Novelties in Diabetes Management in the frame of UN’s Sustainable Development Goals

Ergina Syrigou

Carol Davila University of Medicine and Pharmacy, Faculty of Medicine (Bucharest, Romania)

In the modern world, a world packed with the marvels of technology and advances the humankind has made in all elements of our lives, we also experience the consequences of the never-ending development of our race and the ever-expanding gap between the developed and the developing countries. The chronic and catastrophic disease remains one of the main factors that push households from poverty into deprivation nowadays. Non-communicable diseases (NCDs) impose a large burden on human health worldwide. Currently, 63% of all deaths worldwide stem from NCDs – one of the primary ones being diabetes. Recognizing the interdependence of health and development, the UN has set the so-called “Sustainable Development Goals (SDGs)”, in an effort to provide a comprehensive plan of action for people’s prosperity, for ending the injustices that underpin poor health and development outcomes worldwide, and which aspire to be realized by 2030. (1,2)

Most in our interest is the third Goal (SDG 3), with an ambition to ensure a healthy lifestyle and promote the well-being of people that is essential to sustainable development. As this includes increasing life expectancy and reducing some of the common killer’s associated mortality, diabetes is a complementary part of this action policy. It is estimated that 415 million people are living with diabetes in the world, which is estimated to be 1 in 11 of the world’s adult population. 46% of people with diabetes are undiagnosed, while the figure is expected to rise to 642 million people living with diabetes worldwide by 2040, which makes it simple to understand the urgency to realize this mission. (3)

The UN, and as an extent the health professionals, have grasped that achieving this goal would also require the use of the modern and thus, more efficient technologies. Gladly, the innovations that the medical and technological fields are currently offering us, show a promising future in the management of diabetes. The essentiality comes down to the matter that people with diabetes today spend hours each week carefully tracking blood glucose levels, food intake and physical exercise to calculate when and how much medication they should receive and even though diabetes research has made enormous strides in the past decade, those living with the condition are still faced with the daily reality of the fact that a cure remains elusive. As such, there are many benefits to come from care that is both increasingly automated and personalized for the individual. A novelty of particular interest is the Artificial, or “Bionic” Pancreas. Since despite steady improvements in treatments for Type 1 diabetes, most patients still spend most of their lives outside the ideal glycaemic zone, this has led researchers to concentrate efforts towards the creation of a device capable of sensing a patient’s glucose level and automatically secreting the necessary quantity of insulin.

Ideally, the new product will take over the body’s task of monitoring and regulating glucose levels in the blood. With this device, a signal will be transmitted wirelessly every 5 minutes from a glucose monitor under the patient’s skin to a smartphone app, displaying their blood-glucose status. The accompanying app will then calculate the amount of insulin or glucagon needed to balance blood glucose, automatically sending a signal to the pumps carried by the user in order to administer the required dose via a catheter. At the same time, the system is supposed to require little, if any, input from the user. Steven Russell, of Massachusetts General Hospital, the co-author of the new paper on this device, also claimed that findings in his study proved that the bionic pancreas system reduced the average blood glucose to levels that have been shown to dramatically reduce the risk of diabetic complications. (4)

Inhaled insulin is another auspicious idea. On April 1st 2014 the FDA approved MannKind Corp’s inhalable and ultra-fast insulin called “Alfrezza.” It is a recombinant human insulin that is adsorbed onto Technosphere particles, which are formed by the self-assembly of inert excipient fumaryl diketopiperazine. The size of the Technosphere particles enables delivery of insulin to the deep lung for better systemic absorption. Afrezza has a more rapid onset and shorter duration of action than subcutaneously injected rapid-acting insulin analogues as seen in clinical trials, in which the median time to peak activity of Afrezza was shown to be 53 min, and duration of action to be ∼160 min (2.5–3 h). Its use is associated with less frequent post-prandial hypoglycemia and slightly less weight gain. Taken before each meal, or immediately after starting to eat, it does not require needles of any kind, as the insulin is packaged in powder form, is designed for adults with Type 1 or Type 2 diabetes and it is meant to primarily control post-meal blood glucose spikes. The powder insulin is used with a device that resembles a small whistle and it marks a milestone, or a resolution, for Mannkind, which spent nearly $2 billion and the better part of a decade developing the diabetes drug. (5,6)

