I'm going to start with a new university course about startups. The idea is to begin with something and develop it as the classes go.
I have some ideas that are not D related but it would be awesome to work on a project that involves diabetes.
For that reason I'm here to ask for your creative help! Is there anything that you would like to be implemented? Something that you miss? Or could be better? Online or physically? A service, an app, a dream, anything.
The whole meter accuracy campaign, Strip Safely, suggests there's wide demand for more accurate meters and strips. I haven't read the articles/ blogs extensively but it made me wonder if such a product, that can be lugged around in pockets, etc. can actually be built or if we are up against a limit of science/ technology/ biology. If it could be built, well, then we out to build it I'd think.
Diabetes is a data-driven disease. We measure BGs with fingesticks and CGM. We deliver specific quantities of insulin to metabolize specific quantities and qualities of food. All this plays out over time as we try to live a normal life.
Most of us don't follow the data that closely even though we do notice our realtime fingerstick numbers and the stream of data from our CGMs. Very few of us download all of our diabetes devices regularly and use the retrospective data to fashion a forward-looking plan.
The reason most of us don't do that is because it takes time and the sea of data can quickly put a glaze in our eyes. What we need is a simple visual chart that pulls in many of the various elements that drive BGs and display them on a "dashboard" that succinctly summarizes how we're doing and what exactly we need to work on. It'd be like a mini report card on one piece of paper. It would make sense at a glance.
In short, we sure could use a simple graphic that would focus our attention, direct our energy, and motivate us so to positively influence our behavior. It would gives us feedback and motivate our actions to influence the outcome. Sort of like a speedometer gives feedback to a driver and thereby influence the driver's moment-to-moment actions.
I like Terry's idea of the graph software. I'm not a technical person overall but I think it could be useful maybe to see all of this. I'm a visual person and I tend to brain storm, think and learn more by looking at things than other ways.
I'm too burnt out to think of my own idea at the moment, but I'll post back if I think of one. Maybe a solar fridge specifically made for storing insulin or even better an insulin which doesn't have to be re-fridgerated? Can that be a start up?
1. a smart phone with an integrated blood glucose meter...not just some attachment, but a meter built in.
Flatter containers for holding test strips to go with it. Better test strip containers in general, and how about one that has a discard spot for the used test strips.
2. GEAR...cases to hold everything in, including convenient waterproof cases. Maybe even a fanny pack that does the same. With some, even necklace things or arm bands.
The following is of limited use for StartUps. But I think that the data exchange between devices should be regulated more tightly. This is aimed at overcoming the vendor lock-in situation we currently have:
-using accepted standards for data encryption (like the Bluetooth encryption protocol) for data exchange.
-being able to use CGMS sensors with the pumps we would like to use. This again is a question of standards for the communication protocol. It is not acceptable that pumps will only work with the sensors from the same manufacturer.
-every management software for pumps should be able to export the pump data in the XML format. It is not acceptable that manufacturers are still using the CSV format that has a high risk of misinterpretation (Medtronic for example). It is also not acceptable that the management software is just offered as a cloud based solution. This should be open source so the community can port the software to the operating system they like.
-for the XML format of pump data a minimum standard needs to be defined - comparable to the AGP dashboard standard proposed in the paper Terry is linking too. This would allow developers to focus on these standards. The current situation with multiple standards for every manufacturer and massive changes in the data format from one version of the pump/cgm to the next is really a mess. Terry is absolutely right: Diabetes is a data-driven disease. Here the industry totally fails to deliver - even to understand the most basic needs of their customers! The proposed AGP standard shows that it is possible that different CGM manufacturers and independend researchers can work together constructively. This is what I want to see from pump manufacturers too.
I have proposed this in the past but I would like to do it again: we should build our own plant for test stripes!
Let us assume we need a totally exaggerated investment of 1 billion dollars for research and manufacturing. Let us further assume that we have 40000 members in one year. This is an investment of 25000 dollars per member. It is a lot of money but an investment of 1 billion is far too much for the primitive technology involved here. For 1 billion it should be possible to offer stripes with high accuracy. But maybe this is just the next evolutionary step when we have proven our concept. With more attention of the millions of diabetics worldwide I do not see why it should not be possible that we run our own plant.
Just allow yourself to think about it. We could set prices that low that it is guaranteed that insurance companies will prefer our stripes. With every stripe we use and that we sell to others we as the shareholders participate. To me this is a win-win-win-situation for global customers, insurance companies and us as investors.
Holger - You raise and interesting issue. Companies exist primarily to turn a profit for shareholders. To be fair, some companies define as part of their mission, community service objectives. These community service goals are collateral and incidental to their main objective: turn a profit.
In the case of glucose test strips, there are many constituencies that cannot afford to purchase in therapeutically effective quantities, if at all. This argument boils down to one of philosophy. Is health care a right or a privilege? This question may seem silly to those outside the US, but it's still a matter of open debate in the US.
I believe in this instance that a glucose test strip manufacturing/distribution cooperative, owned by member diabetics, would serve a greater good. It would serve a much larger constituency than the for-profit enterprises currently serve. The case can be made that providing the widest possible distribution of test strips at the lowest possible cost will end up saving the larger society (and taxpayers) substantial sums of money. It also could prevent untold human suffering in terms of avoided amputations, blindness, and dialysis.
