CEO of Liva Healthcare, Kristoffer From explains the emergence of personalised e-health care and asks if e-health can close the gap between doctors and diabetic patients
Type 2 diabetes is a vast and growing, health problem for the UK. 3.7 million people in the UK are currently living with diabetes, 90% of which have Type 21. If the current trend persists, over five million people will have diabetes by 20251. The health consequences of Type 2 diabetes cannot be ignored. The condition is a major contributor to vision loss, kidney failure, heart attack, stroke and lower limb amputation.
Managing Type 2 diabetes
Traditional interventions for diabetes prevention have focused on counselling and medicine. However, these solutions alone are no longer enough to tackle the long-term health crisis the UK is facing. To reduce the number of people being diagnosed with Type 2 diabetes – we need to address the common root cause – unhealthy lifestyles.
Research has looked into using lifestyle interventions to tackle Type 2 diabetes and has shown promising results. In one study, patients with Type 2 diabetes were given either the standard care of counselling and medical therapy or were subjected to the standard care and, in addition, a lifestyle intervention comprising of a dietary plan and five to six aerobic exercise sessions a week for 12 months. 73.5% of participants receiving lifestyle interventions were able to reduce their drug intake compared to just 26.4% of the standard group. What’s more, over half (56.4%) of those in this group discontinued their medication altogether. Compared to just 14.7% of the standard care group2.
The evidence suggests that improving an individual’s diet and exercise regime is effective for those diagnosed with Type 2 diabetes. In addition, the fact that lifestyle interventions lead patients to come off medication altogether is also promising for removing Type 2 diabetes, in those that already are diagnosed as diabetic.
The role of digital interventions
The challenge is that medication is an intervention that is easily scaled up and distributed. All it requires is for the patient to remember to take it. Encouraging lifestyle interventions is a far harder task. Making long-term lifestyle changes requires time, dedication and continuous daily changes to form new, lasting habits.
What’s more, achieving weight loss is one thing, but maintaining it is a whole other mountain. For medical professionals, it is incredibly difficult to monitor whether someone is adhering to the recommended lifestyle changes. As such, whilst lifestyle changes may be optimal, they haven’t always been a realistic option, leading to a dependence on medication to treat the lifestyle disease.
To make lifestyle interventions more accessible to people, technology is starting to get involved. E-health solutions have been trialled and tested and have proved promising in helping people to lose weight. A recent study, for example, found patients lost 7kg over 20 months through online consultations3.
Digital NHS interventions
The NHS currently spends around £8.8 billion a year on Type 2 diabetes – just under 9% of its total budget. Digital interventions may be able to help tackle this pressure.
There are two key benefits of using digital interventions. Firstly, e-health tools can drive efficiency by being implemented on a mass scale and direct change in a significant number of people’s lifestyles. Secondly, because of the potential to reduce medication usage, there are significant cost savings to be made.
This is precisely why the NHS launched a pilot digital stream of the Healthier You: NHS Diabetes Prevention Programme. Over 5,000 patients are expected to benefit as five different technology companies (including Liva Healthcare) provide digital health interventions across the UK. The pilot is testing a range of apps, gadgets, wristbands and other innovative digital products to see their impact on people at risk of developing Type 2 diabetes. The pilot will be run for a year after which the NHS will assess which tool was most effective and should be taken forward and rolled out nationwide.
Keeping the human touch
The question is now whether digital health interventions can replace healthcare professionals entirely. And whether they should. Some health tech companies believe so and are launching products based on an algorithm with no need for human interaction. A recent study into e-health tools, however, found that having a trusted relationship with a healthcare professional was the most important factor in effecting lasting change in patients using digital interventions to lose weight4. Our belief is therefore that algorithms aren’t enough; you still need personal relationships.
For this reason, Liva Healthcare, although a digital health company, is focused on how technology can facilitate the work of healthcare professionals, not to replace them. When using Liva Healthcare, patients are allocated their own personal health coach who they can speak to and discuss their progress on a regular basis. Using an app, the health professional sets and monitors individual goals for their patients. Patients track their lifestyle (e.g. physical activity levels, food intake and blood sugar levels) and have access to an online support group of other patients, as well as a wealth of educational material. The intervention removes the need for patients to tackle lifestyle changes alone. What’s more, our research has found health coaches can support up to 400 patients on a weekly basis.
The future of digital health is exciting. Digital interventions have the potential to provide long-term programmes that can reach more people and even remove diabetes diagnoses. However, there is a need for digital interventions to be built on the science behind forming new habits and look at what it takes to make long-term lifestyle changes.
The research suggests it’s all about the relationship between a health coach and the patient. It is the relationship that is going to help people break poor habits. As we look forward to developing a health service that can treat more people, it is clear that digital interventions have a role to play. However, we mustn’t take the word ‘digital’ too literally. We can’t just rely on algorithms to drive the behaviour change needed to reduce the number of people at risk of developing Type 2 diabetes. We still need the human touch.
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2 Johansen, M. Y., MacDonald, C. S., Hansen, K. B., Karstoft, K., Christensen, R., Pedersen, M., & Iepsen, U. W. (2017). Effect of an intensive lifestyle intervention on glycemic control in patients with type 2 diabetes: a randomized clinical trial. Jama, 318(7), 637-646.
3 Brandt, V., Brandt, C. J., Glintborg, D., Arendal, C., Toubro, S., & Brandt, K. (2011). Sustained weight loss during 20 months using a personalized interactive internet-based dietician advice program in a general practice setting. International Journal on Advances in Life Sciences, 3(1 of 2).
4 Brandt, C. J., Clemensen, J., Nielsen, J. B., & Søndergaard, J. (2018). Drivers for successful long-term lifestyle change, the role of e-health: a qualitative interview study. BMJ open, 8(3), e017466.