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Internet of Things (IoT)
India has the maximum number of diabetic patients, it appears at an earlier age, and
its complication is far reaching when compared to western nations. In the early twentieth century, before the advent of insulin, diabetes was an acute illness, meaning once
diagnosed they had a short lifespan and died of complications. Now diabetic acute complications are well managed, making diabetes a chronic disease. As a chronic case, management of diabetes by the medical world is poor, and far too many progress to kidney
failure, develop heart attacks and strokes, and lose their sight and limbs due to the vascular complications.
We know the science of diabetes up to the molecular level. We have trained physicians
to take this understanding to the patient. We have patients who can afford the drugs or
as in the state of Tamil Nadu, government hospitals providing free insulin injections. We
have laboratory facilities to do blood sugar even in villages at primary healthcare centers.
Yet the disease is not controlled. Complication incidence (number of new ones appearing
every year) is increasing. From where does the problem come from?
There are many dimensions, but the single most reason is that the disease has so
many components, no single physician can document, let alone mange all of them. But
a network of physicians and paramedical workers can handle it more appropriately.
Enlarging the diabetes example, the first step in management of diabetes is the diagnosis of the disease. Diagnosis is made by the symptom or complication of diabetes
e.g., foot ulcer—by the physician or by the laboratory test done for some other problem
or as a screening test. After diagnosis, it is screening for complications: eye checkup, cardiac assessment, cholesterol level, and kidney function measurement. After that, based
on the individual’s body constitution and the complications present, drugs are chosen.
If it is not controlled, insulin injection is given. Lifestyle modification in the form of
exercise and avoidance of smoking and alcohol is stressed. An exhaustive diet charting
is done including what to be avoided, what can be liberally taken, what can be taken in
moderation. Patient education like care of the foot and careful execution of simple procedures like nail cutting are stressed.
In vast majority of health centers, diabetes is managed only by the physicians, who are
at the top of healthcare hierarchy. They concentrate only on bio-medical aspects, and not
stressing the other components, mainly because of lack of time availability. Suppose we
train the paramedical workers to carry out the work missed by physicians, complications
can be greatly reduced. Here comes the comprehensive health record and smart gadgets
to assist them. Physicians can then delegate work, which can be done easily by paramedical workers. This is happening in exclusively diabetic hospitals, particularly in the city
of Chennai.
This delegation has the following components:
1. Domains which can be delegated are basic general information, diet, exercise, and
lifestyle modifications.
2. These “modules” must have evidence-based guidelines. The guidelines if adopted
scientifically should give measurable outcomes, which can be validated.
3. All these have to be “caught” systematically in a health record, which can be transported along with the patient. The entry in them should be legible in a standard
format. When the patient leaves the primary physician, he/she should not fumble
at the second hospital.
4. Several checklists for the diabetic are once a year, eye check-up; once in 3 months,
hemoglobin A 1 c measurement; before retiring to the bed, wash the feet and look
Internet of Things (IoT)
India has the maximum number of diabetic patients, it appears at an earlier age, and
its complication is far reaching when compared to western nations. In the early twentieth century, before the advent of insulin, diabetes was an acute illness, meaning once
diagnosed they had a short lifespan and died of complications. Now diabetic acute complications are well managed, making diabetes a chronic disease. As a chronic case, management of diabetes by the medical world is poor, and far too many progress to kidney
failure, develop heart attacks and strokes, and lose their sight and limbs due to the vascular complications.
We know the science of diabetes up to the molecular level. We have trained physicians
to take this understanding to the patient. We have patients who can afford the drugs or
as in the state of Tamil Nadu, government hospitals providing free insulin injections. We
have laboratory facilities to do blood sugar even in villages at primary healthcare centers.
Yet the disease is not controlled. Complication incidence (number of new ones appearing
every year) is increasing. From where does the problem come from?
There are many dimensions, but the single most reason is that the disease has so
many components, no single physician can document, let alone mange all of them. But
a network of physicians and paramedical workers can handle it more appropriately.
Enlarging the diabetes example, the first step in management of diabetes is the diagnosis of the disease. Diagnosis is made by the symptom or complication of diabetes
e.g., foot ulcer—by the physician or by the laboratory test done for some other problem
or as a screening test. After diagnosis, it is screening for complications: eye checkup, cardiac assessment, cholesterol level, and kidney function measurement. After that, based
on the individual’s body constitution and the complications present, drugs are chosen.
If it is not controlled, insulin injection is given. Lifestyle modification in the form of
exercise and avoidance of smoking and alcohol is stressed. An exhaustive diet charting
is done including what to be avoided, what can be liberally taken, what can be taken in
moderation. Patient education like care of the foot and careful execution of simple procedures like nail cutting are stressed.
In vast majority of health centers, diabetes is managed only by the physicians, who are
at the top of healthcare hierarchy. They concentrate only on bio-medical aspects, and not
stressing the other components, mainly because of lack of time availability. Suppose we
train the paramedical workers to carry out the work missed by physicians, complications
can be greatly reduced. Here comes the comprehensive health record and smart gadgets
to assist them. Physicians can then delegate work, which can be done easily by paramedical workers. This is happening in exclusively diabetic hospitals, particularly in the city
of Chennai.
This delegation has the following components:
1. Domains which can be delegated are basic general information, diet, exercise, and
lifestyle modifications.
2. These “modules” must have evidence-based guidelines. The guidelines if adopted
scientifically should give measurable outcomes, which can be validated.
3. All these have to be “caught” systematically in a health record, which can be transported along with the patient. The entry in them should be legible in a standard
format. When the patient leaves the primary physician, he/she should not fumble
at the second hospital.
4. Several checklists for the diabetic are once a year, eye check-up; once in 3 months,
hemoglobin A 1 c measurement; before retiring to the bed, wash the feet and look