Dosage auto-calculation in apps

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jh0 DAFNE Graduate
The Queen Elizabeth Hospital, London
17 posts

@John

People must realise that controlling their condition is very much a hands-on exercise, be it via DAFNE or otherwise. I can't exactly say that I'm proponent of such a device that spits out some values to deal with the condition willy nilly. Does the app take into consideration past glucose readings to suggest the next reading? It doubt it. It's not that smart. It's imperative that patients maintain their diaries of CP and BG readings and that they adjust the treatment of their condition on the fly, adaptively, using common sense. The App will never be that smart to do this automatically. Instead you have to plug in fixed values of CP ratios at different times of the day into the App etc.

Second if patients choose to remain illiterate then that's their problem. The App isn't helping here at all.
Now I can fully understand why the App isn't condoned by the medical institution.

Now, although the App can be extended in so many ways and made smarter, it could never reach the point of managing one's condition autonomously.

In one of my previous posts I have submitted a template of a DAFNE diary in the form of a spreadsheet which has the purpose of representing the maintenance of one's condition in a more lucid and transparent manner. It's an adaptation of the DAFNE diary. Patients would be well advised to use a diary of this kind instead, and work on their condition in a more hands-on manner using some common sense along the way.

NB. If anyone is looking for engineering advice on improving the App (considerably) then we can discuss it further.

marke Site Administrator
South East Kent PCT
659 posts

Hi, Thank you for sharing your opinion, i think what you need to realise is it is just your opinion not fact. Maintaining paper diaries might well suit you well that doesn't mean its the best solution for all. Also to correct you I don't believe illiteracy relates to not being able to do maths Very Happy . I don't disagree that diabetes needs daily active management and that the App does not provide this it merely provides an electronic means of storing BG readings rather than writing them down on paper. It is an aid not a solution and was never intended to be.

The App doesn't need to be condoned by a medical institution and was never not condoned. We removed the auto-calculation feature because that is classed as providing medical advice and any application that does this requires licensing and a lot of advanced testing that we as 'home' developers could not under take.

Lastly are you a software engineer ? If not what engineering advice can you provide on the App ? Do you understand object oriented programming or REST API's ? If not you are no more qualified to comment on it than anyone else. We are always happy for offers of assistance or constructive advice that can benefit all users of the App, so feel free to offer advice.

Pat N DAFNE Graduate
South East Kent PCT
13 posts

I have been using the DAFNE app for many years now. I find it more convenient than a paper DAFNE diary that I can no longer get from my health care team here in the SE, who no longer teach DAFNE.

The app also gives me direct access to the DAFNE site enabling me to keep updated to anything new on DAFNE.

I find the app very useful in keeping a record, track trends and print my diary before seeing my diabetes specialist or nurse. I hope this brilliant app will continue to evolve đź‘Ť

jh0 DAFNE Graduate
The Queen Elizabeth Hospital, London
17 posts

marke said:
Hi, Thank you for sharing your opinion, i think what you need to realise is it is just your opinion not fact. Maintaining paper diaries might well suit you well that doesn't mean its the best solution for all. Also to correct you I don't believe illiteracy relates to not being able to do maths Very Happy . I don't disagree that diabetes needs daily active management and that the App does not provide this it merely provides an electronic means of storing BG readings rather than writing them down on paper. It is an aid not a solution and was never intended to be.



Pardon, do you consider yourself literate if you can't do basic maths? That's plainly incorrect!
Further, who said anything about paper diaries apart from you? The whole point here is representing the data of your condition in a manner which is lucid and transparent to both yourself and the medical staff helping to manage your condition. the diary can take any form. But if the diary is a black box (such as what you seem to subscribe to) how is that going to help you or anyone to analyse the condition in retrospect?

marke said:

The App doesn't need to be condoned by a medical institution and was never not condoned. We removed the auto-calculation feature because that is classed as providing medical advice and any application that does this requires licensing and a lot of advanced testing that we as 'home' developers could not under take.



