August 19, 2007

...and I would like a side order of Holy Grail while I am at it too

One of my quests is for a diabetes management software application that is worth using. I would like the cure and the Holy Grail while I am at it too.


They seem just about as likely.


One look at the marketing materials and you kind of just know it isn’t going to work out. In Of Independence and Angry Mobs I wrote about the doctor centered mentality of diabetes equipment manufacturers. I think that mind set is one of the reasons we can’t find this Grail.

So what would this holy grail of software do?

It would help families adapt to varying diabetes by:
Tracking for reporting all the data users create in their daily diabetes care without creating a lot more sets of family tasks. We have diabetes – that has enough tasks as it is.

All the BG data, including CGM info. All the basal data. All the carbs entered into the pump to calculate all the bolus data. Any user defined flags on those carbs like pizza. User defined variables that could be things like heavy exercise, set pulled off, ketones, freaky weather, stress, menstrual cycle, weekday, weekend and what ever else people dream up. The key here is being user definable.

Then we need reporting ability and the ability to include or exclude data based on those use defined fields. Build reports that average the midnight to 6 am BD data from meters or CGM for nights following a day with hard exercise. There you have info for tailoring basals for a post activity dip in BG.

How about sorting the data for a school girl’s weekdays, excluding days with PE class to build a normal school day profile and one only for PE days?

Maybe we can make some sense out of Pizza.

The key is to get all that data into one application, WITH some user defined life style information, and then slice and dice to provide intelligent reports for decision making. The doctor doesn’t have the time to do it and we won’t either without some decent tools.

The reports need more than breakfast lunch dinner night time periods. I vote for 24 hourly time slots on the log report with numbers and a graph. But hey why not let the users pick what works for them? 4 may work for some folks 12 for other I want 24. It is software; variables are part of the deal.
Reports should be able to show more than one day’s data, show average days in a range or average user defined days. Toss in some standard deviations too.

Those of us who use a bolus calculation in a pump are putting in a ton of information. Things are moving in the direction of saving and using that data but from what I have seen that movement is in baby steps. Compared to the price of a pump memory chips are dirt cheap and small, load them into the pump. Make the pump talk with the CGM and all of it interface with a simple to use but user controllable desktop reporting engine.

If it was real cool it would let you save or track one data set and use it as a benchmark for another set of data to let the user test to see before and after adjustment. Maybe we can have a few ‘Wizards’ to help calculate ISF, I:C and a partridge in a pear tree.



Since we are talking about a a pipe dream here, all of this should be based on industry standard data structures so that patients (and their doctors) can choose any combination of meter, pump that suites individual needs. As opposed hampering patient freedom and health for proprietary gains.

9 comments:

Kevin L. McMahon said...

Is it software or information on a silver platter that you're after?

Bennet said...

Exactly! That what database software should do suck in raw data and munch it into information on silver platter.

nicole said...

WOW! I think you summed up everything I have been trying to force out of our current software. If you find the answer PLEASE let me know. I just don't understand with all of the technology we have (ie computers, ipod, flat screens) why the pump companies aren't trying to use some of this technology. Wouldn't it be cool if they would integrate bluetooth and even maybe ipod :-D One can wish right!

Kevin L. McMahon said...

Your wish list inspired me to clarify what the heck I've been doing with my life since 2001. I hope this post on my blog encourages and inspires everyone to keep on working toward making that Holy Grail a reality.

Bernard said...

Bennet

One of the key parts to this (and the thing I've been preaching about for a while) is a unified data standard for diabetes data. Something that all device makers (pumps, meters, CGMS) follow. That would make it possible to actually take data from several devices and combine it into a single package for graphing and analysis.

I'm still hoping. Though I will admit to not having done much on my diabetes data standard in a while.

Bennet said...

Kevin

I couldn't hit the blog but I have limited access from this PC I'll try tonight. Thnks for the link.

Bernard

I was ranting about a unified data format at FFL. I will have a good look at you links too. I could not agree more. This is the topic of another blog entry I am working on and I'll read your stuff first.

Tim said...

That would be great. I would like to see something that interfaces in a PDA as well. I carry the Calorie King book, all the nutrition sheets for popular restaurants and all our cheat sheets wherever we go. Would be nice to have it on PDA when we're out to log the carbs and BGs all in one.

Kevin L. McMahon said...

As long as we're talking Holy Grail, shouldn't that include not having to lug around a bunch of paper and extra devices? That info should be available to you via your mobile handset and/or your meter/pdm.

Mark said...

Tim, go to calorieking.com to purchase and download to your pda. It has more food items listed than in the book and you can look up darn near any restaurant food item.

At FFL 2006, Dr. Irl Hirsch told us about a program called CliniPro from Numedics that his practice uses. It will read almost every meter and pump on the market. His patients bring in all their meters from home, school, work, etc and it combines all the data into one report. As long as their all synchronized to the same time, he could segregate by time of day with averages, standard deviations, and several other useful bits of information. Why isn't that available for the public?