Abstract
Diabetes mellitus (DM) is a lifelong metabolic disorder which is caused by the abnormal level of sugar in the blood. The information technology is playing an important role in the seamless data collection of the diabetic patient’s glucose and insulin level, heart rate, and weight and transfer through different devices and made it available to the health practitioner for their observation. This helps the diabetic patient in self management of their health based on the data processed by the apps present in the phone or devices. This paper reviews the information technologies role and benefits in the management of diabetes. Also, the development of different information technologies based systems has been discussed, which will play an important role in the future to treat diabetes.
Introduction
Diabetes is one of the leading causes of the death (1.5+ millions) and more than 347 million people are suffering from this disease (“WHO | Diabetes,” n.d.). Insulin is an enzyme which is produced by the pancreas and it regulates the blood sugar level in the body. So, a person becomes diabetic when pancreas is unable to produce sufficient amount of insulin in the body or body cells are unable to uptake and use it properly. There are two different situations arise:
Hyperglycemia (High Blood Glucose) :- The excess level of glucose in blood is called as hyperglycemia. This arises due to no secretion or low level of insulin in the blood which transfers glucose from blood into the cells (Giugliano, Ceriello, & Esposito, 2008).
Hypoglycemia (Low Blood Glucose) :- This condition arises due to low level of glucose in the blood.
There are two main types of diabetes depending on the insulin production and efficient use by the receptor cells in the body. These are classified into type1 diabetes and type 2 diabetes.
Type 1 diabetes
In most type 1 diabetes, the insulin producing beta cells are attacked by the T-cells which led to loss of beta cells in the pancreas which results in the deficiency of the insulin in the blood. The type 1 diabetes is partially inherited but the factors which causes the onset of type-1 diabetes is unknown. Around 9-10% of all diabetic patients are suffering from type 1 diabetes and it is not preventable (“2014 National Diabetes Statistics Report,” n.d.).
Type 1 diabetes has a swing in the glucose level between high and low levels. The frequency of the swing the glucose is totally unpredictable. It can reach a very level of blood sugar at one moment or it can go down to a serious condition of low blood sugar level. This requires a constant monitoring of the glucose level in the patient and insulin is injected into the patient’s body directly by different methods such as
Syringes: One or multiple injections in a day to control the blood sugar level.
Insulin pens: The insulin pens have use pre-filled cartridges of insulin and a fine needle which goes inside the skin to release insulin into the body.
Jet injectors: It uses a high pressure air to send insulin across into the body.
Insulin pumps: These pumps release insulin through flexible tubing which dispense insulin under the skin of abdomen (“Diabetes Mellitus,” n.d.). It consists of two parts:
Continuous glucose monitor (CGM): It takes the reading of the glucose in the body at every 5 minutes through a tiny patch stuck to the skin. However, the diabetic patients need to check the reading through finger-stick at every 12 hours to correct the readings in the tiny patch stuck on the skin. The reading from the tiny patch is sent wirelessly to the remote monitor or insulin pump (Clarke & Kovatchev, 2009).
Insulin pump: These pumps work in synchronous fashion with the continuous glucose monitor and make sure that blood sugar level always stay in the optimum range. The pump releases a steady amount of insulin in the body. If the blood sugar level becomes critically low then it automatically stopped releasing insulin in the body for 2 hours. The data of glucose reading is available to the health practitioner to understand spikes in the level and correlate with the activity of the diabetic patient. Earlier, it was a trial and error method to determine which activity caused the spike in the glucose level of the blood (Scheiner et al., 2008).
“Mobil Diab” is one of the app used in type 1 diabetes treatment. This uses the information related to the metabolic control, changes in psychological parameters to regulate insulin injection into the patient (Berndt et al., 2014).
Type 2 diabetes
It is one of the most common types of diabetes and more than 90% of cases are related to type 2 diabetes. In type 2 diabetes, pancreas does not produce insulin in sufficient amount or body cells (such as fat, liver and muscle cells) are resistant to insulin (“Diabetes,” n.d.). In most cases, the deposition of fats near the pancreas hinders the release of insulin into the body. Due to this reason, type 2 diabetes is indirectly correlated with obesity. People with weight more than 20% of their ideal weight are at a high risk of developing type 2 DM. Earlier, it is only present in the adult but lifestyle changes with high calories fast food causing the children to become obese and develop diabetes in the teenage (McCarthy, 2010). Type 2 DM doesn’t have any cure and it has several side effects such as blindness, cardiovascular disease, heart attack due to blockage of arteries, liver failure etc. However, lifestyle modification by self management plays an important role in controlling diabetes. Several new devices are playing an important role in quick support, constant monitoring, education and support for the patient to improve their condition to control diabetes and live a healthy life (Donath & Shoelson, 2011).
Apps in the Smartphone’s or computer are helping diabetic patients in a big way to self manage his/her lifestyle. These apps are of diverse ranges such as nutrition management, exercises, stress relief, blood sugar test analysis, platform to contact doctors and fellow diabetic members to contact and get timely response (Dayer, Heldenbrand, Anderson, Gubbins, & Martin, 2013). Also, these apps provide several reminders, updates for the sugar testing, exercise and useful information. Some of the mostly commonly used apps are discussed here:
Nutrient: Daily calories intake based on the type of the food using pictures taken by the phone. Also, it creates a nutrient chart based on the type of food, sugar intake and calories using weight of the food item so that user can have a good understanding of different foods eaten throughout a week or month and their role in maintaining the blood sugar. For example, an app “mdiabetes” send health messages to people and prioritize their food habits during fasting (“WHO | Mobile phones help people with diabetes to manage fasting and feasting during Ramadan,” n.d.).
