← Diabetes Connections | Type 1 Diabetes
Diabetes Connections | Type 1 Diabetes
"It's incredibly exciting" - What's next for Tidepool with CEO Brandon Arbiter
00:43:46
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- [00:01]
A
Support for this episode comes from Dexcom. Here's what really matters. Dexcom G7 is clinically proven to lower A1C, reduce highs and lows, and increase time in range. And we all know that the more time in range, the better you feel. Benny started using Dexcom at age 9 and it's hard to remember the big swings in blood sugar he had before we started using a cgm. I mean, we did it, but it was hard to watch him just feel so crummy. Highs and lows still going to happen, of course, but with Dexcom G7 we're able to avoid those big unexpected swings. And Dexcom is the number one covered CGM brand with most users paying $20 or less per month, which is huge. If you're looking for a CGM that not only gives numbers, but helps improve them, visit Dexcom.com and see how Dexcom G7 could fit into your life. Foreign. This week on diabetes connections Tidepool was founded in 2013, part of the incredible era of DIY diabetes progress, and they've since helped change how hundreds of thousands of people with diabetes see and use their data. I'm talking to CEO Brandon Arbiter about how open source innovation became FDA cleared technology and what's next, including a new partnership with Oura Ring to study sleep activity and menstrual cycles and continued work with Tidepool Loop. This podcast is not intended as medical advice. If you have those kinds of questions, please contact your healthcare provider. Welcome to another week of Diabetes Connections. I'm your host Stacey Sims. You know we aim to educate and inspire about diabetes with a focus on people who use insulin. As this episode goes live, we are just days away from our first Mom's Night out event of 2026. We started Mom's Night out for moms of children with diabetes and Women with Type 1 in January of 2023 and it has just grown so much. We've also expanded into community and healthcare professional events. We've got one in Nashville coming up March 5th. That's a club 1921 as we call it for for healthcare professionals and for patient leaders, camp staffers, Breakthrough T1D volunteers, folks like that. And then we have Moms Night out in Nashville on the 6th and 7th. You can find out more about all of our events over at the website diabetes-connections.com this year. I've said this a couple of times already. This year is so busy looking ahead, not just the events that we're putting on. 4 Mom's Night out events 8 Club 1921 events, and I'm speaking at a bunch of breakthrough T1D conferences, going to Friends for Life. I actually broke down and got myself a paper wall calendar. I mean, I do everything, you know, most of us now on my phone, on the computer, I had a whiteboard when the kids were growing up in my kitchen. And I thought, you know, I need to see something like that this year because in between all of these events and my personal life, I need to figure out where I'm going when I have, like, color coded it. It's ridiculous. But I'm really excited about this year and I hope I get to meet more of you. I'm going to be in Las Vegas at the Breakthrough T1D conference at the end of March. That is March 28th. So if you're in that area, let me know. I would love to see you. And what should I do? Should I go to the Sphere? I've got some extra time. I have been to Vegas a couple of times, but I've never been to the Sphere. So if you're in that area, if you're going to the conference, hit me up, let me know. Otherwise, I'm just going to be like plain Pai Gow in some corner of a casino. All right, my guest this week is Brandon Arbiter. Many of you are very familiar with Tidepool. A lot of you have been following like we have along since they were founded. Brandon is the new CEO. Tidepool's founder, Howard look, stepped back from his role to focus on his health a little less than a year ago. Brandon was named interim CEO immediately, and he became the official CEO this past fall. He was mistakenly diagnosed with type 2 at age 27, and it took five more months to get the correct diagnosis of type 1. Brandon is a founding team member at Tidepool. He was among the first people to adopt and advocate for DIY technology like Night Scout and Open APS and Loop. I learned a lot more about Brandon when he spoke at Mom's Night out in Denver a couple of years ago. So great to meet him in person, and I'm thrilled to have him on the podcast. As I said, we've been following Tidepool since the beginning. I'm going to link up our previous episodes with them. Those will be in the show notes. All right, my conversation with tidepool CEO Brandon Arbiter right after this. From the very beginning, they mean everything to you. And that means you do anything for them, especially if they're at risk. So when it comes to type 1 diabetes, screen it like you mean it Even if just one person in your family has type one, you are up to 15 times more likely to get it, too. Screen it like you mean it, because one blood test could help you spot type 1 long before you need insulin. Talk to your doctor about how to screen for type 1 diabetes because the more you know, the more you can do. So don't wait. Visit screenfortype1.com to learn more. Again, that's screenfortype1.com Brandon Arviter, welcome to Diabetes Connections. I'm so excited to talk to you. Our I'm realizing as I'm introducing you this is your first time on the show. That is unbelievable to me. Thank you for being here. I can't wait to catch up.
