By Nisha Kumari
New Delhi: with the advent of technologies such as artificial intelligence (AI) in the health sector, wearable continuous glucose monitoring (CGM) Sensors are revolutionizing the treatment of diabetes. He diabetes the disease burden has progressively increased throughout the world; India has about 77 million people over the age of 18 suffering from diabetes and nearly 25 million are pre-diabetic, according to the World Health Organization (WHO) report. AI-enabled CGM-targeted insulin suspension has shown promise in the control and prevention of diabetes.
ETHealthworld spoke to some experts about how AI-enabled CGM devices are revolutionizing diabetes management leading to better patient experiences and the limitations that come with it.
Operation of AI-enabled CGM devices
A CGM system has a sensor where there is a needle in the center, which remains in the interstitial tissue, the subcutaneous layer just below the skin. record the blood glucose levels on tissues every 15 minutes. So a large amount of data is generated. A sensor can be left in place for at least 7 to 14 days, depending on the brand being used.
The AI-based software captures data continuously for 14 days and, through a “time in range” parameter, measures the amount of time spent in the blood glucose target range, between 70 and 180 mg/dL . The software then analyzes all the data and classifies it into three categories: time under range, time within range, and time over range. It also records when the data was generated, such as how long the patient spent with low blood sugar (less than 70 mg/dL) or high blood sugar (greater than 180 mg/dL). Therefore, the recommended time in range based on the data generated by CGM is 70 percent. And to read this data a reader is also available. The reader reads the data once approached to the sensor.
Speaking to ETHealthworld, Dr. Sweta Budyal, Consultant, Diabetology and Endocrinology, Fortis Hospital Mulund said: “We use CGM typically in the outpatient department. CGM helps give us a clear picture, and also helps adjust medication and navigate through problems at a particular time for patients whose sugar levels are rising every day. The increase may be related to the type of food the patient is consuming at the time, or if there are gaps between the main dish. So there are several things that one can address with the help of CGMs. They are generally helpful in patients who have unexplained low blood sugar, hypoglycemiawith someone who does not have sugars and patients who are mild with multiple daily doses of insulin where one wants intensive control of sugar as in the case of pregnant women”.
One can remove these sensors after 7 to 14 days and download the data from them. It then gives a curve of all the glucose levels that are compiled together, which is called the ambulatory glucose profile (AGP). From this, one can gain a lot of information about how the patient’s blood sugar levels are best controlled.
Limitations on readings
Although health technology has simplified the way in which populations interact with different health services and systems, these technologies also have certain limitations. Dr Anil Bhoraskar, Senior Diabetologist, SL Raheja Hospital, Mahim and Secretary of the Diabetics Association of India, said: “There are many situations where the sensor reading can be incorrect. First in the case of intraoperative hypothermia. To reduce the metabolism of the patient during surgery, the room temperature is lowered to 18-16 Celsius (°C) and that causes hyperthermia, which can give an incorrect reading. Therefore, during surgical procedures or major supracurgeries, subcutaneous blood sugar tests cannot be relied upon.”
He added: “Secondly, in areas like coronary artery bypass graft surgery (CABG patient) or major cancer surgeries, sometimes lots of fluids are infused to maintain blood pressure. Such perfusion into vital organs causes hemodilutional effects and the CGMS reading may be erroneously too low. And therefore, that reading cannot be relied upon during surgery.”
Another limitation of these sensors is their cost factors. Dr Budyal explained: “For countries with limited resources like India, it is not affordable or accessible for everyone. So we have to use it a bit judiciously. A sensor will cost around Rs 3,000-3,500 in hospitals. And because a device can only be used for 14 days, device this way sounds more expensive for most patients. So, CGMS is something that we recommend when the patient does not have cost problems”.
Device software manufacturers act as problem solvers
Doctors believe that maintaining individualized care glycemic variabilitythat is, it oscillates in blood glucose levels without medication can be dangerous and can have serious complications. Controlling the diet can be beneficial in the long term. Therefore, nowadays doctors also recommend home CGM monitoring devices. To track this, the patient is asked to check her diet and understand from the reader what is beneficial or not beneficial for him. Now, to track these glycemic variabilities, various device software manufacturers act as problem solvers for diabetic patients who self-monitor their blood glucose levels.
Manan Chandan, Senior Director of New Initiatives at HealthifyMe, said: “With the help of CGM, users can continuously monitor their glucose levels and gain insight into which foods and activities work best for them. Trainers can review the data collected by all of these devices and provide personalized guidance to help clients optimize their diets and physical activities.”
But since the software continually produces a large amount of data, data security is an important issue. To this, Dr. Arbinder Singal, CEO and Co-Founder of Fitterfly, commented: “We are all Amazon encrypted web servers and have the usual anonymized patient data, meaning it is all stored in three-layer encryption. . Therefore, the data privacy rules are very serious. The government has also provided guidelines on data privacy, and most companies follow these rules. We also strictly adhere to those guidelines and do not share any patient data with anyone without the patient’s consent.”
Health experts believe that AI-enabled CGM devices help control patients’ blood glucose levels by generating a wealth of data and that they offer a promising future. But there are still gaps that can be filled by incorporating better technologies and new research.
