This op-ed was originally published on Foresight Global Health on 23 August 2021.
The number of people living with diabetes (PLWDs) has quadrupled in the last 40 years, adding to the pressures on health systems, especially in low- and middle-income countries (LMICs). Innovative approaches are required to address this large and growing global health challenge and digital health tools will be an important part of innovative solutions.
Today, more than 450 million people have one of the several types of diabetes, in which the body either cannot produce insulin (Type 1) or cannot properly use what it produces (Type 2 and gestational-pregnancy related diabetes). For diabetic patients, failure to prevent, treat or manage the condition can lead to a range of serious complications, including blindness, kidney failure, heart attack and lower-limb amputation. The burden of diabetes—for individuals, their families, and health systems—is especially acute in LMICs where nearly 80% of PLWDs.
Since the discovery of insulin in 1921, there have been a number of important advances in diabetes treatment and care. The past four decades have seen the introduction of human insulin in the 1980s, analogue insulins in the late 1990s, and new classes of medicines that deliver improved glucose control and other beneficial effects in the 2000s. In addition, PLWDs have benefitted from the introduction of a number of new technologies for precision blood glucose measurement, continuous glucose monitoring and insulin delivery via increasingly sophisticated insulin pens, pumps and “closed-loop” systems, many of which now include sophisticated data capture and data transmission capabilities. Finally, in view of the critical importance of holistic approaches to diabetes care, private sector companies have collaborated with partners around the world to improve diagnosis and glucose control, support patient education/awareness and healthcare professional training, strengthen supply chains and enhance patient access and adherence to treatment.
Digital health has a major role to play in advancing diabetes care, and policymakers need to ensure that there are appropriate conditions to allow innovation to flourish. There are many definitions of “digital health.” We view it as the convergence of information and communications technologies (ICT) with health services delivery, information dissemination and diagnostics through secure digital channels. The goal of digital health is to enhance the quality, efficiency and convenience of public health and healthcare delivery programs to improve patient outcomes. Digital health for diabetes provides a potential “leapfrogging opportunity” for communities residing in low-income and remote settings where timely and regular access to quality diabetes care is hindered by uneven access to local primary healthcare facilities that are properly equipped to help PLWDs manage the complexity of their conditions.
USING DIGITAL TOOLS TO IMPROVE THE LIVES OF PLWDS
Digital health innovations typically leverage the internet, social media platforms and mobile phone usage. These networks bring global reach: more than four billion people used the internet in 2019, more than seven billion people live in an area that is covered by a mobile-cellular network and more than six billion smartphones are in use around the world. Digital health is particularly relevant in LMICS and remote areas, where lack of access to properly trained and equipped healthcare professionals and health facilities remains a significant shortcoming.
Digital health tools are playing an increasingly important role throughout the care pathway, with the potential to provide enormous benefits for PLWDs. These tools can support healthcare professionals in their work through enhanced training, regular contacts with patients and ongoing information sharing regarding the prevention of complications or treatment adaptations. In this regard, digital health tools can also help to monitor blood glucose levels, nutrition habits and levels of physical activity for PLWDs.
Digitally facilitated interactions between PLWDs and healthcare professionals can allow enhanced access to care and prevent avoidable complications. This was demonstrated by the Be He@lthy Be Mobile (BHBM) initiative, run jointly by the World Health Organization (WHO) and the International Telecommunication Union (ITU), which works with governments and other partners (including the biopharmaceutical industry) to improve the prevention and control of non-communicable diseases with mobile technology. One BHBM program helped PLWDs in LMICs to reduce diabetes-related complications through simple SMS interventions.
Digital tools are also being incorporated into holistic diabetes strategies to support enhanced diabetes care in LMICs. Two examples are set out.
DIGITAL HELP FOR DIABETES MANAGEMENT IN CHILDREN
In response to requests from local partners, the Changing Diabetes in Children partnership (supported by Novo Nordisk, Roche, ISPAD and the World Diabetes Foundation) is supporting digital health tools to help improve access to quality care for the most vulnerable children and adolescents living with Type 1 diabetes. The partnership aims to further support country-led sustainable solutions to achieve a number of goals.
