Barbara Harpham, Chair of the UK-based Medical Technology Group, explains the role that technology can play in reducing the financial and societal burden of diabetes
Diabetes is the most significant health challenge facing the world today. Almost one in ten (8.5%) adults over 18 are affected by the condition, with an estimated 1.6 million directly-attributable deaths in 2016 and a further 2.2 million caused by high blood glucose, making it the seventh leading cause of mortality. (1)
The problem is growing. The number of people with diabetes has almost quadrupled since 1980 (2) and experts predict prevalence to increase to over 600 million people worldwide over the 25 years. (3)
The global burden of diabetes
Apart from the human cost of diabetes and its associated complications, the condition delivers a major economic blow to healthcare systems and economies. In England for example, diabetes costs the NHS £10 billion every year. That’s £1 million every hour, or 10% of the total annual budget. Worldwide, diabetes and other non-communicable diseases (NCDs) are predicted to cost over $7 trillion between 2011 and 2025. (4)
According to Professor Nam H Cho from the International Diabetes Federation: “Diabetes threatens to overwhelm healthcare systems and hinder economic growth in many countries.”
Type 1 and Type 2 Diabetes
To appreciate the role of technology in managing diabetes, it’s important to understand the distinction between the two main forms of the condition: Type 1 and Type 2.
People with Type 1 represent between five and 10% of the total number affected. Its cause is unknown, and currently, it is unpreventable. People with Type 1 diabetes do not produce insulin to regulate their body’s blood sugar levels. Symptoms include excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes, and fatigue. Regular administration of insulin is needed to survive.
Type 2 affects around 90% of people with diabetes. It results from the body’s ineffective use of insulin. Symptoms can be similar to Type 1, but as they are often less marked, the disease can go undiagnosed for years and is often only detected after complications arise. Type 2 is largely the result of excess body weight and lack of physical activity.
With both Type 1 and Type 2 diabetes, patients can experience damage to the heart, blood vessels, eyes, kidneys, and nerves. Adults with diabetes are up to three times more likely to have a heart attack or stroke, (5) while diabetes is a leading cause of kidney failure, lower limb amputation, and blindness.
The role of technology
Managing diabetes is a major priority for many governments. Prevention of Type 2 diabetes through education programmes and policies to improve lifestyle, including smoking cessation and physical activity, as well as improved diet is vital.
Effective control of blood glucose levels is a major factor in avoiding complications and reducing healthcare costs. Medical technology can play a key role. For people with Type 1 diabetes who need to monitor their blood glucose levels and administer insulin several times per day, options range from simple test strips to insulin pumps and continuous glucose monitors.
Insulin pumps, worn outside the body, allow the user to programme their background insulin needs and have it delivered steadily around the clock and as needed with food. The benefit over injections is the ability to increase or decrease dosage according to each day’s changing circumstances. Uptake in some countries, including the UK, has been slow though, despite evidence that they can save millions in healthcare costs. (6)
Recognition of the value of continuous glucose monitoring (CGM), and flash glucose monitoring technology is also growing. Both provide more information than finger-prick blood tests and enable the user to make better treatment decisions by reading levels of sugar in interstitial fluid and sending the results to a reader or smartphone.
Point of care innovations for people with Type 2 includes glucose meters paired with applications and devices to enable people to manage their medication more effectively. Self-management and prevention support also comes in the form of mobile health technology, helping people improve their lifestyle or diet. (7)
From artificial pancreas to AI
Research teams across the globe have been developing the artificial pancreas for some time. The technology combines CGM with an insulin pump, using an algorithm to mimic the function of a human organ. Some devices have already been approved, while clinical trials continue on others. Primarily designed to manage Type 1 diabetes, work is also underway to find ways the technology can support glycaemic control among people with Type 2.
Looking further ahead, we can expect to see new developments in microtechnology and implantable devices, as well as 3D tissue printing, which could reproduce pancreatic cells for transplant. Artificial intelligence (AI) will also become more important, as machine learning improves blood glucose control via wearable or implantable devices.
Improving lives and reducing costs
The United Nations has set a target to reduce premature mortality from NCDs, including diabetes, by a third by 2030. Achieving this goal requires a joined-up approach that includes policies for tackling prevention, as well as innovative treatment approaches to reduce the toll on healthcare budgets and society as a whole.
According to the World Health Organization (WHO), every dollar invested NCDs returns to society at least $7 in increased employment, productivity, and prolonged life expectancy. (8) The case for the increased uptake of cost-effective technology is powerful.
The Medical Technology Group (www.mtg.org.uk) is a not-for profit coalition of patient groups, research charities and medical device manufacturers working together to improve patient access to effective medical technologies.
References
(1) WHO Global Report on Diabetes, 2016 www.who.int/diabetes/global-report/en
(2) WHO Global Report on Diabetes, 2016 www.who.int/diabetes//global-report/en
(3) International Diabetes Federation, IDF Diabetes Atlas 8th Edition, 2018.
(4) From Burden to “Best Buys”: Reducing the Economic Impact of Non-Communicable Diseases in Low- and Middle-Income Countries, WHO, 2011.
(5) Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Emerging Risk Factors Collaboration. Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio et al. Lancet. 2010; 26;375:2215-2222.
(6) Keeping Britain Working, How medical technology can help reduce the cost of ill health to the UK economy, Nov 2016 www.mtg.org.uk/campaigns/major-studies. The Medical Technology Group.
(7) Kitsiou, S, Paré, G, Jaana M, Gerber B. 2017. Effectiveness of mHealth interventions for patients with diabetes: An overview of systematic reviews.
(8) Saving lives, spending less: a strategic response to NCDs, WHO, May 2018 Time to Deliver: report of WHO Independent High-Level Commission on Noncommunicable Diseases, WHO, 2018.
Barbara Harpham
Chair
The Medical Technology Group
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