Dr. Rajiv Kumar with his patient Blake Atkins. (Robert Dicks/Stanford Children's Hospital)
Blake Atkins receives regular messages from his mom when he's at school. But unlike most teenagers, he doesn't seem to mind.
That's because Atkins, 15, who lives in San Carlos, was diagnosed with Type 1 diabetes four years ago. His mom, Lori, sends him a text whenever his blood sugar levels are out of the normal range.
"I do like that my mom can look at my numbers," Atkins says. "It keeps me sane. It helps keep her sane."
While enlisting caregivers might seem like a logical way to manage diabetes, it's only recently that such tools have been available. Health experts say sophisticated devices to monitor blood sugar have been around for years, but it's been a challenge to share health data securely with a smartphone -- and from there, add it to a patient's medical record.
"Families of children living with diabetes have been seeking these kinds of tools for years," says Michael Chae, Bay Area regional director for the American Diabetes Association, "and there have been people working on these solutions for some time."
For years, Lori Atkins had little insight into her son's health when he left for school. But she did the best she could in the evenings and on weekends to record Blake's blood sugar levels and his diet in a notebook.
But several months ago, her son's doctor Dr. Rajiv Kumar, an endocrinologist at Lucile Packard Children's Hospital, suggested the family enroll in a new pilot program that turns the iPhone into a sophisticated tool for home health monitoring.
The pilot is one of the first to take advantage of a new service from Apple, called HealthKit, which helps people view their health information in one place. Apple launched HealthKit in 2014 and is attracting the interestof top hospitals.
For Blake's doctor, it offers new opportunities to monitor his patients from home -- and potentially cut costs by decreasing the number of in-person consultations. Kumar says he can now see his patients' glucose levels with a three-hour time delay.
"Last time he [Blake] was sick, I wrote Dr. Kumar an email with all this data I'd manually collected and waited for a response," she says. But now, Kumar can check in on a patients' blood sugar levels at any time and assess whether there's a serious problem.
Kumar says he doesn't have time to monitor a continuous stream of Blake's data. Instead, he receives a report every two weeks from the hospital with all of his patients' analyses and trends. The report clearly shows which patients consistently have the lowest blood sugar overnight, for instance.
"It has made my life a lot easier and I worry less," says Kumar.
How Does It Work?
How does data travel from Blake's glucose monitor to his mother and his doctor? The system is complex, but it typically works like this: He tracks his glucose levels using a Bluetooth-connected continuous glucose monitor or CGM, which was developed by a company called Dexcom. The CGM measures glucose through a glucose sensor that is inserted under the skin.
With Blake's permission, the data then travel to his smartphone via Apple's HealthKit. From there, Blake's health information is sent to his medical record through an app that his doctor uses from Epic Systems. Apple is currently partnered with Epic and half a dozen other electronic health record companies.
Blake's doctor can subsequently send him a secure message through Epic's app, which is called MyChart. His mother Lori can access the data in real-time as the designated caregiver.
"I usually check in on Blake's glucose levels every lunchtime when he's at school," says Lori Atkins. "He doesn't usually know or care, as it's all through the mobile phone."
Barriers to Adoption?
Doctors tell me these types of mobile monitoring programs can improve the outcome for patients and cut costs. They're particularly effective for patients with Type 1 diabetes, who often rely on educated guesswork to determine how much insulin they need.
"Type 1 diabetes is a low-hanging fruit, from the perspective of the major health systems," says Suneil Koliwad, a researcher and endocrinologist at UCSF, who specializes in treating patients with diabetes.
The major challenge for patients and their doctors is to determine how much insulin to give and how to give it. A great "first step," Koliwad says, is to analyze a patient's blood sugar levels over time. Eventually, health systems can use months and months of data to make a prediction about what will happen next.
"Using technology, you can overcome the crux of the problem," he says. "Mobile tools have tremendous potential to help doctors spot potential dangers that could become big problems."
But most doctors do not have time to pore over numbers in Excel spreadsheets. So Koliwad says hospitals either need to invest in tools to present this data clearly to doctors, or hire teams of people to monitor the data streams and be responsive to patients.
Once doctors are on board, health systems will need to convince the patients. And that might be a major challenge.
"From talking to other parents I know that every teen's journey is different," says Lori Atkins. "Some kids get this burnout where they don't want to test themselves or take their insulin. Even Blake could rebel next week and stop wearing his glucose monitor."
But Blake says it's unlikely that he'll give up or get embarrassed about his disease.
"I don't really care what people think," he says. "Anyways, I know that the alternative is grim. Having diabetes, it does make you grow up a bit."
Get the best of KQED's science coverage in your inbox weekly.