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Designing Diabetes Gear?
Joe asks: "I'm a grad student studying medical product design. My thesis work is being done on devices used in the monitoring and treatment of Diabetes. I'd like to solicit feedback from the Slashdot community regarding the state of the art in the field. Are you a Type One who loves the OneTouch UltraSmart, or a Type Two that swears by the multi-strip AccuCheck Compact? My goal is to develop products that meet the varied needs of diabetics, in a manner closer to the iPod, rather than the current products which resemble crappy 2-button Tiger electronics videogames. What features in these devices do you like and dislike?"
If you are going for the cool stuff, a reader that store the results, timestamps them and can display graphs of the sugar levels would be a great tool for doctors. You can bring in the unit to the doctor and he/she can get all the information they need. Adding wireless or USB/Firewire connectivity would let the doctor download the data file directly.
Fear Is the Only God
One thing I've noticed is that though I test regularly, I only create overviews of test results every now and then. Those overview are important to gain insight in how well I'm regulated, though, so I should do that more often.
Now the blood-test device has a serial cable link to my computer (linked to windows-only software, unfortunately), so I can load all the past results on my laptop (the only machine in the house that has windows installed), and create a few nice looking graphs.
The D-Tron pump actually has an infra-red port, but for some reason no software has been released to actually make use of that. This is a shame, since my glucose-level graphs would gain a lot from the extra data of my pump's insulin extrusion.
Then there's the additional data that can be very useful when reviewing blood glucose levels, such as 'right after a hypo', or 'ate too much ice-cream', or '1hr prolonged bolus to compensate for pasta', and such. The only way to store that, a the moment, is good old fashioned paper. Which means that I often don't...
So for me a good device would:
Other things that are appreciated are: small size, inclusion of the finger-pricking thingy in the same package, being able to load a set of control-strips, backlight for checking in the dark, NO SOUND option (my wife is sleeping next to me, and I don't want to wake her just because I want to check my blood sugar).
The freestyle also allows one to check from blood on the arm, instead of the finger. This is significantly less painfull, so encourages checking. It also lags a bit; The values from the finger will be more up-to-date than those from the arm, so it's not good for when you feel a hypo coming up. Still, a good feature.
And I suppose since you're interested in doing this to begin with you already know that there are some very big and very predatory players in that market who tolerate competition less than Microsoft and are significantly less friendly. Still it's a great technology to get started with, it's very easy implement and there is a large market.
Fair disclosure: I work for one of those big companies who may either sue you out of existence or buy you so the world can forget about you.
Nothing in the world is more dangerous than sincere ignorance and conscientious stupidity.
The UltraSmart is pretty good. Nice, highly readable. The backlight only comes on when you hold the button, so it saves on battery time. Those are all good things.
Annoyances: Although it remembers the values used for previous days, it doesn't default them. Eg, if I take 2u Humalog and 8u NPH for breakfast on one day, it will use those values as the default for breakfast the next day, but it won't automatically select them; instead, I have to press the insulin button, add NPH, and add Humalog. Since the majority of the time I'm taking the same amount (or minor variation) of insulin each day, this is annoying.
There's a serial cable to download the data, but it's Windows only. The charts and graphs that the app produces are nice, but I'd like the ability to be able to import them into the database of my choice, rather than having to open the Access file it generates. Also, the settings between the UltraSmart and the program are seperate; it doesn't transfer over (even one way) on the serial cable, which means I had to enter my ranges on the UltraSmart, and then again on the app.
No numeric keypad. The Ultrasmart has the capability to record fat, carbohydrates, and protein entries, but it's a real PITA to enter the number "36" when you have to scroll to it (also, no way to enter exactly what it is that you ate, but a keyboard may be way too big). Hence, I don't use this feature at all, which is too bad.
My mother is blind due to diabetes-induced glaucoma. She is stuck using a crappy end-of-life'd One Touch Profile, because all of the new, nifty meters can't be used by blind people (that is, there are no devices to help them guide the blood onto the strip, there are no voice boxes available, etc.). It's a serious issue that most of these companies (One Touch, Accuchek, Freestyle, etc.) never address. How many diabetics are blind, people? A good bunch. Why don't they design monitoring devices for their use too?
Personally, I have a One Touch Ultra Smart, and I love 90% of it. I hate the fact that I can't edit the labels for "Health" and "Exercise" for instance. I love the graphing. I love the capillary-action strips. The 5-second test time is amazingly convenient, as well.
My dad uses an Accuchek of some variety--he swears by it, even though it takes 10x as long for him to get a reading than I do.
