What is Glucose Trail?

A Concept Letter

Naaznin Lokhandwala
Glucose Trail


Dear reader,

I’ve embarked on a journey to start Glucose Trail, a global diabetes telemedicine solution. Treating diabetes is a complicated undertaking, and even more so in the third world. Yet, there are technologies and improvements that have made it possible for millions of people to fight this disease. This letter serves to outline the concepts and motivation behind this project, and I hope you find meaning in it. If you’re inspired and want to talk more about this, please reach out: info@glucosetrail.com

A straightforward medical problem is like an inflamed appendix. An acute presentation, the inflamed appendix has to be surgically removed and the patient is cured with a one time intervention. Diabetes, however is a complex chronic disease. It’s etiologies are multifactorial, with genetic, epigenetic and environmental causes. Some things we can control, some things we need to accept. The solutions are as complex and variable as the disease itself.

Glucose Trail is a diabetes telemedicine project. Using healthcare companions and a mobile application, we are able to reap the benefits of using technology to reach patients thousands of miles away, while providing them with real human connections in their medical treatment.

What has informed this solution?

From medical school through my 15 years of being an endocrinologist, I’ve been learning from my patients. How do they muster the mental fortitude in dealing with a chronic medical illness? Patience means “calm endurance of hardship.” What makes us calm? And what can increase our endurance?

A walk in Pind Bhegwal, where we are treating around 50 patients so far.

Some among us have an inner strength to heal themselves. They have that power of introspection, their own mental fortitude keeps them calm, preserving their contentment. They have the generosity to smile even if they are uncomfortable, and thank the medical system for our services, despite our scientific limitations. They still think of others despite their own medical challenges. As everyone’s time on Earth is finite, these people are able to embrace this truth. But for most of us, we need a lot more support in facing a hardship. Quality of life, not just quantity, is pivotal when treating patients.

Diabetes presents this important opportunity. Finding diabetes early and treating it properly can preserve wellness. Delayed diagnosis or sporadic, poorly planned treatment leads to irreversible complications: poor vision/ blindness, foot infections that threaten life, leading to amputation, congestive heart failure with perpetual shortness of breath, or kidney failure requiring lifelong machine dialysis. These medical events impair personal productivity and places an enormous burden on family members and the community, creating hopelessness.

Patients who find themselves completely out of control and physically unwell become helpless, fearful and hopeless. Lack of knowledge, loneliness, unpredictability, failed medical interventions and financial stress contribute to this state of existence. This is what Glucose Trail is striving to fix.

Our Healthcare Companions in a training session.

The components of our solution are simple:

1. Provide empowerment through patient education.

2. Find people close to patients, people who understand their circumstances, and can relate to their life to support them. Create a circle of care which champions human interaction and the seeding of a caring community.

3. Implement objective goals that are checked and reviewed on a regular basis to measure patient progress which holds the physician, the care team and the patient accountable.

4. Deliver therapy that is consistent, accessible and affordable. We are using medications that give the biggest bang for the buck. … This may not always be the newest pharmaceutical on the block.

5. Prioritize diet and physical activity. These are powerful therapies that, with the help of a health conscious community, can be integrated into the lives of patients.

Patients who gain control have restored dignity, feel more motivated, and experience a sense of accomplishment, despite their chronic medical illness.This is our goal.

When it comes to diabetes, why go out into the community?

I went on a sabbatical to Pakistan from 2009- 2011. My parents had a small community hospital there, serving low income patients. My mother is a Pediatrician and my father is a Urologist. After his second cardiac bypass, his limited volume of surgery could no longer fully support the functioning of the hospital. I envisioned the creation of a wellness center. We did away with the dialysis unit and emergencies, deciding to get to patients before their complications set in. Freshly renovated, we launched with a big opening. No one came. It was a humbling experience. We learned that no one comes to a hospital to preserve wellness. They only come in dire emergencies, often when irreversible complications set in. We realized we have to go to patients in their own communities to find diabetes early, treat it smartly and preserve wellness.

On a recent trip to Pakistan where we began our Pilot for Glucose Trail

So how did we go out into community and connect with each other in a purposeful, consistent way? We set out to create the first iteration of a mobile app that can connect a remote physician with a patient and health care companion. The literate health care companion is relayed information from the doctor through the app. They are then able to carry out the assigned patient intervention accurately for their community members, while the doctor might be sitting thousands of miles away. The app not only connects the care team but organizes all the critical data required for remote diabetes care to maintain consistent follow-up and enable objective goals to be measured.

Simultaneously, we’re building healthy living communities where healthcare companions develop their skills in caring for their fellow community members. By interacting with patients regularly, they can disseminate education over time and teach them to advocate for their own care. Thus, a community of people who have expertise in managing diabetes can blossom, leading to self-empowerment in preserving their wellness.

As we raise funds, test out this idea in a pilot project, and move into the future, we’ll have lots to learn. But we’re encouraged that quality diabetes care and community building is possible, one patient at a time.


Naaznin Lokhandwala MD
American Board Certified Internal Medicine, Endocrinology Diabetes and Metabolism
Member of Endocrine Society USA
Member of Pakistan Endocrine Society