What's your point? The App is offering some half-hearted advice (quite likely flawed advice) and I can fully understand given licensing restrictions in place from the medical institutions, why it shouldn't be doing this without rigorous testing.

marke said:

Lastly are you a software engineer ? If not what engineering advice can you provide on the App ? Do you understand object oriented programming or REST API's ? If not you are no more qualified to comment on it than anyone else. We are always happy for offers of assistance or constructive advice that can benefit all users of the App, so feel free to offer advice.



In my earlier post I've offered plenty of advice only if people such as yourself are willing to read and listen.
30 years diabetic, 14 years DAFNE, and 20+ years developing various type of software systems. I think that makes me quite qualified to comment on points raised here with your App.
And what are your credentials exactly?

Annette Bell DAFNE Graduate
Sheffield Teaching Hospitals
60 posts

What is your problem? If you don’t like the app don’t use it. The rest of us love it and find it really useful. Also, literacy is not to do with numbers. Some people with high IQ can have dyscalculia, the numeric equivalent of dyslexia. You don’t have to insult people who may have difficulty with numbers. This topic is now irrelevant anyway as the app no longer does the calculations for you. I use the app to show my diabetes nurses the graphs, which I also use to monitor trends and adjust my dosage when necessary. You’re happy using your spreadsheet. Great! We are happy to continue to use this great app as it is thanks.

Theodore Taylor DAFNE Graduate
Cambridgeshire
2 posts

jh0 said:

marke said:
Hi, Thank you for sharing your opinion, i think what you need to realise is it is just your opinion not fact. Maintaining paper diaries might well suit you well that doesn't mean its the best solution for all. Also to correct you I don't believe illiteracy relates to not being able to do maths Very Happy . I don't disagree that diabetes needs daily active management and that the App does not provide this it merely provides an electronic means of storing BG readings rather than writing them down on paper. It is an aid not a solution and was never intended to be.



Pardon, do you consider yourself literate if you can't do basic maths? That's plainly incorrect!
Further, who said anything about paper diaries apart from you? The whole point here is representing the data of your condition in a manner which is lucid and transparent to both yourself and the medical staff helping to manage your condition. the diary can take any form. But if the diary is a black box (such as what you seem to subscribe to) how is that going to help you or anyone to analyse the condition in retrospect?

marke said:

The App doesn't need to be condoned by a medical institution and was never not condoned. We removed the auto-calculation feature because that is classed as providing medical advice and any application that does this requires licensing and a lot of advanced testing that we as 'home' developers could not under take.



What's your point? The App is offering some half-hearted advice (quite likely flawed advice) and I can fully understand given licensing restrictions in place from the medical institutions, why it shouldn't be doing this without rigorous testing.

marke said:

Lastly are you a software engineer ? If not what engineering advice can you provide on the App ? Do you understand object oriented programming or REST API's ? If not you are no more qualified to comment on it than anyone else. We are always happy for offers of assistance or constructive advice that can benefit all users of the App, so feel free to offer advice.



In my earlier post I've offered plenty of advice only if people such as yourself are willing to read and listen.
30 years diabetic, 14 years DAFNE, and 20+ years developing various type of software systems. I think that makes me quite qualified to comment on points raised here with your App.
And what are your credentials exactly?



Dude, Respect for the 30 years diabetes, sure you have a lot you could share with us (18 years now, but the first 5 i just didn't take care of myself at all) I feel like (perhaps not correctly) you might have a different view if you had a low insulin resistance as some of us do. Calculating 0.7 units to every 10g of carbs (absolutely solid for me) and logging the results in the process was absolute magic. I'm no stranger to excel, but it simply isn't as convenient as having an app that does both and syncs - giving you graphs also. The idea isn't to take away responsibility from the user, the idea is to make it simple and convenient for the user to calculate, log and manage their insulin dosage. It was a really useful tool for me. I owe a lot to it. That is not to say my diabetes management has got worse - I'm better than ever Smile - but it helped me a a lot in the early stages and I would totally use it again if it was available.

