By Dr Shane O’Donnell, Research Lead, Care Team, ARCH
As a person with diabetes, I’m extremely passionate about technological innovation in healthcare as I have first-hand experience of the difference that advances in this area can make in improving the health outcomes and quality of life for people with chronic conditions.
Since being diagnosed with type 1 DM at the age of 17, I have been fortunate enough to avail of a wide range of advancements in diabetes therapy, including better insulins, better education and better care, which have made the daily challenges that I face with the condition more manageable and the psychosocial burden infinitely more bearable.
The latest piece of technology I have come to benefit from is what’s called sensor augmented pump therapy. In essence, this system is based on a sensor that sits underneath the skin and takes a measurement of my interstitial fluid (a proxy for glucose levels) at regular 2 minute intervals throughout the day. The beauty of this technology is that is has the capacity to predict when the user is about to have a low blood sugar episode and reacts by suspending all insulin delivery for a period of two hours, effectively helping to reduce the risk of the low blood sugar occurring in the first place. Although by no means a cure, it’s nonetheless another quantum leap forward in diabetes care and has helped me to significantly reduce the number of low blood sugar episodes that I experience on a weekly basis, particularly those that occur at night time and which often leave me exhausted and sleep deprived the following day!
In addition, having only had this new piece of kit for about a month now, I have managed to improve my blood glucose targets by roughly 30-40%. We know that more tightly regulated blood sugar is linked to a reduced risk of all the nasty things associated with diabetes, such as stroke, chronic kidney disease and sight loss, meaning that I’m now even less likely to cost the state a lot of money by offsetting the need for laser treatment, dialysis etc. as I get older.
Given the promise that technologies of this nature hold in reducing costs to the healthcare system as well as society more generally; it stands to reason that everyone with diabetes should have access to it as a fundamental right.However, as a person who also works in advocacy through the International Diabetes Federation Young leaders in diabetes’ programme, I am also acutely aware that I am in a highly privileged position in terms of access, relative to many of my peers with diabetes worldwide. Life expectancy in diabetes varies dramatically worldwide, with those with type 1 diabetes born in the poorest parts of Africa, for example, unlikely to live to see their 21st birthday without experiencing severe complications [i]. However, even in the relatively developed economies of the West, inequalities in diabetes self-management outcomes (both type 1 and 2) not only persist but are on the increase, with those at bottom of the social ladder roughly 2 ½ times more likely to die from diabetes-related complications compared with the top [ii].
Income therefore is a matter of life and death, with access to treatment for so many people remaining and predicated on their ability to pay rather than based on their clinical need. In the US for example many people still struggle to afford insulin and basic testing equipment. For these people[iii], insulin pumps with therapy that is augmented to constantly monitor blood sugar can only feel like a distant dream.
It seems so grotesquely perverse that at time when investment in diabetes-related technology is at an all-time high, and as we move ever closer to Holy Grail of the artificial pancreas [iv], that the basic needs of so many people living with the condition can remain unmet. Unfortunately this is a pattern within healthcare that has been consistently repeated more often than not throughout history.
Link and Phelan have carried out a convincing historical analysis to show how as new technology emerges to address the dominant public health issue of the day, it is the wealthiest sections of society through their ‘knowledge, money, power, prestige, and beneficial social connections’ that tend to monopolise the benefit, while those most in need are left behind [v].
However grossly unjust the situation, it is not irreversible. As Dr Maria Quinlan alluded to in her previous blog on 12th February ‘Moving healthcare upstream – are we ready for that challenge and how can technology help?’, the mechanisms giving rise to inequalities in health are complex, multifaceted and deeply rooted in the social and living conditions in which we grow up, work and play. But we also know that these conditions are influenced by public policy choices made not just in the area of healthcare, but also education, transport, social welfare and employment, and therefore can be improved, depending on sufficient political will. What is clear, however, is that if we do not underpin all the wonderful technological advances we have in with the principles of universalism, solidarity and equitable access of care, then we condemn large sections of the population to poorer health outcomes and utterly avoidable hardship and suffering.
[ii] Balanda, K. P. & Wilde, J. 2001. Inequalities in Mortality: 1989-1998: a Report on All-Ireland Mortality Data, Dublin, institute of Public Health in Ireland. Available At: http://www.publichealth.ie/files/file/inequalities%20in%20mortality.pdf
You can contact Shane on firstname.lastname@example.org. Check out our website for more information about Shane’s research interests.
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