- [05:38]
B
Oh, it's an honor and a pleasure. I'm glad to be here. Thanks for having me, Stacy.
- [05:41]
A
You got it. Let's dive right in. I'd love to start by just asking you about what tide pool is. I feel like a lot of people have a lot of good feelings toward tide pool, but they may not even know what you really do. Would you mind explaining that? How do you explain Tidepool?
- [05:57]
B
Sure thing. It's something I do a lot. So Tidepool is a bit unique in our industry because we're making software and we're a non profit organization. There are certainly nonprofit organizations in the diabetes space. Breakthrough T1D beyond type 1. I mean, there's many, many, many, and they're all doing incredible work. We actually make software and so you could imagine us being a for profit. So it kind of begs this question, well, if you could be a for profit, why are you a nonprofit? And there are a couple reasons behind that. One is, you know, we started off making software for people with type 1 diabetes and that's not a huge market. When you think about being a venture backed for profit startup, they really want you to get to a valuation of a half a billion dollars or a couple billion dollars to get acquired. And all the investors do great. We're not sure that the market is that big, certainly if we're going to be focused on type one. Now, as we've been in market, our products have resonated deeply with people with type 2 diabetes and the doctors and CDCes that provide care for them. So our market has naturally expanded beyond type one, but I still am not sure that it's a $500 million business. So that's part one. Part two is we always wanted to make decisions that were in the best interest of people with diabetes. And as soon as you bring on investors, your company culture shifts and you have to start making decisions that are in the best interest of your investors. And if, God forbid, that should be in conflict with what's in the best interest of people with diabetes, that's a position we don't want to ever be in. Being a nonprofit organization allows us to put the diabetes community first. We've always been able to put the diabetes community first and we will continue to do that.
- [07:50]
A
Yeah. And certainly we've seen enough companies come and go who are trying to make money in this space or be purchased by other companies, which kind of shelve it or, you know, it's. We have seen that happen because the market isn't that big. That's really interesting, product wise. I know tidepool has a few things we're going to talk about, but I remember first hearing about this as like a data uploader. Right. Back in the day. Can you explain what, what that's all about? What, what tidepool started as?
- [08:16]
B
Yeah, that is exactly how we got started. Back in 2013, when Tidepool was founded, the most popular insulin pump on the market was the Medtronic 523 723. And the most popular CGM on the market was the Dexcom G4. So a lot of folks with Type 1 were wearing those two devices and there was no software in the world that would let you see data from those two devices on one screen at one time.
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A
If anyone is confused, no, no, they did not work together.
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B
They did not in any way, shape or form. They didn't talk to each other in real time. They didn't, they didn't talk to each.
- [08:54]
A
Other in lag time at the time.
- [08:56]
B
That was like a pipe dream that they would actually communicate with each other, that a CGM would communicate with an insulin pump. But even just being able to see, oh, here is my bolus for this meal, and then an hour later, here's what happened to my glucose. You couldn't even see those things on a screen a week later when you were in your doctor's office. So this was an issue as these devices were beginning to proliferate and we were all starting to adopt them. Doctors had no way of seeing the data in one place at one time. And so we solved that problem first for the Medtronic devices and the Dexcom devices. Then we added the Animus devices and the Tandem devices and the Omnipod devices. And then we started adding blood glucose meters. We added the Libre cgm. And so this platform that allows you from the comfort of Your home or from the doctor's office to review the data. Regardless of which devices you're using, this is where we got our humble beginnings. It started in 2013, and as of this week, we've had over 950,000 people use the software.
- [10:01]
A
All right, so we'll fast forward to now. I have talked to the folks at tidepool the last couple of years about things like the period project, of course, twist, which we'll get to. But I want to start with Aura. Tell me why you want to partner with a sleep ring.
