Transforming Health: Made-in-Ontario solutions for diabetes care
This is the eighth report in the Connected World Market Insights Series.
This report is also part of the Transforming Health Market Insights Series.
Over the past six months, MaRS Market Intelligence has released two Transforming Health reports where we explored the major shifts occurring within Canadian healthcare. In this blog and two upcoming blogs, we will explore how these shifts directly impact care as it applies to particular conditions.
We start with a look at the challenges faced by individuals living with diabetes, the ways in which diabetes care is changing, and end with several innovative solutions being developed in Ontario.
Living with diabetes
Over 30 million Canadians and Americans have diabetes, and the number of individuals with diabetes continues to grow.1,2 Over 86 million adults in the US have prediabetes (a condition where blood sugar levels are higher than normal, but are not yet in the diabetic state), but 90% are unaware of their condition.2 Between 15% and 30% of those with prediabetes will develop type 2 diabetes within five years.2
To say diabetes is a serious health condition is an understatement. Studies have determined that having diabetes significantly reduces one’s quality of life,1 and if blood glucose levels are poorly controlled, individuals may suffer from devastating complications such as blindness, renal disease and premature death.3 Adults with diabetes have a greater risk of heart disease, stroke, and amputation of toes, feet or legs.2
The good news is that in some cases, type 2 diabetes (which makes up 90% of the diabetic population)4 can be prevented or delayed through mitigating the key risk factors via weight loss, healthy eating and exercise.2 Both types of diabetes can, in fact, be managed by carefully controlling blood glucose levels (through appropriate diet, insulin and medications) in addition to physical activity.2 Increasingly, there are new models for approaching care for chronic conditions as well as [inlinetweet prefix=”Transforming Health:” tweeter=”” suffix=”| @marsdd”]new tech-based solutions coming on the market to help individuals with diabetes[/inlinetweet] care for themselves and manage daily tasks and lifestyle changes.
Transforming diabetes care
In Transforming Health Part 1, we discussed two major shifts shaping the future of health and healthcare:
- Community-based care: Decentralizing healthcare by moving care out of resource-intensive formal care settings (such as hospitals), and into models of community care delivery and even self-management in the home
- Connected care: Using health information technologies and processes to “connect all parts of a healthcare delivery system, seamlessly, so that critical health information is available when and where it is needed”5
These two interdependent drivers have significant potential to address some of healthcare’s greatest challenges, including mitigating the devastating effects of chronic and highly prevalent conditions such as diabetes. The benefits of the shift to a community-based and connected paradigm of health and healthcare include improved patient comfort, greater convenience, better health outcomes, lower service costs and more.
Like other chronic conditions, diabetes must be managed 24 hours a day, seven days a week, 365 days a year.6 In the traditional healthcare model, individuals with diabetes receive episodic interventions when they visit their doctor or other care provider—a frequency that is severely misaligned with their care needs. A combined community-based and connected care model is a more suitable alternative approach, allowing for continuous health monitoring and intervention. It can also facilitate the significant lifestyle changes needed to self-manage one’s condition. Studies have shown that programs leveraging this type of care can reduce emergency room visits, augment quality of life, decrease HbA1C (a measure that represents glucose levels over time) and achieve other positive improvements to an individual’s health.7
Technologies are evolving in response to (or, in many cases, driving) the shift to a connected, community-based system of healthcare. Worldwide, companies as well as health delivery organizations are taking new care settings and interconnectivity into consideration when designing their innovative products and services. As we outlined in Transforming Health Part 2, Ontario is home to many emerging young companies that are creating [inlinetweet prefix=”” tweeter=”” suffix=”for those with diabetes”]innovative health IT solutions that enable connected and decentralized care[/inlinetweet]. Many of these startups are tackling the significant issues of diabetes prevention, care and self-management, with each taking an innovative approach to the many challenges people with diabetes face in day-to-day life.
