Diabetes Management: Killer Apps That Are Revolutionizing Diabetes Care

The advantages of the wireless world are finally being brought to use beyond socializing. For us diabetics, they're being used as a means of communicating critical information about our health and the status of the conditions that can be mortally devastating and an expensive burden.

Of course, nothing replaces weight loss and proper diet. But, in the meantime, communications technology can be used as a means to inform, monitor and support patients.

Indeed, health care providers and medical companies are quickly learning how to leverage emerging communication and electronic technologies to make diabetes management more efficient, reducing hospitalizations and ultimately decreasing the cost of the disease to individuals and on society.

What's more, the health care market is seeing a large influx of companies who are putting technology to use in a growing field of healthcare communications and health-record management. At a basic level, this means using technology to manage health records and share information with a patient's physician or other approved health care providers and caregivers ‒ including family members.

But, for treating diabetes patients in particular, the use of technology has been slow. When killer apps for iPhone and iPad are out in the market days after the devices are released, it is quite ironic that given the ever-changing condition of diabetes ‒ by its very nature we could benefit from up-to-the minute capabilities that technology brings ‒ diabetes management technology remained rooted in the last century. But that’s changing.

At long last, technology is coming to the rescue of diabetics, trying to make diabetes management easier. In fact, just in the past few years, there finally has been marvelous progress in diabetes care. This isn't just with insulin pumps and home blood glucose monitoring systems. The technologies available now and those at the cusp of development are really encouraging and exciting.

Wireless Technology Improves Patient Care For Marginalized CommunitiesOf my favorites is an innovative use of wireless technology will help underserved communities improve diabetes care and prevention in Tijuana. Using 3G mobile technologies, the Dulce Wireless Tijuana project helps patients in remote areas both monitor and treat their diabetic condition. The Dulce Wireless Tijuana system, announced by Qualcomm Incorporated in October last year, combines mobile applications, web applications, mobile phones, netbooks, laptops, diabetes educational content and health care worker and patient training. Service delivery is available to diabetes patients and their caregivers wirelessly through Qualcomm’s 3G technology network.
                                              

Dulce Wireless Tijuana patients now will have access to the system and technology, including primary care diabetes services and disease management programs. The project stands as an example of how wireless technology can improve patient care for marginalized communities — not just in Mexico, but throughout the world.

Goodbye Bariatric Surgery!
Then there is a matchbox-sized gadget called DIAMOND (Diabetes Improvement and Metabolic Normalization Device) ‒ a.k.a. TANTALUS™ ‒ developed by German medical device maker MetaCure. The system is implanted under the skin on the abdomen, and stimulates the stomach muscles when the patient is eating. This tricks brain into thinking more food has entered the stomach than the person has actually eaten. To deal with this supposedly large meal, the brain boosts insulin production as well as triggering the release of hormones that suppress appetite.

This means that the patient feels full much sooner than normal. A wireless charger system allows the patient to recharge the device at home by placing the charger over the abdomen for 45 minutes, once a week. The result is an improvement in blood glucose levels, which is often accompanied by weight loss, and reduction of blood pressure, waist circumference and blood lipid level. Goodbye bariatric surgery!

Over 200 patients are using the DIAMOND system to date, many of them for over two years, and many for over four years. Trials at the Medical University of Vienna showed the device reduced blood glucose levels by a quarter over three months and the DIAMOND has been shown to significantly reduce blood glucose levels and blood pressure levels. Goodbye bariatric surgery!

Diabetes Management System Could Be iTunes of Diabetes Care
A UK-based medical device company, Cellnovo develops and manufactures an innovative mobile diabetes management system. Comprised of a mobile connected micropump, mobile touchscreen controller, blood glucose meter and applications, the Cellnovo system provides intuitive operation, wireless Internet connectivity and real-time activity tracking – all industry firsts.

Cellnovo offers extensive experience gained at the world’s premier medical device and wireless companies, including Medtronic, DuPont, Novo Nordisk, Abbott, AT&T Lucent, and other industry leaders. The Cellnovo system’s advanced micropump technology enables people with diabetes to more efficiently manage their life-saving therapies while benefiting from greater personalization and portability. This mobile-connected, disease management approach to diabetes removes the burden of keeping journals and pushes information to healthcare professionals so they always have a real-time view of this information

Treating High Blood Pressure With Radio Waves
 

The Symplicity Catheter Systemdeveloped in Australia is used to perform a procedure termed renal denervation (RDN). In a straightforward endovascular procedure, similar to an angioplasty, the physician inserts the small, flexible Symplicity Catheter into the femoral artery in the upper thigh and threads it into the renal artery. Once in place within the renal artery, the device delivers low-power radio frequency (RF) energy to deactivate the surrounding renal sympathetic nerves. This, in turn, reduces hyper-activation of the sympathetic nervous system, which is often the cause of chronic hypertension. The one-time procedure aims to permanently reduce blood pressure. RDN may also allow patients to reduce or eliminate the need for lifelong antihypertensive medications.

