Pontificating about Downloading, Oh Yeah and t:connect

At the Diabetes Mine Summit last November Dr. Sidhu of U.C. Berkeley estimated that only one in ten diabetes patients download "stuff". By stuff I mean meters, pumps, cgms, etc. So 90% can't be bothered. 

My feelings about why not are fairly simple. Downloading typically hasn’t worth the extra effort. Some may exclaim ‘but it is your kids’ health!’ Exactly. Diabetes already takes a lot of effort. So extra effort on top of that better come with some serious marginal utility.

Remember marginal utility? They talked about it and widgets way back in economics 101. For the record widgets in economic 101 had no marginal utility for me. Get it? Ha ha ha! I made an economics joke. - Holy crap, am I a nerd or what?

My download experiences with the kids' stuff is it was a PITA to connect it all and that was made worse by the requirements to use a PC not my Mac. (I am not enough of a nerd to think that running a Windows partition on my Mac is Mac compatible.) Some devices needed to be disconnected bla bla bla. In return the data from the pump, meter and CGM all went into different programs and making connections between events was less than easy. 

I wrote this in 2007:

Type 1 isn’t all about the numbers. It is about kids living their lives. That said there are one hell of a lot of numbers. We gotta deal with the numbers, so we can love the kids as kids. Nobody need love the numbers. 

There are a ton of little electronic machines that produce billions and billions of numbers (and about as many strips on the floor.) At times it seems we are floundering in a sea of data points (and strips on the floor.) Unfortunately each machine speaks its own language. What we need is the UN. United Numbers.

We still need United Numbers.

Our friends at Tandem have entered the market with their take on data download. It is called t:connect and is said to available as of yesterday. They were nice enough to let me sit in on web thing about it Monday,  particularly given we don’t use Tandem’s t:slim (I expect the kids will look at it when the next pump renewal comes around.)  My experience with t:slim and t:connect it is limited. Still they seem to have a few things right. 

Their program can connect to PCs and Macs. he t:slim pump is rechargeable and that can happen via the USB cable connected to a computer. While the pump is charging it can sync data. I would love to see it be wireless connectivity but while your are charging is at least a step towards less extra effort. Some meters can also be downloaded by t:connect with the afore mentioned extra effort of finding the meter and cableand hooking them up.  On the plus side the pump remembers the BG numbers you gave it when doing a bolus calculation so some meter data is gonna get there even if you, like me, can’t be bothered to bring the meter to meet the computer. All the information floats off your computer and up into the cloud. You can see it on web enabled devices including mobile. Your device may vary. (See how I did that - YDMV)

Yay team, that seems a little less extra effort. 

The other side of the coin is, does it provide useful data? I poked around a little with a friends account. (Thanks that was very generous. Now change the password so I can't get in anymore, it is your data.)

I liked the reports and when and if t:slim and Dexcom get together there is a lot more potential. I specifically like the combination of the IOB (and it even showed stacked IOB), BG and basals. That seems like a tool that could be useful to help manage a kid tough the ongoing basal rate changes of adolescence. (Consult your physician, I am not suggesting any off label use, YDMV, etc.) So some marginal utility with lower user effort. That is the right direction. Here is a peak at a t:connect report, (this if from a t:connect demo not my friend's data.) 

t:connect looks like real if incremental improvement. That is how diabetes care works right? I look forward to seeing Tandem users' blog posts with more detail. In fact Wil has a piece on Diabetes Mine so have a look, 

The shaded IOB running off reminds me of this: 

Seems like today was talking about technology day over at SixUntilMe too, Kerri wrote Don’t be an Apphole. Brilliant bit that also manages to talk about diabetes management programs without using economics 101 geek speak. 

For more information on t:connect:
http://www.tandemdiabetes.com/products/t-connect/

Will on t:connect at Diabetes Mine: 
http://www.diabetesmine.com/2013/03/tandem-tslim-pumpers-now-connected.html

My prior musings on downloading, parenting, devices and more are here:
http://www.ydmv.net/search?q=download

Do You Do It?

