Applying the design thinking approach to improve type-1 diabetes management working with Stanford Diabetes Research under Prof Michael Berry

Team: Julia Hernandez, Awua Buahin, Janani Balasubramanian

March, 2023

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Introduction

We applied the Design Thinking Approach to improve the experience around managing Type-1 Diabetes. We interviewed around 10 patients and primary/secondary caregivers (family, teachers, etc.). Through these interviews we identified some insights and patterns in our data. Before we dive into the process and our proposal, let’s cover some of the basics around Type-1 Diabetes.

What is Type-1 Diabetes?

Type 1 diabetes is a chronic (life-long) autoimmune disease that prevents your pancreas from making insulin. It requires daily management with insulin injections and blood sugar monitoring. Both children and adults can be diagnosed with Type-1 diabetes.

Managing Type-1 diabetes is complex as it requires:

  1. Constant Monitoring and Adjustments: Managing blood sugar requires frequent checks using devices like continuous glucose monitors (CGMs) and subsequently adjusting insulin dosage based on the readings.
  2. Risk of Severe Outcomes: Poor management can lead to hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar), both of which can result in severe short-term symptoms and long-term complications.
  3. Psychological and Emotional Strain: The continuous need for monitoring, fear of complications, and the social stigma around diabetes can lead to burnout, anxiety, or depression.

Highlights from the Interviews conducted

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“This is the fundamental challenge for any diabetic person: how do you choose to live your life and also have this thing?” - B, Type-1 Diabetes patient

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<aside> 🙆🏽‍♂️ “And as time goes on, you get a sense of what’s normal and what’s not. Then you just get comfortable with the idea that she’s not going to run off the road if she eats a cookie. If she has a bad day, let her have the ice cream. The ice cream is going to do more for her than being under 180 for that day.” - S, Caregiver for Type-1 diabetes child

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<aside> 👬 “I get almost all of my information from the diabetes community. I rarely see my endocrinologist. I mean, he’s all the way back in Marin, like 2 hours away from here. And I mean, just as someone who’s very involved in the diabetes community, I feel like I don’t really need to talk to him a whole bunch anymore.” - J, Type-1 Diabetes patient

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<aside> 📆 “I could send you a picture of my calendar like you could see,"Seamus is eating an apple at 7:17 five months from now. Like I I schedule my life an insane amount, even though I, like, look like I'm busy being. My watch is buzzing at all these in different intervals, and it's telling me - I might not be doing what I'm supposed to be doing, But I have a calendar that's like basically telling me what my optimal situation should be for blood glucose levels” - Se**,** Type-1 Diabetes patient

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<aside> 🚨 “I was worried enough about being outside of range that I had set my alarms to wake me up very often. If anything was happening, I set them to wake me up so that I could do something about it. And then I set them again so that if the problem continued, it would wake me up again” - B, Type-1 Diabetes patient

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<aside> 👨🏽‍💻 “There weren’t any good systems that were FDA approved at Nina’s time of diagnosis. So there was a group of parents in Silicon Valley who developed this algorithm and it’s called DIY (do it yourself) looping. So basically, John copied the software that these other parents have developed. You have to develop your own iteration of it because it’s not approved and no one else wants to like have a liability of your own system. So he bought a MacBook, became a Mac developer and developed his own algorithm. But it’s copying what someone else has done.” - K, Caregiver for Type-1 diabetes child

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<aside> 📉 “Oh I am hungry this morning. Nah, I’ll wait till lab to eat. Oh ok I am eating this much in lab. Let’s see, I give myself whatever amount of insulin. Oh that’s good. This is fine. Oops, didn’t give myself enough insulin. Or oh I gave myself a little too much insulin - time to eat one of my lab snacks” - R, Type-1 Diabetes patient

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Through the interviews, we started seeing the patient’s approach to managing diabetes fall under two broad approaches -