- [10:18]
B
So I'm a very happy Oura Ring user and was before we inked this partnership. It's certainly more than a sleep ring. So OURA does have great data about how you slept. You get a sleep score and a readiness score every day. But it has a lot more than that. It's doing your step counting, your activity tracking. When I go skiing, I live in Colorado. When I go skiing, the Oura ring tells me, oh, Brandon, were you downhill skiing today? It knows. When I'm playing hockey with my son, it says, brandon, were you playing hockey the last hour? It knows. And so it has some sort of intelligence in it where it can start to recognize the activities that you do. So not only is it labeling your sleep minute by minute, hour by hour, overnight, and telling you how well you slept, it's labeling all of your activities. It's also tracking temperature data and helping women using the temperature data track fertility cycles. And then they can use the app to log and give even more high fidelity information into into the app. And when you think about diabetes, Tidepool in 2017 launched the Tidepool Big Data Donation project. This was an opportunity for any of our users when they sign up or if they're using tidepool to opt in to donating their anonymized data to research. Over 50,000 people have donated their data to research and we have provided those data sets to well over 50 institutions. We get probably at this point another request every month for access to data. A lot of them are academic and nonprofit researchers. And so we give those data sets away, generally speaking, for free, to those researchers. And then a lot of times it's industry looking for these kinds of high quality longitudinal data sets. If we're able to license these data sets and actually generate revenue from it, we also ask when you donate your data to select your favorite diabetes nonprofit organizations. And then we share the proceeds that we get with your favorite diabetes nonprofit organization. So we've also shared hundreds of thousands of dollars with other diabetes nonprofits through running this program. The program has a ton of CGM data, a ton of insulin pump data, but what is it missing? It's missing sleep data, it's missing activity data, and it's missing fertility data or data about women's cycles. And this became a huge opportunity. So my co founder and our former CEO Howard look, actually worked with the Oura Ring CEO Tom Hale at a previous job. They were close collaborators. And Howard Kelly and I were in a meeting together talking about how great these Oura Rings are. And Howard said, you know, I. I actually know the CEO of Oura Ring. We used to work together. Then we looked at Howard, we said, what are you doing? So Howard scheduled a meeting with Tom. The two of them talked. I was not there, but the meeting must have gone great. And I think Tom was really inspired by our mission. And Howard was wearing an Oura ring. I wear an Oura ring. A bunch of the folks on tidepool's leadership team were already wearing Oura Ring. So we're sold and we understood the power of this data. Now, Oura Ring is not a medical device. It's a wellness device. And they have a partnership with Dexcom, allowing STELO data to come into the Oura Ring. Stelo is also not a medical device. It's a wellness device. But I think there's a lot of interest from Aura, from Dexcom, from us, from researchers all over the world to actually pull the medical device data together, bring the Oura Ring into the medical device data. And that's where tidepool comes in. Because we can do that in our retrospective data display platform, as opposed to doing it in a real time medical device, which has different regulatory implications. So Oura Ring was very excited to partner with us on this project, and we'll be announcing more over the coming weeks.
- [14:19]
A
Let me ask you, I'm a terrible person to talk to metrics for health and things like sleep and blood glucose about. I don't live with type one. I do have a bed that measures my sleep and I look at it in the morning. I'm like, yeah, I know I slept like crap. Or, yeah, I know I slept great. Like, it gives me a score and I kind of put it to the side. But obviously, when you have type 1 diabetes, they have always said, like, the person with the most data wins, right? Like, I want my son to know, how does sleep affect his blood sugar? I want him to have access to all that. I know somebody's gonna send me an email that says, you should have it too. And I'm like, I know, but Brandon, you live with type 1. Can you talk a little bit about sleep and blood sugar? Because I know it's gotta be complicated and nobody gets a full night's sleep anyway with type 1.
- [15:01]
B
Half the time in my personal life, and this is, I think, key to the daily lived experience of people with diabetes. You know, we say your diabetes may vary. I don't know that I notice an effect of poor sleep days versus good sleep days on my glucose. I hear from doctors that I should, but I don't know that I do. And there is no statistic out there telling me otherwise. So I have a complete lack of visibility to the connection between sleep and glucose. Does the time I go to sleep matter? Does the time I wake up matter? The duration of sleep? If I wake up in the middle of the night, does that matter? Or the other way around, how often is diabetes waking me up? Right, right. We think about, how is sleep affecting our diabetes, but what about how is diabetes affecting our sleep? And I think to have some visibility and transparency into both of those questions would teach me a lot about my diabetes and my diabetes lived experience. Some of these connections are really hard to make even for the person living with diabetes. But once you can see the data, you start to see. It's like seeing a reflection. It's like looking at yourself in the mirror for the first time. You start to see things that you know are true, but it was really tough to put your finger on it before you were able to look at the data.
