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Showing posts with label Diabetes. Show all posts
Showing posts with label Diabetes. Show all posts

Thursday, February 16, 2017

mbant2 clinical trial - a super duper fitbit?

I noticed on the Journal of Medical Internet Research that the mbant2 clinical trial is starting.
 http://www.researchprotocols.org/2016/3/e174/

This is an ehealth cornerstone - evaluating the effectiveness of ehealth applications. mbant2 is a University of Toronto study, where Frederick Banting appropriately enough was one of the discovers of insulin.  I almost think the fitibt could help self-manage type 2 diabetes if there was also a way to measure glucose A1c levels. Apparently Medtronic is looking into exactly that.
 https://www.medtronicdiabetes.com/blog/partnering-with-fitbit-for-type-2-diabetes/

No google contact lens yet for tears to detect blood sugar insulin. Guess they are still working on it. The email alerts I have been getting about always make it sound it is off in the future somewhere. It would be great to have pin-prickless procedures and devices. The research is very hard to make that work well.




Wednesday, November 23, 2016

eHealth Medical Fiction - "Cell" by Robin Cook

I just finished a page turner by Robin Cook called "Cell". I knew from the beginning that it was an eHealth type of medical fiction. It features a smartphone app called iDoc that promises almost to take over the role of the personal physician. I suspected while reading the influence by Eric Topol, who must be one of the greatest champions for spearheading the medical smartphone revolution.

I was not too surprised to find that Robin Cook does acknowledge Topol at the end of the book. For a while I was concurrently reading Topols' "The Patient Will See You Now" and "Cell".  Robin Cook wrote "Cell" in 2014 and he credited Topols' "The Creative Destruction of Medicine".  Reading the medical fiction is  just a diversion. If you really want to learn about how the smartphone will revolutionize medicine - read Topol.

Medicare should be a major department for all Americans, just like Education and Defense. The author appears to argue like this in the book as he alludes often to the Affordable Care Act and Obamacare. The villain is a Health Insurance Company bent on making billions with the miracle app. The iDoc app is wonderful as the algorithms on the smartphone help to prevent illness and conditions. Health advice is immediate and always accessible.

Unfortunately, the app takes a turn for the worse and the "heuristics" start killing off patients in the alpha testing.  That involves what I think is the only science fiction element in the story - a nano-chip implanted in diabetes patients that is remote controlled by wireless radio signals releasing doses of insulin.  In real life the FDA has approved an "artificial pancreas" of sorts - a network of devices - that automagically monitors and controls blood sugar levels - it just doesn't work on the nano scale.

Just saw over at the Geek Doctor blogspot there is a guest blog by Seth Berkowitz, MD about  Apple’s CareKit and ResearchKit frameworks and the HealthKit API being used at BIDMC. Engaging patients in their health like that is a step towards a kind of iDoc.
  


Sunday, May 25, 2014

Tri-corder XPrize News from Canada

Recently there were some CBC news stories about a local company that has entered the Tricorder XPrize.  I have been blogging about this XPrize many times, and here is a link to the collected news stories from this blog <here>. I heard an interview on radio and picked-up the story on one of my voluminous RSS newsfeeds. I heard a joke the other day that Youtube, Twitter and Facebook will merge together as one company some day and it will be called YouTwitFace.

So, there actually is a website called YouTwitFace.com, and they had a story with eHealth relevance, called "Will Your Doctor Friend You Back on Facebook?

Here is the link to the  CBC news story about Biosign's entry into the XPrize:
http://www.cbc.ca/news/technology/tricorder-x-prize-eyed-by-toronto-based-biosign-1.2649258

Biosign is an interesting company and I once did a lot of research on it. They were developing a "pin-prickless" blood sugar reading device for diabetes. This is one of the holy grails of biomedical device research. Unfortunately, their "cuff" did not fully measure blood sugar levels accurately and never obtained FDA clearance, as far as I know. I still don't think there are any devices developed yet that are "pin-prickless", but it is a fascinating science, and well worth the time to look into the controversial developments, frustrations, and failures in this area.


