New Trends in Diabetes Technology
What's new and what's on one device user's wish list
I started the year with a black and white insulin pump, continuous glucose monitor, and blood glucose meter. Now I'm wearing and using, in living color, the Tandem T:slim insulin pump, Dexcom G4 Platinum continuous glucose monitor (CGM), and OneTouch VerioIQ meter. All have easy-to-read full-color screens with extra features. They're also rechargeable and use standard USB cables.
Touch Me, Show Me
In the future, color screens will be a primary factor for me when choosing new devices. Standard cables and rechargeability are both close seconds; I won't have to buy any more strange and expensive batteries or a special cable for each device.
Touch-screen mobile devices (think tablets, phones, and music players) are essentially ubiquitous; their rate of adoption shows no sign of a slowdown. Many people are used to always-on, wirelessly connected, easy-to-use devices. As with previous technology, costs are decreasing and capabilities are increasing. The ability to have larger fonts on these devices makes them usable even for those with severe vision problems. And if you have neuropathy, there are inexpensive pens and pen grips that make it possible to use touch-screen devices.
My Tandem T:slim is the first touch-screen insulin pump. It's well designed and small. Tandem has done a great job using human-factors research to create the user interface, and it shows. The home screen displays all the information you need: date, time, insulin "on board," duration of insulin action, battery charge, and amount of insulin in the reservoir.
In 2012, Abbott started selling its InsuLinx blood glucose meter, which has a large touch screen. The results are easy to read, and three lines of history can be displayed at a time. The screen also has room to display warning and error messages that are easy to understand.
The Customer Is Right
The Food and Drug Administration (FDA) tests new devices only for safety and efficacy—determining whether the device delivers an accurate dose or result safely and effectively. I strongly believe that human-factors, or user-experience, research produces technology that is not only safe and efficacious but enjoyable to use. Other research has shown that incorporating fun or enjoyment helps people while they're completing difficult tasks. I hope we see much more of this in the next generation of pumps, meters, and CGMs.
Call Me, Maybe
For some CGMs and an increasing number of pumps (the existing OmniPod and Animas OneTouch Ping and the in-development Solo), a separate remote is currently used to display results and control the action of the device. As most people already carry phones (and meters, etc.), these extra, single-purpose devices are a burden. I believe this may pressure more device makers to consider integration with phones, which should also reduce the hardware cost of the devices.
Many wearable consumer devices wirelessly connect to smartphones and measure heart rate, exercise intensity and duration, blood pressure, and/or weight. The associated software already connects to websites so that information gathered is stored in the "cloud" and can be accessed anywhere, making it easier to share information with others, including health care providers and family.
Besides wearable devices, consumers already use more and more smartphone applications to track exercise, estimate calories/carbs, track blood glucose readings, and monitor heart rate.
What's in Store
I believe these forces will lead to:
Smarter, friendlier devices: Tools that are smarter, easier to use, and much friendlier (more customization and automation so they demand less attention). Examples are the new Dexcom software and VerioIQ meter. Both point out patterns to users that may help them improve their blood glucose control.
Wireless connections: Communication between these devices and management software running on consumer smartphones, probably using Bluetooth connections, as most phones already support this.
Information sharing: Users choosing what information they share with whom. Some of this sharing may include tweeting "good" or "bad" results for celebration or support from friends. If you don't believe this already happens, watch a #diabetes or #bgnow Twitter feed for a while—you'll see CGM readings and pictures of meters with 100 mg/dl on them. It's all very encouraging.
There are several stumbling blocks on the way to continued device improvements.
Common language: There is no common standard for sharing diabetes data (insulin delivery, blood glucose readings, carb intake). Manufacturers or independent standards bodies must cooperate to develop standards. The recent focus on the artificial pancreas (AP) project by JDRF and the FDA may drive development of these standards to allow different combinations of devices for AP systems.
Regulation: The FDA does not currently regulate health-related smartphone software. But recent FDA guidelines will probably change this and temporarily slow U.S. development of this software.
Reimbursement: Health care providers will need to read and respond to the flood of data that will soon be coming from all these devices. If done properly, providers can use the data to recognize patterns and modify treatments to improve glucose control. Until there's research that proves this, however, it's unlikely that insurance companies will reimburse for this extra work.
My Wish List
Here are some of my wishes for the year.
Device makers: Form a consortium and agree on ways to get data out of all our devices. We can't hope to get a clear understanding of our situation without this. A beneficial side effect? We won't need logbooks anymore. Use standard cables, or Bluetooth, and make devices rechargeable. And please make control software work on Macs and PCs or, if on mobile phones, iOS and Android.
Designers: Usability is important—big bright screens so we can see results easily in sunshine and when we're not wearing our reading glasses. Make health devices easy to use, with error messages that don't force us to call technical support.
Users: Give feedback to the makers and designers. Ask them for features you'd like to see in future devices. Tell them that you need easy ways to get and use your data. Ask for software that runs on Macs. And watch out for chances to tell the FDA what you think. We all can benefit from your work.
Bernard Farrell has lived with type 1 since 1972. He works in software development, blogs about diabetes technology at diabetesdaily.com, and was a judge in the 2011 DiabetesMine Design Challenge.