Internet Of Things 

The next decade may well see a revolution in the treatment and diagnosis of disease.

 

The Internet of Things (IoT) has opened up a world of possibilities in medicine: when connected to the internet, ordinary medical devices can collect invaluable additional data, give extra insight into symptoms and trends, enable remote care, and generally give patients more control over their lives and treatment.

Here are 10 examples of IoT in healthcare that demonstrate what medicine is becoming capable of thanks to technology.

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Embracing Technology in Pharma and Healthcare

1. Cancer treatment

In June 2018, data was presented at the ASCO Annual Meeting from a randomised clinical trial of 357 patients receiving treatment for head and neck cancer. The trial used a Bluetooth-enabled weight scale and blood pressure cuff, together with a symptom-tracking app, to send updates to patients’ physicians on symptoms and responses to treatment every weekday.

The patients who used this smart monitoring system, known as CYCORE, experienced less severe symptoms related to both the cancer and its treatment when compared to a control group of patients who carried on with regular weekly physician visits (with no additional monitoring). Bruce E. Johnson, President of ASCO (the American Society of Clinical Oncology), said that the smart technology “helped simplify care for both patients and their care providers by enabling emerging side effects to be identified and addressed quickly and efficiently to ease the burden of treatment.”

The study demonstrates the potential benefits of smart technology when it comes to improving patient contact with physicians, and monitoring of patients’ conditions, in a way that causes minimal interference with their daily lives. As Richard Cooper, Head of Digital at AXA PPP Healthcare, told Econsultancy in an interview about the future of health tech,

“Some of the developments we see have stopped people being tied to their house, or kept them from being regularly in hospital.

“They’re solving what are in some cases quite simple problems, and giving people that quality of life back. … Technology makes your interaction with your medical professional much more powerful and useful, and puts you more in control.”

2. Smart continuous glucose monitoring (CGM) and insulin pens

Diabetes has proven to be a fertile ground for the development of smart devices, as a condition that affects roughly one in ten adults, and one that requires continual monitoring and administration of treatment.

A Continuous Glucose Monitor (CGM) is a device that helps diabetics to continuously monitor their blood glucose levels for several days at a time, by taking readings at regular intervals. The first CGM system was approved by the US Food and Drug Administration (FDA) in 1999, and in recent years, a number of smart CGMs have hit the market.

Smart CGMs like Eversense and Freestyle Libre send data on blood glucose levels to an app on iPhone, Android or Apple Watch, allowing the wearer to easily check their information and detect trends. The FreeStyle LibreLink app also allows for remote monitoring by caregivers, which could include the parents of diabetic children or the relatives of elderly patients.

These devices are even starting to become available on the NHS: on World Diabetes Day 2018 (14th November), the NHS announced that it would be making the FreeStyle Libre smart CGM available on prescription to Type 1 Diabetes sufferers. It estimated that this would increase the percentage of diabetes patients who have access to smart CGM devices in England from 3-5% to 20-25%.

Image: Eversense Diabetes

Another smart device currently improving the lives of diabetes patients is the smart insulin pen. Smart insulin pens – or pen caps – like Gocap, InPen and Esysta have the ability to automatically record the time, amount and type of insulin injected in a dose, and recommend the correct type of insulin injection at the right time.

The devices interact with a smartphone app that can store long-term data, help diabetes patients calculate their insulin dose, and even (in the case of the Gocap) allow patients to record their meals and blood sugar levels, to see how their food and insulin intake are affecting their blood sugar.

3. Closed-loop (automated) insulin delivery

One of the most fascinating areas in IoT medicine is the open-source initiative OpenAPS, which stands for Open Artificial Pancreas System. OpenAPS is a type of closed-loop insulin delivery system, which differs from a CGM in that as well as gauging the amount of glucose in a patient’s bloodstream, it also delivers insulin – thus “closing the loop”.

