Understanding "Unobtrusive": What People with Diabetes Hope for in an Automatic Insulin Delivery (AID) Systems

Managing diabetes is a daily challenge that requires constant monitoring, insulin adjustments, and lifestyle adaptations. The efficacy of current treatments highly depends on the individual’s ability to correctly track their glycaemic levels and to self-deliver insulin accordingly. Many patients experience this burden as intrusive, inconvenient, unreliable or stressful. MusiC4Diabetes to create an automatic insulin delivery system that autonomously manages diabetes with minimal disruption. But what does "unobtrusive" actually mean for people with diabetes? To answer this, we conducted a survey among different patient groups: adults with type 1 and type 2 diabetes, adolescents with type 1 diabetes, and parents of children with type 1 diabetes. Their insights provide a crucial foundation for designing a system that truly meets their needs.

The first step is to understand their frustrations—what aspects of current diabetes management systems they find most challenging, before investigating what aspects would make for an unobtrusive device and what safety reservations they might have.

Challenges and frustrations with current diabetes management systems

For individuals managing diabetes, the experience is often marked by constant vigilance and the need to stay highly aware of their condition. Many patients express the mental burden of having to think about their diabetes at all times to avoid forgetting something that could be life-threatening. Regular blood sugar checks and insulin adjustments can be time-consuming and invasive, while deciding the correct insulin dosage can be complex and varies depending on a range of factors, from food intake to stress levels, making it difficult to find the right balance and avoid the risk of complications. The need to always have an insulin pump on hand is another inconvenience, as it can interfere with daily activities. Finger pricking for blood sugar testing also leads to skin problems like calluses and irritation. Technical issues with devices, such as faulty equipment or false alarms, add to the stress and disrupt their routines.

The main concerns voiced by patients is the lack of spontaneity and frequent mental preoccupation in their daily lives, as all of these factors require careful planning around meals, activities, and insulin injections.

Key Features of Diabetes Technology That Make It Unobtrusive for Patients

For many patients, an unobtrusive diabetes management system should work autonomously, ensuring reliable and consistent blood sugar control without constant intervention. It should automate insulin injections, providing a seamless experience with just one device, rather than multiple apps or tools. The system should be easy to handle, small, and free of pain, allowing patients to go about their day with minimal disruption. Above all, it should offer the freedom to temporarily stop thinking about diabetes, providing peace of mind without the constant worry. Safety is paramount, as patients need to trust that the system will maintain normal blood sugar levels and work reliably at all times.

The main message is not that patients want to forget diabetes completely, but that an AID device should allow them to do so when they chose, for a certain amount of time and without a bad consciousness or worries. Patients dream of a device that is reliable and as intuitive to use as brushing your teeth.

Additional aspects that are important to patients are the maintenance of the device. If it works well and significantly improves their quality of life, patients would be willing to accept a more than minimally invasive implantation process. Insulin refills shouldn’t be required more often than once a week. And safety protocols and manual interventions are paramount.