Diabetes in eHealth today & the future
How is diabetes managed & what does the future hold?
In my last article, I explored the diabetes patient journey and how it fits into the digital health systems from the perspective of a patient or non-medical individual. If you haven’t read it yet I would strongly suggest giving it a read as these are both two sides of the same coin. We need to explore both to create an integrated digital health system for better communication and care management. For this piece, I want to delve a little deeper into how diabetes is approached in our current ehealth systems and what future tech may provide both the patients and the medical staff.
Key Points
-? ? ? ? ? What is diabetes?
-? ? ? ? ? What are the current treatment and management plans available?
-? ? ? ? ? Tech and diabetes
-? ? ? ? ? The future of diabetes in tech and ehealth
-? ? ? ? ? What to take away
What is diabetes?
Diabetes is a chronic condition that affects the body's ability to produce or respond to insulin. For some people it is genetic and often shows up early in life, this is called Type 1 diabetes. For others, it is caused by diet and is called Type 2 diabetes. Both types are serious and can cause severe complications which include:
· ? ? ? ? Depression
· ? ? ? ? Neuropathy
· ? ? ? ? Heart failure
· ? ? ? ? Kidney failure
What are the current treatment and management plans available?
Treatment for each type of diabetes is different. The approach to the type is different as well as the approach with each individual. Especially since much of the treatment relies on lifestyle choices. When it comes to type 1 diabetes you pretty much only have the choice of insulin via injection or pump. While type 2 diabetes is focused on weight loss and healthy eating. Though sometimes medication and/or insulin are needed in treating type 2 diabetes. However, both require good exercise and a balanced diet. Regardless of the diabetes type, the treatment requires one to monitor the blood glucose level often and the discipline to stick to the lifestyle that is required for stability.?
That is the most traditional route for treatment. In the past, it would require regular visits to a clinic to check blood glucose levels. Over the years though, home devices became popular and required little skill to operate. Reducing the visits to a clinic or doctor. That step into slightly more autonomy for the patient was a big one. It gave the patient space to get more hands-on with their own condition and for the medical staff, it opened up time for them to focus on other patients and ultimately see more people for the appropriate amount of time.
Currently, there are a few options that make management easier. There are a number of smart devices available and online pharmacies that can limit the time between prescriptions. Ongoing management is really about monitoring and maintaining a routine suited to your specific needs while also managing any other complications. Essentially creating the perfect background to develop tech that can alleviate many of the stresses associated with the complications of diabetes. What are these advances in tech designed for diabetes management? I’m glad that you asked, in the next section I am going to get into the details of what tech is currently available.
Tech and diabetes
At this point, we know that diabetes is a chronic condition and that its management requires daily engagement from the patient and caregivers. A number of technologies are on the market that exists under three main areas:
Blood glucose levels are necessary to monitor for both types of diabetes. This is particularly important in prevent of serious issues that commonly occur around the feet and heart. There are two types of glucose monitors: continuous glucose monitor (CGM) and blood glucose meter (BGM). The blood glucose meter works with single-use strips where you prick your finger for a small blood sample and get a reading of your blood glucose levels. Continuous blood glucose monitors are devices that are able to monitor the blood glucose levels throughout the day and overall limit the number of finger pricks needed to check your glucose levels. The device uses sensors to check every 5 minutes or so and relay this information via transmitters. Each has pros and cons and must be looked at carefully for each individual case. The important thing is that both offer the patient a simplistic option for home monitoring and management.?
For people with type 1 diabetes, it is essential to the treatment to have insulin, this is true for some people with type 2 diabetes as well. In this case, there are two options available, one is an insulin pump and the other is an insulin pen. Insulin pumps come in a variety of devices and can be categorised as such:
Tethered pump
Tethered insulin pumps have a flexible tube running between the cannula (the short, thin tube that is inserted into the skin) and the pump. This allows it to be carried in a pocket or what is commonly used, a pump pouch. Some of these pumps double as a blood glucose meter as well.
Patch pump
A patch pump is used by attaching it to the surface of the skin and is then operated via remote control. Some devices on the market have a remote control that doubles as a blood glucose meter as well. The lack of tubing is great to limit catching on items but one should also be wary not to knock the device off.?
