IDRS was developed using four simple parameters namely age, abdominal obesity, family history of diabetes, and physical activity. A maximum score of 100 is given for these categories combined as shown in the figure above figure.It has shown to be a highly cost effective way of testing for diabetes in a resource poor setting like India. IDRS also helps to distinguish type 2 from non-type 2 diabetes mellitus.
Subjects with an IDRS of <30 was categorized as low risk, 30-50 as medium risk and those with > 60 as high risk for diabetes.
The mean IDRS increased significantly from normal (48) to prediabetes (57) to diabetics (61).Limiting the blood sugar testing to those with an IDRS score of 50 and above could identify more than 90% of Indians with diabetes and prediabetes.
The Indian Diabetes Risk Score (IDRS) showed the strongest (5-fold risk) association with incident diabetes─ higher than obesity or hypertension. Obesity and abdominal obesity conferred a 2-fold risk of diabetes, whereas hypertension conferred a 3-fold risk of diabetes.
Higher IDRS is also associated with higher risk of metabolic syndrome and CVD risk even among people without prediabetes or diabetes.
A good step taken by the government by subsidizing essential medicines which include pre-mix insulin 🙂
Essential medicines list in India: The Government has added 106 drugs including that of Cancer, HIV/AIDS and Hepatitis C to the list of essential medicines.
The move will ensure their availability across the country at affordable prices. This also takes the total number of items in the list to 376.
In a revision of the National List of Essential Medicines (NLEM) by the Health Ministry’s core committee, 106 medicines were added while 70 were deleted after a series of meetings and consultations across the country.
Essential medicines are those that satisfy the priority health care needs of the population. They are based on the country’s disease burden, priority health concerns, and affordability concerns etc.
The committee recommended that the list, which comes into effect immediately, be revised every three years.
This does not augur well for India, as 72 per cent of India’s population now lives in rural areas. Moreover, when diabetes affects the poor, the burden of the disease will be heavier. It is estimated that a poor person spends 20 to 30 per cent of his income for the treatment of diabetes. If one happens to develop complications, the costs will increase proportionately.
Moreover, currently, diabetes health care is not available or accessible in rural areas; nor is it affordable. Some 70 per cent of doctors practise in the urban areas. With the help of the World Diabetes Foundation, the Indian Space Research Organisation and the National Agro Foundation, two years ago we took up the Chunampet Rural Diabetes Project. Using telemedicine we successfully screened 42 villages in Tamil Nadu’s Kancheepuram district covering a population of 43,158 people. Using a suitably equipped van, free screening of complications was done for all people with diabetes in these villages. A rural diabetes centre was set up. Within two years, a remarkable improvement in blood glucose level control was achieved in a rural area where such care was just not available. The Chunampet Rural Diabetes Project could serve as a model for delivering diabetes health care to rural India.
The diabetes management system comprises of many stakeholders, products and internal subsystems. Here, the diagram show how these individual components and stakeholders interact with each other.
Insulin delivery device system architectureInsulin pen device architecture
The solution will be comprising of a glucose monitoring device, integrated with mobile apps to enable the patient’s diabetic readings to be transferred to a cloud-based server. This is the first end-to-end diabetic solution which allows the patient to have access to personalized medical assistance for emerging markets like India.
“We are building an affordable, technology integrated diabetes solution that is aimed at middle and lower income groups in India. This will solve two predominant problems-the dearth of affordable diabetes care and the lack of adherence to medication. This solution ensures a seamless connect between patients and healthcare providers, and ensures the patient is monitored and made to adhere to the treatment regime,” states Jyotirmay Datta, Vice President – Medical Devices & Services, Wipro.
Wipro will be the technology partner for providing the entire Information & Communication Technology (ICT) infrastructure. Wipro will design the devices, develop mobile apps and portals, and enable cloud based remote patient monitoring.
Here is an interesting analogy for Diabetes to know how Diabetes actually affects the diabetic.
You are flying from L.A. to New York. You have to maintain a consistent altitude the whole way.
Note: For this analogy we will focus on a good cruising altitude and pretend that taking off and landings aren’t important.
