Diabetes and the role of digital health

Shalini Sharad, Ascensia Diabetes Care, looks at how harnessing digital health solutions can help combat the rise in type 2 diabetes.

Diabetes affects 425 million people globally and this number continues to grow each year, as shown by figures from the International Diabetes Federation. This increase is largely due to the growing number of people with type 2 diabetes. 

As demographic and lifestyle factors put ever more people at risk of developing this condition, the need for personalised, tailored support for those with type diabetes is becoming more important. It is also vital to note that no two cases of type 2 diabetes are the same, and treatment options need to remain varied. However, with restricted healthcare resources and physicians having limited time to spend with each patient, it is increasingly obvious that traditional methods may fall short of offering personalised management.  

Opportunities to improve the experiences of people with diabetes (PWDs) and how they manage their diabetes are evolving, thanks to advances in digital technology. Digital monitoring devices and apps are providing more flexibility in how diabetes is managed and can improve access to care by making it easier for PWDs to access management advice. This is good for PWDs, clinicians, healthcare systems and society by helping to manage the rising burden of diabetes more effectively and efficiently.

Data and diabetes

The major advantage of digital solutions in diabetes is their ability to seamlessly capture and interpret data, and digital solutions are now being developed in all aspects of diabetes management. Novo Nordisk is currently working on its first connected insulin pens, NovoPen 6 and NovoPen Echo Plus, which are expected to reach the market later this year. These pens are designed to automate the capture of insulin dosing data by connecting to smartphones. By adding in a connected blood glucose meter or continuous glucose monitor, they can bridge the gap between glucose and insulin data. However, the bigger potential for digital diabetes solutions is in helping to manage type 2 diabetes.

The usage of digital solutions for diabetes management has seen an exponential increase over the years and this is set to continue. A 2018 report forecasted that in 2022 there will be 23.5 million people using diabetes apps worldwide, which contrasts to 6.1 million in 2017. But technology alone is not enough. For the full benefits of digitisation to be harnessed by healthcare systems and PWDs, there needs to be greater collaboration between payers, providers, and Healthcare Professionals (HCPs). A truly joined up approach to diabetes is something that we should all strive for, but only by working together will we be able to deliver the care that PWDs need -  and we are not there yet.

In order to positively impact people’s health, digital solutions need to be implemented as part of a comprehensive ecosystem, one that factors in all aspects of life that may affect a person’s experience with diabetes, from medication, to diet, to mental health. Adding meters and apps to an already complex landscape of diabetes management can confuse both PWDs and HCPs, and this needs to be managed, along with minimising the effort required from PWDs to integrate digital health solutions into their lives. Diabetes already comes with a long list of diabetes relates tasks and considerations, and additional management tools should seek to simplify and not complicate. 

Interconnected diabetes management (IDM) focuses on treatment beyond the pill. By providing people with much-needed guidance alongside a simplified, holistic management tool, it harnesses digital solutions to bring together multiple aspects of diabetes management which are currently managed in silos.

IDM also aims to improve collaboration with healthcare systems and others involved in a person’s diabetes care, in order to improve outcomes. Health2Sync is one such solution that captures data and makes it available to those involved in a person’s diabetes management. The app enables people to easily log blood glucose, blood pressure, weight and daily activities, and allows them to share this information with family members and HCPs. It also helps to provide customised recommendations and reminders, based on the data collected. And there is growing data to suggest that this holistic digital management approach can improve outcomes in type 2 diabetes.

Ascensia solution

Ascensia Diabetes Care has shown clinically meaningful results from the use of IDM and demonstrated how such a solution has the potential to improve type 2 diabetes management. A study found that using an investigational IDM solution decreased HbA1c levels of 0.43% in people with type 2 diabetes over 12 weeks, independent of any changes to medication. This suggests that IDM solutions could lead to better glycemic control through an improvement in self-care.

The Ascensia solution combines remote behavioural coaching and a mobile application to collect, store, and analyze key data about a person’s health from a variety of sources, which in my opinion represents the ideal digital solution for type 2 diabetes. The coaching needs to be based on the data that is gathered by the app to offer tailored guidance, providing PWDs with actionable information in support of their individual self-management.

The use of digital coaching for diabetes is estimated to increase from 240,000 users in 2017 to 3.8 million by 2022, but the type of coaching is also an important consideration. Coaching should be provided by a combination of human-based and machine-based systems, in order to efficiently manage large populations of people with type 2 diabetes. For example, machine-based support can be used to provide simple recommendations based on analysed data, while regular interactions with trained staff, such as diabetes educators, can provide the more specific coaching for people to make positive behavioural changes in areas such as glucose monitoring, food choices, activity levels, stress, and sleep. The contributing factors to diabetes management outcomes are varied. Ascensia’s study assessed 25 impactful behaviours which could be addressed by the IDM solution it is currently developing.

Behavioural changes, education, more frequent readings, as well as a feeling of being supported leads to PWDs enjoying a healthier and better quality of life, at whatever stage of their diabetes journey they may be. It can help to improve outcomes and studies are starting to show that it can lead to better managed diabetes.

Additionally, the interaction between a patient and a CDE through a digital solution provides access to valuable guidance when visits to HCPs can be infrequent. By educating users remotely and providing tools to track progress, PWDs are still supported whilst payer costs and burden on the healthcare system are reduced. In fact, the total cost of diagnosed diabetes rose by 26% between 2012 and 2017, with costs in the US at $327 billion in 2018.

HCPs, payers, and healthcare systems are increasingly calling for bundled services. Simply offering a patient a drug and glucose monitoring device is no longer enough, with those involved now looking for each aspect of diabetes management to be carefully considered and interconnected in a holistic solution; with a view to  improve patient outcomes.

We are just at the start of the digitisation of diabetes management, but we are making progress. Digital solutions are already beginning to demonstrate their benefits, with 52% of those using a health or wellness app to manage their diabetes seeing positive results. Increasing that figure will require more seamless integration of IDM and digital health solutions into every-day diabetes care.

By taking a more holistic approach to digital management in type 2 diabetes, we can reduce the impact of diabetes on society and healthcare systems, and improve the lives of PWDs everywhere.