I can already hear the free-marketeers rising in indignation. I ask them: do you really think that the "free" market has solved the problems of test strip cost and quality that we diabetics need to fundamentally manage our lifetime illness? I suggest that what we really have is a market dominated by too few players. And now, with the regulatory agencies like the US FDA crippled by budget cuts, there exists a "wild west" environment where the sheriff has retired and the purveyors of poor and inconsistent quality strips can knowingly distribute strips that have the potential to facilitate insulin over-dosing and possible death.
In the US, we have a tradition of small cooperatives that serve people well. Rural farm community grain coops and credit unions come to mind. This idea of a glucose strip manufacturing and distribution cooperative could work!
I think that test strips also could represent a public safety issue, given our general dependence on driving. I investigate claims and, while I can't talk about ones I've had, I'd ***love*** to get a case where a defendant had trouble testing their blood sugar because of an insurance company and try to drag them into a tort case.
We're always looking for creative ways to go about defending our clients and I think that you could make a pretty decent argument that there's no medical point to limits like 4 or 7 strips/ day. You should be able to test hen you need to test. It directly affects our constitutional rights to enjoy the pursuit of happiness and all that sort of thing so I would have no problem at least exploring that type of angle in a case. Unfortunately, should I "run into" one, I wouldn't be ablet to talk about it with anyone.
Maybe a startup can develop a suite of improved pump software features that would be attractive to a pump company. The suite of features can have a default set of features with an optional Advanced setting that allows more customization and ability to disable unwanted alarms or add desired features. How about a bolus calculator capable of determining your optimal prebolus time which automatically sets an alert to remind you when to start eating? I have come up with my own prebolus formula and use an alarm to remind me to eat but I see no reason why a pump can't do that for me. IMO, the Super Bolus feature should already be standard in pumps. If you have a meal where your bg returns to normal within 4 hours but causes a spike above 180 in the meantime, why not utilize a Super Bolus to tame that spike? As it is now, I manually set up a Super Bolus but I often have to look up my basal rates for the subsequent 2 or 3 hours and the calculation gets a bit complicated whereas a software algorithm could instantly calculate a suitable Super Bolus/Super Correction. Pumps should also offer IOB and DIA parameters that are extremely customizable. You should be able to set DIA differently for meal insulin vs correction insulin (DIA for corrections is definitely longer for me).
Another startup idea would be a fitness tracker that is able to correlate your heart rate with bg burn to help you avoid lows. I have no idea if there is a reliable correlation between heart rate and bg burn but it would be really cool to integrate such an algorithm into a fitness tracker/CGM.
I really hope I have calculated this correctly (it is late here):
Imagine 40000 people believing so much in this project that they invest on their own risk. These 40000 people would need 40000*10 stripes per day. With a margin of 8 cents per stripe this is a revenue 40000*10*0.08 = 32000 dollars per day or 960000 dollars per month or 11680000 per year. Per investor this is 11680000/40000 = 292 dollars per year. This underperforms current interest rates.
However if you calculate with the lower price range of current manufacturers of 40 cents this looks differently. Then every investor would earn 1460 dollars per year: 40000*10*0.4*365/40000. This beats current interest rates and that with just 40000 customers.
Of course to earn 1460 dollars per investor and year with 8 cents per stripe we would need more customers. But how many? x*8 cent = 40 cent <=> x=5. So it is 5 x 40000. This means with 200000 customers we could beat the interest rate for our investment. To me this is not socialism but social market economy: win-win-win as I said.
I calculate with 0.08 dollars revenue because I guestimate that the production cost per stripe is 0.02 dollars. So with 0.1 dollars per stripe our 50 stripe package will cost 5 dollars plus logistics. Just imagine how this scales with more customers and how easily we could lower our prices OR could fund research for a cure and so forth. It is mind-boggling that all of this money just goes into the pockets of stripe manufacturers - riping us of with 0.4 dollars per stripe or more.
Again, please correct me if I made a mistake in my calculations!
I don't really see free enterprise working with diabetes stuff and much of healthcare in general. The goal of the insurance industry and medicare/medicaid is to keep short term costs down (and restrict medical equipment) while the goal of pharmaceutical companies is to get a monopoly on a product and screw the consumer for all they can. In what way is free enterprise working in our favor? Seems like ins. prices have increased by 5-6% for 3 decades in the US.
With the insulin, the pharmaceuticals patented the biological component and we need congress to act to get true generics. So for the forceable future. Seems like there are 2 companies operating, and they have no interest in true competition.
With the pumps, the pricing is set so that the cost is pretty much the same regardless of brand, and it just depends of the features you want. Oh and good luck trying to find the actual cost after insurance.
Then with test strips, the pricing is ridiculous, but oddly that is the one area with something resembling competition. There are generic options, but insurance apparently doesn't cover them.
A start up to better distribute and allocate testing across the country. Other companies must have an interest in finding doctors and compensating them for participating in trails. I think that if products can get to market quicker innovation will come quicker. I think that we have an unequal distribution of trails and as such we end up with an unequal distribution of participation and interest for the eventual products.
