• Diabetes
  • Japan extends healthcare to the home

    Welby My Karute is an innovative app developed by Welby Inc, a Tokyo based IT company to support the management of healthcare. The use of such apps for monitoring patient's lifestyles and chronic diseases is a growing trend in Japan.  Medical institutions using this app rely on the information provided to improve treatment and care and reduce the incidence of healthcare visits.  

    The aim of this app is to encourage patients to keep a record of their lifestyle at home, which is then shared with dieticians, doctors and other medical workers. This serves as a “watcher” as it keeps an eye on the patient without them seeing a doctor. Data such as meal choices, blood pressure, pulse, sleep patterns and whether they take drugs appropriately can be shared with computers at the hospital to inform patient management and disease monitoring. 

    Patients have stated that the app makes it convenient for them as they tend to miss hospital checkups due to having other commitments such as work.  This provides a useful use case for Africa, where patients struggle with similar challenges.  Coupling this app with suitable patient incentives can help patients and clinicians shift healthcare away from being reactive, but rather proactive and preventative.

  • Telehealth reduces risk in chronically ill patients

    As the number of patients with chronic conditions increases, telehealth’s role might become more important to meet their needs. A study in the Journal of Medical Internet Research (JMIR) by a team in Alicante, Spain, evaluated telemedicine’s impact of adopting new care models that provide more home supervision. It found it appears useful to improve targeted disease control and reduce resource use. These are to important findings for Africa’s health systems and their eHealth strategies. 

    Target diseases were one, or more of, diabetes, hypertension, heart failure and Chronic Obstructive Pulmonary Disease (COPD).The study’s objective was to evaluate ValCrònic telemonitoring’s impact on patients with these long-term conditions who are at high risk for hospital readmissions and Emergency Department (ED) visits. It compared before and after effectiveness after a year of primary care monitoring.

    Using the Community Assessment Risk Screening Tool, 521 patients used a tablet to self-report relevant health information. It’s automatically entered into their eHealth record for consultation.

    Compared with the year before ValCrònic, there were significant reductions in: 

    Weight, down from 82 kg before to 80 kgThe proportion of people with high systolic blood pressure,36% to 33%High diastolic blood pressure, 14% to 8%Haemoglobin, 36% to 20%Patients attending primary care emergency services in, 13% to 6%Hospital ED visits, 19% to 13%Hospital admissions due to an emergency,20% to 14%Disease exacerbations, 10% to 8%.

    Taken as a group of measures, an important finding seems to be that they’ve all moved in the same direction. The team’s overall conclusion’ that ValCrònic has positive benefits for high risk patients and healthcare by reducing hospital readmissions and ED visits. It supports equivalent investment by Africa’s health systems.


  • mHealth can now control diabetes

    The change in mHealth emphasis from wearables that monitor to one’s that have clinical benefits, especially for chronic diseases, has taken a big leap forward. A study by a team in Shanghai, China in Science Translational Medicine, a publication of the American Association for the Advancement of Science, says its produced a device that can help to control diabetes. Smartphone-controlled optogenetically engineered cells enable semiautomatic glucose homeostasis in diabetic mice, includes a Swiss author, has used a combination of genetic engineering and optics with wireless technology to control remotely the release of glucose-lowering hormones by engineered, implanted cells. It’s seen as an “Elegant feat of synthetic biology.” 

    The technique implants hydrogel capsules that contain engineered cells and light-emitting diode light sources. These provide a semi-autonomous system that maintains glucose homeostasis over several weeks. A custom-designed home server SmartController processes wireless signals so a smartphone regulates hormone production. The eventual result is mHealth for cell-base therapies provided in clinics. 

    WHO has estimated that some 7 million people in Africa were diabetic in 2000. It expects that by 2030, more than 18 million people will suffer from it, up from about 0.6% of the population to 1.5%, an extra 370,000 people each year. The breakthrough for people’s very important for Africa.

  • GluSense making remarkable strides in monitoring diabetes

    More than 14 million people suffer from diabetes. The  International Diabetes Federation has said if nothing’s done, this figure will reach 34 million by 2040. Africa has the highest percentage of undiagnosed people. At nearly 67%, they’ re at higher risk of developing harmful and costly complications.

    GluSense, an Israeli medical device company, is developing Glyde, a miniature injectable, continuous glucose sensor. It’s injected under the skin and transmits Continuous Glucose Monitoring (CGM) values to a wearable device, like a smartwatch, for up to a year. Better quality of life is a big benefit for diabetes patients. It could improve the lives of many Africans.

