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Thursday, December 20, 2018

Constructive Disruption in Diabetes

In its inaugural event, the Disrupt Diabetes Design Challenge brought together new perspectives to tackle persistent challenges diabetes with a human-first, design-centric approach.

A mechanical engineer is sitting in a conference room at Stanford University. At the table, he is joined by an emergency medicine clinical pharmacist and healthcare designer. Across from them sit two medical students – one interested in psychology and the other in surgery. Their group is one of 12 teams spread throughout the room.
What kind of meeting is this? It is the inaugural Disrupt Diabetes event, a 10-week design challenge brought to life by two undergraduates from Stanford University – Urvi Gupta and Divya Gopisetty. The program was shepherded with mentorship from Stanford Diabetes Research Center, Stanford’s Medicine X program, the diaTribe Foundation, and IDEO.
The organizers brought together 12 teams to tackle unmet needs of patients with diabetes in a human-first, design-centric approach. Each team included a Patient Powerhouse, Designer, and Student Lead that identified a real-life challenge for people with diabetes and laid the groundwork for possible solutions. In the last leg of their journey, teams developed their concept in a day-long design sprint that ends with a group pitch to a panel of judges.

“Disruptive, Unpredictable, and Frustrating”

But before we jump to the winner’s circle, perhaps we should ask “was this diabetes disruption needed?” In recent years, we’ve seen major advances in diabetes therapies and a booming field of diabetes technology that includes insulin pumps, continuous glucose monitors (CGMs), and apps that act as platforms for coaching, decision-making, and data integration. Why disrupt an already advancing field?
Although the medical community is steadily improving recognition of the emotional burden of diabetes, it is still a wearisome challenge that makes management more difficult.
While these advances have led to powerful tools to treat and manage diabetes, many people continue to struggle. This is not because patients and providers are aware or uncaring. Diabetes is a challenging mess. Management isn’t as simple as flipping a switch on new treatments and waiting for better glucose control. It is a complex disease that creeps into every aspect of life. On a daily basis, diabetes can be disruptive, unpredictable, and frustrating. As one participant put it, “being diagnosed with diabetes feels like someone is taking away your agency; it takes away your sense of normalcy.” Although the medical community is steadily improving recognition of the emotional burden of diabetes, it is still a wearisome challenge that makes management more difficult.
Something else that is often forgotten is that much of diabetes management happens between office visits when patients are alone, and a provider isn’t there to guide decisions. Yet, the information continues to pour in as day-to-day decisions become overwhelming. We must also recognize that access to newer therapies and technologies is a luxury that many cannot afford.
The Disrupt Diabetes Design Challenge was an interesting approach to deal with these persistent challenges. It brought perspectives you don’t normally see in diabetes conferences and encouraged fresh ideas. In a single room, designers, developers, engineers, architects, researchers, nurses, and students discussed diabetes together. Many of them were living with diabetes themselves. Disrupt Diabetes gave the patient a voice like never before. Teams were solving real-life problems that were sitting right there in front of them and asking questions in real-time.
It was also the only diabetes-related conference with a “Hypo Table” replete with glucose tablets and juice boxes.

