Health Technology - The Digital Revolution: Part 2 Digitising Diabetes
By Akash Patel, Outreach Manager and Writer, Science Entrepreneur Club
Technological advances are permeating into the healthcare industry and are transforming the norns of patient care. The development of medical technology (MedTech) devices that can be used by clinicians, nurses, technicians and, most importantly, patients themselves is rapidly increasing. Such technologies are enabling greater access to patient data to monitor disease status and predict future health events. With tech giants such as Google and Apple diving into healthcare, only further acceleration of these patient-centred technologies can be expected, unlocking a wealth of patient data. Not only this, but the rise of wearables and mobile technologies has expedited the mass collation of health data.
With increasing numbers of people suffering from chronic diseases, often contributed to diet and lifestyle choices, blood testing and physiological monitoring is ever more important. Healthcare is currently designed as ‘sick care’, a model by which when you’re sick you go to the doctor or hospital and they treat you. Yet there is serious lack of preventative health measures put in place by either the healthcare system or patients themselves. MedTech offers the necessary revolution to this approach, aiding the shift from 'sick care’ to actual preventative healthcare. The shift in technology enables patients to monitor the physiological changes in their body brought about by disease to prevent it from worsening. This engages with the main concept of preventative healthcare, preventing people from becoming ill, or their illness worsening. Healthcare systems are then liberated from becoming inundated by the continually worsening complications of chronically ill patients.
We have seen an almost 30% increase in diagnostic testing in the last 5 years (2). This is set to increase in line with the increasing pressures from an ageing population and the growing incidence of long-term health conditions to our healthcare systems. In part 2 of this series we explore the current digital solutions for diabetic patients.
There are currently an estimated 400 million people living with diabetes globally, a disease that requires frequent monitoring of blood glucose levels. There are approximately 3.7million diagnosed diabetes sufferers in the UK alone, with a further 12.3 million estimated to have an increased risk (2). The dangers of diabetes take the form of systemic and long-term consequences to health, such as cardiovascular diseases. Apple, Fitbit, Google (plus its fellow Alphabet company Verily), and the SME's Dexcom and Sano have all recognised this problem, and are developing non-invasive glucose monitoring devices that easily transmit data and provide continuous feedback. The result is leading towards a revolution of our healthcare system: a radical change to our approach in self-managing our long-term health and wellbeing.
The status quo of blood glucose monitoring has remained unchanged for decades. Patients are able to check their own blood glucose levels and then, if required, take either medication or a dose of insulin according to the level. However, the current method of doing so is uncomfortable, involving drawing a drop of blood from the finger and onto a strip which is then read by a glucose meter.
The real revolution in monitoring is non-invasive blood testing using patches with mini sensors that draw interstitial fluid from the epidermis (top skin layer) by means of a small electric current (3). This encourages regular monitoring of blood glucose levels without the need to use invasive needles, thereby increasing compliance in monitoring and medicating. In turn, this reduces the chance of patients developing long-term diabetes-related conditions.
However the efficacy of these patches compared to traditional meters is still controversial, (3) so it studies incorporating the use of these technologies are crucial. Those on insulin have to check their blood glucose at least 4 times a day and companies like Verily, Dexcom and Sano have realised the potential value in designing more user-friendly products. A downstream effect of this has been the increasing behavioural compliance and treatment adherence (4) and thus a positive effect of the health of diabetes sufferers and the overall healthcare system.
Diabetes is about to boom: a 69% increase in the global prevalence of diabetes is predicted in MICs (medium-income countries) between 2010 and 2030, and a 20% increase in developed countries. Blood glucose testing has vast potential for mobile health, so-called Mhealth, with Apple producing glucose monitoring kits for their products. Devices can be brought and plugged into the Iphone, allowing regular monitoring and tracking of blood glucose levels in a simple and easy way. Importantly, such monitoring technology enables patients to manage their own chronic condition and identify healthier lifestyle habits to control their diabetes.
Progressing forwards, such technology can tie in easily with physicians remotely monitoring patients’ blood glucose status and taking note of current prognosis.
With Apple now striving confidently into the Mhealth monitoring of diabetes, Fitbit have invested $6m in glucose monitoring company Sano in order to remain competitive. The ‘holy grail’ is to produce a non-invasive solution that doesn’t pierce the skin at all, and both Apple and Fitbit are attempting to develop technology that will enable their respective smartwatches to achieve this. Sano have developed a minimally invasive method of wearing a patch that monitors the interstitial fluid just beneath the skin, thus proving valuable for detecting blood glucose via a smartwatch (4) (5). Technology companies are investing in programmes to develop increasingly less invasive glucose monitoring devices and platforms that integrate the monitoring of their diabetes with general health data.
Verily are also developing a minimally invasive glucose monitor in a clear attempt to become a major player in the space and reinvigorate Alphabet’s innovative efforts in tackling diabetes. In the last few years Google X, another subsidiary of Alphabet, has worked with Novartis’ eye care business Alcon to develop a smart contact lense that would detect glucose level from the tears of individuals. However, this has been deemed incredibly ambitious by both companies and is not being progressed to clinical trials for the time being. Verily, in conjunction with Dexcom, are working on what they call a ‘Miniaturised Continuous Glucose Monitor’ (CGM). This will enable continuous measuring of blood glucose, producing timely, actionable insights for those living with Type 2 Diabetes.
CGMs aim to provide a better alternative to the current regimen of glucose meters. Conventional methods for the daily monitoring of diabetes results in the infrequent measuring of blood glucose - increasing the risk of long-term side effects.The CGM would offer incorporation of miniaturised sensor electronics onto a adhesive patch, on a similar basis to Sano’s technology, and make CGMs a far less invasive process. With several players in the health technology space aiming to dominate the blood glucose monitoring market (currently valued at $12.27bn in 2017 and projected to generate $18.87bn by 2024, with a CAGR 5.1%)(7), diabetes is set to become digitised.
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