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?"

Comments

BIG High Contrast Display Readout - Data Storage

[Unholy_Kingfish]

My father has adult onset and uses the One Touch. His degraded vision was one of the major problems he developed as a result. I know he has trouble seeing the LCD. Another problem is the loading of the tiny strips. I imagine the multi strip would be better for him, but he resists change and having to pay for it.

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.

Implants and tattoos

[cmaxx]

Implants constantly monitoring blood chemical levels and reporting to your PDA would be kinda nice.

A tattoo on your arm that responds chromatically to insulin, sugar, etc. etc. levels in the blood and that could be read by something like a barcode reader would be good. Doesn't even have to be visible to humans, just the machines.

The whole puncturing yourself to get at real actual blood thing is Not Good(tm).

Re:Implants and tattoos

[LWATCDR]

The trick is to test on the sides of your fingers and not the tips. Yes I have to test twice a day.

Insight

[iawia]

I'm a type 1 diabetic, using a disetronic d-tron pump and a disetronic freestyle blood tester.

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:

• Allow me to store either free text, or some pre-defined tag, along with the glucose-level values. (or voice tags?)
• Allow for ease transfer of data to the PC (and preferably not just in a windows-only proprietary interface. I want to be able to load stuff into a spreadsheet and such...)
• Allow me to read my pump data, though that is a software issue, not for the device you'll be working on

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.

Re:Insight

[Andy Dodd]

Type 1 here, no pump.

I've used three meters in my life:

The One Touch II (a classic, and for a long time THE meter used by diabetics.) Big, clunky, single-strip design.

Glucometer Dex (There is a Dex II now, I can't see what the difference is.)

Accu-Check Compact

I would never use the One Touch again - Lifescan still has no cartridge-based meters, and being able to load the meter with multiple strips is REALLY nice.

The Glucometer was a damn nice meter. 10 strips per cartridge (they were the first company to release a cartridge-based meter), you could order the interface cable for free and their software (WinGlucofacts) was pretty nice, and it was free (free as in beer, that is) too.

The Accu-Chek Compact is also really nice.
Pros: IR data transfer
17 strips per cartridge
Formulary with my insurance company. That's $30 per strip refill. (You'll see a common theme that the insurance company dictates what type of insulin/meter you use to some degree. Although I'm using a Novo Nordisk insulin pen with Novo cartridges because there are no pens for Lilly insulins that dispense half-unit increments anymore.)
AA batteries - the button cells in the Dex were annoying.
Form factor and carrying case make it great to put in a jacket pocket for a night out.
Adjustable puncture depth lancet device. (The other meters had this too but you had to change tips to do so.)

Cons:
Battery holder is loose. I often find myself having to push the batteries back in. Meter loses its time frequently because of this and has to reset the drum. The "find next unused drum slot" feature is nice in cases where you accidentally take the batteries out for too long or accidentally hit the cartridge chamber release.
Cartridge chamber is too easy to unlatch, and comes unlatched often just by removing the meter from its case.
No open protocol documentation, software is $30 and may be rigged to only work with their external serial-to-IR adapter instead of a normal serial IRDA port (they do not mention IRDA ports at all, they ALWAYS try to sell their $30 adapter even though I know the meter can speak to a normal IRDA port.) There are protocol dumps linked to from the Zaurus User Group forums, I think the "off-topic" section. I wrote a Perl script from those dumps, it's posted to those forums.
Form factor of the meter/case is good for a night on the town but not as good for extended trips. The Dex case had lots of extra pockets for pen needles, extra lancets, etc. and was very flat. The Compact case has no extra pockets, just an elastic band to hold a spare test strip drum and one to hold the lancet device.
Lancet device is not compatible with half the lancets on the market, including my personal favorite, the B-D Ultra Fine. Most lancet devices have a round holder that can also hold "flat" lancets via a friction fit. The Accu-Chek lancet device can only hold "flat" type lancets, not round ones like the B-Ds.

The Compact also allows "alternative site" testing (i.e. not the finger) but has so many restrictions on when you can do it (see parent posts' mention of lag in the reading) that I never bother.

Don't try to go too fancy. People say they will want it, but so far every attempt at a meter that "does everything" (onboard statistics/data collection) has bombed. Non-invasive testing is a VERY desirable feature, but so far no one has succeeded in making an accurate NI meter that wasn't more trouble than it was worth. (The Glucowatch was expensive, known for causing skin irritation, and not very accurate. Due to the skin irritation, people preferred the occasional pinprick, which with a good lancet and properly adjusted lancet device depth, you barely feel.)

My advice: Try and convince Lilly and Novo Nordisk to bring back their 1.5 mL pen cartridges. Pens for 3 mL carts such as my new NovoPen Junior are fucking huge. :(

Type Two that swears by the multi-strip AccuCheck

[LWATCDR]

This is the one I use. Frankly who cares about style? The main thing is cost. I am lucky and my insurance pays for most of my cost of strips but I know some people that even with insurance have a hard time making ends meet. It needs to be acurite, reliable, and cheap. The cheaper it is the more people can afford to test and the better control they will have over their blood sugar. Reliable means they can use the same meter for a long period of time. I so do not care about what it looks like. A back light on the screen might be nice for those with failing vision. Open specs on the dumping system so open source can make FREE tracking software to help keep the cost down as well.
BTW I would recommend that most slashdoters get there blood sugar checked at least once a year. Some of the risk factors are over weight, are not very active, have a waist size greater then 38", eat crap, and being a member of one of these racial groups , Native American, Hispanic, Asian, or African American.
I was over weight, and Native American and even though I was right at 38" I won the lotto and got it. Another big risk factor is if it runs in your family the problem is that it might run in your family and you might never know it. It is a sneaky thing.

Simple is better

[bhima]

A few years ago I worked on a team that developed a complex blood glucose device, sort of like the one you described yourself interested in developing but the market just wouldn't bear it, so it was canceled. The only thing the market will tolerate is nearly cost free and designed so the criminally stupid can use it. Forget graphs, forget statistics, forget all of it. If you can figure out how to do it without any buttons so much the better, it's a shame we can't eliminate the user entirely. Do keep data storage and data transfer, because if there is a larger group of (walking free) self delusional pathological liars than diabetics, I'm not aware of it. It's not that I hate diabetics I just hate the devil inside them. (If my sister is reading this she knows I am talking about her too!)

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.

My immediate family are all Type II.

[RainbearNJ]

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.

Type I - Use the Accu-Check, when I use it...

[Aboo]

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. :(

Unwrap that rascal!

[stuffduff]

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.

Glucowatch was a bomb

[Andy Dodd]

Not 100% accurate is an understatement - it was apparently severly inaccurate if you were sweating.

It also caused significant skin irritation (People preferred the occasional pinprick) and was insanely expensive. I was looking forward to it greatly but when it was released, the reviews were so horrible I didn't even bother.

I believe the company is out of business now. The company didn't even come close to selling enough units to pay for all the R&D, the watch bombed so badly.