Features, South Africa

eHealth Driving Diabetes Management

There has been upsurge of electronic solutions being developed to educate and help patients better manage diabetes outside of a healthcare setting.

Diabetes - EHN

Today marks World Diabetes Day, a global awareness campaign led by the International Diabetes Federation (IDF) that aims to promote the importance of screening to ensure early diagnosis of type II diabetes and treatment to reduce the risk of serious complications.

According to the IDF, globally there are 415 million people living with diabetes, of which 14.2 million are in Africa. In South Africa diabetes has been classified as an epidemic due to the high number of almost 3 million people living with the chronic disease, a number which is in fact a lot more due to the number of undiagnosed cases, which is estimated to be as high as 60% of the diabetic population. The diabetes epidemic is worsened by the lack of access to information about the causes and symptoms of diabetes, as well as a lack of access to treatment.

To counteract this growing epidemic, which is responsible for a number of serious healthcare issues such as stroke and blindness, the government has made reducing the prevalence of diabetes a goal in the Strategic Plan for the Prevention and Control of NCDs 2013-17. The impending controversial sugar tax is one of the latest National Department of Health (NDoH) led initiatives being implemented as part of the  Strategic Plan, which aims to curb obesity, the leading cause of type II diabetes. While such laws can be commendable from a healthcare point of view, a broader view of the healthcare landscape is needed to fully realise how best to go about treating and managing diabetes.

eHealth to the rescue    

Globally, curbing the diabetes epidemic is synonymous with wider healthcare goals, including reducing the burden on health services, reducing the overall cost of healthcare and engaging citizens in preventative health measures. This has led to an upsurge of electronic solutions being developed to educate and help diabetics better manage their chronic condition – from innovative wearables that can monitor the patient’s glucose levels to online management platforms and programmes intended to support patients through screening, diagnosis, treatment and management of the disease – enabling patients to monitor and manage their disease outside of a healthcare setting.

Unsurprisingly, IBM Watson has been at the forefront of helping eHealth organisations develop diabetes management and treatment solutions. Using IBM Watson’s cognitive computing power, Medtronic has developed an mHealth app, called Sugar.IQ, to find hidden patterns in diabetes data that can help diabetics and their doctors detect potentially fatal hypoglycaemia events before they occur. This is accomplished by analysing data pulled from blood glucose meters and wearable activity trackers.

On another diabetes related project, IBM Watson Health is collaborating with the American Diabetes Association to develop Watson-powered solutions that enable the diabetes researchers to optimise clinical, research and lifestyle data to create a cognitive diabetes database to create personalised treatment plans and improve care management. Providers can then use the database to identify potential risk factors for their patients based on comparisons to populations found in the database.

Google has also embarked on a number of projects related to diabetes management, such as the recent collaboration between its subsidiary, Verily Life Sciences, and pharmaceutical giant, Sanofi, which aims to develop high-tech tools for managing diabetes by combining devices, software, medicine and professional care. Last year Google also collaborated with one of the leading continuous glucose-monitoring (CGM) companies, DexCom, to develop cheaper, miniaturised glucose monitors.

Health tracking wearables like Fitbit are also fast becoming the preferred method of conducting a number of clinical trials, including those focused on diabetes, because of how easily the IoT enabled device can send data to electronic health records (EHRs) for easy analysis. The University of California, San Francisco (UCSF) conducted one such trial where they jointly used the wearable and a gamified app to prevent diabetes in teenagers. The app had a number of features including tracking of physical activity and diet, goal setting and monitoring, tips on incorporating activity into everyday life, and interactive games related to physical activity and healthy diet. After a specified amount of time the participants’ BMI, activity and blood pressure data was analysed by the researchers.

Some organisations have taken their electronic diabetes management solutions an innovative step further, like as a team of researchers in the US who have developed a digital pancreas that is capable of delivering insulin via a wearable insulin pump controlled by a smartphone.

The unwavering need for data

Despite the growing number of eHealth solutions available on the market to help diabetics, there are still a few challenges facing the industry, primarily the need for quality data. Data has become an industry buzzword for a good reason because it’s the ticket to driving improvement in patient care; data can help inform doctors on what their patients are doing, enabling them to make more informed decisions about treatment.

In relation to diabetes, according to industry leaders from IBM, Dexecom and Novo Nordisk, insulin dose data is still a major missing piece of the ecosystem, specifically those on injections, which needs to be generated and made available for improved healthcare interventions. If there was a system in place that could generate and store data sets from IoT enabled insulin injections in real-time relating to how much insulin a diabetic patient is taking, when they are taking it and how it’s affecting their blood glucose, doctors could use that data to make insulin dosages more personalised and safe. As such, healthcare organisations need to update their business models to make important data, such as insulin injection data, available to strengthen treatment options.

The appification of diabetes

Other than taking medications to help manage blood sugar levels, diabetes management relies heavily on monitoring and managing blood glucose levels, which is done by knowing how different foods affect their blood sugar. Patients with diabetes often go for months between doctor’s appointments and are therefore required to constantly monitor and make their own decisions on medication, food and activity. As a result, apps have become an essential component in the drive for consumer-orientated care in that it allows patients to track and plan their health and wellbeing and, most importantly, be held accountable.

On the Play Store and iTunes there are possibly 1,000s of apps available to help diabetics track their glucose levels and to follow a healthy and active lifestyle. There are even apps that can collect data that can be shared with healthcare practitioners during medical consultations. One such example is DarioHealth, which is offering an app as an integral part of their diabetic mHealth platform. By enabling their glucometer to plug into a smartphone’s headphone jack, blood-glucose readings are automatically recorded and synced with a companion app, enabling users to self-monitor and test their blood sugar level.

With the advent of Apple’s Healthkit platform, app developers like HelpAround are also developing apps that are interoperable with the platform, enabling the transfer of real-time blood glucose data which can be used to issue a notification via an app when the user’s blood glucose level falls above or below predefined limits.

Other popular consumer-orientated diabetes apps include MyNetDiary’s Diabetes Tracker app, which is designed to help users better understand and control their diabetes and pre-diabetes – along with improving their diet, losing weight and providing feedback, support and motivation. Meanwhile, in the Play Store one of the top rated diabetes apps is Sirma Medical Systems’ Diabetes:M app, which is intended to help diabetics manage their diabetes by logging their values in an electronic record which can generate detailed reports, charts and statistics that can be shared with their physician.

These mHealth apps are valuable because they offer patients with chronic disease like diabetes with a continuous, long-term means of monitoring their condition, with the potential to improve the way their chronic disease is managed. And while the IoT in healthcare is still a relatively new concept, the phenomenon is responsible for generating unprecedented amounts of data that has the potential to be tapped into and utilised for the improved management of diabetes on both an individual and population level. However, as apps become more relied on by healthcare professionals to manage disease, they will require more serious regulation, especially in light of the new PoPI Act, in terms of how the patient’s data is stored, used and shared.

The shift towards eHealth

Reducing the burden of diabetes on the health system could help elevate a number of issues plaguing the industry, from enabling the country’s already overburden healthcare professionals to focus on other, more urgent healthcare issues, to reducing healthcare costs and even the overall cost of healthcare to the economy.

With the upsurge of technology being used to drive programmes focused on tackling diabetes, there’s a global shift towards eHealth being more than just a tool to treat disease; eHealth is becoming an entire ecosystem consisting of professionals, patients, data collection, remote monitoring, lifestyle changes and more. As 2016 draws to a close we are excited to see what 2017 has in store for the industry and how the eHealth ecosystem will be further expanded with new innovation.

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