Technological Advancement in

Treatment of Diabetes

Mr. Vinaytosh Mishra IIT-BHU (ECE),MBA,IMNU Ahmedabad

MD. Panacea Hospital ,Varanasi Visiting Professor on Digital Marketing IMT-

Ghaziabad & CIMP Patna

Overview

• Economic burden of diabetes • Role of Technology in diabetes management • Future of Glucose sensing and Insulin

delivery devices • Use of Internet & ICT in treatment of

Diabetes• Smartphone-Based Glucose Monitors and

applications in the Management of Diabetes• Recommendation

Economic Burden of Diabetes

• In the next 17 years, India, China and the US would have the largest number of diabetics. It is estimated that every fifth person with diabetes will be an Indian.

• Due to this, the economic burden due to diabetes in India is amongst the highest in the world.

• As per WHO estimates, mortality from diabetes, heart disease and stroke cost about $210 billion in India in 2005.

• Much of the heart disease and stroke in these estimates is linked to diabetes.

• Diabetes, heart disease and stroke together would cost about $ 333.6 billion over the next 10 years in India alone, estimates WHO.

Alarming Facts• Current Population of India: 1.27 billion• Per Capital Cost of Diabetes =$333.6 billion/1.27 billion =$263 /Year • Per Capital Income of India =$1127 /Year • % of Spend on Diabetes= 29.6%

• Future is Dark!• India has may lose its demographic advantage. More and more young

people are falling in trap of diabetes • Danger is increasing due to sedentary life style • Cost of therapy will further increase because many of patients will shift to

multiple drug therapy in near future.

Technology can share the burden

• Better Glucose sensing and Insulin delivery devices can not only help is managing the Diabetes efficiently but also reduces the cost of therapy by reducing the incidences of Hospitalization

• Information Technology enabled Diabetes Management (ITDM):

• Of the existing technologies targeting providers, patients, and payers, provider centered interventions, such as diabetes registries currently show the most potential for benefit in improving outcomes and reducing costs.

Glucose Sensing and Insulin Delivery

Trends • Short term:

– easier, smaller, better use of data

• Long term: – more accurate, implantable, sensor-

pumps linkage

Enabling Technologies

• Wireless• IT• Micro Electo Mechanical Systems• Nanotechnology• Biomaterials

Things are getting smaller!Advancement In:Blood Glucose Meter

But things can get much smallerthanks to MEMS technology!

Self Blood Glucose Monitoring

Fourth Generation Glucometer

Things are getting more convenient!

Glucose Meter with Built in USB

Cell Phone Test Strip Analyzer with auto-texting and web download

All-in-One Finger stick:(includes meter, lancing device, lancets, test strips)

SBGMS connected to Games Console

Continuous Glucose Monitoring

Current Practices in CGM CGM is shown to Clinically Meaningful

• Combination of CGM and pump therapy improves A1c significantly compared to multiple daily injections

• No increase in Hypoglycaemia• Significant effects in both

children and adults

Technologies on Horizon

CGM in the ICU Intravascular sensors allowshort-term monitoring withgreater accuracy and less lagcompared to subcutaneoussensors• Electrochemical (like currentCGM technology, exceptplaced in blood, not SQ)• Spectrophotometric (in-lineanalysis of extracted plasma)• Fluorescence (glucosesensitive fluorophoreimmobilized on tip of fiberoptic catheter)

Transdermal:Glucose in ISF Fluid

MEMS Viscometric Sensor for CGMS

Cantilever

Fluorescing Implantable Capsule

Magnetic Glucose Sensor

Mass-sensitive magnetoelastic sensor as the transducer.The glucose biosensor is fabricated by first coating the magnetoelastic sensor with a pH-sensitive polymer and upon it a layer of glucose oxidase (GOx).

The pH-responsive polymer swells or shrinks, thereby changing mass, respectively, in response to increasing or decreasing pH values.

Optical Scanning of Eye

A thin plastic sensor is embedded in a typical soft contact lens; The sensor detects the amount of glucose in the tears -- and changes color accordingly.

a hint of green (normal), blue (hypoglycemic - low blood sugar), violet (very hypoglycemic).

• Display on digital hand-held format• Non-invasively scanning the eye with light to screen for diabetes and monitor glucose levels.