- [16:21]
A
It makes a lot of sense, and.
- [16:23]
B
That'S my two cents on sleep. But I think that for women living with diabetes who are living with menstrual cycles every month. We know the science has already told us that insulin resistance, insulin sensitivity changes throughout the menstrual cycle, but the data is so limited. I think the largest study to understand the impact of menstrual cycles on insulin sensitivity and glucose has something like 40 participants in it.
- [16:53]
A
Wow.
- [16:54]
B
Through the Tidepool big data donation project and our partnership with Aura, we are looking to recruit thousands of women to donate data for months or years so we can track this anonymized data over time in a prospective IRB approved study and then make all of that data available to all of the researchers who want to dig into it in many different ways. And the menstrual cycle is just the beginning. We're gonna be looking at the whole life cycle of what it is like to be a woman living with diabetes from puberty, pregnancy, perimenopause and menopause. I think as a community, I don't even think it's fair to say we've scratched the surface. I think we're at the very beginning. We have so much to learn and I think that we can go 0 to 60 very fast with the amount of data that we are planning to collect in this upcoming study.
- [17:48]
A
It is interesting to think about it that way because I think even my earlier question about being skeptical of my health and my sleep, we don't know.
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B
I don't know.
- [17:56]
A
Would going to bed half an hour earlier, would changing the temperature in my room, would having less light, you know, in the hour before I go to bed without type 1 diabetes, these are all things that I'm not sure we know. So I really think that's fantastic. You said studies are going to be starting this year, right? Back with more of that conversation. But first I want to bring you a word from our community. Type 1 diabetes doesn't end at childhood, so why does support at Grown Up t Wendy's? It doesn't. I'm Kelly Dawes, founder of Grown Up T1DS, a nonprofit built for adults living with type 1 diabetes. We don't gather because of diabetes, we gather because of each other. We're adults living with type 1 diabetes, whether diagnosed later in life or decades in, who still want to hang out, laugh, make friends and feel normal again. Our meetups aren't clinics or lectures. They're social, welcoming and full of that moment of relief when you realize, oh, I found my people. We spend a lot of time connecting online, but being together in person hits differently. Learn more and find a meetup near you@grownupt1ds.org because life with T1D is Val better together.
- [19:15]
B
The collaboration between Tidepool and Aura will be done under an IRB approved study protocol and that is going to be launching over the next few weeks.
- [19:25]
A
The other big piece of news that I wanted to talk to you about is of course tidepool loop and integration with the first insulin pump. We've already mentioned Howard. Look, I had interviewed him in 2018 when it was all announced that Tidepool was gonna try to shepherd this first really DIY software system into an insulin pump. And now here we are and people are using it. Let me just ask you, Brandon, how is that for you all to have seen this go from 0 to 60 to use what you just were talking about?
- [19:53]
B
It's thrilling. We have worked so hard to take the Loop app that so many people in the open source community have been using for years. Best estimates right now are that 20 to 30,000 people are using the open source version of Loop. There's clearly such a high demand for this product and to be able to establish a partnership with an amazing company like SQL that moves very fast. They're very innovative and it's a wonderful product partnership that we have. So what we've done is we have made the Loop app and then we have an agreement with SQL where they basically take what we've built, they re implement it. They've actually put the algorithm from Loop onto their insulin pump. So if you walk away from your phone, the pump will keep looping. The algorithm is still active. You can still use the great app to announce your meals, to enter an activity mode, or just to look at how you're doing right now. But this partnership with SQL has been wonderful. It's incredibly exciting for the team to see the fruits of the labor, to see what we've built get into the hands of so many people with diabetes.
- [21:03]
A
One of the questions I get asked a lot is, well, if it's a DIY app and it's always improving and people are iterating on it, what happens to the app in the pump which has to go through FDA regulations and updates? In other words, can they use a later or latest version of Loop?
- [21:23]
B
Yeah. We are all standing on the shoulders of giants here. The folks in the open source community who have built Loop, who have continued to improve and iterate on it, are just some of the great heroes of our community and they should continue to do their thing and keep making it better and better and better. Tidepool is like a translation unit. We're taking their innovation and putting it into our process to convert it into what is really an FDA grade medical device. Right. And that requires different processes than what a DIY or an open source community is going to independently do. So we are running extensive user research and human factors testing. Right. That is a level of rigor that the open source community is not going to do. We're establishing partnerships with commercial entities also not something that an open source community is going to do. So as the community is innovating, we are always looking at those innovations. I am a user of that open source version and I am constantly benefiting from those innovations. But at tidepool, we're thinking about how can we translate those innovations into something that could go mass market.