Sunday, January 19, 2014

A different kind of google glass - contact lens that detects glucose for diabetics


Google X is a "moonshot" group of experimental projects Google is exploring. A recent news story about one of these projects is hitting the media called Google Contact Lens. The premise behind this is one of the holy grails of diabetes research, finding a "pin-prick-less" way to test for glucose levels. I did a study of the various devices under-going development and the history is a bitter one of trial and error, fraud and failure. To my knowledge, there is no FDA approved device yet that can do this. I will set up an email alert for more news about this in the future. CBC technology coverage is great. Here is some info from our working paper on a mobile solution for self-management of diabetes:


A non-invasive technique capable of measuring blood glucose concentration with accuracy equal to or better than the current chemical glucose meters may improve compliance for glucose monitoring. 53 Considerable efforts have been made by several scientific research groups and organizations in the past few decades to develop non-invasive blood glucose monitors.  Diverse optical approaches have been proposed to achieve this objective. These approaches include polarimetry, Raman spectroscopy, near-infrared (NIR), absorption and scattering and photoacoustics. These techniques appear to be promising, but have limitations associated with low sensitivity, accuracy and insufficient specificity of glucose measurements at physiologically relevant levels. 53 Non-invasive continuous Glucose Monitors like GlucoWatch G2 Biographer and Continuous Glucose Monitoring (CGM) which are FDA approved have been found unreliable for detecting hypoglycemia. 54 There are non-invasive solutions available in Canada for measuring blood glucose level by BioSign Technologies’ UFIT Care. 25 However, this product is yet to be approved by Health Canada and therefore, cannot be used.
And various references to the above:

23. Medgadget. MedGadget Web site.
http://www.medgadget.com. Published 2009. Updated 2009. Accessed november 2009.
24. Pain-free precision: Clinical trial reveals new option for blood sugar testing. . 2002;1 No 2.
25. Biosign Technologies Inc: Online Health Monitoring, Getting the Numbers Right Fact Sheet. http://www.biosign.com/Web_Files/factsheet_biosign.pdf. Updated 2009november 2009.
53. Kirill V, Mohsen S, Montamedi M, Esenaliev R. Noninvasive Blood Glucose Monitoring With Optical Coherence Tomography. Diabetes Care. 2002;25(12). http://care.diabetesjournals.org/content/25/12/2263.abstract.
54. Accuracy of the GlucoWatch G2 Biographer and the Continuous Glucose Monitoring System During Hypoglycemia. Diabetes care. 2004;27(3). http://care.diabetesjournals.org/content/27/3/722.abstract.

Saturday, November 10, 2012

Should diabetics eat grapes?


I was listening to an acquaintance of mine talk about her mother who was recently diagnosed with diabetes. She was debating with her whether or not grapes could be part of the diabetic diet. Where to get an answer on that one? Yes, make an appointment with a professional dietician, which is what she recommended to her mother.

But what do most people do? Right, they google. And, what do they find? Research has shown that most people will click on the first five search return links that come up (thus the lucrative power of Search Engine Optimization or SEO). But when searching for health information, which is one, if not the highest usage for internet searching, do most people know if they are getting reliable or trustworthy information? Anyone even heard of Health on the Net?

I just searched on "should diabetics eat grapes?" and I did not see some of the more trustworthy internet health sites out there, like mayoclinic.com or medline. I don't know if Canadians automatically go to their provincial health authority website to seek this information. There is a lot of research on health information seeking behavior, and what patients print off before they visit their family physician.

What I am getting at, is that the trend towards personalized medicine should be able to answer this question in the context of their personal health record system (which ideally has been prescribed or recommended to them by their personal family physician).  You could have a Dr. Watson type search engine answer the question. You could have data crunchers analyzing health information in the health record, comparing to the ocean of health data that could be analyzed. Genetic information could be a factor for grapes, blood type, and insulin levels. Socio-economic factors loom large, for example, what is a grape in a food desert?

But what I think the reality is, most people don't have personal health records or know how to set them up, and the personal health records that do exist, won't be able to automatically answer this type of question, though we all speculate that it should. The family physician should be answering this question, either through a referral to a nutritionist, or a diabetes guidance counsellor. 