Implanted insulin pump
Implanted insulin pumps are inserted to live permanently under the skin. The device delivers insulin into the peritoneal cavity which has a large number of blood vessels. Though this form of ongoing management has shown to improve the lives of many patients it is also a difficult treatment to get hold of and maintain at this stage.?
Closed-loop insulin pump - artificial pancreas
These closed-loop insulin pump systems are often referred to as artificial pancreases due to their design to manage your glucose needs automatically. The insulin pump is linked to a continuous blood glucose monitor and is linked in such a way that the system is able to monitor and regulate blood glucose levels without the patient having to engage frequently.?
The other option is to use an insulin pen. Newer insulin pens offered are smart pens and have allowed for better digital management for tracking one's status. Standard insulin pens are available in two forms, those are disposable pens and reusable pens. Smartpens are reusable pens connected to an app that controls dosage, has alerts, and offers reports.?
Lastly, we have the technology for the daily management of diabetes. These include apps for dietary needs, exercise, and weight management. The apps are there to provide information on diabetes, food and diabetic-friendly recipes, and daily exercise routines. Many of them can give you a report on all of the above which, in combination with the blood glucose monitoring, the patient is able to get a whole picture perspective into self-management.?
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The future of diabetes in tech and e-Health
What can we look forward to in terms of digital advances for diabetes?
Diabetes continues to be a pressing condition in the medical world and for the general public. It affects many people worldwide and is disproportionately affecting certain populations, particularly people living in urban areas and carrying out sedentary lives. Not to say that having a fulfilled life is bad, but sometimes too much of a good thing can lead to diabetes. With millions being affected, research in the area has increased and moved onto some very interesting tactics for treatment.
In 2020 three NIH-funded research groups are started looking into technologies that may change the way medical professionals understand, diagnose, and treat diabetes. The technology in question is an islet chip. Islet cells are cells found in the pancreas and have been found to provide significant improvement when transplanted from one individual to another.?
“Islet chips are bioengineered three-dimensional models that imitate the way the human body supports islets to allow human islets to survive and function in the lab. Islet chips will allow researchers to study how the immune cells interact with beta cells to mimic aspects of the autoimmune process involved in type 1 diabetes.” - NIH NIDDK
These advances in lab tech give way for easier research which in turn may open up a route to better long term management for type 1 and type 2 diabetes. The integration of more advanced closed-loop insulin systems where implanted insulin pumps can be used to create a solid sustainable future possible by making those needed improvements to current tech. However, the advancements in the lab will bring about grand changes in treatment and monitoring.
What ehealth is able to do is offer the best possible tracking and online pharmaceutical services that will alleviate the stress associated with chronic diabetes management and reduce the amount of medical related errands needed to be done physically. The future for diabetes in ehealth may hold connected home systems designed to care for the lifestyle needs of someone with diabetes. Imagine a home system where the fridge is connected to your glucose and insulin monitoring devices and then is able to suggest recipes specific to your current needs. This home system would be able to send you alerts and monitor your wellness in terms of mood and exercise and make suggestions accordingly. Basically, a home system that will be your diabetes management buddy.?
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What to take away
From this you can clearly see that there are strides to be made in the industry, particularly in upping the digitisation of diabetic care management. Taking all of these innovative devices and monitoring systems and bringing them together is what we need to create a new system where medical staff and patients are able to have access to improved health management.?
Though we must acknowledge all of the amazing work that has gone into the management and shift towards digitisation already. We are all part of someone’s health journey in one way or the other and digital health systems have the potential to be one of the greatest assets in diabetes management.
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How can you make a difference?
Become part of the change, become an e-health pioneer striving to reshape the future of health journeys. Each one of us plays a role in designing and implementing health systems. It Is the relentless effort put into making a difference for everyone affected by diabetes and lessening the chances of life-threatening complications occurring. With these tools, we can improve overall communication between medical staff as well as patient to medical staff and reduce the moving targets in the diabetes patient health journey.
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Author Notes:?
My name is Damien and I am inquisitive, curious and many times stupefied, about? all that tech has to offer the world. Most recently around the areas of AI, ML and UX/CX? in e-Health and Digital Health Journeys. All of my views expressed here are those of my own and do not represent the views of the Zur Rose Group. Follow me to journey through e-Health and tech in the healthcare industry.
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