OpenAPS was started in 2015 by Dana Lewis and her husband Scott Leibrand, who hacked Dana’s CGM and her insulin pump in order to automate the delivery of insulin into her system. Using the data feed from the CGM and a Raspberry Pi computer, their own software completes the loop and continuously alters the amount of insulin Dana’s pump delivers.

Automating insulin delivery offers a number of benefits that can change the lives of diabetics. By monitoring an individual’s blood glucose levels and automatically adjusting the amount of insulin delivered into their system, the APS helps to keep blood glucose within a safe range, preventing extreme highs and lows (otherwise known as hyperglycaemia – excessively high glucose – and hypoglycaemia – excessively low glucose).

The automatic delivery of insulin also allows diabetics to sleep through the night without the danger of their blood sugar dropping (also known as night-time hypoglycaemia).

Although OpenAPS is not an “out of the box” solution and requires people to be willing to build their own system, it is attracting a growing community of diabetics who are using its free and open-source technology to hack their insulin delivery. The OpenAPS website declares that, “As of January 15, 2018, there are more than (n=1)*1,078+ individuals around the world with various types of DIY closed loop implementations.”

The OpenAPS community aren’t the only ones to have had this idea. In 2013, Bryan Mazlish, a father with a wife and young son who both have Type 1 Diabetes, created the first automated and cloud-connected closed-loop artificial pancreas device. In 2014, he founded SmartLoop Labs – now known as Bigfoot Biomedical – to scale and commercialise the development of an automated insulin delivery system based on his invention.

The company is currently preparing for a pivotal trial of its solution, details of which are due to be announced in “late 2018 or early 2019”. Bigfoot currently anticipates that its automated system will be launched commercially in 2020, pending FDA review and approval.

4. Connected inhalers

Like diabetes, asthma is a condition that impacts the lives of hundreds of millions of people across the world. Smart technology is beginning to give them increased insight into and control over their symptoms and treatment, thanks to connected inhalers.

The biggest producer of smart inhaler technology is Propeller Health. Rather than producing entire inhalers, Propeller has created a sensor that attaches to an inhaler or bluetooth spirometer. It connects up to an app and helps people with asthma and COPD (Chronic Obstructive Pulmonary Disease, which includes emphysema and chronic bronchitis) understand what might be causing their symptoms, track uses of rescue medication, and also provides allergen forecasts.

The company was founded in 2010, and in 2014 received FDA clearance for two sensors designed to work with inhalers from major pharma companies: GlaxoSmithKline’s Diskus inhaler, and the Respimat inhaler from Boehringer Ingelheim. Since then, Propeller has continued to collaborate with a number of major producers of inhalers, and now says that its sensor “works with most inhalers and leading bluetooth spirometers”.

One of the benefits of using a connected inhaler is improved adherence – in other words, medication is taken more consistently and more often. The Propeller sensor generates reports on inhaler use that can be shared with a patient’s doctor, and show whether they are using it as often as is prescribed. For patients, this provides motivation and also clarity, showing how the use of their inhaler is directly improving their condition.

How AI is transforming healthcare

5. Ingestible sensors

Proteus Digital Health and its ingestible sensors are another example of how smart medicine can monitor adherence. According to a study by the World Health Organisation in 2003, 50% of medicines are not taken as directed.

Proteus’ system is one effort to reduce this figure: the company has created pills that dissolve in the stomach and produce a small signal that is picked up by a sensor worn on the body. The data is then relayed to a smartphone app, confirming that the patient has taken their medication as directed.

Proteus has so far trialled the system with pills for treating uncontrolled hypertension and Type 2 Diabetes, and antipsychotic medication. In late 2017, ABILIFY MYCITE – an antipsychotic medication created by Proteus and Otsuka Pharmaceutical Co. – became the first FDA-approved drug with a digital tracking system.

As with connected inhalers, ingestible sensors can help to track and improve how regularly patients take their medication, as well as allowing them to have a more informed dialogue with their physician about treatment. While the idea of taking pills with a sensor might seem invasive, the system is opt-in on the part of patients, and they can discontinue sharing some types of information, or opt out of the program altogether, at any time.

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