The current outbreak of diabetes reflects the high prevalence of type 2 diabetes. According to the Centers for Disease Control and Prevention, type 2 diabetes accounts for approximately 90 to 95 percent of all diagnosed cases of diabetes in adults (Santos, 2017). 29.1 million people in the United States have diabetes; however, 8.1 million may be undiagnosed and unaware of their condition (Santos, 2017). Approximately, 1.4 million new cases of diabetes are diagnosed in the United States annually and more than 1 in every ten adults who are 20 years or older has diabetes.
Approximately 80% of the people with diabetes live in the developing countries including India, China, and South-East Asia nations such as Malaysia and Indonesia. More than 60 % of the people with diabetes live in Asia, with almost one-half in China and India combined. The most populous region in the world (The Western Pacific) has more than 138.2 million people with diabetes (Nanditha et al., 2016). South Asia constitutes one-fifth of the world’s population and includes countries which are undergoing lifestyle changes that make their populations more vulnerable to develop type 2 diabetes mellitus (Rhee, 2015).
Closely associated with obesity, Type 2 diabetes is the most frequent and common subtype of diabetes and is a chronic condition characterized by high levels of blood glucose (hyperglycaemia), insulin resistance, and relative insulin deficiency. The risks of type 2 Diabetes mellitus in Asian countries tend to increase sharply. 50% of people with diabetes die of cardiovascular diseases, such as heart disease and stroke and the American Diabetes Association reports that more than 70% of the United States adults with diabetes had hypertension.
A person with type 2 diabetes is two to four times more likely to get cardiovascular disease, and 80% of people with Diabetes will die due to it. Cardiovascular disease epidemic continues to evolve on a global level rapidly and is currently responsible for twice as many deaths in developing countries compared to developed countries. Diabetes mellitus is closely associated with an increased risk of cardiovascular death and a higher incidence of cardiovascular diseases including coronary artery diseases (CAD), congestive heart failure (CHF) and atrial fibrillation (Chiha, Njeim & Chedrawy, 2012). On the other hand, Hypertension is often found at the time of diagnosis of type 2 diabetes.
Currently, SMBG (Self-Monitoring of Blood Glucose) techniques are more widely utilized in more developed economies, for instance in Germany and the United States, in comparison to developing countries such as Malaysia, India or Pakistan. Mobile healthcare has been applied to manage diabetes requiring self-management. Healthcare by mobile apps has a significant advantage when applied to patients with diabetes; the adherence to self-management activities for diabetes can be provided through the apps. Since 2010, The Food and Drug Administration (FDA) has cleared and approved the use of some mobile apps as medical devices for the management of diabetes (Jo, Yoo, Lee, Park & Kim, 2017).
Right now, there are more than 165,00 health and fitness applications in app stores. In the year 2016, researchers identified 120 free patient apps for Android and Apple devices and evaluated 89 that were in English and did not require subscriptions (Crist, 2017). Out of the 89 applications, only four integrated all the diabetes management tasks. The FDA is always interested in new technologies that can help make the care of people living with chronic conditions, such as diabetes, easier and more manageable (Buhr, 2017). FDA-approved mobile medical apps include an app combination that transforms a smartphone into an ECG rhythm-strip recorder. Other FDA-approved devices combinations turn a smartphone into an ultrasonography machine, blood pressure cuff, or pulse oximeter. In 2016, 36 connected blood glucose monitors and devices received clearance from the Food and Drug Administration (Mack, 2016).
The AliveCor’s FDA approved Heart Monitor and companion smartphone app is an example of a potential game changer in cardiology (Wilson, 2014). The device, a one-lead ECG, attaches to a smartphone and records accurate ECGs and heart rate. Moreover, it can monitor the effects of medications, track such symptoms as palpitations and shortness of breath, record the cardiac effects of alcohol or caffeine consumption, and monitor such activities as exercise or sleep (Scher, 2015). The FDA has also approved the Glooko MeterSync; it connects over 30 non wireless glucometers to patient smartphones, which are transformed into wireless devices that enable syncing of blood glucose readings, integrates food and lifestyle data, and allow for real-time connection between patients and providers.
Self-monitoring blood glucose is under-utilized by patients and physicians in most cases. There are other barriers such as the cost of monitoring supplies, lack of diabetes self-management skills and concerns about the reliability of blood glucose readings. While SMBG is useful for measuring blood glucose levels only; it is not helpful for the patients who do not regularly check other health vital signs. For SMBG does not enable them to manage blood glucose levels or capture marked and sustained hyperglycaemic excursions. Diabetic patients over a period tend to have some vital health signs like Heart rate, Heart Rhythm being affected. Hence it is to regularly monitor body fat, BMI, blood pressure and heart rhythm. These are vital health signs that would if one is developing diabetes.
