Home and community based care – Type 2 diabetes

Type-2 diabetes accounts for around 1 percent of GDP spend and this is expected to rise to about 2 percent in the next 10-15 years. This is around $3 billion in direct and related costs today. If we can personalise care and increase patient-led care this will reduce costs, improve independence and health outcomes, while increasing productivity.

While Type-2 diabetes is incurable, it can be managed to allow many of the 240,000 New Zealanders who have been diagnosed with it, the opportunity to enjoy good health and quality of life.

Managing Type-2 diabetes is complex. The range of insulin is the same across the population, but mismeasurement is common. Failing to keep on top of the variability within that range is dangerous and not as simple as finger prick and thigh stick.

One size does not fit all, and the way measurement and provision of insulin is currently done doesn’t encourage people to keep to good practices. For example, if a diabetic was able to keep an eye on their levels of insulin at the beginning, middle, and end of a regular bike ride after breakfast, this could allow them to reduce their likelihood of hypoglycemia through understanding of their body’s reaction to food, exercise, and time of day. This isn’t currently possible.

For tangata whenua, taking blood is tapu. A non-invasive technology that takes no blood during insulin measurement increases the equity of access for Māori, who are over-represented in diabetes statistics. A Māori business-led approach is a primary focus for commercialisation. For context, 30-50% of Pākeha with type 1 diabetes have an insulin pump or/and a continuous glucose sensor, however there is minimal uptake of this technology with Māori due to cost.

Three areas are crucial to delivering better home-based Type-2 diabetes care: measurement, management and monitoring.

It starts with new technology that allows for non-invasive monitoring of glucose and insulin levels. This is crucial to a person’s ability to control the disease. The team’s unique needle-free light-based glucose sensors allow quick and accurate blood glucose readings to be taken in the home.

The team also developed technology to deliver insulin to patients as part of their treatment. This has traditionally required regular injections, but researchers have also invented a jet system that delivers a burst of insulin through the skin for single doses, as well as ultra-low cost insulin pumps for those requiring regular insulin. This pump is the first of its kind in the world and is phone-driven, ultra-low-cost, and easy use.

The team is using patient-specific data to create computer models that accurately suggest dosing regimens and treatment plans. These allow better tailoring of drug or treatment dosing to the individual. Results are very promising and the hardware developed will remove many of the financial constraints to measuring insulin. At present the hardware costs between $50-100 a week. The hardware from this project will have a total one-off cost of $100. This was achieved by harnessing novel design, smartphones and wearable devices.

With its multiple themes of work, from engineering insulin pumps to writing algorithms to model an individual patient’s disease characteristics, the project is a template for examining treatment of chronic diseases.

In addition, the new technology and methodologies developed by the team, from medical sensors to informatics systems, could be applied more generally to healthcare problems. It could also generate intellectual property for local and international commercialisation.

The team now has ethics approval to approach people to be part of their trials.

All images courtesy of University of Canterbury.

This Spearhead Project commenced in 2016, ending in June 2022 and has received a total of $5.8M funding. The project was initiated through a process whereby a cross-disciplinary group of academics and practitioners came together to design research projects with the aim of supporting solutions for some of Aotearoa-NZ’s grand challenges.

More information 

Meet a group of Post Doc and PhD students from the Home and Community Bases Care - Type 2 Diabetes Spearhead project  - who took part in the SfTI and KiwiNet commercialisation pre-accelerator program, Rewa. Read more about their experience in; The right tech, the right time, the right connection

Spearhead team member and PhD candidate, Lui Holder Pearson, joined a SfTI video storytelling workshop in May 2021 and produced this video on his work related to the Spearhead research project. Read more about Lui and other SfTI researcher's experience of the workshop in; Reality TV meets hi-tech science 

The team have recently published in a study in the Journal of Diabetes Science and Technology, which shows how needle free jet injection technologies used for drug delivery can also be used for insulin monitoring. Read more.