Ontario’s legacy of innovation in diabetes care
Since the early days of diabetes research, Ontario has been the site of major discoveries and innovation. In 1920, Alliston-born doctor Frederick Banting hypothesized a way to isolate and extract insulin from animals.8 In 1921, he and a young medical student assigned to work with him, Charles Best, experimented with the extraction and testing of dog, pig and cow insulin in their University of Toronto lab.9 They were greatly assisted and advised by JJR McLeod, a Scottish-born biochemist and physiologist who directed the Physiology labs at the University of Toronto.10 James Collip (a Belleville-born biochemist) joined the team to assist with purification of the animal insulin for human testing.9 Collip’s contribution provided the critical breakthrough in purification of the pancreatic extract that came to be known as insulin.11 The following year, the team was ready to test their insulin in humans. Leonard Thompson, a 14-year-old boy, was the first person with diabetes to receive insulin. The test was a success, rapidly transforming the dying teenager into someone with strength and appetite.9 It was not long before mass production of insulin began12 and diabetes was no longer considered a death sentence.
This legacy continues to serve as an inspiration. The location of the first human insulin tests, the old Toronto General Hospital, is now the site of MaRS Discovery District’s heritage building,13 where we strive for economic and social prosperity by fostering innovation and entrepreneurship.14 Adjacent to MaRS is the University of Toronto’s Banting & Best Diabetes Centre (BBDC), located at the new Toronto General Hospital. The BBDC truly honours the legacy of its namesakes by continuing to advance diabetes research, education and clinical care (see inset).15
Founded in 1978, the BBDC is Canada’s leading centre of excellence for innovation in diabetes research, education and clinical care. Throughout its 37-year history, it has successfully nurtured a community for diabetes researchers in the Greater Toronto Area.The BBDC actively pursues two types of research:
The BBDC also runs a number of platforms that support and enable these research goals. These include clinical trials, informatics, core laboratory, and training and research excellence.
Innovation in action: Emerging Ontario technologies for diabetes patients
Regular blood glucose measurement
One of the challenges that many individuals with diabetes encounter is having to measure blood glucose levels at regular intervals, to ensure they are maintained within a particular safe range. Blood glucose meters have come a long way since their introduction in the 1970s,17 but still present a number of inconveniences to their users. Although meters are smaller than ever, many people with diabetes find it inconvenient to take the meter and the accompanying supplies along whenever they leave the house.18 To measure glucose levels, they must prick a finger (or other part of the body) to retrieve a droplet of blood. Lancets (the blade- or needle-like devices used for pricking the skin) have become slimmer, but they still can cause pain if they hit a tender spot.9 Individuals who use the finger prick method to check blood glucose frequently find their fingers become sore and irritated,9 which can interfere with activities such as cooking or playing a musical instrument. Most importantly, however, these meters only allow for blood glucose to be measured intermittently—meaning that great (and potentially dangerous) variations can occur in the interim.
Continuous blood glucose monitors were developed to solve many of these issues, but these devices come with their own set of burdens. Continuous glucose monitoring systems (CGMS) use a small catheter that must be inserted under the skin. The sensor within the catheter measures glucose levels and transmits the results to a monitor for data storage or display.8 Similar to the lancets used in traditional meters, inserting the catheter is meant to be pain-free, but can actually result in skin irritation or tenderness.19 Depending on sensor placement, these devices can also create a visible bulge under clothing. Users have expressed that this can make them self-conscious and affect their self-confidence.10
With these challenges around blood glucose monitoring in mind, Ontario startup Medella Health is developing contact lenses that monitor glucose levels. By placing the sensor within a non-invasive contact lens, this solution aims to eliminate the pain aspects related to lancets and catheters involved in traditional meters and monitors. Medella’s lenses will connect wirelessly to a mobile device, which will do away with sensor-related bulges under the clothing. Most importantly, however, the device will provide continuous, real-time blood glucose monitoring, allowing users to immediately react when levels dip or peak unexpectedly.20
Translating blood glucose data into actionable insights
