India is facing an unprecedented growth in non- communicable diseases like Diabetes. It
can be attributed to a variety of lifestyle, genetic and dietary causes and is broadly categorised
into Type 1 and Type 2 Diabetes. Type 1 DM , is caused due to the insulin producing beta cells
of the pancreas being destroyed by auto-immune reaction or injury and is seen predominantly in childhood or adolescence. Type 2 DM is caused due to the body’s inability to respond to insulin, a hormone that regulates the absorption and use of glucose in body cells. Both cause the sugar levels in the blood to rise.
What are the common symptoms and complications in diabetes?
Hyperglycaemia, or high blood sugar, results in various complications such as
cardiovascular disease, slow wound healing, lowered immunity, diabetic injury to kidneys and
eyes. Patients could feel extreme thirst, dehydrated; have frequent stomach upsets and episodes
of vomiting and urination, fatigue, laboured breathing, recurring skin, genital and urinary tract
infections, as well as mood changes.
Blood Tests used for the Diagnosis and Monitoring of Diabetes
With its associated mortality and morbidity rates, the most important step is accurate and
timely diagnosis of diabetes. Several blood tests can estimate sugar levels in blood and are
recommended, both as preventive health checks for the community, as well as for patients who
are experiencing symptoms.
The most common tests are:
- Fasting, Post prandial or random blood sugar and urine tests
- Oral glucose tolerance test (samples are taken at fasting, as well as 2 hours after consumption
of a fixed amount of glucose in water, and tested)
- To get a more accurate representation of the patient’s status, Glycosylated Hemoglobin
(HBA1C) testing was estimates the amount of glucose attached to hemoglobin in red blood cells,
during the red cells lifespan of 120 days. This value is not subjective to the patient’s variation in
daily sugar intake, which may cause changes in fasting sugar levels. Instead the three month
average gives an overall picture of glycemic control.
Although initially glucose monitoring was done through collection of a peripheral vein sample,
the advent of Point of Care testing systems, like Glucometers, have made the monitoring of sugar
levels convenient for patients, improving their compliance to treatment and follow up.
In addition to the routine tests for diabetes, tests for insulin, cholesterol, ferritin, micro albumin
or creatinine may also be done, in order to detect complications of progressive diabetes if any.
Routine eye examinations for diabetic retinopathy may also be advised, and work up for diabetic
nephropathy (kidney injury) or diabetic foot may also be done.
Technological Advancements that aid in the management of diabetes
Technology plays a large role in helping with lifestyle modification by providing
platform for patients to log their test results, food habits and medication dosages and timings, in
order to attempt lifestyle modification. The age-old mantra, “What can be measured can be
improved” is applied to patient goals to maintain healthy sugar levels.
Due to the rapid digitalization of healthcare, patient empowerment through self-
management was a natural segue. Automatic logging of Gluco-meters and Continuous
Subcutaneous Insulin Infusion Therapy (CSIIT) data into a cloud based system, or even in smart
phones, improved communication between doctors and patients. This data could also be added to the patient electronic health records (E-HR) to get more comprehensive history from patients.
Health data applications like My Sugr, (available on IOS and Android) ,enables patients
to log their data in the form of insulin or drug dosages and timings, meal times and caloric
intake, syncs with other health or fitness applications for physical activity metrics and with a
Glucometer (Accucheck) for glucose levels. These are gaining popularity and many other have
launched like: Sugar Sense, Health 2 Sync, Diabetes Connect and Glucose Buddy.
Although some of the software and hardware have been vetted and approved after
extensive clinical trials there are many still in development stages, expected to launch in the next few years. One of the more exciting innovations under trial is the Non-Invasive Blood Glucose Monitoring system, which aims to measure circulating capillary blood glucose without having to undergo repeated finger pricks or blood draws. Epic Health App was working on software that makes it possible for a patient to place a finger tip on the lens of the camera of a smart phone, which in turn captures a series of images and with the help of measurement through sensor pads and infra red technology, to measure temperature, blood pressure, heart rates, and blood sugar concentration. Still early in its research phase, the future goal is to develop smart phone
applications that provide intelligent analysis and forecast trends in blood glucose levels.
This will lead to patients regaining control of their health and their bodies, which has
helped them to psychologically deal with the impact of handling the disease and its progression.
Self management with the use of advanced technology and tools has helped to improve patients’
lifestyles and decrease their dependency on hospital or lab visits.
Barriers to using digital tools for diabetes management
The implantation of technology trends in diabetes may be limited due to relatively high
costs, undetermined reliability, or awaited regulations and standardizations. Data Protection and
security are also concerning, considering that some devices use blue tooth connectivity for data
transmission, which leave it susceptible to disruption by electromagnetic waves or cyber hackers.
The large amount of data produced from smart technology and wearables (watches, bands, apps
etc) stored on servers, also needs to be protected.
Dealing with the Psycho-Social Aspect of Diabetes
In order to combat the lack of awareness of diabetes, especially Type 1 DM and its
associated stigma, many private companies, government bodies or NGOs have initiated
Social media campaigns like “Beyond Type 1”, helps to raise awareness globally and acts as a
source of support and information for patients with diabetes. NGOs like “Diabetes India Youth
in Action” (DIYA) works towards youth education and aims to eliminate discrimination in
educational institutions and work environments. It is also working to improve the availability
of insulin as a life saving medication, with coverage under national health insurance schemes to
reduce the cost to under privileged patients.
The “Mittayi Project” run by the Government of Kerala, works for the provision of insulin
pumps for children from low income households. “Changing Diabetes in Children Program”
(CDIC) and the Indian Diabetes Education Program 2010-2012, help in patient and care giver
education in both rural and urban areas.
In addition to looking after dietary and nutritional needs along with physical therapy and
exercise, the patient’s mental well being also needs to be considered. For people with chronic
diseases, motivation, education and awareness, help them to embrace their condition and take
their health into their own hands. This holistic, multidisciplinary and patient centric methods
used to approach the management of diabetes, will continue to show improved patient outcomes.