Download?

I have been to a few diabetes events where a point was made that few folks download there stuff* (* a word that hear means; meter, pumps, CMG, food log, workout schedule and a partridge in a pear tree.) Why is that?

Now that may come as surprise to folks who have read my bits on diabetes technology, DEWY and the data frontier that while I value data, we don't download. So forgive a little Sheldonesque nerdieness and let me suggest that there are reasons we don’t boldly go where no one has gone before.

In our case it is too much of a PITA - pain in the Apple. We use Macs. A program is not Mac compatible if it requires me to run windows on my Mac or even an old version of Mac OS. For that matter a program isn’t PC compatible if it can’t run on the current version of Windows either. All of which is totally irrelevant because the stuff may not be best downloaded into a Mac or Windows computer anyway. Possibly the target device device should be more, dare I say it, in touch with our lives - portable across all the devices we use. It should probably be in the cloud and accessible with any computer or phone with current browser.

I realize that may give a lot of cardiac physicians patients at FDA a heart attack. But the reality is dirt simple: people choose to carry mobile devices. These could be a great conduit to move information relevant to diabetes management into a data cloud. To boldly go where the PWD already are.

Syncing data is a manual process. Why is that? Why do we need to drag out a cable connect it to some legacy port on a computer and jump through hoops to move the data? At one point our the meters and pumps all used cables connecting to the serial port but the Windows XP box I had at the time only had one such port. Naturally the cables were different so to down load the meters and pumps meant swapping cables. Care to guess how often that seemed like a good idea?

Why do we need to manually sync at all? Why not just introduce the stuff* to our cell phone. Like paring a head set and then let the devices do all the work. Isn’t that what the devices are meant to do. Diabetes care is extra work. Why in the name of all things holy do we have to do extra processes to sync the stuff that is already extra work.

I think the prime directive for device manufacturers needs to be to not inter fear with the  lives that they touch. Look we all know Kirk broke the prime directive every other episode but at least there was some token angst before heading off into a romance with some alien babe.  Strive for no extra work.

The data we downloaded was less than complete. Why doesn’t the information a PWD enter into the bolus wizard come out with the download? Also the limited data downloaded it ends up in different programs. Wouldn’t it be great if the meter, cgm, pump info and maybe user information like ran three miles all showed up on the same report?

What the heck why isn’t that report smart? The rules of diabetes are not that complex. Can’t the devices apply some algorithms and point out trends.  Like, "Dude you are always high at 4:30, seriously look at these numbers." Or how about, "Listen man I love ya but I haven’t seen at lunch time blood check in ages how do you feel about a little reminder?"

Why don’t we download?

• Not compatible with our computers or devices.
• Our diabetes varies and at times we vary the meters we use.
• It is a different manual process for each device and all are pain in the ass.
• The data ends up in different reports
• It hard to pull together to figure out how it impacts life.
• Diabetes is already an intrusion and this is an intrusion we can choose to skip.

That maybe more than enough from me. What about your views on downloading, do you do it? Why or why not and how can it be mage better?

Previous data rants at YDMV:

http://www.ydmv.net/2011/04/diabetes-data-standards.htmlhttp://www.ydmv.net/2007/08/and-i-would-like-side-order-of-holy.html

Dexcom Acquires Sweet Spot. Is Dewy on the way?

Dexcom released their earnings call online today. (Listen here for your self to see how off I am in my reporting.)


These calls are like a crystal ball. Fun but future looking. I looked for a picture of a Dexcom and a crystal ball ad found Kerri's Dexcom isn a glass with a super cute cutest Birdie picture. Close enough.

Right off the bat I found it interesting. Terry Gregg announced the acquisition of SweetSpot http://www.sweetspotdiabetes.com/.

Even the most casual reader of YDMV knows I have a particular interest in diabetes data. SweetSpot was identified on the call as adding sophisticated diabetes data management to the Dexcom portfolio. Terry Gregg identified two shortcoming in the Dexcom offerings; CGM pump integration and universal data integration. Ultimately they hope to see seamless data flow from the CGM to a mobile device and into the cloud.

