Life between the check-ups

How might we empower people in urban India to prevent and manage metabolic syndrome and Type 2 diabetes?

Metabolic syndrome brings together related health risks, but managing them crosses separate places: a doctor’s appointment, a prescription, a meal, a workout and the next test.

I wanted to understand the choices between those touchpoints. What felt “healthy”? What made change worth the effort? When did advice stop fitting someone’s life?

I focused on day-to-day management of diabetes, obesity and hypertension, excluding acute complications and severe deterioration.

I explored awareness, access, habits, emotional needs, spending and openness to technology to shape an intervention, not a treatment protocol.

The Double Diamond connected secondary research, people’s accounts, everyday behaviour and co-designed possibilities.

1. Discover

   Literature review and an exploratory survey.

2. Define

   Interviews, design probes and thematic synthesis.

3. Develop

   Co-design, prioritisation and service definition.

4. Deliver

   Wireframes, visual language and a connected prototype.

Two kinds of evidence.

I reviewed conditions, management and urban Indian life through databases including MEDLINE, EMBASE and Global Health, using explicit inclusion criteria and a PRISMA record.

Primary research combined a social-media survey, semi-structured interviews and design probes. I used frequencies and cross-tabulation for closed responses, thematic analysis for open responses.

With consent, and with limits.

The RCA Research Ethics Team approved the work on 12 November 2020. Participant information and consent covered interviews, diaries, focus groups and testing.

Personal networks and social media shaped recruitment; later participants had access to urban services and technology. These small, self-selecting groups were not representative.

The literature gave me a map. The survey showed me where to look more closely.

Beyond the clinical picture.

I explored how work, family, food culture, beliefs, mental wellbeing and care access intersected. A Johari Window separated my understanding from questions the literature left open.

Recommendations were plentiful. Making sense of them, acting on them and keeping going was harder.

A starting point, not a census.

I analysed 51 survey responses on diagnosis, management routines, devices, record-keeping, app use, emotional friction and COVID-19 changes.

Time pressure, unclear information, difficult routines and uncertain progress stood out. I focused next on adults aged 25–45, who combined interest in new approaches with everyday obstacles.

What the survey helped me ask next

Why did recording readings feel unhelpful? What made advice hard to follow around meals or work? How did trust, family support and a doctor’s language affect what happened next?

The questionnaire also covered demographics, condition history, management priorities and difficulties, device motivations, app deterrents and perceived pandemic effects. These informed interviews, not a feature checklist.

Interviews and design probes made the practical and emotional parts of management harder to separate.

Listen to the routine.

Twenty survey respondents were taken forward for interviews to explore care journeys, relationships and the gap between knowing a change mattered and making it happen.

Three research portraits explored different circumstances: the sedentary adult, busy parent and proactive senior. They were lenses, not fixed labels.

Then look beyond the account.

Four participants used three design probes: an activity book with emotional cues, a 60-second reflection and postcards exploring visual associations.

The probes surfaced values, daily routines and feelings direct questions might miss. Anxiety, guilt, frustration and confusion belonged within the care experience.

Four participants joined remote co-design workshops, moving from shared problems to ideas, priorities and a connected service.

Themed workshops began with research and “How might we” questions, followed by two rounds of Crazy Eights, scenario prompts and dot voting on Zoom and Miro.

Participants wanted a connected team, useful feedback and personal support, not another tracker.

Across the six care themes, I considered the connecting information, motivation and monitoring.

I compared analogous services’ focus and availability in India. The concept needed to fit local care, not import another market’s model.

I developed the visual language, icons, illustrations, colour system and prototype around one principle: empathetic, understandable communication.

Neutral, respectful language avoided blame. Organic illustration and a muted palette supported daily use. I developed the interface from wireframes and connected the flows in Sketch.

The strongest idea was a service connecting care, daily life and the support needed to keep going.

What the work established.

I developed a research-informed service concept, revised its architecture with participant feedback, and built the interface and prototype.

Chronic care became a relationship across people, routines and organisations. Improving touchpoints mattered; making them work together was the bigger problem.

What it became.

sugar.fit was built entirely on this thesis: the idea, the research and the solution. I pitched the work to leadership at cult, and we created a subsidiary to bring it to life. I was sugar.fit’s founding designer.

When my thesis became real

What still needed to be tested.

Clinical benefit and long-term adherence remained untested. Small, self-selecting groups and the pandemic limited generalisability.

Next came questions of sustained use, broader accessibility, care-team operations and delivering support over time.

A future direction: exploring bio-impedance

An early bio-impedance exploration began with the burden of repeated finger-prick measurements, documenting a circuit, apparatus and two experiments.

This remained exploratory. The experiments did not establish clinically reliable glucose measurement or a safe replacement for a validated monitor.