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A
Yeah.
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B
Putting it through those processes, taking it to the FDA as needed. We also have what's called a predetermined change control plan. There are many changes that we are permitted to make to Tide Pool Loop to that do not need to be submitted to the fda. We can just push them through. Sometimes we notify the FDA after the change is made. Sometimes we don't even have to do that. There is a process and I think to have the rigor to hit to, to meet the scale that SQL intends to meet, we really do have to have this rigor of a medical device. And that's what tidepool brings to the table. So will there be a discrepancy between what the open source community is using and and what is available in tidepool, Loop or in the Twist app? There will likely be some discrepancies. Tidepool is always working to not just catch up to where the open source community is, but also to make improvements that get fed back into the open source community should they choose to take them on. Because our code is also open source so the community can take the benefits. And with Loop 3.0, the open source communities. Loop 3.0, that was released a couple years ago that had all of the improvements from tidepool Loop. So it's kind of a two way street, right? We get improvements from the open source community and then the open source community, should they choose to adopt them, can also bring in improvements from tidepool.
- [24:04]
A
What is your favorite part? Or do you have one of Loop? Like is there part or a feature of the system? Assuming you've used other systems or looked at commercials, I mean, is it the little icons and the fun little cartoon? Is it the flexibility? I mean it sounds silly, but I'm just curious if there's anything that still stands out to you.
- [24:25]
B
I have a short list. So one is the Apple Watch control. Being able to announce carbs and like enter a bolus from an Apple Watch and not have to take a phone or a controller out of your pocket is just amazing. To be able to bolus from a ski slope like, like that is just phenomenal. That's one novel feature that I think is just above and beyond another. And this is so simple and people use it all the time and it is not available on any other commercial system is the ability to edit your carb entries. If you entered 40 grams of carbs, but it turns out you only ate 20. With loop you can just edit that because it's an iPhone app and you can edit numbers on an iPhone app if you forgot to announce your meal and you realize 45 minutes later, oh, I ate 45 minutes ago. On these other systems you get into quite a conundrum because you can't tell it when you ate it, it's going to assume you're eating it now. So do I tell the system that I'm eating for this meal now? Do I lie to the system and say that I'm eating half of a meal now?
- [25:29]
A
I think we've all done that. Right? We're like trying to figure it out.
- [25:32]
B
Right. So with Loop, as you're entering the meal, you can just change the time backwards or forwards. So you can announce a meal you're gonna eat in 30 minutes or you can announce a meal that you ate 30 minutes ago. It's the simplest user interface, but it, it is, it's incredibly user friendly and it's still unique on the market.
- [25:53]
A
Yeah, okay, so dumb question though, cause I'm not sure I even understood when you say if you told the System I'm eating 40 carbs but you eat 20, isn't that insulin already in your body? Is it changing future basal rates? Like what's it doing?
- [26:05]
B
That's exactly what it's gonna do. So it's gonna do two things. One, it will change your future basal rates so it'll cut off insulin delivery immediately. Second, it's gonna show you a forecast of what's gonna happen to your blood sugar and maybe you're gonna be fine, or maybe you need to eat some carbs. And that is another unique thing about the Loop app that other systems don't provide is a future forecast. One great use case for that is my blood Sugar's low, I'm 45 milligrams per deciliter and I'm eating some carbs. How many carbs do I need to eat? Do I need to eat 15? Do I need to eat 30? You can enter your rapid acting carbs into Loop and it will show you in the forecast is your blood sugar gonna come back up into range. That helps prevent overeating, which is, I think something we've probably all done.
- [26:54]
A
When you're talking about Loop here, I just wanna be super clear for listeners. Are you talking about the DIY loop that is still non commercial, or are you talking about the loop that is on Twist?
- [27:04]
B
Everything I've talked about is true of both systems, the open source as well as Twist. You can bull us from an Apple watch, you can edit your carb announcements and you can input your low treatments and see what's going to happen. All of those are both on the Twist app as well as in the open source community.
- [27:22]
A
Can we talk about you for a minute?
- [27:23]
B
Sure.
- [27:24]
A
Okay, so earlier in this interview, one of the first things we talked about was the this thing doesn't talk to that thing. The Medtronic and the Dexcom. And I wanted to hear about tide pool. And I went through that, but I didn't stop. And I should have, because you developed that, right? This was part of your story. Now, I know there's a lot of people who did a lot of things. No one ever wants to take any credit, but isn't that how you got started in the DIY community?
