Satish Kumar Garg singles out tackling of hypoglycaemia for effective handling
Many health care solutions today, increasingly, ride on the technology train.
The pills and syringes, devices are still there, sometimes, but now have the ability to do their task faster, better, with greater sophistication, and least intrusion. That’s the way medicine is heading, and certainly in diabetes care.
An expert sitting at the very cusp where healthcare and technology have begun to work together, Satish Kumar Garg, the editor-in-chief, Journal of Diabetes Technology & Therapeutics, talks to The Hindu on emerging technologies in diabetes care. He was in Chennai to deliver the 22nd Dr. Mohan’s Diabetes Specialties Centre Gold Medal Oration.
“The real problem today,” he begins, “when we manage patients with diabetes is hypoglycaemia or low blood sugar. If we can take that one hurdle away, we can manage diabetes better.”
How does one reduce hypoglycaemia? “One way is to come up with new insulins that will limit low blood sugar conditions. There are some of these insulins that have already been approved in India and Europe, but not yet in the U.S. These are more reliable; they limit hypoglycaemia; effectively control blood glucose; and even help patients shed weight.” But here’s how technology gets a play here. “We ask people to check blood sugars two, three times a day, but what do they do with this. Now, it is possible to have metres that can provide advisories to the patient,” he says.
The moment they check their sugar, this data will show up on the iPhone. The phone has already mapped out their dosage, and based on their blood glucose, the phone will advice them on how much insulin to take.
“Now, if you can check your blood glucose continuously, it will reinforce for patients their actions: what dosage to take, should they eat more or less. This helps improve care.”
When patients start taking the right amount of oral drugs/insulin, this will reduce their glucose excursions both on the high and low end, data has shown.
Insulin pumps, very popular in the United States, indicate another way in which technology has come to the aid of the patient. There are over half a million people in the U.S. using insulin pumps, and data clearly shows that those using these devices have better glycated haemoglobin (HbA1C) levels and lower hypoglycaemia. This is because insulin is sent in smaller doses, not a large dose as when one takes insulin shot.
Since it is smart to marry relevant technologies to take on complex tasks; that is precisely what is happening in diabetes research as well. The culmination of that would be, naturally, replacing the human pancreas (which produces insulin) with an artificial one. Work is already on for this.
Dr. Garg predicts that the truly artificial pancreas will be complete in five years.
The artificial pancreas is actually a combination of the insulin pump and sensor. The part that has been approved so far, does the task of keeping a watch on the blood glucose, and when it senses a drop, it immediately sends a message to the pump to suspend insulin supply. This way, patients can avoid episodes of hypoglycaemia. The second innovation is for the sensor to tell the pump to speed up when sugars are high, but this is yet to be approved.
The third innovation already being contemplated is to use predictive algorithms to prevent hypoglycaemia events before they occur. “When we inject insulin, there is a delay in onset of action, for about 30 to 40 minutes. The sensor will know your glucose trends, so if it reads your glucose level at 110 mg, and it can predict that if you don’t act in the next half-hour, you are going down to 60 mg, and drop to hypoglycaemia,” he explains.
If these innovations are also approved, then the only part that will be missing is glucagon. Dr. Garg says. “Glucagon is a hormone secreted by the pancreas to increase blood sugar levels. The artificial pancreas cannot do this as yet, but it will be a matter of time, I guess.”
Just as is the norm, technology which starts out expensive, will become cost-effective eventually. “It will make things easier for the patient. Imagine if he can control everything with his mobile phone. But the issue now is whether we can put this data on the cloud.”
The problem with putting all this information on the cloud is leaving all of it open to those who can hack into it. “If someone hacks into the cloud, and we do have some crazy people, then, he can hack into your pump and increase the insulin dosage.”