    “Today, diabetic patients need to endure frequent finger pricks daily in order to manage their glucose level, and even with modern CGMs, frequent calibrations, measurement verifications and replacements are still a hassle and limit efficient treatment,” GluSense CEO Dr. Boaz Brill said in an article in mobihealthnews. “In contrast, our Glyde continuous glucose monitor (CGM) will provide accurate glucose measurement for a full year with significantly fewer blood glucose calibrations. This ground-breaking technology will simplify and improve the life of people living with T1D and insulin dependent T2D worldwide.” 

    There’s more to do for Glyde to attain commercial viability. New funding from the Diabetes Research Fund (DRF) T1D Fund, a recently launched philanthropy dedicated to financing early stage programs for T1D. It’ll help GluSense to launch its first human clinical trial, an important step before it seeks regulatory clearance.

    GluSense says it “uses a proprietary fluorescent glucose-sensitive biosensor that ensures accurate glucose measurement across the full physiological range, with enhanced accuracy at the medically important hypo glucose range.” The biosensor’s made of “engineered live cells.” These enable it to replenish itself over a year. It also minimizes the need for less frequent calibrations.

    Many CGMs last about a week before they need replacing. Others can last up to 90 days. If GluSense can deliver Glyde with a one year life, it’ll be life changing for many diabetes patients. Its value in Africa could be considerable.

  • mHealth helps diabetes management

    As diabetes spreads across Africa, an encouraging study reported in Diabetes Care found the mHealth helps deal with it. A team from Cardiff University in Wales investigated 14 mHealth services used in glycaemic control,  HbA1c in diabetes 2 self-management by 1,360 users.

    Results are encouraging for Africa’s mHealth initiatives. The mean reduction in HbA1c of mHealth users was 0.49% compared with control groups. Sub-group analyses indicated that younger patients were more likely to benefit from mHealth for their diabetes. Benefits increased when health professional provided feedback, indicating that mHealth plus health professionals can be a better healthcare model that mHealth alone.

    Two other findings are, mHealth for diabetes can be effective for populations, and mHealth’s functionality and use need standardising. The latter highlights the need for Africa’s health systems to enhance their overall eHealth regulation that can lead to appropriate mHealth policies and guidance.

  • mHealth helps diabetics lose weight

    As diabetes threats increase globally, better ways of helping patients reduce their weight can help. mHealth has a role to play. A study of the US National Diabetes Prevention Program (NDPP) in the British Medical Journal (BMJ) found that mHealth helped to achieve significant weight loss at 16 and 24 weeks with 56% of starters and 64% of completers losing over 5%. Mean weight loss at 24 weeks was 6.6% in starters and 7.5% in completers. Participants were highly engaged, with 84% of the sample completing nine lessons or more.

    mHealth offers a promising means of delivering pre-chronic and chronic care. It’s a scalable, convenient, and accessible way to deliver the NDPP. The findings also support the effectiveness of using mHealth pre-diabetes interventions. It’s producing weight loss comparable to studies with high engagement, with potential for scalable population health management.

    The research evaluated Noom's smartphone and NDPP-based curricula with coaching of a user group of overweight and obese hyperglycemic adults. Weight loss efficacy of an mHealth service to deliver a total, structured NDPP wasn’t tested.

    The results support Africa’s health systems, that prioritise mHealth for diabetic patients. It’s also a priority for many of Africa’s mHealth start-ups.

  • SMSs can make people healthier

    mHealth’s impact on people’s health is quite hard to demonstrate. A study in India, reported in Northwestern, shows that a simple SMSs about health and diabetes, sent twice a week to a million people in India, can mitigate diabetes risks. Advice included more exercise, eat less fat and eat more fruits and vegetables. It increased these health behaviours known to prevent diabetes.

    The research by Northwestern Medicine, in Chicago, and Arogya World, a global health non-profit organisation with a large diabetes programme, aimed to use the power and reach of mobile phones to change diabetes risk behaviours in a large number of people from different parts of India. It’s findings are directly transferrable to Africa’s health systems to support their diabetes prevention efforts.

    People in both the experimental and control group improved their health behaviours over six months, but the experimental group improved significantly more. They improved their fruit, vegetable and fat intake and exercised more. SMSs led to almost 40%t more people, 299 improving their health behaviours, 299 showing improvement in the experimental group. In the control group, 185 people changed.

    The study used 56 SMSs. Emory University helped construct them for use on basic mobile phones. The SMSs were culturally adapted for India with extensive consumer feedback. In India, an estimated 66 million people live with diabetes, about 5.5% of the population. About a million die from it each year. In Africa, diabetes prevalence’s is about 4%. This approach is worthy of replication by Africa’s health systems. Arogya World’s planning to extend its India approaches to South Asian communities in the US. It reinforces the value of Africa’s health systems adopting their own approaches now to mitigate diabetes risks and avoiding higher levels like those in India.