Once blood glucose has been measured, the challenges continue. It takes skill and experience to interpret blood glucose readings. Food, activities and lifestyle impact an individual’s blood glucose levels in unexpected ways, making it difficult to spot patterns. Adding to the challenge, many healthcare providers do not have the time to investigate blood glucose records in-depth, so a patient may receive little to no guidance or feedback.9 This is unfortunate, because this information can assist with decisions regarding diet, exercise, medications and more.9
For individuals with type 1 diabetes, the teen years are particularly challenging because this is often when they begin to take over responsibility from their parents for their own blood sugar monitoring and management.21
UHN’s Centre for Global eHealth Innovation, with Healthcare Human Factors devised a solution to help teens with type 1 diabetes manage their blood glucose: an app named bant.22 When a user measures his or her blood glucose, the readings are transmitted wirelessly to the app where they are logged over time.12 Users can also enter other relevant data, such as foods they have eaten,12 enabling better trend detection by adding context to the glucose measurements.23 To appeal to teens, the team has incorporated elements of gaming and regular use is rewarded with iTunes redemption codes.12 By facilitating the interpretation of blood glucose over time while appealing through interactivity and rewards, this solution helps teens improve their glycemic control.14 An added feature, which complements the busy, transitional time in users’ lives, is that bant can upload data to the cloud, enabling it to be shared with parents or other care providers.14
In 2010, bant was piloted at the Hospital for Sick Children in Toronto with a group of 12- to 15-year-olds who have type 1 diabetes. This study determined users’ adherence to the app and its impact on measurement frequency, active self-management, and HbA1C.14 Amongst bant users, the daily average frequency of blood glucose measurement increased by 50%.24 A randomized controlled trial is now underway, incorporating updated features and learnings from the pilot.
Finding trusted information and family support
Individuals with health conditions often experience social isolation, as their friends and family tend to have different diets, activities, priorities and concerns. Many people with diabetes often find themselves in a position where they must learn how to communicate information about their condition to family members and others in their support network. This circumstance can be particularly challenging for those with type 2 diabetes, who may have feelings of shame, embarrassment or guilt that their lifestyle may have brought on or accelerated the disease.25 But lack of communication can be harmful—particularly when trying to rally support for lifestyle changes that also affect family and friends (e.g., group meals).
ForaHealthyMe.com has created an online and mobile solution to empower both patients and their caregivers to manage their own health. Patients can create a profile where they track condition-specific health factors. For individuals with diabetes, this means a tool to chart stress, medications, physical activity, diet, dizziness and more. The patient can then grant access to caregivers or others with whom they’d like to share information on their condition. Many other features are available on ForaHealthyMe to facilitate learning and deliver support, such as article sharing, messaging, appointment scheduling, and medically-validated condition information.26 With these tools, people with diabetes can invite others into their world and share their progress and challenges. This helps to educate and inform loved ones, which in turn helps them to provide support.
Continuing innovation in diabetes care
The innovations outlined above represent just a few technologies emerging from Ontario that address the challenges presented by diabetes. Throughout Ontario and the rest of Canada, many entrepreneurs and researchers are choosing to explore solutions that drive or enable connected and decentralized care. By continuing support of these innovators (through the many resources outlined in Transforming Health Part 2), we can ensure new models of care emerge in our communities, advancing care for those with diabetes and other widespread health conditions.
1. Diabetes in Canada: Facts and figures from a public health perspective. (2012, July 4). Retrieved from http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php
3. Epidemiology Report – Type I Diabetes. (2014).
4. Epidemiology Report – Diabetes. (2014).
5. Accenture. (2012). Connected Health: The Drive to Integrated Healthcare Delivery. Retrieved from http://www.himss.eu/sites/default/files/Accenture-Connected-Health-Global-Report-Final-Web.pdf
6. American Diabetes Association. (2014, December 5). American Diabetes Month. Retrieved from http://www.diabetes.org/in-my-community/american-diabetes-month.html
7. Bodenheimer, T. (2002). Improving Primary Care for Patients With Chronic Illness. JAMA: The Journal of the American Medical Association, 288(14), 1775-1779.