Specifically, the partnership seeks to ensure comprehensive patient education through digital patient education materials, as well as via future digital pathways, patient journals, and artificial intelligence (AI)-enabled chatbot support. It also looks to strengthen healthcare professional capacity through online/hybrid training & education, as well as, in the longer term, supporting national registries (for data collection and policy making), enhanced patient management, digital pathways and enabling patient check-ins with diabetic nurses (particularly in remote areas). The partnership also aims to bring care closer to the people who need it via online consultations and telemedicine, as well as through future patient referrals and cross-system migration, data accessibility and secure data transfers. Finally, the partnership uses digital patient records and other tools that enhance supply chain management, track inventories, and optimize distribution (including cold chain and “last mile” capabilities) to enhance patient access to insulin and associated devices.
MAKING COMPREHENSIVE CARE AVAILABLE TO LOWER-INCOME PATIENTS
Clínicas del Azúcar (“Sugar Clinics”), the largest chain of specialized private diabetes clinics in Mexico, provides a comprehensive approach to diabetes management at price points affordable to lower- and middle- income patients. The organization offers services through a subscription model, whereby patients’ annual memberships enable them to access an integrated quality set of services including medical consultations, diagnostics, medicines and other health products, nutritional and psychological services. Clínicas del Azúcar integrates information technology and data analytics to monitor patients more effectively – including levels of physical activity – to provide tailored advice and treatment adaptation. Over time, the program plans to incorporate AI into its daily operations to help personalize patient care and further improve quality outcomes.
RECOMMENDATIONS FOR IMPROVING DIABETES CARE IN A DIGITAL WORLD
As these examples show, digital health can bring many benefits to PLWDs, healthcare professionals and health systems in a way that is both effective and efficient. However, the successful introduction and scaling up of innovative solutions requires enabling environments supported by governments and other health system stakeholders. In this regard, sound national policies and appropriate resources are needed to deliver sustainable benefits from digital health innovations for diabetes. We recommend several measures.
First, governments should build and implement national digital health strategies and build ecosystems, in alignment with national diabetes and more broadly with NCD plans, to ensure sustainability. This process will involve developing secure digital health infrastructure and interoperability to improve connectivity. In addition, national authorities need to implement appropriate data governance to enable effective, secure transmission and management of data.
Second, regulatory authorities should introduce harmonized regulatory processes to address digital solutions for diabetes.
Third, payers and reimbursement authorities should ensure that they have appropriate payment pathways to foster uptake and utilization of digital solutions that will improve the lives of PLWDs.
By supporting stakeholder collaborations and partnerships, governments, regulatory and payer authorities can accelerate implementation of digital solutions tailored to local needs and provide sustainable financing and incentives as part of increased efforts to prevent and control diabetes.
Many stakeholders, including the biopharmaceutical industry, are now investing in digital health innovations for diabetes. To support PLWDs effectively, the global health community needs a joined-up approach that incorporates the measures described above into comprehensive diabetes control plans. Our industry is committed to collaborating with WHO, governments, civil society, PLWDs, health system stakeholders and other industrial sectors to create enabling environments that will deliver sustainable benefits to PLWDs and health systems. Given the potential of digital innovations in health, especially in LMICs, it is now more important than ever that we work together to accelerate the use of digital tools that benefit people and health systems. With its complex, multi-faceted care needs and the role of prevention, control and risk factor management, diabetes is a disease for which digital technologies can make significant contributions. Now is the time to invest in strengthening appropriate infrastructures and policies to support the uptake of digital health solutions for diabetes, in particular in lower-resourced areas where health literacy and timely access to quality healthcare services remains challenging. •
Ann-Lise MIKOLAJCZAK, Associate Manager Value & Access, IFPMA. Ann-Lise joined IFPMA in June 2019 and supports policy development work on the value of and access to medicines and vaccines, as well as strategic engagement with multilateral organizations on health and innovation. Ann-Lise holds a PharmD with a specialization in Hospital Pharmacy, with complementary diplomas in medico-economics, global health, and statistics for medical trials.
Herb RIBAND, Senior Advisor, Global Health. Herb is an independent consultant based in Switzerland who works with a select group of multi-national organizations, startup companies, NGOs and academic professionals that are bringing truly innovative approaches to global health and healthcare delivery.