- [27:45]
B
I developed a flavor of it. I like that there's a number of people working on a number of flavors of things. And my particular flavor, I was living in New York City when I was diagnosed at age 27, and I have type one. So that was an uncomfortable nine months without insulin. Fortunately, I got through that and eventually got on insulin. But once I did, at the time, I was working in analytics at New York's online grocer FreshDirect. And my career, my specialty was taking time series data across logistics networks and pairing that up with food data. How often are eggs getting to our customers broken and what trucks did they go on? Questions like that. All of a sudden, I get diagnosed with type 1 diabetes, and I get put on an insulin pump and a glucose monitor, each one generating about 300,000 data points per year that, frankly, were not being used for anything. And at the time, I was an avid user of an app called Foursquare.
- [28:52]
A
Oh, yeah.
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B
Which would track my location as I went around New York City. And every restaurant I would go to, I would check in on Foursquare. And the insight that I had is, what if I took the data from my cgm, my insulin pump, and Foursquare and put them all together into an iPhone app. So when I walk into a restaurant, the app would show me the last time you were here, this is what you ate, this is how much you bolus, and this is what happened to your blood sugar. And so, with the help from a couple friends, I built that app and I used it all over New York City, and it worked. I was solving meal boluses at restaurants around New York. I remember one of my, like, proudest moments was eating this ridiculous dinner at Hillstones. I don't know if you are familiar with Hillstones. It's basically like a steakhouse. They. The portions are just humongous, right? Sometimes it's called Hillstone, sometimes it's called Houston's. But I got like, a spinach artichoke dip appetizer, a veggie burger with fries, and then whatever their lava chocolate cake Is and I did this three times in succession. And I like iterated on my bolus over this time period. And the third time, my blood sugar didn't go above 180. And that was mind blowing to me that I could eat this crazy meal and have a blood sugar under 180. And that was the power of solving for meal boluses. People that I would meet in the diabetes community would see this app cause I would excitedly show it to them. And one day I was at a wedding in Los Angeles and sitting next to a young woman and we were chit chatting and she mentioned that she works at Medtronic Diabetes. And I said, oh my goodness, I use your insulin pump. Can I show you this app that I made using the data from the pump? And so I showed her the app and she was so excited. She said, can I talk about this at work on Monday? And I said, of course you can. And a couple weeks later, I got a phone call from Lane Desborough, who was at the time the chief engineer of Medtronic Diabetes. And this was just an absolutely crazy moment in my life. Someone who has so much influence in the diabetes space in just product roadmaps of the biggest insulin pump company in the world is calling me to find out what I'm working on. Anyway, he loved the concept of the app and he introduced me to Aaron Kowalski and David Panzer in New York City. I ended up going to beers with the two of them.
- [31:15]
A
Wow.
- [31:16]
B
And the rest was history. In fact, it was Aaron, a couple months after that meeting, who got an email or had a conversation with Howard, look. Who would become my co founder at tidepool. And Aaron called me and said, hey, I just talked to this guy. He's yelling at me about the same things you are. We don't have access to data. Can you two talk and figure it out and then let me know what we should do? And that was the moment. That was the introduction I got to Howard, who would then become one of my closest friends, my mentor for the last 13 years. And absolutely that changed the trajectory of my life.
- [31:54]
A
That's an amazing story. I kind of knew that you were connected with those people early on, but. And as you listen, a lot of name dropping there. We've talked to all those people. So I will link up lots of podcast episodes in the show notes. I think most of you are probably familiar with them. And I just talked to Lane last fall for the podcast, but I had no idea that it was a wedding. Just a seating arrangement at a wedding that made your first connection with Lane. I have to believe that you would have been connected eventually anyway with what you were doing. But that's pretty remarkable.
- [32:22]
B
Isn't it funny the way life unfolds?
- [32:25]
A
Yeah, it really is. I mean, especially the diabetes community is so small. And I'm so thankful that all of you found each other early on to make these changes. Do the folks at Foursquare know that they were instrumental? Have you talked to them?
- [32:37]
B
They do. Dennis Crowley, the founder of Foursquare Nephew, was diagnosed with type one.
- [32:43]
A
Oh, my. I was gonna say, look, well, I can probably introduce you to Dennis. Cause he's an SU grad, I think. And that's so funny.
