Mobile Health "Significant" for Low Income PWDs

Mobiheathnews has an interesting report on the possible impact of mobile health for lower income PWDs. I was a little confused as to who was going to pay for what. Particularly in an environment where the value of BG testing is questioned and number of strips restricted in to low income patients.

http://mobihealthnews.com/18518/report-mobile-significant-development-for-low-income-diabetics/

For me the real issues with diabetes care, for any economic group, are; will there be good education and support for the changes that education promotes. Mobile gizmos are cool but better health will come from teaching people how to take care of themselves and supporting them in making those changes.

For the T2D community that may well mean better access to health foods and safe walkable environments that promote more active living. An anonymous 'mobile health' text message to walk is not going to be anywhere near as effective as a group at church or on the block that is mutually supportive of getting together to walk and eat a more healthy diet. Admittedly that isn't as sexy but

Glooko, the Grail and Audrey Hepburn

Glooko was kind enough to give me a cable to review, no string attached as it were. I’lI get to that review in the upcoming weeks because this is more an editorial Grail Quest than review.

I have been been on this search for the diabetes management version of the Holy Grail for a while.  Back in 2007 I wrote “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.”

The thing about Grails is that your definition of it tends to grow while you are looking for it. Data standards became part of my Grail Quest because I want all the data, that comes from different machines, to play nice together in the diabetes sandbox. I wrote about this back a then too but what I have forgotten in my quest is that a UN translator is almost as good as data standards. If you don’t think a UN translator can be sexy, go watch Audrey Hepburn in Charade. (I am sure it will be more interesting than the rest of this post.) 

Glooko may be such a UN translator, if not as classically lovely as Ms. Hepbrun. It looks like a step in the direction from a different nations of the diabetes globe talking together perspective 

It is also a shift in the center of the diabetes data management universe. Glooko is a cable that connects a meter to an iPhone. I think data in your smart phone instead of your computer is a move closer to where folks with diabetes live their lives. 

You maybe thinking, where have I seen this before? Probably the presentation of introducing the iPhone 3 back in 2009.  Apple had J&J dummy up an cable and and app for the big unveiling. It never saw the light of day - well maybe until now.

Glooko is a cable that can connect meters, from a variety of manufacturers, to an iPhone, iPod, or iPad. The application does the translation of the data from Bayer, Abbott or OneTouch’s data format and fill in the log book. That mix of brands is part of the path to the grail. To me it is significant that Glooko plays the roll of Audrey Hepburn and translates data from different meters into one log. You can email that log right out of the device. 

That is not the only step towards the chalice. I see shifting from computer based applications to a mobile device as moving data collection, and hopefully use, closer to people with diabetes' lives. A more mobile logbook and translations of data are steps towards the grail even if they are not the goblet itself. 

Back in my UN inspired post I suggested that the makers of meters would come out ahead if they joined in a common app and data development effort. I wrote, some what flippantly, “Just think, all the manufacturers could all reduce the cost of R&D spent on the machine that listens to the Machine that goes PING if they didn’t each have to invent a new language in the process. Hey guys in expensive suits! Lower expenses means more profits and bigger bonuses for the guys in expensive suits or they could then invest that saved R&D money into better design, clearer user interfaces and compete on usability! Yeah I think it would go to bonuses too.”

The logbook is Glooko first step. They say they want to make better tools for diabetes management. Time will tell what that means. More meters and more mobile devices showing up at the UN, probably. More functionality than a basic log book, maybe - but that is an FDA regulation issue and why we all should care about mobile apps. I would love to see devices other than meters talk to the app, not that I am directly lobbying Glooko or anything. OK maybe I am. 

I still define the grail like I did back in 2007 as software that 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?

To that I would add that grail should ultimately connect to devices wirelessly and store information in a cloud accessible with any modern browser. Which is fairly sophisticated and outside the mindset of the FDA. -  All of which is what makes it a Grail. 

Dear FDA It is Me Again, Again.

If you scroll down a few post you will see my two bits on FDA regulation of mobile apps. Here is another form letter you can feel free to edit and use to comment. It runs a bit over the 2000 character limit on the FDA site so edit away.   

Thank you for the opportunity to comment on Mobile Medical Applications. I live with type 1 diabetes (or "my child lives with type 1 diabetes"). I try to live a useful life not limited by diabetes. To that extent, mobile medical applications can be a great help. Through guidance, the FDA can help improve our lives by facilitating a robust mobile device ecosystem.   

I and others like me use many portable medical devices to manage type 1 diabetes; insulin pumps, glucose meters and continuous glucose sensors. Each as its own software. None of those systems are capable of sharing the diabetes information with systems made by others. 

Diabetes care is all about balancing blood glucose with insulin, food and activity.  The Diabetes Control and Complications Trial (DCCT) showed that tighter control leads to healthier lives. Applications can combine data from multiple devices to help give insight into the whole of diabetes care. Mobile apps offer the promise of accurately combining the information from different diabetes management tools, the correct formulas and analysis from the care textbooks into wizards that can help manage diabetes to the standards of DCCT.  

Recent articles in the New England Journal of Medicine call for “Balancing Regulation and Innovation” (Curfman and Redberg, 9/15/2011) and the need for “Creating a New Regulatory Framework for Moderate-Risk Devices” (Challoner and Vodra 9/15/2011) As a patient whose life depends on devices I am frustrated to learn that innovative US designed and manufactured products are available overseas but not here.  "A Comprehensive Analysis of the FDA 510(k) Process: Industry Practice and Implications for Reform" shows that three quarters of the firms bringing innovation to heath devices do so out outside the US first. (Linehan, Ph.D. Northwestern). As the FDA considers guidance for mobile applications I encourage the adoption of regulatory models used in the EU that balance regulation with improving heath care.   

Thank you for taking into consideration this comment. They are made with the hope to improve the lives of people with diabetes.