David Klonoff 0:22

Welcome to the Diabetes Technology Society Podcast , diabetes Technology Report . I'm David Klonoff . I'm an endocrinologist at Mills Peninsula Medical Center in UCSF . I'm going to be co-moderating this session today with Dr David Kerr and I'm introducing Dr Kerr .

David Kerr 0:43

Hello everyone , david Kerr here . I'm Senior Investigator at Sutter Health . I'm based in Santa Barbara , california . It gives me enormous pleasure to welcome Dr Kanter today . We were really struck by a recent article that Doug was first author published in the Journal of Diabetes Science and Technology . The title of the article was Designing the CGM Experience an app design process overview . So before we get into the impetus behind the article , doug just want to tell the audience a little bit about who you are and what you're doing at the moment .

Doug Kanter 1:19

Yeah , absolutely . First off , thank you so much for having me on the podcast . It was a pleasure to write the article for the Journal of Diabetes Science and Technology and also to be here today . As you mentioned , I'm Doug Kanter . I am the Director of User Experience Design at Dexcon . We produce a continuous glucose monitor devices , and so I am part of the design team that helped design and develop the G7 product that we recently launched .

David Kerr 1:52

So what was behind ? Why did you put this article together ? Why do you think it was important to put this in writing today ?

Doug Kanter 2:03

Yeah , the opportunity to work on G7 was a terrific one for me . Full disclosure I am a patient myself . I've had type 1 diabetes for over 35 years , so it wasn't just sheer happenstance that I ended up at Dexcon . I work at Dexcon because I use the product and I have benefited from it . My health has improved as a result of it , and I both love it but also think that we can always do better . I think every product out there can always improve and evolve .

Doug Kanter 2:40

So this article that I wrote was about capturing how design influences the development of a product like G7 . One of the things we talk about in the article is that CGMs have evolved over time . These started off with this really promising technology and the software was not as advanced . But as we get more and more users on products like this , the design needs to improve . It needs to be more user friendly and it needs to .

Doug Kanter 3:14

It can best serve users people with diabetes by allowing them to get in , address the problems that they have in their life or help them to manage their health and then get out and get back to the rest of their life , and that aspect of the experience is actually really important to me . It's that whole mental burden of diabetes . People talk about how having diabetes can be like having a part time job or a full time job and then , by making all these decisions , there's tremendous power in having glucose readings from a CGM . At the same time , that's a lot of data , and data can either be really powerful or overwhelming , and we want it to be the former . We want you to be able to live healthier by using these devices and software .

David Kerr 4:05

I guess the question is what's the main message you want to get to other designers , creators of digital health products who are wanting to help and support people living with all forms of diabetes ?

Doug Kanter 4:22

Sure , Thank you簽eber . You know , living in the US , there's no shortage of problems with our healthcare system . I think there's a lot of frustrations across the experience , probably from everyone involved . Living with type 1 diabetes for as long as I have for several decades I can definitely I know several aspects of it myself and I definitely wanted to just be part of that solution . I think that there's a lot of designers out there doing great work and there's no shortage of great design work being produced by all industries .

Doug Kanter 5:00

But we're seeing a lot of change in healthcare in America and around the world right now and we're seeing this digitization of the experience and that the whole industry needs as much help as we can get . We need great design to be more prevalent . We need to cut down these frustrations that people experience , whether it's managing themselves on a day-to-day basis or even you know , probably in your experience talking with your patients and even caregivers . There's another part of the whole experience about getting data so that others can see it as well , with real-time monitoring tools . So , whether it's with a medical device industry or with other aspects of healthcare design , there's lots of problems to be solved . There's so much great work going on , but I feel like it's just the tip of the iceberg , to improve the overall experience for users and to give people the tools that help them live healthier .

David Klonoff 6:03

Doug , what are some of the important steps that you take when you're designing a product for diabetes ?

Doug Kanter 6:13

Well , there's definitely a range of different inputs that we have to manage , for we obviously have to get this past the regulatory review , be it with the FDA or whichever agencies we work with around the globe . So you have your regulatory requirements , you know that the app needs to be , considerate of certain things .

Doug Kanter 6:36

We have our technical limitations . We are designing for both iOS and Android , so we need to know how those systems work all the background technology of getting data off of the sensor and onto an app or onto the receiver or into the cloud but the most important one is understanding your users and understanding the needs that they have and the problems that they're facing in managing their health , and so we have a lot of different inputs to that . We conduct a lot of user research ourselves , so we'll go out and speak with patients with different treatment regimens . A product like G7 is very focused on what we call IIT patients intensive insulin therapy patients , type ones like myself , for example , who are on mealtime insulin , but we also speak with type twos and different treatment regimens . There we speak with other care providers , be it parents of someone who is helping to manage their child's health , and we talk with a lot of health care providers as well .

Doug Kanter 7:41

So you have to be able to distill all this information and be able to see Sometimes people are very good about straight up telling you the exact problem that they're looking for help solving , but sometimes all they can say is they're frustrated , and you need to distill a lot of that feedback and come up with a problem statement that really gets the heart of what they're really talking about , and then be able to first figure out whether you can actually address that problem with the software or the product that you're working on and then , if so , how are you going to do it ? Are you going to be able to get all the features out right away , or are you going to have to first get out a V1 or then a V2 and then a V3 ? But that voice of the user that is core to being a user experience designer . You need to be able to represent the challenges and needs of users when you're in discussions with your regulatory team , with your legal team , with your R&D team , and there may be different voices about how we should approach the design .

