December 3, 2010

Zen and the Connected Type 1 Diabetes Devices Don’t Exist

I wish they did. I have a radically different view of the technological future of diabetes care. It isn’t as much a Artificial Pancreas as it is a peace treaty between armies of robotic healthcare devices fighting over our data for their proprietary sales gain.

This treaty would make diabetes data available to, and this is the really radical part here, patients. The data will be presented in ways that would facilitate using all the information to help individuals understand how each little bit represents one of the variables that makes any type of diabetes vary.

The treaty would also facilitate patients picking the equipment and using the every day devices they already use to manage their diabetes. Now that may not sound radical but it is the opposite of what happens now. Our every day devices don’t help manage the whole of life with diabetes as our tools don’t share the little bit of information on our lives that they know. In fact they tend to guard our data as a hostage to the continued use of a given device.

I should talk about what prompted this version of my ongoing diabetes information rant. I have a RSS feed for Continua Health. Continua is, in theory, a means of connecting medical devices. Diabetes has been part of the Continua marketing line from its earliest days. Big diabetes firms are part of the Continua Alliance. Diabetes care keeps popping up in the press stories about Continua. Recently Med Gadget had a post about about a health data router for home heath care devices that said “One can imagine this device as being a central control unit for continuous glucose monitors.”

Not if one has ever used a CGM they can’t. Getting past the hurdle that no CGM is bluetooth enabled or Continua certified why would a CGM user want device with less functionality than the CGM’s own receiver? By less I mean less ability to interact like calibrating the CGM. Why would they want to carry Yet Another Device Already. (YADA)

Insulin users carry something to deliver insulin, a pump YADA, a pen YADA , a syringe YADA. They carry a meter YADA. Increasingly folks wear a CGMs YADA. Being normal every day folks they probably carry a cell phone YADA. It sound like a Seinfeld bit - Yada Yada Yada.

In case anyone is wondering those things for the most part don’t talk to each other very well. The solution isn’t Yet Another Device Already. Sadly the trend is to make for more devices and or less choice. Some may say, ‘Our pump displays meter and even CGM readings.” OK but only if we use the proprietary combination of strip meter, CGM and pump. Notice that the marginally usable food database left the pump and went into the meter with one pump so if you want the food data you gotta now carry YADA. Oh and for fun, to get the data out of any device requires proprietary software, running though a special cable, to a desk top PC, running a old operation system you probably don't use anymore.

The solution is that all the devices need to talk a common language. Continua is right about that part. Then the data can be combined to make something that resembles sense. Meter data by itself only has value in as point in time. CGMs are good at stringing those points in time together and making trends. Knowing the amounts of insulin taken would help make sense of those trends as would what was eaten (and a lot of folks enter that into a bolus wizard on their pump.) The data exist it just needs to play nice. Set the information free! Common language is the start of a treaty.

In a glorious world somehow activity, stress, hormone cycles and a partridge in a pear tree. Oh and a button to just reject freak events would be handy too.

The Continua model is data is collected sent to an electronic health record and via some mysterious process (using YADA above) doctors will have the time and be compensated for looking it over and making recommendations. If that happens, and that is one big ass if, I am sure the doctor will be using some kind of data collection device with logic tools that sift out relevant data and trends.

Why not keep that local? People living with diabetes are there own primary diabetes care giver. Cut the loop short. Get the logic into the users' smart phones. The phone they choose to use not some goofy medial phone.

Artificial pancreas fans are saying OK - why not just make the whole thing automatic? Make it all just work without any patient input. My answer is that there is value in knowing. There is value in being cognizant of the implications of what specific choice and events do to the individual. As in, wow that really work well maybe I should try to do that more often or opps that wasn’t so great how can I avoid doing the same thing again or wholly crap six hours after a really physical work out I crash and burn like the Hindenburg.

More awareness of how one live life is better than less. I think that is true on the purely physiological level and that the physical has a big impaction the emotional and spiritual levels too.


  1. It really is a major PITA how nothing talks to anything else.

    It seems that nobody is really working on making all of this data easier to make sense of.

    Thanks for talking about this Bennet. More of us should.

  2. Forgot about this post Bennet, I need to study what Continua is doing.