    An option’s to construct a programme around myArogya. It’s Arogya’s app to support initiatives to deal with chronic diseases, including diabetes.

  • New films about diabetes in pregnancy

    Diabetes is considered to be the biggest global health crisis faced today. Around 422 million adults live with the condition, resulting in 1.5 million deaths per year, and these numbers are expected to double in the next 20 years.

    One type of diabetes often goes unrecognised; gestational diabetes. It develops in pregnancy and affects an estimated 3.7 million births each year.

    Medical Aid Films (MAF) has launched Diabetes in pregnancy: Stories from Saint Lucia, new films that tell the stories of women affected by diabetes during pregnancy. They were shot in Saint Lucia with the help of the Saint Lucia Ministry of Health, Wellness, Human Services and Gender Relations and the Saint Lucia Diabetes and Hypertension Association and support from W Science. The films aim to raise awareness of diabetes in pregnancy, how to manage the risks through healthy diet and exercise, and how to reduce chances of developing type 2 diabetes later in life.

    Permanent Secretary in the Ministry of Health, Cointha Thomas said, “Diabetes is one of the greatest health challenges facing our country, and little is known about gestational diabetes. This film will enable the Ministry to share lifesaving knowledge and strengthen our efforts to reduce the impact of this condition, helping to ensure more mothers and their babies are healthy in pregnancy and throughout their life course.”

    These new films are available in English and Saint Lucian Creole and part of a major drive to raise diabetes awareness in Saint Lucia and the Caribbean. They’ll be screened in hospital waiting rooms, antenatal clinics and in the wider community as part of a campaign to transform understanding of gestational diabetes, complementing a nationwide diabetes screening programme and training for diabetes specialists.

    You can watch the full-length film here or view this short trailer – both available for free, in English and Saint Lucian Creole.

    Feedback’s important to MAF. Please take five minutes to complete this a short survey. And films like these are dependent on donations so please support MAF’s work.


  • Which apps protect against this silent killer?

    It can be fatal. Risks include blindness, kidney disease, stroke, heart attack and amputation. The risks are largely avoided through early detection, lifestyle changes and where necessary, treatment, but up to a quarter of people don’t know they have it.

    Diabetes is a silent killer and according to the WHO’s 2016 Global Report its prevalence has more than doubled since 1980. According to the report, the rise mirrors increasing obesity and deceasing levels of physical activity.

    With numerous apps appearing to help you improve your health, which ones might be good for diabetics? Below is a 2015 list of top diabetes apps from Healthline.

    "Everyone has a role to play - governments, health-care providers, people with diabetes and those who care for them, civil society, food producers, and manufacturers and suppliers of medicines and technology are all stakeholders," says the WHO.

    Apps can be part of the solution too. Which ones are working to reduce diabetes and help diabetics in African countries? eHNA's found interesting initiatives in Tanzania and Senegal. We're on the lookout for more.

  • EHRs are more than sharing, they help detect type 2 diabetes

    Until a few years ago, EHRs’ benefits were mainly about sharing data for quality and efficiency gains. With Big Data and analytics, it’s more. EHRs can now be used to detect undiagnosed type 2 diabetes.

    A report in the Journal of Biomedical Informatics by a research team from University of California, Los Angeles (UCLA) describes how it started mining thousands of EHRs in 2012 to find a cheaper and more accurate way to identify people with type 2 diabetes. The approach offers big benefits for Africa’s health systems.

    The study had five main stages:

    Extract features from EHRs to predict diagnosed type 2 diabetes Predicted patients’ diabetes diagnosis using 9,948 clinical-quality EHRs Show that EHR phenotyping out-performed conventional screening Show EHR phenotyping had superior overall predictive accuracy Show EHR phenotypes also improved predictions of new patients with type 2 diabetes.

    Its initial data was an estimate of 25% of type 2 diabetes patients undiagnosed, due to inadequate screening. A long string of EHR data was used for the predictions and analysis. It included commonly prescribed medications, diagnoses as ICD9 categories, and conventional predictors, Body Mass Index (BMI), age, sex, smoking status, hypertension, Migraines, depot medroxyprogesterone acetate and cardiac dysrhythmias had negative associations with type 2 diabetes. 

    EHR phenotyping resulted in markedly superior detection of type 2 diabetes, including patients with EHRs with missing and unsystematically recorded data. The improvement should enable an extra 400,000 patients to be identified with active, untreated type 2 diabetes compared to the conventional pre-screening models. 

    By using analytics to reach undiagnosed patients, the methodology offers big benefits for healthy Africans. It offers big benefits for Africa’s health systems too, when they step up their combined investments in EHRs and analytics.