Yet researchers have found that the newer methods to manage diabetes are not being widely used because physicians may be reluctant to prescribe them, and even patients who are using them may not be deriving their full benefits.
According to the Duke researchers, the lack of strong scientific evidence on the efficacy of newer devices, combined with insufficient patient-education resources for physicians and their patients, hinders the diffusion of new devices and contributes to their incorrect use. In addition, the researchers pointed to the higher costs of newer medical technologies and the demographics of diabetes as probable causes of low usage – i.e., its disproportionate prevalence among racial and ethnic minorities, persons of low socioeconomic status, and the elderly.
These findings have emerged from a literature review conducted by the Medical Technology Assessment Working Group at Duke University, focusing on technologies used to monitor glucose and deliver insulin outside of conventional methods, such as daily injections and finger stick tests.
Diabetes is a serious and costly disease whose prevalence is expected to increase by 165 percent between 2000 and 2050. In 2002, the total cost of diabetes in the U.S. was $132 billion, $92 billion in direct medical costs and $40 billion in indirect costs representing disability, inability to work and premature death.
Empirical evidence, the researchers say, is sufficient to conclude that new devices for delivering insulin and monitoring blood glucose, when applied correctly and consistently, are less painful and provide a more specific and continuous level of dosing and feedback. As a result, patients benefit from improved quality of life and decreased risk of developing a serious diabetes-related medical condition such as hypertension, blindness and end-stage renal disease.
According to Linda K. George, Ph.D., professor and project director of the study, for all of its risks and complications, diabetes is largely controllable, especially type 2 diabetes, which accounts for 90-95 percent of cases. "It's clear that the rate of diffusion of cutting-edge technologies for diabetics is sluggish. We haven't systematically investigated why, but it appears that the bottleneck to widespread use of new technologies is resistance from physicians rather than patients."
Dr. George pointed to several possible reasons to account for physician resistance. For example, lacking clinical evidence of the long-term benefits of new devices, physicians may not be confident that they are more effective and cost-efficient compared with traditional treatments. The disease's demographic prevalence among minorities, the elderly and people of low socioeconomic status, is a major contributor to low use rates. Across a range of diseases, these populations are historically less likely to be prescribed cutting-edge medical technologies for treatment, she said.
Further, physicians' own lack of experience in selecting the devices and teaching patients to use them could hinder utilization, which may also explain why patients' who use new devices often do not derive their full benefit, Dr. George said. While new devices require a degree of patient education, researchers say there is no evidence to suggest that the skill set required is more or less complicated than for conventional methods. The study points to the need for new patient education and monitoring techniques to ensure that patients use devices properly, e.g., using the feedback from the glucose monitor to adjust insulin delivery and/or relevant behavior, or to maintain the necessary level of insulin in the pump.
Duke researchers also examined emerging innovations in minimally- and non-invasive methods of glucose monitoring and insulin delivery, indicating that continuous glucose sensor (CGS) technology has the potential to revolutionize diabetes management because it provides real-time feedback about glucose levels, and the rate and direction (high-low) of changes.
According to Dr. George, inhaled insulin (via nasal spray or inhaler) in powder or aerosol form, will surpass all previous methods of insulin delivery in terms of pain and convenience. This method has the potential to deliver insulin in one long-acting dose per day and provide a closer match to the body's natural production of insulin.
"Compared to most chronic diseases, diabetes is unusually burdensome. It also holds exceptional promise for effective management and control," said InHealth Executive Director, Martyn Howgill. "There is clear evidence that tight blood glucose control can prevent or delay complications and increase quality of life for diabetics. Ultimately, patients need access to the best technology which provides the highest patient satisfaction and the least pain and inconvenience."
The literature review is part of larger study funded by a grant from The Institute for Health Technology Studies (InHealth), to examine the effects of medical technology on patients, particularly those who have completed treatment or received care, across a range of diseases and conditions. In addition to diabetes, the Duke team is researching medical technology impact on treatment for cardiovascular disease and stroke, sensory impairments (hearing and vision loss), musculosketal diseases, and neoplastic diseases (cancer).
Robyn Stein | EurekAlert!
Penn study identifies new malaria parasites in wild bonobos
21.11.2017 | University of Pennsylvania School of Medicine
NIST scientists discover how to switch liver cancer cell growth from 2-D to 3-D structures
17.11.2017 | National Institute of Standards and Technology (NIST)
The WHO reports an estimated 429,000 malaria deaths each year. The disease mostly affects tropical and subtropical regions and in particular the African continent. The Fraunhofer Institute for Silicate Research ISC teamed up with the Fraunhofer Institute for Molecular Biology and Applied Ecology IME and the Institute of Tropical Medicine at the University of Tübingen for a new test method to detect malaria parasites in blood. The idea of the research project “NanoFRET” is to develop a highly sensitive and reliable rapid diagnostic test so that patient treatment can begin as early as possible.
Malaria is caused by parasites transmitted by mosquito bite. The most dangerous form of malaria is malaria tropica. Left untreated, it is fatal in most cases....
The formation of stars in distant galaxies is still largely unexplored. For the first time, astron-omers at the University of Geneva have now been able to closely observe a star system six billion light-years away. In doing so, they are confirming earlier simulations made by the University of Zurich. One special effect is made possible by the multiple reflections of images that run through the cosmos like a snake.
Today, astronomers have a pretty accurate idea of how stars were formed in the recent cosmic past. But do these laws also apply to older galaxies? For around a...
Just because someone is smart and well-motivated doesn't mean he or she can learn the visual skills needed to excel at tasks like matching fingerprints, interpreting medical X-rays, keeping track of aircraft on radar displays or forensic face matching.
That is the implication of a new study which shows for the first time that there is a broad range of differences in people's visual ability and that these...
Computer Tomography (CT) is a standard procedure in hospitals, but so far, the technology has not been suitable for imaging extremely small objects. In PNAS, a team from the Technical University of Munich (TUM) describes a Nano-CT device that creates three-dimensional x-ray images at resolutions up to 100 nanometers. The first test application: Together with colleagues from the University of Kassel and Helmholtz-Zentrum Geesthacht the researchers analyzed the locomotory system of a velvet worm.
During a CT analysis, the object under investigation is x-rayed and a detector measures the respective amount of radiation absorbed from various angles....
The quantum world is fragile; error correction codes are needed to protect the information stored in a quantum object from the deteriorating effects of noise. Quantum physicists in Innsbruck have developed a protocol to pass quantum information between differently encoded building blocks of a future quantum computer, such as processors and memories. Scientists may use this protocol in the future to build a data bus for quantum computers. The researchers have published their work in the journal Nature Communications.
Future quantum computers will be able to solve problems where conventional computers fail today. We are still far away from any large-scale implementation,...
15.11.2017 | Event News
15.11.2017 | Event News
30.10.2017 | Event News
21.11.2017 | Physics and Astronomy
21.11.2017 | Physics and Astronomy
21.11.2017 | Life Sciences