- [32:49]
B
That's funny.
- [32:49]
A
Oh, wow.
- [32:50]
B
So Dennis was an absolute hero of mine, being a startup junkie in New York City in the aughts. Foursquare was really the first big New York City based startup. And so I would go to events at Foursquare all the time. I'd never met Dennis, but I was power user Zap. And then I got introduced to him and it was. It was a milestone moment in my life. And actually there's a photo of me in a zoom meeting with Dennis, telling him about how his work in Foursquare changed my life and led me to Tidepool.
- [33:22]
A
That's wonderful. I love it so much.
- [33:24]
B
One topic that has been gaining a lot of steam recently is what we call Timely Interventions for Diabetes Excellence. This is a program that we have been partnering with Stanford Medicine on for the last couple of years. They pioneered it. That name comes from Stanford. Their leadership team had this hypothesis that in the first year after diagnosis, you know, you start in this honeymoon and then your blood sugar starts to get progressively worse. And as that happens, you're coming in to see your doctor every three months. Well, what if your blood sugar starts to get noticeably worse two weeks after that appointment? And then you're not coming in for another two and a half months. You're missing an opportunity, a well timed opportunity to teach a person with diabetes about how to make those changes. And so they created a dashboard where glucose data, CGM data, would flow into this dashboard. The dashboard would prioritize what patients need to be reached out to right now. When I say right now, this week.
- [34:31]
A
Right, Right.
- [34:32]
B
Not real time monitoring, but it's week to week monitoring. And they saw an A1C improvement of 1.1% between the patients who were enrolled in this intervention from the patients who were not enrolled in this intervention. And they were also teaching good habits to people right after diagnosis instead of waiting five or ten years for bad habits to form and then trying to intervene. Tidepool has partnered with them to create the Tide Dashboard in tidepool, where it now sits. And we have been working on rolling that out across the country. Now, it's not as simple as just here's the software, everyone's going to use it. It's a change in clinical workflow, so the clinicians need to get behind it. And as Dr. David Maaz Stanford says, you have some clinicians in this country that look at their outcomes and say, this is not good enough. We have to do better, we need to make a change, and this is the change. And then you've got other clinicians who look at their outcomes and say, this is what it is, this is good enough. We're not starting with them.
- [35:42]
A
Well, and to be fair, and I know you know this, we also have so many clinicians who are already like overworked and have no time. And I would imagine would look at something like this, that's a challenge too, to tell them this is something else to take on. I mean, not to be negative about it, but that's my first reaction, is.
- [35:58]
B
Like, oh, no, another tool that's 100% correct. It requires some change management. You're implementing a new workflow. So the diabetes educators at, at Stanford Medicine who run this program, they each spend about four hours a week looking at this dashboard and reaching out to patients. It doesn't have to be any particular four hours a week when they have a last minute cancellation. That's a great time to spend 30 minutes in this dashboard. Reach out to a few patients remotely. You can have real impact on people's lives, even just slotting in time when appointments are canceled at the last minute. But it is a workflow change. And so one of the things that tidepool is doing in this process is mapping out that workflow change and discovering how can we take everything that we've learned from the clinics who have already rolled this out and then teach the next clinic to make it even easier. So that's the process, that's part of the commercialization process. Right. And that's part of what our role is in this community, is teaching folks, how can you do this? What are the barriers to expect and how do we knock down those barriers?
- [37:03]
A
Before I let you go, I have to ask, you had mentioned Howard as a mentor. Howard, look, you know, stepping down as CEO, you stepping up as CEO, first interim and now, you know, the permanent CEO, you've been there since the beginning. Brandon, what is this like, for you.
- [37:18]
B
I think there was some imposter syndrome over that first week. It was certainly like drinking from a fire hose. There was part of tide pool, the HR part. There were just. There were some parts of tide pool that I just didn't have exposure to all of the tax documents that we get in from the 12 different states in which we employ people. So there was a week of it being a fire hose, but that period ended very quickly because it was a tough time. That time of that transition was a very tough time. And it was, I think, trial by fire, and we had no time to nurture me through a transition. Right. And I think that's kind of the best way to do it. They pushed me into the deep end, and it was like sink or swim. And so far, we're swimming. So I appreciate you asking. Yeah, that's. It's been an interesting year, for sure.
- [38:10]
A
I mean, there's so much going on. I hesitate to ask, but big goals for tide pool. Like, ultimately, what do you want to do?