David Klonoff 8:47

Doug , in your article that appeared in JDST in July , you mentioned the double diamond process . How does that process affect the types of products you design ?

Doug Kanter 9:00

Yeah , absolutely so . One of the things that I mentioned is that the healthcare industry , as we improve the design , can follow the best practices that have been used for a long time in mainstream technology all of your big technology players and the double-diamond design process is a means of going from a problem that you're handed to the actual final solution . People who have less insight into how technology works might think you immediately go to the final UI screens , the user interface screens , the final mock-ups of how this is going to work . There's a lot of work you need to do before you get there .

Doug Kanter 9:46

When we get into a product like G7 , we actually had different stakeholders telling us a lot of different things . We had our business goals , we had our clinical goals , then we had our user goals . These are some of the inputs that you have , and so if you're working with a team and everybody's thinking that what we're building next is something different , well then you have a problem . So you first have to get everyone on the same page . You need to gather all of these inputs from these various stakeholders and then be able to translate that into a problem statement that everybody can get behind . If you don't agree on what the problem is , then you're probably not going to agree on what the solution is , and so that first diamond in the double-diamond approach is all about what are we solving for .

Doug Kanter 10:39

And then , once you get to that problem statement and you share it and you get buy-in from your team , that's when you go into the second phase of the work , which is around the how how is the best way that we could address that problem statement that we have ? And then , each of these phases , you have an exploration phase where you quote , unquote , go wide . You're looking at every possible idea out there , just get it all up on the board and think about any number of different approaches you can have . And then , once you get through that , you start to narrow it down . You start to look at why one approach might be better than the other . You get designs in front of users . You get their feedback , you refine those problem statements that may have been a little bit perhaps they were a little bit vaguer and they need to be more specific and it's through this process that you finally get to what you actually see when you , for example , download the G7 mobile app on your phone .

David Kerr 11:45

So , doug , just to take this further , you said in your article that once the app launches , you're looking at the feedback , and that comes through . Apps still reviews against social media and people calling Dixcom . What's the value of that ? Do you think it represents the greater world of people living with diabetes and how much value do you put into that ?

Doug Kanter 12:11

That's a great question . We do have a means of taking every app store review , for example , that comes in and we look at those , and I was just talking with one of my colleagues earlier today . It's a little bit of a challenging channel to distill the feedback because a lot of it tends to be pretty negative , a lot of one-star reviews , and of course you have to sit with that and hear it and acknowledge it .

David Kerr 12:41

That must be quite depressing , or is it just ?

Doug Kanter 12:44

part of the course . I think I probably I probably take it a little bit more personally than I should and I think over time you kind of get more used to it . As I said , as someone who uses these systems themselves , I take it all very personally , but we have to hear it and we have to escalate or raise up the feedback that we think is most noteworthy . That's one channel where the feedback tends to skew a little bit more critical . We obviously have our whole sales team , so they are interacting with health care professionals . They're also interacting with users of the systems themselves .

Doug Kanter 13:29

We have people posting on YouTube or any of the other social media channels . We'll see that as well . We have reviews written by people like Diatribe and Close Concerns . This is another voice . And then obviously , there's just the experience of walking around a conference . You can see it , people you know or people who visit our booth . So there's no shortage of channels . We have other metrics , like our scores , that will rank us and we look at those as well . We look at our call support volume . All of these channels serve a good purpose . We can see our , we can de-identify the data and look how people are actually using the app and maybe if they are getting stuck somewhere , we know that's an area that we want to improve . So we get G7 out the door . We see its launch , we know there's already other features that are going to be coming to market down the line . We always know that there's more work to do . Some of it's expected and some of it's not , and so you just do your best to roll with it .

David Kerr 14:41

I find this very reassuring that it's not a question of if we build it , you will come . The fact that you're reflecting on it is really positive . I'll hand it back to David Klonoff .

David Klonoff 14:52

Doug , do you see any trends for future devices in the whole industry ?

Doug Kanter 14:59

I think one of the most interesting things I am seeing is just looking at the adoption of CGMs as a technology .

Doug Kanter 15:10

I went on my first CGM I think it was about 11 or 12 years ago and I've been very focused on the data and the knowledge that's in there that I feel like we haven't been leveraging as much as we could , and so when I first went on a CGM , it was quite unique , but it's become much more mainstream now .

Doug Kanter 15:34

Obviously , the adoption amongst , for example , the Type 1 users is rather significant , and it's growing globally as well , but when I hear about people in Silicon Valley and other places wearing CGMs when they don't even have diabetes or not even pre-diabetes , I think that's really fascinating . When I look at all the work around personalized medicine and glycemic wellness , one of the things that I've been thinking about for a long time has been nutrition and how our meals affect us , and obviously for me , that's about calculating how many carbs and how much insulin I take . But this is something that's important to everyone . Everyone wants to live healthier , everyone wants to live longer , and so we're seeing in CGM this tool that may eventually have broader adoption within the population . I've also had researchers in cancer come up to me and say that they're looking at the correlation of glucose management to the progression of things like cancer . I think all this stuff is fascinating and is beyond the original reason that people were using Dexcom CGMs , but I think that's really exciting .

David Klonoff 16:53

Doug , thank you for joining us On behalf of myself , david Konoff and Dr David Kerr . You've been a very nice guest . The Diabetes Technology Report is available on Spotify , apple Store , diabetes Technology Society website and our new website , salud Diabetes . So until our next Diabetes Technology Report podcast . See you later .

Doug Kanter 17:19

Thank you so much for having me . This has been great .