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Could new technology solve America’s diabetes crisis? Find out.
It’s no secret that diabetes is one of the most difficult and expensive chronic conditions to manage in healthcare. Nearly 30 million Americans have diabetes, which costs an average of $13,700 in medical expenses per patient, per year, according to the most recent study released by the American Diabetes Association (ADA). The medical expenditures of diabetes patients are more than double the costs of someone without the ailment, according to the ADA.
There’s hope that technology will be the answer to the diabetes problem, though experts stress that finding solutions takes more than just creating mobile apps and collecting large amounts of data.
“Technology can lower the barriers between patients and physicians, but we are not there yet,” says Ameet Bhattacharya, director of the healthcare practice for iVEDix, a data, analytics and mobile technology company. “The ultimate goal is to have the technology take a back seat, and bring the patients and clinicians closer together. We need to get to that point.”
Consumer demand for easy to use, minimally-invasive diabetes devices continues to surge as the elderly population grows and more plans and government programs seek to support newly diagnosed patients, according to a May 2016 report by Grand View Research, Inc. The report found that the global diabetes device market could reach $35.5 billion by 2024. Test strips and blood glucose monitoring devices currently make up the largest market share, however new technology that can offer continuous care to patients will be commonplace in the market, according to the report.
Bhattacharya says the future of diabetes technology includes more intelligent data management. “Artificial intelligence becomes more and more valuable to send clinicians appropriate alerts-they won’t be alerted for every event a patient has. Encounter management systems will play a big part so that clinicians are not flooded with data,” he says.
Empowering patients to adhere to treatment is the goal for the next generation of mobile apps for diabetes patients. For example, the Sugar.IQ app developed in partnership with Medtronics and IBM Watson technology, makes lifestyle and food suggestions to patients based on data collected from continuous glucose monitoring devices. Eli Lilly recently received FDA clearance for Go Dose, a mobile app for patients and clinicians that allows patients to enter data and receive insulin dosage recommendations. Also, WellDoc received FDA clearance for the non-prescription version of its popular BlueStar mobile app for type 2 diabetes management that will also feature an insulin dosage calculator.
Gaining FDA clearance for these mobile apps has another intention: to make it easier for health plans to adopt them for patient care and engagement. In November 2016, the AMA approved guidance on coverage and payment policies for mobile health technology.
“The new AMA principles aim to foster the integration of digital health innovations into clinical practice by promoting coverage and payment policies that are contingent upon whether mobile health apps and related devices are evidence-based, validated, interoperable and actionable,” Steven J. Stack, M.D, AMA immediate past president, said in a statement.
New research suggests that wearables that monitor heart rate, blood oxygen levels, physical activity and other continuous body functions can help clinicians predict illnesses, including diabetes. Researchers at Stanford University used seven activity trackers, including Scanadu, Basis, and Masimo, to track essential data from 60 patients. Researchers found physiological differences between people with normal insulin levels and those who were insulin sensitive or resistant.
In a study published in January 2017 in PLOS Biology, the researchers state that the infrequent monitoring of these vital statistics makes it harder to detect early insulin resistance before it can be treated. The data collected from activity tracker wearables can assist clinicians in finding diabetes before patients have symptoms, they said.
“If a healthy person with reasonable healthcare access visits his or her physician every two years for a routine visit, then a condition may arise many months, or even longer, prior to a clinical symptom onset and thus go undetected for some time,” the authors wrote. They added, “Because sparse clinical measurements of an individual are often compared to the average measurements of a population, the large variation within and among individuals results in a difficult medical assessment.”
The study found correlations between elevated heart rate that fluctuated at night and during the day, as a precursor to cardiovascular disease and insulin resistance. “The fact that these differences can be measured using wearable devices raises the likelihood that this approach may someday be a useful measure for early detection of insulin resistance and risk for type 2 diabetes,” they wrote.
Several “artificial pancreas” devices are in development, with the Medtronic MiniMed 670G System being the first to receive FDA approval in September 2016. The device is attached to a patient’s abdomen and monitors blood sugar and adjusts basal insulin doses in people with type 1 diabetes.
Because treatment for diabetes varies depending on type, artificial pancreas devices can offer various treatment options for patients. For patients with type 1 diabetes, the devices are closed loop, meaning that they are continuous glucose monitors and insulin pumps that can administer nonstop insulin to patients painlessly right below the skin.
Devices to monitor type 2 diabetes can predict low glucose levels in patients. These devices aren’t fully automated (non-closed loop)-they can require patients to approve dosage changes or alert them to glucose level changes. A study in the May 2016 issue of Diabetes Science and Technology, found that artificial pancreas devices to treat and manage type 1 diabetes are easier and more effective than those for type 2 diabetes, which were labeled “first-generation” systems.
In the study, 18 different closed-loop artificial pancreas devices were analyzed, and researchers found that the usability of the devices will pay a big part in how effective that will be for patients.
“How an artificial pancreas device system looks and feels from the users’ perspective will be vitally important. There are various ways in which the three key functions of an artificial pancreas device (to monitor, control and treat) might be configured in commercial products,” the study’s authors say, adding that some devices include their own, separate monitor device, while others have mobile apps that collect data and allow users to make changes. “For this new form of technology to be adopted successfully, developers would also need to ensure that their products meet user expectations in terms of design, functionality and impact on quality of life.”
Donna Marbury is a writer in Columbus, Ohio.