- [38:18]
B
Ultimately, I want to do two things. I want us to raise the ceiling on outcomes that people with diabetes can achieve. There are so many examples out there that we can do better. And personally, I try to stay on the cutting edge so I know we can be doing better. Ten years ago, it was, everybody needs to get on an aid system, and there were no aid systems commercially approved. Now you've got GLP1s that have tremendous impact on people with type 1 diabetes, but they're not commercially approved for people with type 1 diabetes or they don't have FDA approval for type 1. There are these changes that we need to make as a community to continue to raise the bar on what we can achieve. And there's many other examples of that. But while we look to the future and to the sky, we also need to look at who in our community has kind of become invisible to the system. Who is not getting the care that they deserve to be getting, who does not have access to the doctors or to the technology that they should have access to. And we need to raise the floor for those people. We need to make the invisible visible. Those are, I think, the two paradigms that I am pushing us at tidepool to think about every day and to drive the needle on if we can improve the outcomes that are achievable and then make sure that more people are able to achieve them, we're going to make the diabetes community a much healthier community.
- [39:50]
A
Brandon in 2026, I'm asking all of my guests for a Diabetes organization or group or, I don't know, meetup that made a difference to them. You know, I, maybe it's Tide Pool. I, I understand that's, that's changed your life in a lot of ways, but is there anything else that you'd like to mention?
- [40:05]
B
You know, he said, earlier in the podcast, we talked about standing on the shoulders of giants. I feel like so many of us are doing that and people reach out to me for help occasionally and they're so apologetic about it. I said, please don't apologize. You have my phone number. Contact me 24 7. Never hesitate. If you knew how many people have supported me on this journey, your mind would be blown that my greatest privilege is to be able to pay it forward. You know, when I think about the people, the organizations that have supported me and my journey, certainly breakthrough T1D is one of them. The Helmsley Charitable Trust is one. And the Open source community, you know, folks in the Night Scout foundation and the developers of Loop. I mean, to have such a direct impact on so many people's lives and not even have a job in this industry is incredible. So I would, I'd give a shout out to them.
- [41:04]
A
That's fantastic. Well, Brandon, thank you so much for joining me. I kept you longer than I had told you, so I appreciate you hanging out. But it was wonderful to learn so much about what's going on there and I hope you come back and tell us more. Thank you.
- [41:15]
B
Thank you for having me, Stacey. Bye Bye.
- [41:22]
A
More information about everything we spoke about. You can head on over to the Show Notes wherever you are listening. If it's difficult to find on Apple podcasts or Spotify or wherever, head on over to diabetes-connections.com every episode has its own homepage. We are redoing some little backend things on the website right now and trying to make the events page, frankly look a little better because there's a lot going on over there. So every once in a while you may find that there's an issue getting to the website. I feel like I need a little like a standby sign right now. But if you ever do have trouble getting to the homepage, just let me know. It's usually a very easy fix, but you can always also go to like diabetes-connections.com events and that'll get you there. I know that is way too much inside baseball, but if you are still listening right now, hey, you're here for that kind of stuff. I'll see some of you this Friday in Silver Spring, Maryland. For our mom's Night out event. Super excited about that. If you're thinking about coming to Nashville, please don't wait. That will be here before we know it. And then check over to the website please for our Club 1921 events. Thanks to my editor, John Buchenis from Audio Editing Solutions. Thank you so much for listening. I'm Stacey Sims. I'll see you back here soon. Until then, be kind to yourself. Diabetes Connections is a production of Stacey Sims Media. All rights reserved.
- [42:49]
B
All wrongs avenged.
- [42:55]
A
At one of our recent Moms Night out events, the Omnipod team was on site asking moms about their experience with the OmniPod 5 automated insulin delivery system. It was so much fun and it was great to hear what the moms have to say. Here's what Angela, mom to Dominic, told us. My son is 10 years old and.
- [43:15]
B
He uses an Omnipod 5.
- [43:16]
A
It's the only pump he has used since he was diagnosed. It's been a life changing piece of.
- [43:21]
B
Equipment for him to have.
- [43:22]
A
He's a competitive swimmer, he is able to keep it on in the pool and we don't have to worry about disconnecting. So we absolutely love Omnipod and it is really, really just made a big difference in his life. Want to try Omnipod 5 for yourself? Request a free Omnipod 5 starter kit today by visiting omnipod.com diabetesconnections Terms and conditions apply. Eligibility may vary.