Stenopool: A Comprehensive Platform for Consolidating Diabetes Device Data

Abstract

Background: The growing adoption of diabetes devices has highlighted the need for integrated platforms to consolidate data from various vendors and device types, enhancing the patient experience and treatment. This shift could pave the way for a transition from conventional outpatient diabetes clinics to advanced home monitoring and virtual care methods. Overall, we wished to empower individuals with diabetes and healthcare providers to interpret and utilize information from diabetes devices more effectively.

Methods: Stenopool integrates most diabetes devices for glucose monitoring and insulin administration in our clinic. The platform was initially developed with inspiration from open-source software, and the current version is a unique digital platform for managing and analyzing diabetes device data. The development process, outcomes, and status are described.

Results: Since November 2021, Stenopool has been used in our outpatient clinic to integrate over 30 different diabetes devices from around 7000 individuals. Data are primarily uploaded via wired connections, but also using semi-automated and automated cloud-to-cloud data transfers. The platform offers a streamlined workflow for healthcare providers and displays data from various glucose meter, insulin pump, and continuous glucose monitor (CGM) vendors on a single screen in a manner that healthcare providers can modify. A data warehouse with data from Stenopool and electronical health records is nearing completion, preparing the development of tools for population health management, quality assessment, and risk stratification of patients.

Conclusion: Using Stenopool, we aimed to enhance diabetes device data management, facilitate the future for virtual patient care pathways, and improve outcomes. This article outlines the platform's development process and challenges.

Keywords: BGM; CGM; diabetes; insulin pumps; treatment technologies.

Figure 1.

Stenopool architecture. Data from devices like CGMs and insulin pumps are transferred from vendor cloud solutions or by cabled upload from readers, which is then stored on secure servers. The data are visualized on a web portal for use by clinicians and patients. The portal can be integrated with EHR systems. The data warehouse support clinical reports and research, completing the data management cycle from collection to application. The trademarks Dexcom, Medtronic, Insulet, Abbott LibreView, Tandem Diabetes Care, and A. Menarini Diagnostics are the registered trademarks of their respective companies in the United States and other countries. Abbreviations: EHR, electronic health record; SSO, Single Sign-On; Labs, Clinical Laboratory Data.

Figure 2.

Glucose trends. Screenshot illustrating the glucose trends and time in range (TIR) over the last two weeks, with data from Abbott Freestyle Libre and Insulet OmniPod Dash devices. Interactive elements allow for detailed examination of time in tight range (TITR) metrics upon hovering over specific time points within the range. The view displays all relevant metrics, including glucose levels, average daily insulin doses, carbs, and other pertinent parameters.

Figure 3.

Overview of continuous glucose monitoring (CGM) data across weekdays. This gives a comprehensive view of CGM data for each weekday, highlighting the relationship between insulin boluses and glucose fluctuations. Each day is depicted with clear indications of bolus timing in context with glucose levels. Interactive functionality allows viewers to click on a specific day to access detailed data, as presented in Figure 4. In addition, this figure includes a summary metric showing the mean number of days between changes of the insulin delivery device, offering insights into device usage patterns over the week.

Figure 4.

Single-day overview of diabetes management data. This provides a detailed overview of diabetes management for a single day, organized into three distinct sections. The upper part of the figure displays the continuous glucose monitoring (CGM) curve, with markers below indicating the timing and amount of insulin boluses and carbohydrate intake. In the bottom section, basal insulin rates are shown, illustrating the continuous insulin delivery throughout the day. This graphical representation allows for a clear visualization of the interplay between glucose levels, insulin administration, and dietary factors. On the right, a summary panel provides key metrics and data points from the day’s management, including total insulin dosed, carbohydrate consumption, and significant glucose trends or events. This comprehensive layout offers a holistic view of the day’s diabetes management in a concise and easily interpretable format.

Figure 5.

Insulin pump device settings overview. This view provides information on insulin pump device settings. It clearly displays the programmed basal rates for different times of the day, the target blood glucose levels, as well as the carbohydrate ratios and correction factors, which are integral to the insulin delivery process. The figure also indicates the maximum bolus dose and the duration of insulin action. This depiction offers a clear and concise reference to the current settings that govern the pump’s operation, serving as a snapshot for clinicians or patients reviewing the device’s configuration.