Case Study: Advanced Bolus Calculator for Diabetes

DigitalHealth.London met with NHS intrapreneur Dr Nick Oliver to find out how he’s using digital technology to support people with type 1 diabetes to effectively self-manage their long term condition.

Dr Nick Oliver
Dr Nick Oliver

Dr Nick Oliver is the Wynn professor of human metabolism at Imperial College London and honorary consultant at Imperial College Healthcare NHS Trust. His clinical and academic interest is type 1 diabetes and the application of technology.

Here, Nick introduces DigitalHealth.London to his innovation – a mobile app called the Advanced Bolus Calculator for Diabetes.

Health impact

Currently, type 1 diabetes requires insulin treatment for life. For those managing their condition, if their blood glucose is high, it can cause problems with their eyes, their kidneys or their nerves. If their blood glucose is too low, this can cause significant functional effects. Low blood glucose is probably still the leading cause of heath in young people with type 1 diabetes.

Challenges affecting the delivery of care

For those with type 1 diabetes, managing this condition can be burdensome, potentially impacting quality of life. People with type 1 often take four or five injections of insulin each day to manage things like food intake and need to consider their food, work out how much carbohydrate is on the plate, and convert this into an equivalent requirement of insulin, taking into account the day of the week, how much exercise they’ve done, what they’ve had to drink, what the weather’s like, what they’re going to be doing later on.

There’s a huge number of variables that people with type 1 diabetes need to consider when preparing their insulin injections.

Introducing innovation

Developed by a cross-faculty team at Imperial’s NIHR Biomedical Research Centre, the Advanced Bolus Calculator for Diabetes is a simple smartphone app which aims to support people with type 1 diabetes to effectively self-manage their long term condition.

This tool is self-learning, and uses previous information to support people in making more effective decisions around their insulin. For example, if you were having lunch on a Thursday, you had a glass of wine, and you’d previously exercised that day, the next time you have a similar meal the system will recognise how much insulin you need based on previous results.

The system learns in an incredibly structured and systematic way, and therefore takes into account lots more variables than often people with diabetes are able to do on a day-to-day basis. All the user needs to do is tell the app their blood glucose level alongside simple information such as food and alcohol intake and any exercise they’ve done.

Importantly, this technology integrates with lots of other systems including continuous glucose monitors.

Progress to date

Nick and his colleagues have been able to demonstrate that this innovation helps people manage their blood glucose level, and arguably more importantly, that people like using it. From the very beginning of their innovation journey, they’ve closely aligned with patient advocate groups to ensure that the technology will effectively meet service user needs.

They’re now about to begin a much larger randomised control trial (RCT) across west London, in order to build the evidence base for this technology.

5 minutes with an NHS intrapreneur

We quizzed Nick on some of the challenges he’s faced during the innovation process and his tips for other NHS intrapreneurs.

The importance of regulation

“One of the big problems with digital innovation is, how do you regulate it? Regulation in terms of how do we protect our code? How do we prevent malicious intent? How do we demonstrate that it’s clinically and cost effective? How do we regulate who gets it?

“These are some of the challenges around the digital space that need addressing.”

A three-way partnership

“When you go to any of the research councils for support to develop a digital intervention, if you’re a group of engineers it’s critical to have clinical input and, if you’re a group of clinicians it’s imperative to include engineering expertise. If you don’t have patient involvement you’re going to be asked how, in the absence of a user group, you’re going to get it right.

“Funders find it much more credible if you have all three of these partners. You’ve got to approach them as a group and make sure everything you do is cross-faculty and includes your intended user group.”

The funding gap

“There’s funding for engineering-focussed projects and there’s funding for clinical studies, but there’s a gap which needs to be addressed between a good idea and demonstrating effectiveness. That might be in the form of a small pilot or feasibility study to demonstrate that an idea is worth pursuing. So that’s often a challenge.

“We’ve been fortunate to have had the support of Imperial’s NIHR Biomedical Research Centre and the Medical Research Council-supported Confidence in Concept scheme.”

An evidence base is crucial

“There’s huge potential for clinical and cost effectiveness using digital technology but all of it has got to be supported by an evidence base. We’re at risk of spending a huge amount of time, resource and finance on digital solutions that do not have an evidence base that they support clinical care of people and we’ve got to do that first. We wouldn’t implement anything else without an evidence base, so why is digital an exception?”