An article published last week in The Wall Street Journal, “For many diabetes patients, skin patches and phones are replacing finger pricks”, reviews the evolution of diabetes treatments, focusing on how the use of transdermal patches and apps are replacing the need for patients to extract a small amount of blood from pricking their thumb to monitor blood glucose levels, an essential part of the day-to-day life of diabetics. Nothing that most diabetics didn’t already know or that has not been explored in specialized publications, but an interesting article for the general public.
In the United States, there were approximately 840,000 patients out of a total of thirty million using continuous glucose meters at the end of March, a market of about 3.2 billion dollars increasingly dominated by brands such as Abbott, Dexcom, Eversense or Medtronics. The treatment is not available to anyone: the devices cost between $1,300 and $3,000, which with medical insurance usually results in co-payments of between $31 and $50 per month. The treatment consists of patches placed on the skin for between ten and 90 days that carry out measurements of blood glucose levels every five minutes and transmit them to a device, typically via a smartphone or smartwatch that can be shared with other people, which is particularly useful in the case of vulnerable patients. Some companies are already offering trials for conference attendees with the idea of providing blood sugar indicators not just for diabetics, but to anybody who wants to monitor them.
The patches, which are virtually painless, pierce the skin with tiny needles, allowing capillaries to be monitored in the dermis with growing accuracy. This method seems to be much more efficient than others, such as measuring the tear fluid through smart contact lenses, a project that Verily, a company belonging to Alphabet, abandoned in 2016.
The most accurate way to monitor blood sugar levels is through the blood itself by extracting a drop pricking the skin. For a long time, many medics and patients rejected other methods as unreliable, but by being able to carry out a higher number of measurements, pretty much continuously, the standard error decreases ensure even higher levels of accuracy, in exchange for a far less intrusive procedure. This is similar to how many cardiologists criticized the accuracy of devices such as Kardia or the Apple Watch 4 without understanding the advantages of continuous monitoring, which in my view suggests ignorance of the value of basic statistics.
In the future, many of our basic health parameters will be monitored continuously or regularly, from blood pressure to urine analytics, and will be recorded in the corresponding apps for constant algorithmic monitoring and notification to the user and the appropriate professional when one parameter or another points to a possible problem. This is an approach, anchored in the most elementary statistics, that should already be taught in all medical schools. In the case of diabetes, which affects many millions of people around the world, these developments are already changing our understanding of monitoring and treatment not just of many patients, but also of numerous endocrinologists, as is the case with many cardiologists. All that is required for this approach to extend to other medical areas of specialization is the publication of case studies and feedback from medics. The future of medicine lies in the use of these types of devices.
(En español, aquí)