Disrupting the Status Quo

The day of the design sprint began with a reminder of the most pressing challenges and unmet needs in diabetes by Daniel DeSalvo, MD, a pediatric endocrinologist at Baylor College of Medicine. DeSalvo also happens to live with type 1 diabetes and spoke from firsthand experience of the diverse patients he cares for and the difficulties he faces. Larry Chu, MD, MS, anesthesiologist and executive director of Stanford’s Medicine X program, followed with a powerful message on the value of empathy, perspective, and inclusion in our design process.
The group was then treated to presentations by innovators that shared personal stories of how they disrupted the status quo in diabetes healthcare. The breadth of innovations was impressive – from provider education (Project ECHO), patient coaching (Lark), decision-making (Sugar.IQ), and caring for underserved populations (NICH).
Primed with inspiration and direction, the design sprint began. Dennis Boyle, partner at the international design company, IDEO, led the groups through a process of brainstorming and prototyping in an intense afternoon of workshopping. At the end, each team gave a creative pitch for its concept. They used video, skits, or presentations to deliver their design solution in a five-minute window.
Individuals with diabetes are more than a collection of symptoms and targets. Individuals with diabetes are people first and each has a unique perspective and set of life challenges. It is a reminder that individuals with diabetes are at the center of their care and should be at the center of solutions.
Notably, each group seemed to leverage digital platforms in a “behind the scenes” approach to minimize the burden of inputting and interpreting data. The concepts also sought to empower patients, to give them a sense of control in chaotic or unpredictable moments such as when they are eating outside their home, exercising, or experiencing hypoglycemia. The solutions also aimed to restore a sense of normalcy to an otherwise chaotic condition.
Concepts included tools that:
  • Reduce the stress of new diagnosis
  • Connect peer communities
  • Make CGM alerts/alarms discrete and sharable
  • Lower barriers to finding healthy food alternatives
  • Integrate cultural sensitivities into coaching platforms
  • Track and anticipate the impact of exercise
  • Aggregate and simplify data across devices
  • Leverage crowdsourced information on restaurant choices
After deliberation, the judges selected a combination of two teams as the winner. Each of the teams had presented concepts that build off existing CGM systems to give patients more control, support, and discretion while also building a sense of community and alerting others in emergency situations. The combined group received a monetary award and continued mentorship to further develop their concepts.
At the end of the design challenge, the teams were exhausted and delighted. As Bruce Buckingham, MD, pediatric endocrinologist at Stanford University and Disrupt Diabetes judge said, “The journey and process will be transformative to the way you work and treat others.”

“A Hectic, Unpredictable Life”

As technology and healthcare continue to blend, this transformation will likely be more powerful and lasting than the design challenge itself. Diabetes technology is reshaping how care is delivered and is putting more information and control in patients’ hands for day-to-day treatment decisions. Designing solutions for patients – rather than providers – is an increasing demand in a world of self-care diabetes technology. However, the patient’s voice is often absent when designing solutions despite more information and treatment decisions resting in their hands. Disrupt Diabetes is taking on the changing landscape with a new approach to solving problems that puts the patient “in the driver’s seat.”
As Dennis Boyle said, “to be truly patient-centric, perhaps the inspiration for solutions needs to come from the people facing the challenges rather than relying on past experiences.”
A pessimist might say the concepts were too lofty or impractical to be taken seriously. However, several of the now successful Disrupt Diabetes speakers were likely told something similar along their own journey. It’s also worth mentioning that one of the winning teams was able to develop a working prototype of their discrete CGM alert device in the 10-week span of the design challenge. The broader diabetes DIY community has also shown us that a motivated, tech-savvy group can make wild ideas into a reality. This is not fiction; it can be a reality.
This constructive disruption should be a welcome addition to the thought-space of innovative approaches to solving diabetes dilemmas. Throughout this atypical process, participants were repeatedly reminded that individuals with diabetes are more than a collection of symptoms and targets. Individuals with diabetes are people first and each has a unique perspective and set of life challenges. It is a reminder that individuals with diabetes are at the center of their care and should be at the center of solutions.
These are valuable reminders for practice and research. Invite patients to express their challenges. Seek to understand their perspectives and build solutions collaboratively. Then think about how those solutions are going to impact life between visits in a hectic, unpredictable life with diabetes. New solutions will hopefully emerge that are more sustainable, satisfying, and ultimately, successful.
We are confronted with an evolving world in diabetes care that may benefit from some disruption in how we typically perceive and solve problems. While it is true that the concepts presented were not be fully developed, they were certainly disruptive.
— Harris is the associate director of content strategy & outcomes at the Endocrine Society, who is living with type 1 diabetes.

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