8. Nobelprize.org. Frederick G. Banting – Biographical. (2015, January 29). Nobel Media AB. Retrieved from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1923/banting-bio.html
9. Nobelprize.org. The Discovery of Insulin. (2015, January 30). Nobel Media AB. Retrieved from http://www.nobelprize.org/educational/medicine/insulin/discovery-insulin.html
10. Nobelprize.org. John Macleod – Biographical. (2015, February 2). Nobel Media AB. Retrieved from http://www.nobelprize.org/nobel_prizes/medicine/laureates/1923/macleod-bio.html
11. Chemical Heritage Foundation. Frederick Grant Banting, Charles Herbert Best, James Bertram Collip, and John James Rickard Macleod. (2015, February 2). Retrieved from http://www.chemheritage.org/discover/online-resources/chemistry-in-history/themes/pharmaceuticals/restoring-and-regulating-the-bodys-biochemistry/banting–best–collip–macleod.aspx
12. Diabetes.co.uk. (2015). History of Insulin. Retrieved from http://www.diabetes.co.uk/insulin/history-of-insulin.html
13. Vijayananthan, S. (2011, November 15). Photoblog: Toronto’s gift to the world. MaRS Discovery District. Retrieved from https://www.marsdd.com/news-and-insights/photoblog-torontos-gift-to-the-world/
16. University of Toronto Banting & Best Diabetes Centre. (2012, May 7). Fulfilling the Promise of Banting and Best: Our Vision for a Cure and improving the lives of those with diabetes (5-Year Vision and Plan: 2012—2015). Retrieved from http://www.bbdc.org/images/pdf/5-yearVision&Plan.pdf
17. Clarke, S.F., & Foster, J.R. (2012, March 6). A history of blood glucose meters and their role in self-monitoring of diabetes mellitus. British Journal of Biomedical Science, 69(2), 83-93. Retrieved from http://www.bjbs-online.org/pdf/pp83-93 BJBS69(2).pdf
18. Polonsky, W.H. (2013, June 24). Ten Good Reasons to Hate Blood Glucose Monitoring. Diabetes Self-Management. Retrieved from http://www.diabetesselfmanagement.com/managing-diabetes/blood-glucose-management/ten-good-reasons-to-hate-blood-glucose-monitoring/
21. Pearce, T. (2010, December 5). Diabetes app designed with teen behaviour in mind. The Globe and Mail. Retrieved from http://www.theglobeandmail.com/life/health-and-fitness/health/conditions/diabetes-app-designed-with-teen-behaviour-in-mind/article597024/
22. Centre for Global eHealth Innovation. (2015). Projects: Bant – A diabetes app for the ePatient. Retrieved from http://ehealthinnovation.org/what-we-do/projects/bant-a-diabetes-app-for-the-epatient/
23. Healthcare Human Factors. (2012). bant – a diabetes app for the ePatient. Retrieved from http://humanfactors.ca/our-work/bant-–-a-diabetes-app-for-the-epatient/
24. Cafazzo, J., et al. (2012). Design of an mHealth App for the Self-management of Adolescent Type 1 Diabetes: A Pilot Study. Journal of Medical Internet Research, E70-E70. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/22564332
25. O’Donnell, C. (2008, April 11). I Got Over My Shame and Got My Weight, Diabetes, and Life Under Control. Health. Time Inc. Network. Retrieved from http://www.health.com/health/condition-article/0,,20190995,00.html
The Connected World Market Insights Series
The Connected World Market Insights Series will cover such topics as:
- Advanced metering infrastructure (AMI) and smart meters: Building upon a home advantage
- Automation and energy: Unlocking home and building energy management opportunities
- Entertainment for the connected home
- Security: Privacy, data ownership and data risk
- Transforming health: Decentralized and connected care
- Connected mining opportunities and new technologies
- The value of real-time meter data
Accessing data is key, but we think that being able to format and analyze that data is where the real value can be found. During this series, MI will delve into the market opportunity now becoming available due to progress in opening up datasets, and the development of infrastructure and analytics that are creating new services and products and bringing them to market.