scholarly journals A case study in open source innovation: developing the Tidepool Platform for interoperability in type 1 diabetes management

2015 ◽  
Vol 23 (2) ◽  
pp. 324-332 ◽  
Author(s):  
Aaron Neinstein ◽  
Jenise Wong ◽  
Howard Look ◽  
Brandon Arbiter ◽  
Kent Quirk ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Open Source ◽  
Diabetes Management ◽  
Cloud Model ◽  
Clinical Care ◽  
Web Design ◽  
Agile Development ◽  
User Centered Design ◽  
Privacy And Security

Abstract Objective Develop a device-agnostic cloud platform to host diabetes device data and catalyze an ecosystem of software innovation for type 1 diabetes (T1D) management. Materials and Methods An interdisciplinary team decided to establish a nonprofit company, Tidepool, and build open-source software. Results Through a user-centered design process, the authors created a software platform, the Tidepool Platform, to upload and host T1D device data in an integrated, device-agnostic fashion, as well as an application (“app”), Blip, to visualize the data. Tidepool’s software utilizes the principles of modular components, modern web design including REST APIs and JavaScript, cloud computing, agile development methodology, and robust privacy and security. Discussion By consolidating the currently scattered and siloed T1D device data ecosystem into one open platform, Tidepool can improve access to the data and enable new possibilities and efficiencies in T1D clinical care and research. The Tidepool Platform decouples diabetes apps from diabetes devices, allowing software developers to build innovative apps without requiring them to design a unique back-end (e.g., database and security) or unique ways of ingesting device data. It allows people with T1D to choose to use any preferred app regardless of which device(s) they use. Conclusion The authors believe that the Tidepool Platform can solve two current problems in the T1D device landscape: 1) limited access to T1D device data and 2) poor interoperability of data from different devices. If proven effective, Tidepool’s open source, cloud model for health data interoperability is applicable to other healthcare use cases.

scholarly journals A Time-Friendly, Feasible Measure of Nutrition Knowledge in Type 1 Diabetes: The Electronic Nutrition and Carbohydrate Counting Quiz (eNCQ)

2018 ◽  
Vol 13 (1) ◽  
pp. 68-74
Author(s):  
Arwen M. Marker ◽  
Amy E. Noser ◽  
Nicole Knecht ◽  
Mark A. Clements ◽  
Susana R. Patton
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Nutrition Education ◽  
Diabetes Management ◽  
Clinical Care ◽  
Nutrition Knowledge ◽  
Diabetes Diagnosis ◽  
Carbohydrate Counting ◽  
One Year

Background: Greater knowledge about nutrition and carbohydrate counting are associated with improved glycemic control and quality of life in youth with type 1 diabetes (T1D). However, limited assessments of nutrition and carbohydrate knowledge have been developed, and existing measures can be time-consuming, overly broad, or not conducive to routine clinical use. To fill this gap, we developed and examined the feasibility of administering the electronic Nutrition and Carbohydrate Counting Quiz (eNCQ). Method: Ninety-two caregivers and 70 youth with T1D (mean age 12.5 years; mean time since diagnosis 5 years; English speaking) completed the 19-item eNCQ via tablet during a routine clinical visit. Completion time and item completion rates were used to assess feasibility. Relationships between eNCQ scores and patient demographics, diabetes management, and health outcomes were examined. Results: Participants took 10 minutes, on average, to complete the eNCQ. Total and Carbohydrate subscale scores (youth report) were negatively correlated with youth hemoglobin A1c (total r = –.38, carbohydrate r = –.38, Ps < .05), indicating that greater nutrition knowledge related to better glycemic control. Nutrition knowledge scores were generally high, but knowledge was negatively related to time since diabetes diagnosis ( r = –.276, P < .05). Conclusions: Findings support feasibility of the eNCQ to assess nutrition knowledge in routine clinical care. Following additional acceptability and validity testing, the eNCQ may identify families in need of further nutrition education. Nutrition assessment is particularly indicated for youth over one year since T1D diagnosis, as these families displayed lower nutrition knowledge and may need continuing education to maintain diabetes-specific nutrition knowledge over time.

scholarly journals Evolution of Do-It-Yourself Remote Monitoring Technology for Type 1 Diabetes

2020 ◽  
Vol 14 (5) ◽  
pp. 854-859
Author(s):  
Michelle Ng ◽  
Emily Borst ◽  
Ashley Garrity ◽  
Emily Hirschfeld ◽  
Joyce Lee
Keyword(s):  
Type 1 Diabetes ◽  
Open Source ◽  
Remote Monitoring ◽  
Diabetes Management ◽  
Rapid Development ◽  
Artificial Pancreas ◽  
Commercial Space ◽  
Technology Innovations ◽  
Do It Yourself

