Talk of Mr.Vinaytosh Mishra at CARDIABCON 2013

1. Technological Advancement in
Treatment of Diabetes
Mr. Vinaytosh Mishra
IIT-BHU (ECE),MBA,IMNU Ahmedabad
MD. Panacea Hospital ,Varanasi
Visiting Professor on Digital Marketing IMT-Ghaziabad & CIMP Patna

2. Overview
• Economic burden of diabetes
• Role of Technology in diabetes
management
• Future of Glucose sensing and Insulin
delivery devices
• Use of Internet & ICT in treatment of
Diabetes
• Smartphone-Based Glucose Monitors and
applications in the Management of
Diabetes
• Recommendation

3. Economic Burden of Diabetes
• In the next 17 years, India, China and the US would have the largest
number of diabetics. It is estimated that every fifth person with diabetes
will be an Indian.
• Due to this, the economic burden due to diabetes in India is amongst the
highest in the world.
• As per WHO estimates, mortality from diabetes, heart disease and stroke
cost about $210 billion in India in 2005.
• Much of the heart disease and stroke in these estimates is linked to
diabetes.
• Diabetes, heart disease and stroke together would cost about $ 333.6
billion over the next 10 years in India alone, estimates WHO.

4. Alarming Facts
• Current Population of India: 1.27 billion
• Per Capital Cost of Diabetes =$333.6 billion/1.27 billion =$263 /Year
• Per Capital Income of India =$1127 /Year
• % of Spend on Diabetes= 29.6%
• Future is Dark!
• India has may lose its demographic advantage. More and more young
people are falling in trap of diabetes
• Danger is increasing due to sedentary life style
• Cost of therapy will further increase because many of patients will shift to
multiple drug therapy in near future.

5. Technology can share the burden
• Better Glucose sensing and Insulin delivery devices can not only
help is managing the Diabetes efficiently but also reduces the cost
of therapy by reducing the incidences of Hospitalization
• Information Technology enabled Diabetes Management (ITDM):
• Of the existing technologies targeting providers, patients, and
payers, provider centered interventions, such as diabetes registries
currently show the most potential for benefit in improving
outcomes and reducing costs.

6. Glucose Sensing and Insulin Delivery
Trends
• Short term:
– easier, smaller, better use of data
• Long term:
– more accurate, implantable, sensor-
pumps linkage
Enabling Technologies
• Wireless
• IT
• Micro Electo Mechanical Systems
• Nanotechnology
• Biomaterials

7. Things are getting smaller!
Advancement In:
Blood Glucose Meter
But things can get much smaller
thanks to MEMS technology!

8. Self Blood Glucose Monitoring
Fourth Generation Glucometer

9. Things are getting more convenient!
Glucose Meter with Built
in USB
Cell Phone Test Strip
Analyzer with auto-texting
and web download
All-in-One Finger stick:(includes meter, lancing device, lancets, test strips)

10. SBGMS connected to Games Console

11. Continuous Glucose Monitoring
Current Practices in CGM
CGM is shown to Clinically
Meaningful
• Combination of CGM and
pump therapy improves A1c
significantly compared to
multiple daily injections
• No increase in Hypoglycaemia
• Significant effects in both
children and adults

14. Technologies on Horizon
CGM in the ICU Intravascular sensors allow
short-term monitoring with
greater accuracy and less lag
compared to subcutaneous
sensors
• Electrochemical (like current
CGM technology, except
placed in blood, not SQ)
• Spectrophotometric (in-line
analysis of extracted plasma)
• Fluorescence (glucose
sensitive fluorophore
immobilized on tip of fiber
optic catheter)

15. Transdermal:Glucose in ISF Fluid

16. MEMS Viscometric Sensor for CGMS
Cantilever

17. Fluorescing Implantable Capsule

18. Magnetic Glucose Sensor
Mass-sensitive magnetoelastic sensor as the
transducer.
The glucose biosensor is fabricated by first
coating the magnetoelastic sensor with a pH-
sensitive polymer and upon it a layer of
glucose oxidase (GOx).
The pH-responsive polymer swells or
shrinks, thereby changing mass, respectively, in
response to increasing or decreasing pH
values.

19. Optical Scanning of Eye
A thin plastic sensor is embedded in a typical soft contact lens;
The sensor detects the amount of glucose in the tears -- and changes color
accordingly.
a hint of green (normal),
blue (hypoglycemic - low blood sugar),
violet (very hypoglycemic).
• Display on digital hand-
held format
• Non-invasively scanning
the eye with light to
screen for diabetes and
monitor glucose levels.

