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Key points
Diabetes prevalence is increasing in the UK but most rapidly in low- and middle-income countries
The current method for self-monitoring of blood glucose (SMBG) has both financial and clinical limitations
Non-invasive glucose measuring devices (NIGMD) might be a future solution
In the UK, the prevalence of diabetes is approaching epidemic proportions. According to Diabetes UK, around 4.6 million people are living with diabetes, with a further 5 million estimated diagnoses by 2025. Around 90% of diabetics have Type II diabetes mellitus (T2DM) and must manage their hyperglycaemia by constantly monitoring blood glucose levels. However, the current method for self-monitoring of blood glucose (SMBG) has both financial and clinical limitations. Instead, the emerging non-invasive glucose monitoring devices (NIGMD) may transform management of T2DM.
The current SMBG technique involves a lancet prick on the finger, obtaining a blood drop which is applied to a reagent strip and read by an automated device. However, this method is not cost-effective, as each test strip and lancet can only be used once. Studies estimate that around ~£180 million per year is spent by patients and NHS trusts combined; Clinical Commissioning Groups are struggling to cope with escalating SMBG costs.
Repeated skin pricking is a psychological and physical barrier, causing patient non-compliance and increased risk of hyperglycaemic episodes. Drawing blood also increases the risk of transmitting blood-borne infections. According to the World Health Organisation, diabetes prevalence is increasing most rapidly in low- and middle-income countries, where blood-borne diseases such as HIV, Hepatitis B and Hepatitis C are major risks. Thus, a non-invasive glucometer would address many of these major drawbacks.
At Polygeia, we are looking at the current and emerging non-invasive glucose measuring devices (NIGMD) from an economic and clinical perspective. The global diabetes care device market is estimated to be worth ~$20 billion (almost $30 billion by 2022!); how will this be affected by technological innovations?
At the moment, Abbott’s FreeStyle Libre is the only NIGMD available in the US and UK for T2DM, with more due to launch throughout 2018/19. These devices use a range of non-invasive techniques, including optical (e.g. spectroscopy), transdermal (e.g. reverse iontophoresis), electrochemical (e.g. amperometry) and even contact lenses measuring refractive changes in the eye.
A current hurdle is in developing accurate devices without long and complex calibrations. The GlucoWatch was the first NIGMD approved by the US Food and Drug Administration but it was removed from the market within a year; it still required finger-pricking for a 3-hour long calibration (every 13 hours), had low accuracy and caused skin irritation through its transdermal technique.
The availability of a NIGMD should significantly disrupt the SMBG market but any developments must overcome their potential shortcomings. They will be more cost-effective for an already pressured NHS and health systems around the world. By eliminating blood-borne infection transmission, a NIGMD may also contribute to the systemic shift from disease treatment to disease prevention.
Our research will evaluate these novel technologies to test their practicality, clinical accuracy and, for some more bizarre techniques, their viability. Our findings will be available online from Autumn 2018.
Further reading
About me
Fourth year medical student at Cambridge. Super interested in MedTech and Innovation in Healthcare, with advisory roles at two MedTech start-ups: DemDx and ImproveWell. I really wish I could code.
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