The role of digital healthcare and solutions in diabetes management
Following their appearance on The MedTalk Podcast, Athar Siddiqui, global head digital connected solutions (patients), and James Richardson, medical lead for mature markets at Ascensia Diabetes Care discuss the digital tools and the role technology can play in diabetes management.
An estimated 463 million adults worldwide are living with diabetes[i], which is regarded as a life-long condition that demands continuous self-management. This means that those living with the condition rely heavily on medical devices and digital tools, which has been exacerbated by the pandemic. With reduced face-to-face contact, the uplift in telemedicine and remote consultations has seen digital tools coming to the fore, allowing data sharing with healthcare providers so that they are informed enough to properly assess each person’s condition.
At the same time, it’s important to bear in mind that diabetes is a complex condition that often sits alongside co-morbidities, which can be worsened if glucose levels are not monitored and managed. There is no one size fits all. Everyone’s condition is individual, and it is known that there are over 40 factors that can affect glucose levels, ranging from nutrition, exercise, age and even the time of day or temperature outside. Understanding how these factors interplay and impact an individual is critical in terms of optimising diabetes management decisions and influencing the long-term outcome for those living with the condition.
The good news is that there are medical technologies, digital solutions and mobile tools that exist to make things easier. Their purpose is to simplify daily management and improve peoples’ understanding of their condition. In fact, there is an ecosystem of different digital solutions that connects the dots and/or aggregates data together to enable easier analysis, management and understanding.
These tools range from personal apps that provide medical guidance, disease information or lifestyle changes through to community and data analysis platforms which allow data to be shared by the person with diabetes (PWD) with their healthcare provider (HCP). The latter enables data to be turned into easy-to-read reports which look at the trends and patterns that have evolved over the time between appointments. This has the benefit of enabling more informed decision making and fosters a more consultative appointment between a PWD and HCP rather than a one-way interaction, since both parties have data. Then adding another piece to the digital solutions jigsaw, there are medical and healthcare portals which enable information transfer to happen in the wider healthcare environment. This creates connectivity to electronic health records, making it possible to look beyond diabetes to the wider landscape of an individual’s health which has benefits, given the high propensity to co-morbidities in diabetes.
However, it is important to remember that data, in itself, does not necessarily drive improvements in health. It’s about having enough data to be able make informed decisions, as those decisions are what actually can have an effect on health. Getting quality data requires not only arming people with the right technology, but also ensuring that the apps that can be accessed via tablets or smart phones are simple, intuitive and easy to use. This is the premise behind Ascensia’s CONTOUR DIABETES app and real-world evidence shows that those using the app for more than 180 days have demonstrated improvements in glycaemic control when compared to the first 30 days[ii]. Simple digital solutions really do work.
What is interesting is that the medical world is starting to recognize digital connectivity as the sixth vital sign of health[iii], after blood pressure, pulse, respiratory rate, temperature, and pain. The idea behind this is that digital health has become such an important aspect of clinical care that digital literacy, access and connectivity is just as important a measurement for health as the vital signs from your own body. For virtual health to be as successful as it can be, it is essential the people have the necessary skills, training and equipment to use it properly.
The next step for digital health is the integration of artificial intelligence (AI) and we are already seeing this have a significantly positive impact in some areas of healthcare. The challenge with AI is that it doesn’t use regular algorithms – AI is able to improve its own algorithm without outside help, adapting itself based on the ongoing analysis of the data it is continuously receiving. This can create difficulties for regulators, who have to balance the benefits of the technology with the risks and uncertainties arising from an ever-evolving product. A potential solution is more of a hybrid AI model, where decisions that are deemed high risk, such as how much insulin to dose, are handled through more traditional algorithms, whereas those that are lower risk, such as providing motivation to exercise, can utilise AI.
One area where AI is more likely to be seen in the near future is in prevention and detection rather than direct disease management. For example, in the US, the FDA has approved some AI-based medical technologies for the identification of retinopathy in PWDs, but they all have one thing in common, they use locked algorithms. Similarly, Google in 2018, created a new AI algorithm for predicting heart disease using data from analysing scans of patients’ retinas. There is vast potential for AI here and preventative health would save healthcare systems billions.
AI’s progression in healthcare is difficult to predict but what is clear is that digital solutions more broadly are dramatically changing the face of healthcare. Given the chronic nature of the condition, diabetes is a great example of the progress being made, but digitalization is becoming increasingly interwoven in every corner of healthcare. We are highly encouraged by the impacts that current technologies are having on the health of people across the globe, and we are tantalized about what is around the corner.
Athar and James recently discussed the impact of digital tools on diabetes with Ian Bolland, the Editor of Medtech Innovation News, for the MedTalk Podcast. The conversation which took place during Diabetes Week in the UK can be listened to here.
[i] IDF Diabetes Atlas, 9th Edition (2019)
[ii] Impact of Real-world Use of the CONTOUR®DIABETES App on Glycemic Control and Testing Frequency, A, Stuhr and S. Pardo, Poster presented at the Diabetes Technology Meeting 2018
[iii] Klonoff DC, Shang T, Zhang JY, Cengiz E, Mehta C, Kerr D. Digital Connectivity: The Sixth Vital Sign. J Diabetes Sci Technol. 2021 May 12:19322968211015241. doi: 10.1177/19322968211015241. Epub ahead of print. PMID: 33980049.