I'd love to see something that has a built-in voice box for blind people (seriously, how hard would this be nowadays??). I'd love to see that same model allow them to use the newer capillary-action strips, as well.
Lucky for me I always have Emergency Pants!
I'd agree with the above poster who said Diabetics are mostly pathological liars, we are. Believe it or not, testing your blood sugar SUCKS. It hurts, I don't care if it's your finger or your arm. (By the way, 20 minutes ago isn't good enough for Humalog insulin, so arm testing is risky at best.) If you have a tester with an IR port, there IS software that will read and input the data, but you might need an M.D. to get it. My doctor has some really nice software for the Accu-Check, but as a "user" I'm only able to get a really really dumbed down version of it for 50 bucks from the manufacturer. >:( I don't like implants, which is why I don't pump. But if you can give me a way to test my sugar that doesn't hurt all the friggin' time, I'd use it. I like feeling good as much as the next guy, but being in pain my entire life just isn't worth it, to me. That's what I care about. With the technology and resources available today, there has got to be some way to remove the pain from treating this damn disease. At least until we can convince the Bible belt to allow continued research in stem-cell technology... But I think we'll have to destroy a lot of drug and equipment manufacturer's before that'll ever come about. :(
As an EMT, I'd love to see timestamped results with some sort of authenticity - it's burdensome enough to do all the paperwork, but it's all the more tedious trying to read the number you scrawled on your glove sometime between marking on scene and clear-available in district.
And the form factor is all wrong, too - at least for the portables. The strips are too tiny, the glucometer device itself, too large and too circular. Of the hosts, the AccuCheck is the best, but it's got a lot of room for improvement.
And the device has to be rugged.
And the display backlit with super nova-degrees of intensity and contrast.
And do something about the strips - they yield poor results when it's cold, inflexible to the point of breaking, difficult to remove from sterile packaging without contaiminating and when combined with lancets, present yet another set of tiny sharps to be sat on by firefighters.
And did I mention make it rugged?
What is really hurting the meters IMHO is feature creep. What I'd be interested in is the equivalent of the open-source radio. That is to day: put the mechanics on a pcmcia card, compact CF appliance, or even a modified SDIO card. Then wrap it in a really simple meter that just gives you a one shot readout. All too often, the data goes into a 'proprietary trap-door' in that the patent can get it into the meter (a major accomplishment for many) but the clinic cannot access the data because that can't afford the plethora of cables/cradles/ports and or software products to access the data and do something useful with it. Maybe it's time to have the meters all have a standards compliant infra-red connection based on HL7. Then the devices can be plugged into handhelds, laptops, or even smart phones for the convenience of the patients and still be accessible to the health care providers.
"Can there be a Klein bottle that is an efficient and effective beer pitcher?"
My daughter is five years old and was diagnosed with Type I when she was 15 months old. She was on injected insulin 3-4 times per day until this past October when we got her a Medtronic MiniMed Paradigm 712 insulin pump. Along the way she used the Bayer Glucometer Elite (now Ascensia), the OneTouch Ultra and now the Paradigm Link meter (by B-D) that works with her pump. Her first two meters both had the ability to connect to a Windows-based PC using a proprietary cable to a serial port. I bought both cables, and used them a total of maybe four times. It was cumbersome to get to the serial port on my computer, and the software provided was not good (although the Bayer WinGlucofacts wasn't too bad). Perhaps a USB connection would make more sense.
The things I liked about the meters was their simplicity. I like the fact that all of the graphing and trending requires data upload to a computer. On the meter itself, about all you could do was see a 14- or 30-day average, plus recall (through monotonous pushing of the single multi-function button) the last few hundred readings. We only ever need to check the most recent one anyway, so scrolling through wasn't much of an issue. But the fewer the knobs and switches on the meter itself, the fewer things can go wrong.
I'm neutral on the question of one strip at a time versus the cartridge-loaded multiple strip meters. I can see how that could be handy, but all of her meters have been one at a time and it doesn't really bother me. What is more important in terms of the strips is the smaller the amount of blood they require, the better. It's tough to get a decent amount of blood out of an infant's finger, and even now it's nice that her current meter needs only 0.3 microliters since it allows us to use a lower setting on the lancet device, which reduces the likelihood of calluses.
The one improvement I would make to all of the meters is the addition of a backlight for the primary display, and perhaps an LED light for the "business end" where the strip is. We have to check her blood at 2:00 AM to watch for lows, and turning on the lights in the room sometimes wakes both kids.
I would also echo the suggestion another poster made about getting a meter and performing checks on yourself for a while. It's really the only way you can truly understand.