Background: The Nightscout Project is a leading example of patient-designed, do-it-yourself (DIY), open-source technology innovations to support type 1 diabetes management. We are unaware of studies that have described the evolution of patient-driven innovations from the Nightscout Project to date. Methods: We identified patient-driven, DIY innovations from posts and comments in the “CGM in the Cloud” private Facebook group as well as data from Twitter, GitHub, and the Nightscout website. For each innovation, we described its intent or its unaddressed need as well as the associated features and improvements. We conducted a thematic analysis to identify overarching patterns among the innovations, features, and improvements, and compared the timeline of innovations in the DIY space with the timing of similar innovations in the commercial space. Results: We identified and categorized innovations in Nightscout with the most commonly appearing themes of: visualization improvements, equipment improvements, and user experience improvements. Other emerging themes included: Care Portal support, safety, remote monitoring, decision support, international support, artificial pancreas, pushover notifications, and open-source collaboration. Conclusions: This rapid development of patient-designed DIY innovations driven by unmet needs in the type 1 diabetes community reflects a revolutionary, bottom–up approach to medical innovation. Nightscout users accessed features earlier than if they had waited for commercial products, and they also personalized their tools and devices, empowering them to become the experts of their own care.

scholarly journals Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

2021 ◽  
Author(s):  
Ran Sun ◽  
Imon Banerjee ◽  
Shengtian Sang ◽  
Jennifer Joseph ◽  
Jennifer Schneider ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Language Processing ◽  
Diabetes Management ◽  
Clinical Care ◽  
Glucose Monitoring ◽  
Diabetes Diagnosis ◽  
Cohort Identification ◽  
Patterns Of Utilization ◽  
Device Use

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>

scholarly journals Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

2021 ◽  
Author(s):  
Ran Sun ◽  
Imon Banerjee ◽  
Shengtian Sang ◽  
Jennifer Joseph ◽  
Jennifer Schneider ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Language Processing ◽  
Diabetes Management ◽  
Clinical Care ◽  
Glucose Monitoring ◽  
Diabetes Diagnosis ◽  
Cohort Identification ◽  
Patterns Of Utilization ◽  
Device Use

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>

Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes?

2021 ◽  
pp. 193229682110213
Author(s):  
Stuart Chalew ◽  
Alan M. Delamater ◽  
Sonja Washington ◽  
Jayalakshmi Bhat ◽  
Diane Franz ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Racial Disparity ◽  
Diabetes Management ◽  
New Technology ◽  
African American Youth ◽  
Glucose Monitoring ◽  
Supportive Role

Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.

scholarly journals A global perspective on the issue of access to insulin

Diabetologia ◽  
2021 ◽  
Author(s):  
David Beran ◽  
Maria Lazo-Porras ◽  
Camille M. Mba ◽  
Jean Claude Mbanya
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Multinational Companies ◽  
Global Perspective ◽  
Patient Access ◽  
Middle Income ◽  
Middle Income Countries ◽  
Wide Range ◽  
Pricing And Reimbursement

AbstractThe discovery of insulin in 1921 changed the prognosis for people with type 1 diabetes. A century later, availability and affordability of insulin remain a challenge in many parts of the globe. Using the WHO’s framework on understanding the life cycle of medicines, this review details the global and national challenges that affect patients’ abilities to access and afford insulin. Current research and development in diabetes has seen some innovations, but none of these have truly been game-changing. Currently, three multinational companies control over 95% of global insulin supply. The inclusion of insulin on the WHO’s Prequalification Programme is an opportunity to facilitate entry of new companies into the market. Many governments lack policies on the selection, procurement, supply, pricing and reimbursement of insulin. Moreover, mark-ups in the supply chain also affect the final price to the consumer. Whilst expenses related to diabetes are mostly covered by insurance in high-income countries, many patients from low- and middle-income countries have to pay out of their own pockets. The organisation of diabetes management within the healthcare system also affects patient access to insulin. The challenges affecting access to insulin are complex and require a wide range of solutions. Given that 2021 marks the centenary of the discovery of insulin, there is need for global advocacy to ensure that the benefits of insulin and innovations in diabetes care reach all individuals living with diabetes. Graphical abstract

Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

2022 ◽  
Author(s):  
Yu Kuei Lin ◽  
Caroline Richardson ◽  
Iulia Dobrin ◽  
Rodica Pop-Busui ◽  
Gretchen Piatt ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Interactive Voice Response ◽  
Medical Center ◽  
Academic Medical Center ◽  
Text Messages ◽  
Management Support ◽  
Cross Sectional Survey ◽  
Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

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