20. Fiber Optic Sensors that Mimic Hair
glucose solutions have a magnetic optical rotatory effect (MORE) such that
when a magnetic field is set up in a glucose solution there is a rotation of
the polarization vector of the incident light that is proportional to the path
length, magnetic field strength, and the concentration of glucose in the
solution.
Fluorophore-
Biosensing
Material

21. Smart Tattoo for CGM
The skin is permeable to near-
infrared light (NIR). As a
consequence, near-infrared dyes
can be measured across the skin
without the need of an optic
fibre, which has been termed
“smart tattoo”.

22. 1. Aichmophobia
2. Belonephobia
3. Enetophobia
4. Trypanophobia

23. Progress in Insulin Delivery

24. Inhalable Insulin
MEMS Tooth Concept Islet Cell Encapsulation

25. Inhalable Insulin
• Inhaled Insulin reaches lung capillaries and
absorbed there
• Inhalable insulin was available from
September 2006 to October 2007 in the
United States
• The inhalable insulin was effective but not
better than inject able short acting insulin
• Concern of Lung cancer and Alzheimer disease
• More volume is required for similar effect 1:8
• Unpredictable absorption in smokers and
COPD patients
• Pfizer announced that it would be
discontinuing the production and sale of
Exubera due to poor sales

26. MEMS Technology :Nano Pumps
• The MEMS-based Nanopump provides better control
of the administered insulin doses.
• The Nanopump is able to control delivery at the
nanoliter level, very close to the physiological delivery
of insulin.
• The device prevents over-dosing and detects under-
delivery, occlusion, air bubbles and other potential
malfunctions in the pump to further protect patients.
• As a disposable device, manufactured using high-
volume semiconductor processing technologies, the
MEMS-based Nanopump will also be much more
affordable, allowing the patient or the health system
to avoid the typical up-front investment associated
with current pump solutions.

27. Beta-Cell Encapsulation
• These devices could eliminate the need
for of immunosuppressive drugs in
addition to finally solving the problem of
shortage of organ donors.
• The use of microencapsulation would
protect the islet cells from immune
rejection as well as allow the use of
animal cells or genetically modified
insulin-producing cells.
• It is hoped that development of these
islet encapsulated microcapsules could
prevent the need for the insulin injections
needed several times a day by type 1
diabetic patients

28. Artificial Pancreas
First Version of Artificial
Pancreas
Nanotechnology: Future of
Artificial Pancreas
Inject able nanogel can monitor blood-sugar levels and secrete insulin when needed.

29. Internet in Diabetes Care
The Wild Card for the Future

30. Internet Technologies Diabetes Treatment
• Web technologies used in facilitating the delivery
of diabetes care.
– Web sites & Web portals
– Electronic medical records(EMR)-Diabetes Registry
– Videoconference (Adobe Connect, Go Tomeeting and
WebEx)
– Interactive voice response (IVR) –input gathered
through voice responses
– SMS for alerts & recommendation

31. Diabetes Registry
• What is a disease registry?
– A electronic database containing data from
electronic and medical records
– Focus on patients with specific chronic disease
and medical condition
– Used by patient care provider ,patient and
administration to facilitate the delivery of health
care

32. Diabetes Registry
Advantage : Healthcare
providers
• Identification and tracking
of patients with diabetes
• Notification for abnormal
test results, missed
appointment s,up to date
information for patient
encounters
• Tracking progress of high
risk patients
• Promote the se of evidence
based care
Advantage :Diabetic Patients
• Allow patients to see all
results at one place
• Enable patients to compare
their heath outcomes with
others
• Permits patients to share their
information with other
providers
• Help patients to see results
over time to access
improvement and area of
concerns

33. Mobile Apps in Diabetes Management
Diabetes Buddy app.
Log Frog DB app.
Wave Sense Diabetes
Manager app.

34. Diabetes Management
Mobile Applications
Behaviour Change Theory and
Evidence-Based Medicine
World Social Marketing Conference 2013
~Kitty Harding
Project Objective: Rate iTunes mobile applications for diabetes self-management
against criteria to assess the use of behaviour change theory and evidence-based
guidelines
Study done for 50 Unique Apps

35. Diabetes Self Management & Theories
• Diabetes Self-Management
Behaviours
– Physical activity
– Healthy eating
– Medication taking
– Monitoring blood glucose
– Problem-solving
– Reducing risk of diabetes
complication
– Psychosocial adaptation
• Behavioural Theories
– Theory of Planned Behaviour
– Health Belief Model
– Social Cognitive Theory
•Result of Study
No app replaces in-person diabetes
self-management education
Apps may acts as a booster
Apps needed which provide
complete support across all skill areas
More research needed on mobile
apps for health

36. -Vinaytosh’s Web Model for Diabetes Portal
Proposed Model for
Diabetes Management
Internet
Healthcare
Provider
Actuators