The procedure is highly effective with 84 per cent of patients who underwent renal denervation experiencing a reduction in systolic blood pressure by more than 10 mmHg. The study also found that the therapy was safe, with no serious device or procedure-related events, no cardiovascular complications and no kidney-related complications.

Removing Pain From Diabetes Management
A quick and painless way to measure blood sugar is highly sought-after by diabetes sufferers, who currently have to prick their fingers to draw blood several times a day. Now, researchers in the US may have found a solution – a device that works by simply shining a light on skin.

An MIT team has developed an algorithm to relate blood glucose to interstitial glucose levels. “We’ve incorporated a mass-transfer model into the overall Raman spectroscopic algorithm, which allows us to seamlessly transform between blood and interstitial fluid glucose,” explains Ishan Barman, lead author of the research.Using an early version of the device, the team tested the blood-sugar levels of some human volunteers and found that the accuracy and precision of the test was just as good as conventional finger-prick tests. In addition, the new algorithm allows the test to predict impending episodes of high or low blood sugar (hyperglycemia and hypoglycemia) by extrapolating the rate of change of sugar concentration.

The vision is to create a laptop-sized device that could be kept at home or carried around. Rather than having to pierce the skin to obtain blood samples, the device measures sugar levels by simply placing a scanner against the skin. Because measurement is fast and easy, it is hoped that the device may encourage people with diabetes to check their blood sugar more often, giving them better control over their condition.

This research addresses a real problem and appears to provide an important means for improving the calibration of non-invasive sensors. It may also be helpful in the development of a so-called ‘artificial pancreas’ – where insulin can be dispensed automatically in response to sugar levels.

High-Tech Tattoo For Monitoring Blood Sugar
Another MIT team has given people with diabetes one more reason to join the tattoo craze: a special tattoo under development could help them monitor their blood sugar. The team is developing a glucose “tattoo” that could give people with diabetes a visual track of their blood sugar, and reduce the need for the painful finger pricks required for traditional monitors. The glucose tattoo ink, which would be injected under the skin, would be made from a substance that can reflect infrared light back through the skin to a watch-sized monitor that the person with diabetes wears over the ink.

By having this special ink injected under their skin, and by consistently checking the small monitor worn over it, people with diabetes can get a “real-time” feed on their glucose. They can note and take action when they see their blood sugar climbing or dropping; they don’t have to wait until they can get to a convenient place to conduct a finger prick or, worse, until they start to feel ill. The device also opens up an avenue of thought: if special ink can alert people with diabetes to dropping glucose levels, could an automatic, implanted glucose dispenser or pump be far behind?

Shed a Tear to Test Blood Sugar
On diabetes forum like TuDiabetes, diabetics are forever discussing lancet devices, painful pricks, first drop of blood, and callused fingertips. Now a team of researchers at the Arizona State University in collaboration with the Mayo Clinic is developing a new sensor that could make the lives of diabetes patients much easier. The team has come up with a sensor that would enable patients to take tear fluid from their eye to test their glucose levels. The researchers claim the tear sample would give just as accurate a reading as a blood test does.

Team members assessed how current devices were working – or failing – and how others have attempted to solve monitoring problems. They came up with a device that can be dabbed in the corner of the eye, absorbing a small amount of tear fluid like a wick that can then be used to measure glucose. Because of its potential impact on health care, the technology has drawn interest from BioAccel, an Arizona nonprofit that works to accelerate efforts to bring biomedical technologies to the marketplace.

Improving Compliance
A number of companies have developed continuing blood glucose monitoring and insulin injection products with the goal of improving compliance in diabetic patients. Today's children with diabetes also have the opportunity for better blood glucose control than any generation before.

A research study reported in Pediatric Diabetes showed that, compared to multiple daily insulin shots, children on insulin pump therapy for 12 months significantly and consistently lowered their A1C levels. In fact, insulin pump therapy has been shown to significantly decrease severe hypoglycemia in youth. Recent studies showed that adolescents and young children on insulin pump therapy had over 50 percent fewer episodes.

To encourage compliance in diabetic children, Bayer Diabetes Care recently released its Didget blood glucose monitor, which connects to the Nintendo DS and DS Lite. The meter provides children with an adventure game that rewards consistent testing with points, which can be used to unlock new game levels. The product was approved by the FDA in April.

Bioject Medical Technologies markets a needle-free injection system that is approved for delivering subcutaneous or intramuscular injections.

The system forces liquid medication through a tiny opening held against the skin, creating an ultra-fine high-pressure stream that penetrates the skin. The technology can be used for a variety of applications, including diabetes, malaria and influenza.