Diabetes is a no-day-off illness. Anything that lightens the load, and helps us to live a more "normal" life is a god-send.

Ps. Love you all, never let it get you down ;)

jh0 DAFNE Graduate
The Queen Elizabeth Hospital, London
17 posts

Annette Bell said:
What is your problem? If you don’t like the app don’t use it. The rest of us love it and find it really useful. Also, literacy is not to do with numbers. Some people with high IQ can have dyscalculia, the numeric equivalent of dyslexia. You don’t have to insult people who may have difficulty with numbers. This topic is now irrelevant anyway as the app no longer does the calculations for you. I use the app to show my diabetes nurses the graphs, which I also use to monitor trends and adjust my dosage when necessary. You’re happy using your spreadsheet. Great! We are happy to continue to use this great app as it is thanks.



I didn't insult anyone. But if you consider yourself to be literate when you can't do basic maths then yes you deserve to be insulted.

John Syer DAFNE Graduate
Diabetes Australia-Vic, Melbourne, Victoria
19 posts

Oh wow!

John Syer said:

This topic was started 3.5 years ago, so I'm not sure why you are adding to it now (unless it is to be inflammatory), but I'll jump in (rightly or wrongly) and "humor" you.



So I guess we have the confirmation on my inflammatory speculation. Although I'm not sure that my 34 years since diagnosis as a T1, 8 years DAFNE practitioner, 25+ years developing software including 7+ in the biomedical field (including getting many medical devices through the legal quagmire that is FDA approval), and Beta tester for this DAFNEonline app qualifies me to determine that. The above mentioned life experience has taught me that there is no one "correct" way to solve a multi-faceted problem such as managing diabetes.

jh0 said:

In my earlier post I've offered plenty of advice only if people such as yourself are willing to read and listen.



If you'd read this thread properly, you'd see that it was a post on the removal of the auto-calculation convenience functionality (3.5 years ago), that was forced upon the developers by MHRA (https://en.wikipedia.org/wiki/Medicines_and_Healthcare_products_Regulatory_Agency), although based on your posts, you seem to have a different perception of what is going on, or perhaps an agenda to push.

jh0 said:

Second if patients choose to remain illiterate then that's their problem. The App isn't helping here at all.



It would appear that your use of the word "illiterate" is a poor choice when I can only assume you mean "ignorant". But it does reinforce the inflammatory verdict. Now that you've stated that illiterate people deserve to be insulted, then you've really just escalated to online troll.

Regards, John

Simon Site Administrator
Sheffield Teaching Hospitals
558 posts

Just to clear up some definitions:

Illiterate - unable to read or write
Innumerate - without a basic knowledge of mathematics and arithmetic

It's an unfortunate truth that Type 1 Diabetes doesn't choose to only affect those who are good with numbers. The dosage calculation in the app was intended to help those out with the number crunching needed to follow the DAFNE principles correctly. It did show all the working out that were performed so people could verify these themselves. As we have already described we were told to remove it as it meant that the app was classified as a 'medical device'.

Thanks for the messages of support on this thread - it's great to know that there's people out there still getting value out of the app and site in spite of features needing to be removed. As ever if there are any specific features you'd like to see or feedback you'd like to share (ideally more specific than the App needs improving considerably) then don't hesitate to get in touch.

jh0 DAFNE Graduate
The Queen Elizabeth Hospital, London
17 posts

Simon said:

It's an unfortunate truth that Type 1 Diabetes doesn't choose to only affect those who are good with numbers. The dosage calculation in the app was intended to help those out with the number crunching needed to follow the DAFNE principles correctly. It did show all the working out that were performed so people could verify these themselves. As we have already described we were told to remove it as it meant that the app was classified as a 'medical device'.



You can understand why. The App is offering 'medical advice' when it's not actually doing this.

Importantly, given the direction that this discussion has gone in, people seem to think that it's ok to be considered literate even if they're innumerate. Basic arithmetic, barely number crunching.