Food raises blood sugar (altitude.) Insulin lowers it. Non-diabetics don’t have to think about altitude, as you all have a working pancreas (autopilot) and don’t sweat altitude. Diabetics, on the other hand, have to constantly wonder if they are at a safe altitude. Staying at a consistently high altitude (high blood sugar) will eventually make you sick; while a low altitude (low blood sugar) will kill you quickly.
When I prick my finger to check my blood sugar with a glucose test strip, that’s an altitude check. I want to know how I’m doing. Each time I do it, it costs about 70 US cents. So, I can only afford about 200 test strips a month, which is about 7 finger pricks a day.
Each time I feel I need to lower my blood sugar, I take insulin. In the old days I took a manual shot by measuring the insulin and filling the syringe by hand. I would typically take about 5 or 6 shots a day. Now I have an insulin pump that’s attached to me 24 hours a day. I attach it with a needle to a new place every 4 days or so. I have a remote control that tells it what to do. I keep the whole thing in my pocket with a tube leading under my clothes.
Note: I’m always asked if an insulin pump does things automatically. Answer: I wish. It is delivery only. I have to “close the loop.” There are currently no publicly available closed-loop systems that automatically test blood sugar AND deliver insulin. Not yet.
Here’s where the analogy gets interesting. Remember in the analogy we are flying from L.A. to New York, except we only get to check our altitude seven times. And, we only get to change altitude (take insulin) less than ten times. But, when I check my blood sugar, I’m actually seeing the past. I’m seeing a reading of what my blood sugar was 15 minutes ago. And, when I take insulin, it doesn’t start lowering my blood sugar for at least 30 minutes.
Now, imagine yourself in that plane with an altimeter that shows you the altitude 15 minutes in the past, and a yoke that changes the altitude – but when you press on the yoke, your altitude won’t change for a half-hour. It would be a challenging trip.
Kind of reminds one of the delays in controlling the Mars Rover by remote, eh? This is what Type I diabetes is like. It’s a daily “chasing of one’s tail.” This is why I prefer to eat at Subway when I’m in NYC or SFO. It’s consistent. I can count on it. I know how much insulin to take for a Steak & Cheese. Believe me, I’d love to eat new kinds of food every time I visit a new city, but I’d have to discover how much insulin to take and that’s and exhausting series of calculations and trial & error.
A day of a normal individualA day of a diabetic person
The glucose levels are extracted by a non-invasive technique which transmits low-power radio waves through a section of the human body, such as the area between the thumb and forefinger or the earlobe. These areas have adequate blood supply and are thin enough for waves to pass through the tissue. These signals are then received by a sensor on the opposite side of the GlucoWise device, where the data about the characteristics of the blood within the flesh are collected and analysed.
GlucoWise™ utilised two unique technologies to achieve unprecedented accuracy in non-invasive glucose measurements. First, it utilise high-frequency radio waves around the 65 GHz range. These waves are large enough to allow penetration through the tissue, yet simultaneously small enough to provide sufficient resolution of the blood regions inside the tissue. Second, the sensors have integrated nano-composite films which temporarily make the skin transparent to the radio waves when a measurement is initiated. This ensures consistent readings across all people independent of age, or skin type and colour.
The App and Smart Cloud technology delivers personalised advice and alerts, helping you to fully manage your condition. Intelligent analytics will use your current and historical data to calculate and forecast immediate trends in your blood glucose levels, allowing you to adjust your food or medication intake according to your activities or how you are feeling.
I have recently came across this very useful book called ‘BIODESIGN – The Process of Innovating Medical Technologies’ because of my friend Aniket Sase. The book has provided the detailed process and various case studies regarding medical product innovation.
A new patch the size of a penny can potentially perform both tasks, constantly monitoring the wearer’s blood sugar levels and automatically dispensing insulin when needed. The patch contains over 100 tiny needles, each one as thin as an eyelash. Each microneedle contains enzymes, which can detect blood sugar levels as well as store insulin, which is automatically released when needed.
Trials on mice have been successful, and since mice are even more resistant to insulin than humans, researchers feel the patch may work even better on people once the necessary clinical trials are underway. The patches can also be personalized to account for an individual’s weight and insulin sensitivity.
the blue circle project 