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05-16-2018 | Devices and technology | Editorial | Article

Digital diabetology

Author:
Sanjay Kalra

Author bio | Disclosures

Introduction

Diabetes care has benefited enormously from advances in the field of medicine over the past few decades. However, developments in pharmacology, engineering, and information technology have had an undeniable impact on the use of novel diagnostic and therapeutic tools and devices.

In recent years, interest has grown in concepts such as “e-health” and “m-health” [1]. These fields have leveraged modern communication platforms to provide better health to large numbers of people. Diabetes care, with its inherent patient-centric, community-oriented ethos, needs to utilize these opportunities to improve the lives of people with diabetes. Digital health, an all-embracing term, takes this movement forward [2].

Scope and spectrum

The US Food and Drug Administration (FDA) describes digital health as encompassing mobile health, health information technology, wearable devices, telehealth and telemedicine, and personalized medicine [3]. The overall aim of digital health is to reduce inefficiencies, improve access, reduce costs, increase quality, and make medicine more personalized for patients. A similar definition is used by the American Medical Association (AMA) [4]. Others propose that digital health is the convergence of the digital and genomic revolutions within healthcare and society, which have empowered people to track, manage and improve their health [5]. Inclusion of a psychosocial component, whether informative, diagnostic or interventional, will allow what I am terming “digital diabetology” to live up to the expectations of the biopsychosocial model of health [6].

Digital diabetology includes technology capable of providing individualized, accurate and evidence-based solutions to people living with diabetes and their caregivers. Caregivers comprise not only family members, but also healthcare professionals and healthcare system administrators. The solutions may be informative, diagnostic or therapeutic in nature but, crucially, an ideal digital diabetology network should be able to achieve integration of all these aspects.

A working example of the concept of digital diabetology would necessitate the seamless transfer of data from a blood glucose monitoring device – in concert with data on food, physical activity, and lifestyle diary entries – to prompt insulin dose adjustments and lifestyle modification. In circumstances that require it, a change in insulin regimes may also be suggested. Such interventions should be assessed and correlated with outcomes such as glycemic control and complication rates.

The data described above may be assessed at a micro-, meso-, or macro-level. For example:

  • at the level of the individual, allowing healthcare providers to plan the future course of action on a per-patient basis;
  • at the patient group level, allowing healthcare system administrators to decide diagnostic, monitoring and therapeutic strategies that will be cost-effective for a specific group of patients; or
  • at the population level, allowing healthcare policy makers to make/plan large-scale policy changes.

Mobile prescription therapy: a peek at the future?

Various forms of digital diabetology are already in use, for example, mobile prescription therapy (MPT) [7]. MPT includes products that connect the individual with diabetes with his or her diabetes care provider, allowing better daily management of diabetes through guidance and advice on an enabled device. MPT products are regulated by the FDA, are available only on prescription, and after guidance on treatment, as opposed to prevention- or lifestyle intervention-only approaches. One such example is the Blue Star™, an MPT marketed by WellDoc (Columbia, Maryland, USA) [8], which is designed for non-pregnant adults with type 2 diabetes who do not use insulin pumps. Similar to other evidence-based interventions, MPT has demonstrated efficacy, safety and tolerability, as well as improved adherence to suggested treatment [9]. The device provides guidance, education, and motivational support based on glucose and lifestyle data that the patient enters. It also offers clinical decision support if required by the physician. MPT helps empower individuals with diabetes, and engages them to play a more proactive role in their own care.

Man versus machine?

By definition, digital diabetology is technology-intensive. This does not mean that technology will replace the healthcare professional in diabetes management. Rather, digital technology will support the professional and the individual with diabetes in understanding challenges, arriving at informed and appropriate decisions, and adhering to decided courses of action.

It is a myth that digital diabetology will reduce the responsibility of the diabetes care professional. On the contrary, such responsibility will widen (as well as deepen). The diabetes care provider will have to shoulder the onus of choosing evidence-based digital platforms for the person with diabetes, and will need to guide their patients through the maze of informative (and misinformative) resources and applications available online. Diabetes therapy “by the ear” [10] will thus extend to and encompass diabetes therapy “by the net” or “through the cloud” management.

Intelligent diabetology

Digital health is extremely important for the field of diabetology. Digital diabetology has the potential to increase the reach of current care methods to a larger number of people living with diabetes and, at the same time, improve the quality of existing care. Creation of cost-effective, patient-centric platforms will enhance efficiency and reduce the cost of intervention. Platforms that allow dual exchange of information will provide confidence to people living with diabetes, and empower them to take charge of their condition.

Thus, digital diabetology should be a trailblazer and spectrum enhancer for digital health. Development of this field will help healthcare professionals achieve the aims of digital health, as described by the FDA and AMA. Ongoing research developments will certainly expand the reach and utility of digital diabetology in the near future. Proper use of such technology, in a regulated and responsible manner, will help improve the quality and reach of diabetes care, and contribute to the improvement of clinical outcomes [11].

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