Daily exercise required to burn a specific amount of calories burned in the process. For example, an app show the required distance of walking, running required to burn specific amount of calories burned (Praet & van Loon, 2007). Also, different exercise videos are available on the internet to decrease obesity and waist to hip ratio. Ex: - “Power 20” is a 20 minute daily exercise app to reduce the blood sugar level.
Stress levels: Stress also play an important role in increasing the blood sugar level. Songs, group activities, stress relieving exercises are available on the internet which is helping in a big way.
Blood sugar test results: A patient need to attach the blood sugar meters with the apps in the phone. The blood glucose meters take the reading and transfer the data directly into the apps for the patient’s observation. Ex: - “MyNetDiary” sends blood sugar reminders, integrates the data of physical activity, insulin dosages, blood pressure and suggest less calories food items to eat, better management of medication, etc.
The information technology based management system is used at three different levels:
Hospital and medical practitioner;
Patients, and
Insurance agency and employer.
Hospital based medical facilities can have access to the different database, clinical decision support systems, Electronic medical records, Telemedicines, and internet based services. All these support system application depend on the patient medical condition.
On the other side, diabetic patients can monitor their treatment using videoconferencing, telephonic sessions, internet based services to analyze the medical condition using artificial intelligence or human interface, and mobile based services (Bu et al., 2007). Usually, a patient access self management tools through web or mobile. In 2004, an estimated saving of 32 billion (in 10 years) dollar is achieved by using information technology based self management.
There are several factors which are helping the information management based approach in the treatment of the diabetes. These are as follows:
Big data and better understanding: Different apps make the diabetic patient more informative about their daily routine and help them to take care of their daily activities. More information is available for the health practitioner to understand the response of medication in different cases of diabetes. 24-hour medical record helps the doctors to prepare a personalized treatment of the patient combining medication, life-style changes, and exercise (Pagoto, Schneider, Jojic, Debiasse, & Mann, 2013).
Personalized Medicare for diabetic patients: The data collected from different patients is used to create big data and create new algorithm so that apps will be more powerful in the future to suggest best medicare solution combining life-style and food habits changes, exercise, and medicines (Bellazzi, Dagliati, Sacchi, & Segagni, 2015).
Tailored messages: A tailored SMS message motivates the patient to follow a new lifestyle change and an opportunity to speak with other persons in different online forum further help them to analyze their medical condition and lifestyle. It makes people more accountable towards their own health.
Cost effectiveness: Online tools are highly cost effective and in most cases it is free for the patient. For example, patients can contact clinics and get their queries answered without meeting the doctor. Self-management education through internet and support programmes are rich in provide engaging interactive elements. Low priced Smartphone’s and internet access made it affordable for people living in developing countries everyone to have these hand held devices and check their health conditions without meeting a doctor (Li, Zhang, Barker, Chowdhury, & Zhang, 2010).
Ease of access to information: Several blogs and platforms available for patients to get more information about their health conditions anonymously. Other diabetic patients share their information and improve the knowledge base (Wyne, 2008).
Informative treatment: Health practitioners are able to help the diabetic patients more efficiently in less time due to access of the previous medical records (Buntin, Burke, Hoaglin, & Blumenthal, 2011).
Early detection of emergency conditions: Health practitioners are in better position to detect any future emergency conditions due to availability of 24*7 medical data of the patient. Also, doctors can easily reach out to the patient and inform to take preventive measures early stage to prevent further complications.
Support from Insurance agencies: Insurance companies support the medical check-up as it detect major complications at an early stage and reduce health expenses (Kaufman, 2010). Different employers also preferred to have medical records of the patients to avoid any future legal claim.
A systematic review conducted on the application of different information technologies effect on the diabetes showed that internet based application has positive impact on the blood sugar level, physical activity, diet and healthy eating, blood pressure etc (Holtz & Lauckner, 2012).
There is large number of apps available for diabetes self management for both type 1 and type 2 diabetes (Table 1).
Some new technologies that are going to be highly useful for the diabetic patients in the future are as follows:
Smart Lenses: It is developed by Google to measure the glucose level in the tears of the eye using a wireless chip. A miniaturized glucose sensor is embedded in the lens to detect high or low blood sugar level. After detection, the data is transferred to the app in the phone.
Bionic pancreas: The ultimate cure of type 1 diabetes to have an artificial pancreas. Pancreas release insulin as well as glucagon hormone. Glucagon hormone increases the blood sugar level which is falling due to insulin. Bionic pancreas releases both insulin and glucagon in response to high or low blood sugar respectively after every five minutes interval (Russell et al., 2014).
Improving medication: The patients having diabetes with several other complications such as hypertension, epilepsy are being analyzed to suggest the best intervention for these patients to improve their medial health.
Virtual health: Already doctors are providing health consultation to the patients online.
Smart monitors: Iphone is replacing the monitors used for the continuous glucose monitoring and provides the instruction for the insulin pump. It directly shows the patient glucose level in the blood. “Gmate Smart” app is used for this purpose (“Gmate,” n.d.).
Conclusion
Information technology enabled self management provides a great opportunity for the patient, health practitioner in cost saving, informative self care, education and flow of information. Hundreds of Smartphone apps serves the same purpose and help the patient. New technologies further advanced the Type 1 diabetes and it might be curable with the help of bionic pancreas. For Type 2 diabetes, self control is an essential and the information technologies serves this purpose by motivation, free access to different tools.
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