Digitizing Diabetes Care: A Revolution in Medical Tech
A new wave of technology offers promising innovations for diabetes patients in the age of COVID-19
By Thomas Roades, Erin Gregor, Jenna Patterson, and Andrea Feigl
Diabetes, one of the most common non-communicable diseases (NCDs), has been on the rise around the world for years. In 1980, just over 100 million people were living with diabetes, but by 2014, the number of diagnosed cases had skyrocketed to 422 million. And these are just documented cases — research suggests that as many as 45% of all global diabetes cases go undiagnosed. Diabetes is particularly difficult to treat because controlling the disease requires constant vigilance and monitoring both by patients with diabetes and their doctors. As a result, even when diabetes is diagnosed and treated, there’s no guarantee that it will be controlled and patients will be safe from complications.
A new wave of digital technologies, however, offer promising solutions to help diabetic patients and their care providers monitor their progress and control their condition. If health financing backs these evidence-based innovations, better quality care could be extended to countless new patients with diabetes globally.
E-Health Innovations for Diabetes
For patients with diabetes and hypertension, tracking blood sugar, blood pressure, and other indicators, as well as consistently taking prescribed medications can be overwhelming. A wide range of new apps offer to simplify and streamline these processes for diabetes patients and their doctors. Many offer uncomplicated interfaces for patients to enter and track the relevant health data, and some can even share that data with care providers. Provider-facing technologies also show promise, allowing doctors to more quickly view and understand patients’ medical history and more easily conduct screenings and enter results. A variety of apps are offered in many different languages and have begun to gain traction in regions across the globe.
There is evidence from scientific studies that such technologies can have a real impact on health outcomes for NCD patients. A 2017 study from the Journal of Diabetes acknowledged the importance of self-management and education for diabetes patients, the “numerous daily decisions” these patients make, and the “vast amounts of data” those decisions generate that could be harnessed to improve care.
Those researchers’ review of the literature showed that, while there is still significant variation in outcomes, usage of telemedicine apps aimed to aid diabetes care was associated with a small average reduction (.28%) in blood glucose levels in trials ranging from 4–12 months.
Other trials show similarly encouraging results. An earlier study, from 2011, of over 1,600 diabetes patients found that those using SMS messaging technology to send and receive updates on their blood glucose levels and diabetes management advice experienced a 0.5% reduction in blood glucose relative to the control group. Yet another, more recent, study in 2017 analyzed the results of 13 trials on mobile apps for diabetes and found “overall efficacy” in reducing blood glucose, with an average reduction of .44% compared to control groups. These solutions are needed now more than ever, as the prevalence of diabetes, and particularly uncontrolled diabetes, is on the rise around the world.
Treating and Controlling Diabetes
The global upward trend of diabetes has been driven in large part by the increasing prevalence of the disease in low- and middle-income countries (LMICs); the WHO reports that diabetes prevalence has been rising more rapidly in LMICs than in high-income countries (HICs) in recent years. Undiagnosed diabetes cases are more prevalent in LMICs, too. Researchers estimate that over 80% of undiagnosed cases are concentrated in LMICs.
In comparing diabetes care across global income groups, it’s important to examine data disaggregated across the care cascade, not just sheer prevalence. Although the overall prevalence is lower in LICs (partly because more cases go undiagnosed), those who do have diabetes in LICs are far less likely to be able to control and manage their condition, putting them at higher risk of complications.
A 2019 cross-sectional study published in PLOS Medicine assessing health system performance for people with diabetes in 28 LMICs offers a closer look at how diabetes care really serves patients across the country income spectrum. The study included a combined sample of nearly 850,000 diabetes patients across low-income, lower-middle-income, and upper-middle-income countries. The researchers’ findings showed diabetes to be more prevalent in UMICs than LICs or LMICs, as shown in the figure below.
This finding may be somewhat surprising, since LICs, unfortunately, tend to bear the largest burden of many of the world’s deadliest diseases, including common chronic diseases. These data, however, are actually in line with previous research in the field, which has consistently shown that the urbanization found in UMICs is often associated with higher rates of physical inactivity, less nutritious diets, obesity, and diabetes. The issue of undiagnosed cases likely contributes to this disparity as well; higher-income countries are able to diagnose and document more cases than lower-income countries where more go undetected.
The PLOS Medicine study did include cause for concern for diabetes care in LICs, too. Though the prevalence of diabetes is lower in those countries, rates of blood glucose control among diabetic patients are also lower than those in LMICs or UMICs (the study defined “control” as having HbA1c < 8.0% or equivalent). The researchers’ findings on this point are shown below.
In LICs, more than four out of five people with diabetes do not have their blood glucose levels under control. Even in UMICs, which were the most successful in treating diabetes of any World Bank income group represented in this study, three out of four people with diabetes are living with uncontrolled blood sugar levels. The researchers note in their conclusions that “absolute rates of glycemic control were higher in the U.S.” than LICs and even than the UMICs in this study, but they also acknowledge that increased health spending alone — at least on traditional diabetes care — is not always enough.
In the U.S., the researchers comment, there are large gaps between rates of treatment and rates of glucose control; “there are similar difficulties for health systems across all income groups in translating services delivered into effective disease control.” According to these findings, there is a “need for innovative, scalable, and locally acceptable approaches to influence human behavior in order to improve rates of glycemic control.” New e-health innovations are perfectly positioned to meet that need.
Financing Digital Solutions
Some might assume innovative new technological solutions for healthcare, like these e-health softwares for diabetes management, would be too expensive to implement effectively in LICs, where cost constraints are already tight. But these methods can be cost-effective, and blended finance investments can help to keep risks low for private-sector companies entering emerging economies, thereby allowing them to keep their price points down as well.
The COVID-19 pandemic also makes these options all the more valuable as alternatives to traditional in-person care, which has too often broken down due to the burden of the virus. Nearly half of countries surveyed by WHO this summer said care for diabetes has been disrupted due to the pandemic, and more than half said the same of hypertension care. Now that even visiting a doctor’s office in person can be a high-risk activity, tools to allow patients to manage their conditions effectively at home and keep their doctors in the loop could be more valuable than ever. Many investors and tech companies in the global health space may view LICs and emerging markets as risky, but we at HFI see a great opportunity to fill an urgent need, especially during the COVID-19 pandemic. Blended finance vehicles bringing together public and private funders offer a promising path toward better care for more people, particularly in LMICs.
The demand for new and better care is rising. The evidence to support these innovative solutions is out there. The investments should follow.