This report presents a design proposal for a product-service system to support type 1 diabetes patients in the first stages of treatment after diagnosis. Diabetes is one of the largest health care problems globally in terms of prevalence, cost and burden placed on individuals living with diabetes. It impacts these people and people around them every day and remains one of the leading causes of death. Although the great efforts that have been made in the treatment of diabetes care, many patients still do not achieve adequate glycaemic control and experience devastating complications that result in decreased length of and quality of life. Our healthcare system is designed to deliver acute, symptom-driven care, and is therefore poorly configured to effectively treat chronic diseases, and especially diabetes. The proposed design aims to increase the effectiveness of diabetes self-management in adult patients and thereby increase their metabolic control, quality of life and decrease healthcare-related cost.

Fundamentals
The principles of the design are based on extensive literature research, user research, consults with healthcare professionals (HCP) and user participation design. The difficulty of diabetes treatment lies in its complex and personal character. The latter causes that patients cannot surrender the responsibility of diabetes management and are therefore mainly designated to self-management. Patients provide 98 percent of their own care and diabetes is fully woven into the fabric of everyday life. The complexity of diabetes makes self-management a daunting task. The main goal of treatment is to normalise blood glucose levels (BGL) to an as normal state as possible. To gain control over their BGL, patients need to uncover how they respond to a plurality of influencing factors. This does not only mean that they have to acutely adjust to different lifestyle factors, they also have to unveil patterns in their treatment regimen and adjust accordingly. Together, this places a high level of demand on patients and is highly intrusive in a person’s life.

Problem
Besides the issues demonstrated above, user and HCP research revealed barriers to effective self-management. These were categorized in two sets of problems (A) ineffective self-management, which includes (1) lack of reference, (2) lack of knowledge and (3) lack of structure and (B) lack of support from (4) HCPs, (5) social environment and (6) others with diabetes. Together this leads to sub-optimal self-management, decrease in metabolic control, decrease in quality of life, decrease in health status and increase in cost.

Design proposal
Together with patients, a holistic design was developed to support patients in their self-management. The design consists of a physical product supported by a smartphone application (see adjacent page). The essence of the design is described in three key user benefits.

1. Simplify, by providing one place for everything in one clean and simple design, automatically logging most relevant data and enabling the user to effortlessly log relevant contextual factors.

2. Structure, by providing the user with an action plan for self-management, personalised information and meaningful data overviews.

3. Support, by guiding the user with nutrition support, dose calculators, reminders, automation of repetitive actions and personalised feedback and messaging.

Evaluation
The design proposal was evaluated together with patients and HCPs. User evaluation demonstrated that the concept is certainly promising in increasing self-management effectiveness and participants acknowledge the value of the holistic nature of the concept and its features. In addition, healthcare professionals indicate that they see the concept as a great addition to current treatment, think the design has the potential to increase patient insight and would recommend it to their patients.

It is concluded that, although the final design proposal has a huge potential to increase the effectiveness of diabetes self-management, this cannot be fully substantiated within the context of this project and needs to be validated in follow-up long-term research.