Finding patterns in diabetes treatment may be key for telemedicine

Dr. David Klonoff of Mills-Peninsula Health Center and UC San Francisco gave a talk at yesterday’s Printed Electronics USA09 conference in San Jose titled Diabetes Applications for Printed Electronics. The talk was not particularly strong on printed electronics, but rather delved into how technology in general can aid in developing support technology for Type 1 Diabetes, a key part of which is making diabetes  treatment and monitoring less onerous but most importantly, more accurate for the diabetic patient.

(Dr Klonoff was speaking at a printed electronics conference because printed electronics technology has characteristics that make it particularly well-suited for diabetes treatments: It’s light, inexpensive/disposable, bendable, and lends itself to narrowly-defined applications such as medical treatment and monitoring.)

With current technology, Type 1 diabetics typically have to check their blood glucose level four times a day using needle pricks; they have to figure out how much insulin to use; and they have to give themselves insulin injections– again, four times a day. What researchers are working towards is technology for automatic measurement of blood glucose, automatic dose calculation, and automatic insulin delivery.

For this ideal scenario to develop, five technologies need to be solved, and Klonoff sees printed electronics being used in every one:

• Self-monitoring of blood glucose
• Continuous (and ultimately non-invasive) monitoring of blood glucose
• Alternate routes for delivering insulin rather than needles, such as micro-needles. (Klonoff referred to work being done at UC Berkeley; I saw some demonstrated at the University College Cork/Ireland (PDF poster here) although using traditional semiconductors, not printed electronics.)
• Artificial pancreas
• Telemedicine

The last technology, telemedicine, is apparently far from being ready for prime-time. Klonoff says that currently when companies announce a telemedicine product, what they mean is telemonitoring. Telemonitoring is decision-support software, whereas the telemedicine software itself makes health decisions. He gave as an example a diabetes telemedicine nurse, who does case management for several hundred diabetic patients. Patients send in their blood glucose levels, either manually or over a wireless link, and the diabetes nurse revues levels and suggests changes in insulin dose or diet. Telemedicine software, working in conjunction with case management, can make patient decision based on the latest treatments as well as what to do in every situation. (Getting FDA approval for the first telemedicine software packages is a whole ‘nother set of challenges.) It’s easy to imagine a point in the not too distant future where telemedicine can take the place of most rudimentary health care. The challenge for telemedicine is in getting all of the knowledge out of the heads of doctors and nurses and into an AI (artificial intelligence) software package.

There’s an article over at Slate, “Do you see a pattern?” about architect Christopher Alexander who wrote the book, A Pattern Language, back in 1977. “[His] ambitious goal was nothing less than to catalog the entire built environment—from towns to bedrooms—as a collection of discrete "patterns," 253 of them. Each pattern was explained, supported by research, and illustrated by sketches and photographs.”

The book became popular with non-architect do-it-yourselfers who were building their own homes. The article goes on to say that the concepts of patterns have influenced other non-architectural disciplines, especially computer science. Here’s a 1996 ACM paper, The Origins of Pattern Theory.  However, “[Alexander’s] fellow architects, on the other hand, who didn’t like seeing their art reduced to a formula, were ambivalent.” 

Hoo boy, if architects are ambivalent about seeing their art form abstracted into a set of patterns, imagine what health professionals, who can be pretty clannish, will think about telemedicine. But perhaps the technology being developed for diabetes management will be able to prove its practicality in this subset of general health care, and find its way into more generalized health and medicine practice.