Tech Vision: Innovating to zero diabetes

• Over 3.2mil Malaysians have diabetes, country has highest obesity rate in Asia
• Emerging technologies can help realise the vision of a near-zero diabetes nation

AS soon as my previous column Tech Vision: Innovating to zero crime had been published, my colleagues in our healthcare team rushed to me and stated their displeasure.
 
They were upset that we had discussed crime, traffic congestion and floods, while ignoring the ‘silent killers.’
 
While crime is high on the list in terms of perception of top concerns amongst Malaysians, diabetes is a bigger killer in Malaysia (34,422 deaths in adults due to diabetes in 2014, according to the International Diabetes Federation).
 
Over 3.2 million Malaysians suffer from diabetes. The country also has the unenviable distinction of having the highest obesity rate amongst all countries in Asia, at about 17%.
 
Clearly our love for local delicacies such as nasi lemak (644 calories excluding the fried chicken), char kuey teow (744 calories) and roti canai (414 calories for a single one) have contributed significantly in helping us achieve this unique status in the region.

Type 2 Diabetes, which is the most prevalent in Malaysia, is a result of three different factors – genetic, behavioural and environmental.
 
Outside of genetic factors, which are beyond our control, it is sedentary lifestyles and unhealthy diets which lead to obesity. Diabetes results in heart diseases, renal complications, strokes, and peripheral vascular diseases.
 
Treating diabetes-related complications results in a significantly higher financial burden compared with treatment to control blood sugar levels.
 
As we look to tackle this growing menace, it is very clear that prevention – through a combination of education and early detection – is the most effective solution.
 
Many patients can live for 12 to 15 years before getting diagnosed. The problem is aggravated in rural areas, where the nearest medical centre can be tens of kilometres away.
 
Possible measures

• Education needs to start very early, in schools, about a healthy lifestyle;

• Create awareness of diabetes as a national problem, high on the list along with crime, corruption and traffic;

• Diagnose all diabetes patients nationwide;

• Develop a framework for monitoring patients, running programmes in targeted areas or segments of the population with high levels of incidence;

• Support care to patients especially in remote areas; and

• Gather and disseminate information on the quality and quantity of food and its nutritional value.

This week I have picked the following technologies from Frost & Sullivan’s top 50 technologies in our Tech Vision research publication to help address this challenge of diabetes.

• Health informatics: This consists of knowledge, skills and tools which enable information to be collected, managed, used and shared to support the delivery of healthcare and promote health.

• Predictive data analysis: The method of extracting useful information from huge data sets to identify significant patterns and predict futuristic trends and outcomes. Predictive data analytics leverages data mining, statistical modelling and machine learning techniques to analyse data and make probabilistic predictions.

• Wearable electronics: Small and compact electronic devices that are meant to be worn by a user. The applications are varied and include sports and fitness, health and medical monitoring.

• Quantified self: The ‘quantified self’ movement aims to measure all aspects of our daily lives with the help of technology. Wearable devices such as activity trackers, along with apps that let us log our every step, snack and snooze, could provide us with a better understanding of ourselves and our nature, and may even benefit our health.

• Sensor fusion: The combination of sensory data or data derived from disparate sources such that the resulting data provides useful information than would be possible when these sources are used individually.

These technologies can be applied in the framework below to help realise the vision of a near-zero diabetes nation.

 

1. Education:
   1. Formative education: It has to start with education, and that too in the formative years. Diabetes education has to be part of the syllabus across several years so that it is well understood. It should be supplemented with extra-curricular activities such as celebrating Diabetes Day. Compulsory certification in healthy living should be administered across multiple grades in the school. The certification can be conducted in the form of gaming applications online or on mobile platforms.
   2. Education for adults: With such a high prevalence of diabetes in adults, there is a huge sense of urgency in educating them on the high risk to their health. A sustained nationwide education programme or certification (in the form of gaming apps) in lieu of tax rebates or healthcare subsidy could help achieve this.

E-health and smartphone linked interactive solutions can revolutionise the way health information is provided across all sections of society (young/ old, literate/ illiterate).
 
Regulations mandating fast food restaurants share food nutritional value, and integrating these with smartphone applications, will help provide the much needed personalisation to make it engaging and relevant to the users.

2. Collection of data: To be able to take any concerted action, we need data on the patients. There are almost one million undetected cases of diabetes in the country.
   1. There should be a concerted effort to collect data at pharmacies, hospitals, supermarkets, 7-11s and other public places. The use of sensors is evolving very rapidly. Very soon, many smartphones will be able to work in conjunction with medical devices and capture information in a less intrusive manner. It is also getting easier to detect prevalence of diabetes with fewer data points by using predictive tools as discussed in Point 3 below.
   2. At some point it may even make sense to give away smartphones/ smart devices to help patients monitor their own health. It will be more cost-effective than treatment-based approaches. IBM, Apple and Japan Post are planning to give five million iPads to the elderly in Japan as part of a remote monitoring initiative.
   3. Integrate this step with the education process of Point 1. Involve young schoolkids in the process of collecting data from their homes and neighbourhoods.

3. Predictive data-based risk prediction models: There has been great progress on risk prediction models which can now accurately predict (up to 90%) the likelihood of an individual contracting diabetes, based on few data points. These data points can be fed into visualisation software that can help provide a good perspective into the incidence by age, city/ village, gender, school, etc. This can help drive more targeted programmes.

4. Programmes: Armed with information, very specific targeted programmes can be run across the country with strong partnership between government, private sector, non-governmental organisations, telecom service providers and technology vendors (Samsung, Apple, Google, Facebook, etc.).

5. Monitoring: This has traditionally been the weakest link in the entire value chain. A combination of initiatives both at the personal as well as community level to monitor the progress will be needed. A large number of global companies like Apple, Samsung and Google are rushing to provide mobile health-related services. The biggest impact will however come when this information is integrated with healthcare information systems across the country. Wearable electronics, quantified self-solutions and health informatics systems will work together to help achieve better success in having a proper nationwide monitoring system.

6. Remote care services: Armed with targeted information of affected patients, it will be more economical and effective to deliver remote care services, especially to patients in rural areas.   We are seeing tremendous progress in development of telemedicine and mobile-health solutions which will make this a reality.

It is not a simple challenge to solve, and there may as yet not be a single silver-bullet. Government legislation, educational programmes, the healthcare industry, corporate responsibility, and personal responsibility, combined with Internet and mobile services, are all crucial elements in Malaysia’s quest to give its citizens the best tools to live and eat healthy, and fight diabetes.
 
A strong programme management office is needed to make this vision a reality.
 
Whist we work on this platform to help address this nationwide challenge, many scientists around the world are developing a more radical solution.
 
Given our poor track record at implementation of projects, they believe the best approach is to let us enjoy the taste of our nasi lemak, but genetically modify it to ensure it has healthy properties. With our ongoing romance with food, there is a very good chance we will need this breakthrough to achieve the vision of a diabetes free nation!
 
Manoj Menon is senior partner and Asia Pacific managing director at Frost & Sullivan.
 
Previous Instalments:
 
Tech Vision: Innovating to zero crime
 
Tech Vision: Technology and improving the response to floods

 
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