DiabeXO

Why it exists

The titration

In school chemistry lab work, we all studied titration: acid is added to alkali drop by drop. The indicator changes colour only when the reaction is complete. A chemistry teacher once made the point that matters: the reaction starts with the first drop. It is only invisible until then.

Type 2 diabetes works the same way. Medicine usually notices the colour change, which is the complication. DiabeXO exists to show the drops.

Damage to the kidneys, eyes, feet, nerves, heart and vessels begins years before it is diagnosed, and much of it is already measured in the NHS annual checks. Yet in England only about half of people with type 2 diabetes receive all eight of the care processes each year (National Diabetes Audit). The early signs exist; they are scattered, unseen, or seen too late.

The aim is not to frighten anyone. It is to help each person become an informed Captain of their own condition: someone who can see the drops and act on them in time, with their care team.

Why “XO”

On a naval ship, the XO is the Executive Officer, the captain’s second in command. The XO keeps the watch and the log, sees that every station is ready and brings the captain what he needs to decide. The captain commands. In DiabeXO the person is the Captain and the app is the XO.

Diabetonomy

The first name for the idea was Diabetonomy: diabetes and autonomy. It survives as the destination. DiabeXO is the ship; Diabetonomy, autonomy over one’s own diabetes, is where the voyage ends.

What the XO does

Watches, records, reminds, prepares

• Keeps the logMedicines by sitting, food, notes and readings from the devices a person already uses, gathered in one place, each figure with its source.
• Reminds, and checksReminders at each medicine time, a check that the right insulin is in the right pen, and help to fill each pot of tablets by voice without missing one.
• Prepares for the clinicA plain summary for the GP or diabetes team: the key figures against the person’s own usual, the changes, the person’s own reasons, and the open questions.
• Keeps the data with the personThe record lives on the person’s own phone. Nothing leaves it without their consent.

What it will not do

The lines it does not cross

• It never suggests doses, treatment changes or carbohydrate amounts. Those decisions belong to the person and their care team.
• It never replaces the glucose sensor maker’s alarms, and it never interferes with them or with a carer’s sharing.
• It does not judge readings as safe or unsafe; it describes them.
• It never sells or shares a person’s data, and it will always be free for patients.

Who is building it

Vinayak Supekar, founder and first Captain

Vinayak has lived with type 2 diabetes for about thirty years and is now on insulin. He has been a carer to a family of diabetics since his teens. He also lives with Crohn’s disease, heart disease with angina, fibromyalgia, osteoporosis and the fatigue of long COVID, so he knows from the inside what happens when the rules written for one condition contradict another, and when a ten-minute appointment has to hold all of them.

He has used many diabetes apps. None satisfied him, because they collect readings without understanding the person, the condition, or the conversation between patient and clinician.

The idea came in a dream about fifteen years ago, soon after he began wearing his first Apple Watch. It was ahead of its time. Then came the pandemic, and years in which his own health came first. Those years were not lost: they filled the hazard log with dangers learned from experience rather than imagined. Now the tools have arrived. Someone who does not write code can build a working app with an AI collaborator, and he is doing exactly that, carefully, in the open.

How it is being built

Safety first, and everything written down

1. A hazard log from the first day. Every way the XO could cause harm is entered with its controls before the feature ships: 44 hazards so far, among them the wrong insulin in a pen, ketoacidosis with normal glucose, and remedies with unknown ingredients.
2. A decision record and an evidence log. Every design choice is recorded with its reason and what was rejected; every check against a reference source is logged with its result.
3. The data checked against its source. Glucose arriving by an official data route has been compared, reading for reading, with the sensor maker’s own record: complete at 15-minute intervals, with an average difference of 0.03 mmol/L.
4. Independent clinical review. An independent consultant diabetologist will be asked to review the safety case, and a clinical safety officer to sign it off, before DiabeXO reaches anyone else.

The full reasoning, the nine convictions and the ten principles are set out in the founding statement.

What comes next

Sea Trials

A ship is tested at sea before it is commissioned. Sea Trials is DiabeXO’s planned first study: a small feasibility study of the XO with a narrow group of people, to learn whether it is usable and safe, whether the record is complete, and whether the clinic summary changes consultations.

Contact

Come aboard

If you can help as a clinician, researcher, NHS partner or adviser, or simply want to know more, please write.

Please do not send personal medical information by email. DiabeXO cannot give medical advice; for that, speak to your GP, diabetes team or NHS 111.