Weight alone is not a clear sign or indicator of good health since it does not differentiate between pounds that come from body fat and those that come from body mass or the muscle. It is essential to more frequently monitor body fat because carrying too much fat puts an individual at risk for chronic diabetes and heart disease. Chronic diabetics cannot process body fat and over a period a risk of fat deposits in the arteries leading to stroke and Acute Myocardial Infraction.
Approximately 25 % of people with type 1 diabetes and 80% of people with type 2 diabetes have high blood pressure. Diabetes and high blood pressure raise the risk of heart disease and stroke. In case of people with diabetes, medical professionals will want to make sure that their blood pressure is well controlled. Increasing fat deposits in the arteries leading to increased blood pressure which is critical to measure to manage diabetes. High blood pressure (hypertension) is associated with atherosclerosis (Lip & Makin, 2013), which is the hardening of the arteries caused by deposits of fat, cholesterol and other substances inside the blood vessels.
Monitoring of the heart’s rhythm is the cornerstone of the diagnosis of cardiac arrhythmia such as atrial fibrillation which is closely related to diabetes. The risk for irregular heartbeats rises higher in people who have diabetes and uncontrolled blood sugar levels. Atrial fibrillation is the most common cardiac arrhythmia and is strongly associated with stroke risk and a variety of cardiovascular conditions (Camm, 2011). AF early detection is of paramount importance, to define proper medical treatment.
Some of the key companies that offer a comprehensive range of FDA-certified devices such as glucometer, blood glucose testing strips and continuous glucose monitoring device include Abbott Laboratories, Bayer AG, Dexcom Inc., Johnson & Johnson, Medtronic Plc, Merck & Co., Roche Diagnostics Limited and Terumo Corporation. These ground-breaking sensor technologies deliver clinically accurate heart activities monitoring anytime, anywhere. Moreover, such technologies fit seamlessly into the modern lifestyle and address the need for smarter health management tools available to both the patients and their doctors. The single lead wearable ECG can potentially provide early warnings of any arrhythmia. Also, most of these wearable ECG devices are splash and rain-resistant, perfect for everyday use.
Approaches to managing chronic illness such as heart disease and diabetes are shifting from the traditional provider-patient relationship to a model in which people with these chronic conditions play a crucial role in guiding their care, in partnership with healthcare providers. Though unique in their attributes and demands, such chronic diseases share common challenges associated with their management. Individuals with such chronic conditions have to deal with symptoms and disability. They have to monitor physical indicators, manage complicated medication routines, as well as to maintain proper levels of nutrition, diet, and exercise (Grady & Gough, 2014). Moreover, they have to adjust to the psychological and social demands, including difficult lifestyle adjustments; and engage in productive interactions with health care providers and medical professionals.
Specifically, a multitude of apps have been developed to assist patients in the management of diabetes mellitus type 1 or 2. Despite the massive amount of currently available diabetes apps, several of them offer a small number of similar functionalities. Patients and healthcare providers should probably be directly involved in the applications development to resolve the lack of usability and needs-orientation. Mobile applications which can educate patients, as well as track vital signs, medication adherence, and other patient-derived data are certainly expected to do what they claim they do and deliver accurate medical results. Unfortunately, this is not always the case. Some applications that are used to measure vital signs of chronic diseases offer inaccurate readings. Moreover, most of these apps are downloaded at a cost and are only meant for entertainment purposes only. Medical applications for which false claims are made may be useless at best and harmful at worst to the patients.
First and foremost, preventive monitoring of overall health ensures lesser healthcare costs. Regular medical monitoring helps in saving a good amount of money in the long run. This is because it mitigates the risk of potential chronic illness that can be life-threatening. With regular preventive monitoring, it will be easier for the medical doctors to test and diagnose any chronic diseases at an early stage. Self-glucose monitoring mostly focuses on diabetes despite that fact that there could be other chronic illness. Therefore, preventive monitoring of overall health offers a clear picture of one’s health status and could determine the vital signs and symptoms of chronic diseases before they become worse and costly. The healthcare providers will help you find problems early to get your chances of treatment and cure are better. By getting the right health services, screenings, and treatments, you are taking steps that help your chances of living a longer, healthier life.
Hence Chronic and Prolonged Diabetes people needs to have a holistic Health Management approach to monitor vital signs like ECG for Heart Rate, Heart Rhythm, arrhythmia for Cardiac conditions, Body Fat and weight for Obesity conditions, Cardiac output and Oxygen saturation, Blood pressure for Cardiovascular conditions and Hypertension conditions in addition to Blood Glucose. All other vital signs ought to be measured to offer a clear picture of one’s health status.