The questions sparked an interesting and productive conversation among all of the participants. We tweeted most of the questions as polls using the #ddata18 hashtag.

Questions included:

  • Which do you care more about: Convenience or privacy?
  • Which do you care more about: Accelerating medical advances or protecting data rights?
  • AI (augmented intelligence) is most valuable to help: providers care for patients, or patients care for themselves?
  • AI technology is innocent until proven guilty or guilty until proven innocent?

Thought-provoking stuff!

Hot New #DData Demos

Per tradition, we closed out the D-Data exchange with demos from new companies in the diabetes space including:

  • bgAWARE: a new startup aiming to improve quality of life through sensory augmentation that shifts vital CGM data from audio and visual alarms to tactile input.
  • Dance Biopharm: the next generation of inhalable insulin as a soft mist.Check out our past coverage of them to learn more.
  • DiaBits: an AI-powered monitoring app that boasts 94.9% accuracy on blood glucose predictions based on research using Fitbit and Dexcom data.
  • KLUE: creator of a new system that tracks diabetes eating via hand movement. They’ve also just launched the first bolus reminder app for Apple watches. Learn more in our recent article.
  • Sugarmate: a companion app for CGMs that syncs across all devices with customizable real-time stats and voice-enabled activity feeds for tracking food, insulin, exercise and more.
  • Diabeloop: a patient-led closed-loop system coming out of France that has just been approved for sale in Europe.

Be sure to check out diaTribe’s detailed coverage of the Fall #ddata18 demos here.

Why DiabetesMine Innovation Events Matter

We were privileged to have diabetes podcaster (and 2018 Patient Voices winner) Stacey Simms on hand interviewing attendees for what we were calling “DMU Radio.”

Just a few of the comments included:

“This conference is so important because Amy brings together a really big group of people from industry, and clinicians and patients and just getting that cross-section of everybody who’s here really gives me a great idea of what’s happening in the field so I can bring it back to educators… The Workshops were engaging and fun and really made people think outside the box.”

– Crystal Broj, Head of Technology and Innovation for the American Association of Diabetes Educators (AADE)

“It’s always very inspiring to be here and to listen to what’s currently being discussed… You meet everything from crazy scientists to hackers, entrepreneurs, industry, and the FDA. It’s an amazing mix, (and) the discussions you have with attendees are always mind-opening. We find it the most interesting diabetes conference of the year.”

– Frank Westermann, CEO of MySugr

“Bigfoot is a sponsor of the conference and that is testament to the support we have for the community and the incredible thing Amy has created over the years. I’ve been coming since the very beginning, and these are my people: it’s the resolve, the commitment, the passion – people who get it, at a disease level, what it’s like to live with diabetes. The technology is secondary to that. ”

– Lane Desborough, Co-founder & Chief Engineer of Bigfoot Biomedical

“This is a big focus area for JDRF. It’s absolutely an important event for JDRF to attend, given our long history in supporting innovation, device development, and voice of the patient.”

– Karen Jordan, JDRF International Board Member & President of the Greater Bay Area Chapter

Our next event will be the Summer 2019 D-Data ExChange taking place on June 7 in San Francisco. Please reach out if interested.