Vinay Chauhan from Uttar Pradesh has so far taken over 40,000 insulin injections to keep his high blood sugar levels (hyperglycaemia) in check. Like many with type-1 diabetes, which he was diagnosed with at the age of 14, he needs three injections of insulin a day.
Chauhan’s struggle motivated him to launch Pathshodh Healthcare, a medical device research and development startup, aiming to reduce costs and improve the accuracy of blood sugar monitoring devices. Currently, their device can take a reading with just a single drop of blood, but they are working towards a non-invasive and less painful solution to benefit millions.
Detecting sugar through the years
Ways to monitor glucose have existed since the mid-1800s when urine was first used to determine glucose levels in the body. The drawbacks of this method paved the way for better analyses using blood, culminating in the invention of the first glucose meter in1970.
Some of the earliest glucose monitors were inaccurate and bulky. It was not until the mid-90s that these devices became more sensitive, using smaller amounts of blood. As technology advanced, we began monitoring glucose levels without the need for frequent finger pricks, which only provide a single reading at a particular point of time.
The development of continuous glucose monitoring (CGM) devices, where readings are taken at regular intervals, makes it easier for those with type-1 diabetes to manage their condition better.
The need for CGM devices
According to the International Diabetes Federation, 77 million people in India have diabetes, with this number expected to rise to 134 million by 2045.
Diabetes is a chronic condition, caused either by less insulin made in the body (type 1-diabetes) or due to the body’s inability to use insulin even though it is produced (type 2-diabetes).
Also read: Diabetes: Signs, symptoms, causes, diagnosis and treatment
Insulin is a hormone produced in the pancreas that enables cells to absorb glucose from the blood. In its absence, sugar levels can become high, leading to long-term health issues, including high blood pressure, strokes, retinal damage, neuropathies, kidney failure, skin ulcers, and cardiovascular illnesses.
Those with type-1 diabetes like Chauhan must constantly check their glucose levels and inject insulin as needed to compensate for the body’s deficiency.
This underscores the importance of CGM devices that can take continuous readings to better understand how sugar levels fluctuate throughout the day and the amount of insulin needed to bring them back to the baseline.
Some CGMs can also be connected to an insulin pump, making for an all-in-one solution. These not only monitor glucose levels but inject insulin as needed, mimicking the body’s own process.
Non-invasive devices are the future
“There have been a lot of technological advancements in diabetes management from insulin pumps to non-invasive devices for continuous glucose monitoring,” Dr Manjunath Malige, lead consultant, endocrinology and diabetes at Aster RV Hospitals in Bengaluru, told Happiest Health.
CGM devices, in the form of enzyme and optical-based sensors, are commercially available today, though they are expensive and require regular sensor changes.
Efforts are underway to make these devices non-invasive and limit how much blood they draw. Alternative methods are also being explored, including the use of spectroscopy (study of light and its properties), radio waves, polarized light (restricted light rays), interstitial fluid (fluid present around cells) to monitor blood sugar with the accuracy of conventional blood tests.
The G-WAVE device by HAGAR Technology, an Israeli startup, is one such sensor that measures blood glucose levels via radio waves. The creators say that the gadget that fits around the wrist like a simple ceramic bracelet can retrieve recorded data and share it with doctors.
Another example of non-invasive CGM is FreeStyle Libre, a sensor and reader system from Abbott. It uses a sensor attached to the upper arm and allows for real-time glucose monitoring without a blood sample. The sensor measures blood glucose levels based on the differences in the flow of the interstitial fluid inside the body. It can also be connected to a mobile or laptop to transfer the recorded data to healthcare professionals. However, the wearable sensor needs to be replaced every 14 days.
In a recent study carried out by Ulsan National Institute of Science and Technology, South Korea, researchers have been able to design an electromagnetic-based sensor that works in a different manner than those already developed.
“The proposed implantable sensor has not only overcome the disadvantages of the existing continuous glucose monitoring systems, such as short lifespan, but has also enhanced the blood glucose prediction accuracy,” the research team said in a statement.
One of the lead researchers, Dr Jagannath Malik told Happiest Health that the “fundamental working principle of our sensor is different than other sensors that are available in the market. Those sensors are either enzyme-based or optical fluorescence based and have an inherent short lifespan. Our EM-based sensor guarantees a much longer lifespan compared to those.”
Currently, this implantable sensor can be used for three years without any degradation in performance, but there remains the issue of fibrous growth around the sensor which could affect sensor accuracy.
Management of diabetes
While technology has always made it possible for recording glucose levels at any time, there remain some limitations. As per the National Institute of Diabetes and Digestive and Kidney Diseases of NIH, the accuracy of the CGM device will still need to be checked against conventional glucometers as there can be some discrepancies in readings. These devices measure glucose levels in the interstitial fluid, which are less accurate than blood glucose readings, potentially delaying treatment of hyperglycaemia.
“Optimizing the use of these currently available therapies for adequate control of body vitals like blood pressure, blood glucose and lipid levels is a challenge faced by diabetic individuals,” adds Dr Malige.
He adds that developing more awareness about diabetes care is an important aspect of managing the condition. It is important to educate individuals and encourage them to follow dietary restrictions and medical treatments.
Another innovative approach is taken by Aarca Research Inc, an India-based healthcare and research technology company that uses thermal videos of people’s faces to assess changes in arterial blood flow. Utilising machine learning models, this technology can predict early signs of diabetes before it is even diagnosed. “We are positioning ourselves as early detection technology for type 2- diabetes,” says Dr Gayathri Choda, founder and CEO of Aarca Research Inc.
Choda says their technology has already been validated in two multi-centre clinical trials carried out in Hyderabad and Bengaluru and has been incorporated in certain hospitals in Hyderabad. Their goal is to expand to more hospitals in the future.