Echo Therapeutics has developed a wireless, transdermal glucose monitoring system for patients with diabetes. The Symphony tCGM Systemuses a skin permeation device, called Prelude, to painlessly remove the outermost layer of skin in approximately three to five seconds, allowing the transdermal biosensor to read glucose levels through the remaining layers of skin.

OrSense has developed a noninvasive continuous glucose monitor that utilizes a patented technology called Occlusion Spectroscopy. A ring-like sensor temporarily closes off (occludes) blood flow in the patient’s finger, creating new blood dynamics that generate a unique optical signal. Clinicians can analyze the signal to obtain measurements of glucose levels and other blood parameters.

Online Diabetes Resources
Then there are new computer programs that support the analysis of home blood glucose data. Insulin pens are finally the norm and diabetes sufferers are using not just more convenient and expedient methods of insulin administration ‒ they are now using more accurate methods because of technologies that provide improved measurement and monitoring. The idea of subcutaneous glucose sensors were a dream only a decade ago and now they're an everyday part of diabetes care.

Bethesda-based Telcare, a Bethesda-based company that has developed blood glucose monitoring technology that combines a glucose meter with wireless connectivity to Telcare's "cloud" server. The electronic device keeps an open two-way communication between a patients and caregivers ‒ those that are loved ones and those that are professionals such as the nurses and doctors.

Telcare monitor users can access all of their glucose data, as well as offering additional electronic logbook capabilities such as manual recording, nutrition recording, weight management, exercise regimens, medication amounts, and blood pressure statistics. Most impressive is that Telcare provides a cross-platform social community where people with diabetes and healthcare professionals can interact, share stories, discuss the diabetes technology that they use, and learn from one another.

Many diabetes-related health problems ‒ such as eye, kidney and heart disease ‒ are the result of high levels of blood glucose affecting organs over time. So doctors are encouraged that today's young diabetes patients can achieve consistent, lower blood sugar levels from an early age that can continue for a lifetime. For example, Roche makes the ACCU-CHEK® Spirit insulin pump system.

These pumps are milestones above the traditional method of treating fluctuating glucose levels. These pumps can deliver 480 basal doses of insulin each day. But here's where technology comes in: A Palm device and the ACCU-CHEK Pocket Compass software with a bolus calculator determines a patient's bolus doses and even creates pie charts and other graphs to track a patient's progress. This software application can be loaded onto smartphones.

Another company is PositiveID Corp, a growth-stage micro-cap known for their digital personal health records technology. The company unveiled its new 'iglucose' technology at the Cellular Technology Industry Association (CTIA) annual conference in Orlando, Florida last week. It is a wireless communication device for the automatic transmission of blood glucose readings from market leading, data-capable glucometers to the iglucose database.

PositiveID's iglucose technology is making great strides in the advancement of diabetes management and control by allowing patients to wirelessly track blood glucose levels. It connects to the patient's existing glucometer and, using M2M (machine-to-machine) technology, collects, records and transmits a patient's blood glucose data to the iglucose database.

From there, it can be shared automatically via text message, email or fax with family members and health care professionals in real-time. In doing so, iglucose helps eliminate the burden of keeping journals and empowering individuals with diabetes to be more engaged in the self-management of their condition.

Cure for Diabetic Neuropathy
Neuropathy is typically measured by taking skin biopsies from the foot and running a series of specialized tests that can take up to a week to complete. In many cases, this debilitating condition is not identified until serious, and irreparable, damage has already been done.

But in a profound and important breakthrough, Nathan Efron, an Australian optometrist, has discovered that the nerves affected by neuropathy are an exact match to nerves found in front of the eye, and is testing whether looking at their level of degeneration in these nerves over a period of time would match the nerve degeneration found in arms and legs.

Quick and non-invasive eye tests would deliver results in a matter of minutes. In short, the importance of Efron’s discovery lies in the fact that since the eye is a transparent structure, it is the only place in the body where you can look directly at nerves and their degeneration over time.

There are multiple benefits of being able to measure the onset of neuropathy, one being that there are drugs in development that aim to cure diabetic neuropathy. When these drugs are ready to come onto the market the method would be able to detect nerve degeneration early and then hopefully cure it.

For the tests, patients would receive a drop of anesthetic in the eye. A corneal confocal microscope would then capture a 20 second “movie” of their eye for analysis. Two more eye tests will look at the effect of nerve degeneration on the retina.

Efron hopes his discoveries will lead to early testing for diabetic neuropathy that will motivate sufferers to better manage their disease. Testing could be carried out at the same time as diabetes patients are tested for other eye problems caused by the disease. The test has been used to monitor nerve regeneration in patients who have undergone kidney and pancreas transplants, and it could help track the effects of new treatments.

It’s interesting to ponder how technology – much of which already exist for other uses – can help us maybe not cure diseases like diabetes, but at least treat them in a way that takes the burden off the patient. There's more to come…What ideas do you have?

With inputs from Huffington Post