Dexcom also mentioned the recent Tandem and Roche agreements. Interestingly the used the term “open architecture” repeatedly on the call in the CGM pump context.

Generation 4 sensors were said to be expected to be submitted to the the FDA end of Q1 early Q2 2012 and it sounds like CGM/Pump about a quarter days after Gen 4. YDMV.

Gen 5 was briefly mentioned and in the context of connecting out to open architecture devices including mobile and the cloud. Also accuracy was said to be at therapeutic levels.

The business model for sweet spot was covered in a question. At times it sounded a little big brother like with the VA, clinics and possibly insurers being customers of the data service. Naturally I would love to hear more about patients and later in the call they noted that the current product is approved for clinics.  Patients can see see what the clinic sees gets, so i guess (key word guess) patients aren't approved recipients of SweetSpot. A desire for a more patient centric data model was shared by one of the Dexcom C suite dudes. Anything is ways off in the future. There was also mention of criticism from the physician community of Dexcom for not having a means of connecting Dexcom information to the clinic. The future is digital and the acquisition of SweetSpot look like good positioning of the future.

At about 36 minutes into the call there was an interesting exchange on the Gen 5 product and the FDA. Specifically comments about the FDA concern that the health data being primary in on the mobile device. There were some interesting real world comments about os upgrades and aps running on devices. It was brief but good to know someone is having the conversations with the FDA and helping move the ball forward. I am sure the conversations are happening elsewhere but still it comforting to hear about the exchanges. Also interesting comments at about 56 min about their relationship with FDA. I'm "happy" with the FDA, industry has to make an effort.

On a personal note my kids don’t like carrying another thing so getting the CGM into the pump and ultimately the cloud is a step that may help them choose to wear sensor more.

Full disclosure, I own Dexcom shares.

http://www.ydmv.net/2012/01/of-fantasy-diabetes-devices-sheldon.html

YDMV Interviewed as an e-Patient

I was happy to participate in a Medsider.com conversation about e-Patients. I am still not sure what an e-Patient is but I jumped in with Scott Nelson moderating e-Patient DavdeBronkart and Hugo Campos none the less.

I think that we in the Diabetes Online Community share issues with other online patient communities. In this case the issue we talked about was access to our individual medical data.

I think it is everyone mutual benefit if we take the time to learn about the issues others face and honor their struggles without offering trite solutions. Finding areas where we share concerns present opportunities to share insights on how to work to common goals.

I hope I did the DOC proud. The full round table conversation is on Medsider.com  

New Study - Context Matters.

Who Would Have Guessed It?

Roche offered an opportunity to hear the results of a new research study on T2 and self monitoring. Dr. Andreas Stuhr was going to be presenting and being a fan of Andreas, I joining the conference call this afternoon.

This was a study of type 2 diabetics who do not use insulin. There were two groups studied. Both groups had similar access to testing equipment, doctors and heath care visits. The difference was one group used a paper based tool to put the data from blood test into context. Both groups lowered their A1C. So being in a study and having access to a meter and doctors lowers A1C. The group with a structure tool to collect data and talk about it with their health care team had a more significant drop in A1c than the control.

The tool is simply a paper form. It is available free here.  You don’t need a Roche meter to use it but you need a meter. The tool itself is not the conversations with a health care provider.  It may be a place to start.

So while it sounds a lot like "we hold there truths to be self evident" putting context around the data you collect can provide better results.

Context Matters.

/begin disclosureI have been to Roche’s diabetes social media summits. They pay my way. I speak my mind. I suspect there are still photos of my sign from last summer's conference floating around with circles and arrows and a paragraph on the back to be used as evidence against me. (Feel free to link the photo in a comment if you have it, or Alice's Restaurant for the circles and arrows.  As a hint the sign was two words and the words had the same first letters as Blood Sugar.)  Roche invited me back - go figure. They doesn’t push product info at us. So much so that as a group we expressed and interest in hearing news from them. This call to the social media summit group was part of the sharing we asked for. 
/end disclosure