Meanwhile, probably the most popular application of technology for today’s patients are the “smart” smartphone apps that have made possible the communication of a diabetes-specific device with a smartphone, enabling the creation of a powerful platform for remote monitoring and advice, a platform that permits various independently developed proprietary modules to interact in a system that assists patients in both real time and longitudinally across episodes of care. “Glooko” has emerged as the leading commercial integrator (with “Tidepool” the nonprofit competitor) of data from disparate diabetes devices. Rich silos of valuable proprietary cloud-based data from key device manufacturers (e.g., Medtronic, Dexcom, and Abbott) are beginning to share common formats (e.g., ambulatory glucose profile) and data, yet catalyzing this progress is a new regulatory openness by the FDA with regard to software interoperability.  These smartphone apps are monitoring tools that provide users with a clearer visual understanding of trends in their glucose levels throughout the day, though it incorporates a diary for diet, medication, and exercise habit logging too. Some of these apps even aim to close the gap between patient and healthcare provider, by including the option to have glucose readings sent via e-mail to the patient’s diabetes team. (3,7)

Smart “Sox” is another case of a smart device, this time in the form of socks that use fiber optics and sensors to monitor changing pressures in the patient’s feet, applicable in diabetic foot disease. Developed by American doctors, “Smart Sox” are designed to identify locations in the foot as well as ranges of motion that could lead to problems and though it, whether a patient is at a clinic or at home, they’ll get word from the Smart Sox (via diagnostic component) that there is a need for treatment. In this way, doctors will also be able to provide more effective treatment in the form of exercise or medicine. Ultimately hoping to help wearers avoid additional complications, these socks can alert patients ahead of any developing foot ulcers and other painful trauma. (8)

Here is necessary though to underline that one great benefit of these online databases formed by the data gathering of the users is that, through this database, the medical community all around the world is constantly updating its information on the status, the evolution and the management of the disease, helping them in such a way to develop new ways of treating it and re-evaluating the prognosis and current medication options, being possible by comparing and cross-checking the evidence of these devices and the population using them. In my opinion, as these databases continue to expand, their value to the medical community will be incalculable, as understanding what long term benefits the patients and what does not, can not only simplify the caregiver’s management choices and reduce the costs, but it will also greatly improve the quality of life of the public involved. (9)

In the final denouements we recognize that new therapies, monitoring, and revolutionary-enabling technologies applied to healthcare represent a historic opportunity to improve the lives of people with diabetes. Based on the initiative of the SDGs but taking it even a step further, technology can indeed prove extremely helpful in the way we manage this disorder. It appears that shortly, connected care and telemedicine will replace more expensive, less convenient face-to-face clinic visits by enabling new models of care that increase velocity-to-control with more aggressive and frequent interventions that speed the achievement of glycemic goals, thus accomplishing what the UN’s third Goal pursues to do, as it is the yearning and commitment of us all to better the lives of our fellow citizens in the most effective ways accessible to us each time.

References:

  1. Goal 3: Good health and well-being, SDG Sustainable Development Goals Fund Organization, available here.
  2. Goal 3: Ensure healthy lives and promote well-being for all at all ages, United Nations Organization, Sustainable Development Goals for 2030, available here.
  3. Kerr D, Axelrod C, Hoppe C, Klonoff DC. Diabetes and technology in 2030: a utopian or dystopian future. Diabetic medicine: a journal of the British Diabetic Association 2018;35(4):498-503, PMID:29356078, doi:10.1111/dme.13586
  4. Pfützner A. Diabetes Technology. Endocrine development 2016;31:57-83, PMID:26824436, doi:10.1159/0004393894
  5. Quinn Phillips , “10 Diabetes Technologies to Watch in 2019”, October 17, 2018 , Diabetes Self -Management, available here.5
  6. Timothy S. Bailey, , John Walsh, , and Jenine Y. Stone, 1 Jun 2018,  “Emerging Technologies for Diabetes Care”, Diabetes Technology & TherapeuticsVol. 20, No. S2, available here.3
  7. Hartz J, Yingling L, Powell-Wiley TM. Use of Mobile Health Technology in the Prevention and Management of Diabetes Mellitus. Current cardiology reports 2016;18(12):130, PMID:27826901, doi:10.1007/s11886-016-0796-8
  8. Goal 3: Ensure healthy lives and promote well-being for all at all ages, United Nations Organization, Sustainable Development Goals for 2030, available here.
  9. Jared Hill, “‘Smart’ diabetes technology on the horizon”, Diabetes Ireland – Latest Articles

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