Fiber Optic Sensors that Mimic Hair

glucose solutions have a magnetic optical rotatory effect (MORE) such that when a magnetic field is set up in a glucose solution there is a rotation of the polarization vector of the incident light that is proportional to the path length, magnetic field strength, and the concentration of glucose in the solution.

Fluorophore-Biosensing Material

Smart Tattoo for CGM

The skin is permeable to near-infrared light (NIR). As a consequence, near-infrared dyes can be measured across the skin without the need of an optic fibre, which has been termed “smart tattoo”.

1. Aichmophobia 2. Belonephobia3. Enetophobia4. Trypanophobia

Progress in Insulin Delivery

Inhalable Insulin

MEMS Tooth Concept Islet Cell Encapsulation

Inhalable Insulin• Inhaled Insulin reaches lung capillaries and

absorbed there • Inhalable insulin was available from September

2006 to October 2007 in the United States• The inhalable insulin was effective but not

better than inject able short acting insulin • Concern of Lung cancer and Alzheimer disease • More volume is required for similar effect 1:8• Unpredictable absorption in smokers and

COPD patients • Pfizer announced that it would be

discontinuing the production and sale of Exubera due to poor sales

MEMS Technology :Nano Pumps• The MEMS-based Nanopump provides better control

of the administered insulin doses.• The Nanopump is able to control delivery at the

nanoliter level, very close to the physiological delivery of insulin.

• The device prevents over-dosing and detects under-delivery, occlusion, air bubbles and other potential malfunctions in the pump to further protect patients.

• As a disposable device, manufactured using high-volume semiconductor processing technologies, the MEMS-based Nanopump will also be much more affordable, allowing the patient or the health system to avoid the typical up-front investment associated with current pump solutions.

Beta-Cell Encapsulation• These devices could eliminate the need for

of immunosuppressive drugs in addition to finally solving the problem of shortage of organ donors.

• The use of microencapsulation would protect the islet cells from immune rejection as well as allow the use of animal cells or genetically modified insulin-producing cells.

• It is hoped that development of these islet encapsulated microcapsules could prevent the need for the insulin injections needed several times a day by type 1 diabetic patients

Artificial Pancreas

First Version of Artificial Pancreas

Nanotechnology: Future of Artificial Pancreas

Inject able nanogel can monitor blood-sugar levels and secrete insulin when needed.

Internet in Diabetes Care

The Wild Card for the Future

Internet Technologies Diabetes Treatment

• Web technologies used in facilitating the delivery of diabetes care.– Web sites & Web portals– Electronic medical records(EMR)-Diabetes Registry – Videoconference (Adobe Connect, Go Tomeeting and

WebEx)– Interactive voice response (IVR) –input gathered

through voice responses – SMS for alerts & recommendation

Diabetes Registry

• What is a disease registry?– A electronic database containing data from

electronic and medical records– Focus on patients with specific chronic disease

and medical condition – Used by patient care provider ,patient and

administration to facilitate the delivery of health care

Diabetes Registry

Advantage : Healthcare providers

• Identification and tracking of patients with diabetes

• Notification for abnormal test results, missed appointment s,up to date information for patient encounters

• Tracking progress of high risk patients

• Promote the se of evidence based care

Advantage :Diabetic Patients • Allow patients to see all results

at one place• Enable patients to compare

their heath outcomes with others

• Permits patients to share their information with other providers

• Help patients to see results over time to access improvement and area of concerns

Mobile Apps in Diabetes Management

Diabetes Buddy app.

Log Frog DB app.

Wave Sense DiabetesManager app.

Diabetes Management Mobile Applications

Behaviour Change Theory and Evidence-Based Medicine

World Social Marketing Conference 2013~Kitty Harding

Project Objective: Rate iTunes mobile applications for diabetes self-management against criteria to assess the use of behaviour change theory and evidence-based guidelines

Study done for 50 Unique Apps

Diabetes Self Management & Theories

• Diabetes Self-Management Behaviours – Physical activity– Healthy eating– Medication taking– Monitoring blood glucose– Problem-solving – Reducing risk of diabetes

complication– Psychosocial adaptation

• Behavioural Theories– Theory of Planned Behaviour – Health Belief Model– Social Cognitive Theory

•Result of Study No app replaces in-person diabetes

self-management education Apps may acts as a boosterApps needed which provide complete

support across all skill areas More research needed on mobile

apps for health

-Vinaytosh’s Web Model for Diabetes Portal

Proposed Model for Diabetes Management

Internet

Healthcare Provider

Actuators