Peter van Rijt

Please join the discussion on GitHub pull request 6717 – Unburdening diabetes care: comparing and reducing manual interventions. This blog is translated automatically to your language here. View all related articles using this link.

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Hi all,

I am Peter, living in The Netherlands, and hope someone will find a cure for type 1 diabetes (T1D). Since my girlfriend (soon to be the mom of my son ^_^) was diagnosed with T1D only three years ago both of our lives rapidly have changed. We hope this is the right place for this improvement.

Love to hear feedback and hope to implement this together. This to provide insight on the number of manual interventions, and hopefully help each other to reduce them.

Best regards,
Peter (and girlfriend)

A good quality of life

Our assumption for ‘a good quality of life’ is the combination of physical health (body) and psychological health (little as possible manual interventions).

Closed loop systems really have improved my girlfriend’s physical health and ensure less worrying (especially at night). We both are very grateful for this. At the same time, I see a physical burden arise. This because all (sensor) data, options, and alerts are always available. In one of our home discussions with my girlfriend, I asked what is most important to her. She mentioned:

1. a healthy HbA1c
2. a good TIR
3. fewer life interruptions because of diabetes

Her deepest desire is to live a normal – as possible – life without being bothered by diabetes. And stay healthy in the long run!

ADMI as new psychological metric

The above kept me thinking. The first two (HbA1c and TIR) are measurements already characterized as a number. You can view them in Nightscout on report tabs like ‘Daily Stats’. Because of this, people are actively helping each other to adjust close loop systems to healthy levels.

Because of our closed loop system (AndroidAPS), my girlfriend has a very healthy HbA1C. But…nobody sees the effort it takes her to achieve it: the hidden costs. I daily see my girlfriend putting a tremendous effort in balancing between a hypo and a hyper. Often I wonder how to compare her efforts and results with others in the closed loop community.

Out of curiosity, I asked how many daily interventions she has (enter carbs, change cannula, start temp profile, snooze low alert(s), …) compared to the best minimum amount. She could only guess because this currently is not (yet) characterized as a number.

This caused our idea to add a psychological metric: average daily manual interactions (ADMI). Because you enter all information in an app it should be possible to distinguish between manual and automatic actions. With this, our community gets a tool to inspire each other in unburdening daily diabetes care even more, whilst no forgetting a healthy HbA1c and TIR. Long story short: fewer life interruptions because of diabetes.

In natural language

Basically, this is an indicator of how much effort you have put into your diabetes care.

Suppose you bump into a T1D friend who uses the same equipment as you do and achieves similar physical results. For example, an HbA1C of 42 mmol/mol and TIR 85%. Both something to smile for.

Then you compare ‘(mean) daily manual interactions’ and see a difference of 20 manual interactions. Quickly you see an opportunity for more peace of mind and improved confidence in the closed loop system.

Example

To clarify the metric, I made a screen concept in which column ‘Manual interactions’ is added and filled with fictitious values:

Technical implementation

Educated as a programmer I tried to get an overview by analyzing MongoDB data collections. I saw our MongoDB (filled by AndroidAPS) does not seem to have a usable characteristic like inputType (‘unknown’, ‘manual’, ‘loop’ or ‘automation’). The use of the metric (and) can only be added jointly by the #wearenotwaiting community:

1. Review this suggestion

2. Screen design
We suggest to expand Nightscout reports below with ‘manual interactions’:

• Day to day
• Daily Stats
• Distribution
• Weekly Distribution
• Treatments

3. Screen design and reporting
Report based on inputType (‘unknown’, ‘manual’, ‘loop’ or ‘automation’ where default should be set to ‘unknown’ to prevent interfering with current database values).

4. Storage in database
Closed loop components like AndroidAPS, xDrip, Loop, OpenAPS, … should enrich database information with inputType (‘unknown’, ‘manual’, ‘loop’ or ‘automation’ where default should be set to ‘unknown’ to prevent interfering with current database values).

Facebook

On Facebook, this idea has been shortly discussed with positive feedback (use this direct link). It took me some time to get it in writing on GitHub pull request 6717 – Unburdening diabetes care: comparing and reducing manual interventions.