And this has made me think that what we need are more self-tracking stations. These would be counselling services where people can go to learn and maybe even procure self-tracking technologies, like fitbit, personal health records, mobile smartphones with blood pressure cuffs, etc.  What if there could even be fMRI, ultrasound, and Transcranial Magnetic Stimulation machines in these stations. This would be one way to deconstruct medicine, and I would like to venture on this idea in a future post on practising medicine without a license. There are so many medical and other devices which can be used to support healthy living. Maybe the model of the York University "Health Coach" would fit this idea, or the Self-Tracking Station counsellor.



Saturday, September 15, 2012

eHealth Ontario Diabetes Registry is no more

A variation of this article in whatever edition of the Toronto Star I saw, was headline news.  The story line in the current online edition says"Diabetes Registry obsolete, ehealth tells liberals". The headline I saw on the shelves in the grocery store at around 10:00am this morning was something like "eHealth Ontario Axes Diabetes Registry". The twists and turns in this story are many and varied.  I remember the eHealth Ontario procurement and spending scandal in 2009 mostly because I had just starting working towards a graduate degree in eHealth (or Health Informatics) at the time and I was beginning to feel a lot of regret about the name of my degree. The real concern here should be about people who have diabetes and the epidemic this is now becoming globally - not some provincial political hot potato, or football, or whatever metaphor pleases you.

I was studying the clinical efficacy of using personal health records to manage diabetes, looking for systematic reviews of the literature in the Cochrane Collaboration.  They were not many because they are not many clinical trials involving diabetes and electronic medical records (let alone personal health records).  Yes I looked on the clinical trials registry site as well - clinicaltrials.gov   and found a rare few clinical trials, mostly involving large hospital systems that had electronic health records in the United States. I had learned in my courses that clinical trials present the highest form of medical evidence, exept for meta-analysis or systematic reviews, which is a composite study of all the best clinical trials.

It was when I was studying the project management issues in a mobile application for managing type II diabetes, that I came upon the understanding that clinical efficacy should precede business opportunity. See the COMPETE studies at McMaster. In healthcare, the return on investment is improvement in quality of life, but why spend millions on a system because it is believe to be clinically helpful, when the evidence for the actual efficacy is not in yet.  There were experiments and studies that did show promise for this, and maybe they showed promise because they were all small studies and easy to manage.

We were aware that a smartphone or mobile solution for persons with diabetes tracking and managing their condition always seemed to involve a triage person or nurse practitioner who monitored the data flows from the patients.  York University's Department of Health is now started a course of training for Health Coach Professionals, which was part of the subject of my last blog post on a consortium of academics, business and health organizations to develop the open source OSCAR EMR and it's companion PHR call MyOSCAR.  It is this kind of triage person who I think could really help fill the gap between the patient with diabetes using the smartphone or the computer, and the personal health record or electronic medical record where data measurements and journaling provide the tools necessary to self-manage the condition.  A coach is really needed to get people to exercise, eat well, adhere to regimes of all sorts, etc.

Later in 2011 when I was researching the system architecture of personal health records systems in Ontario and their relationship to the national blueprint architecture of the Canada Health Infoway, that main benefit for using them would evolve in the prescription model that physicians currently have with their patients.  A personal health record system could be prescribed to a patient, because of the clinically proven benefits of using them to manage the condition. Again, this involves the evidence based medicine preceding the business model or expediency.  As well, the prescription model maintains the traditional trust between physician and patient, and as far as I know, diabetes is not something you want to try and handle on your own, without professional guidance and help.

When in 2010 we learned eHealth Ontario was going to create a Diabetes Registry for all Ontarians, I for one thought they really did not know what they were getting themselves into.  It is not that I am proved right, it is just that technology projects are often started for the wrong reasons, and pulling the plug on them, before trying to fix the short comings, is the right thing to do.  Wished it could have turned out better for the eHealth Ontario people, CGI, and I suppose the Liberal government, who I know have the patients in Ontario and their health in mind first.