How has the use of blood glucose monitoring technologies contributed to diabetes management in the United Kingdom within the context of personalised medicine?

Diabetes is a global public health concern, particularly Type 2 diabetes. In 2019, worldwide diabetes prevalence was \(9.3\%\) (463 million people), projected to increase to \(10.2\%\) (578 million) by 2030 and \(10.9\%\) (700 million) by 2045, as per the International Diabetes Federation Diabetes Atlas. (Saeedi et al., 2019) In the UK, over five million people have diabetes, with an estimated 7% prevalence, and nearly one million have undiagnosed Type 2 diabetes. (Diabetes UK, n.d.) The impact includes compromised quality of life, contributing to 530 heart attacks (myocardial infarctions) and 175 amputations weekly, costing the NHS \(£10\) billion annually, with \(80\%\) allocated to treating complications. (Whicher, O'Neill, & Holt, 2020) Healthcare resources for diabetes management in the UK are substantial, and Diabetes UK's "Diabetes is Serious 2022" report addresses this issue.

The increasing interest in diabetes research is driven by the escalating global and local burden of this chronic condition. The prevalence of diabetes in the UK is higher in urban (10.8%) than rural (7.2%) areas, and in high-income (10.4%) than low-income countries (4.0%). (Whicher, O'Neill, & Holt, 2020) Understanding and improving diabetes management is of huge significance, not only for individuals living with the condition but also for the sustainability of healthcare systems and the broader economy. Effectively addressing diabetes can enhance the quality of life for millions and decrease the economic and healthcare burdens it imposes.

Having witnessed the adults in my family being diagnosed with diabetes and witnessing their transformative lifestyle adjustments, I developed an interest in healthcare technology as they would constantly need to use various devices to monitor their health. This fascination with the integration of technology into the healthcare sector ultimately drove my decision to pursue this research. The research will explore the biological aspects of diabetes and human insulin production, as well as the effects of using technology to solve real-world problems on stakeholders through Digital Society. This is a world studies essay since it discusses how the health industry has developed because of the usage of technology, specifically the development of blood monitoring systems in personalised medicine.

The question of, 'How has the use of blood glucose monitoring technologies contributed to diabetes management in the United Kingdom within the context of personalised medicine?' arises from the essay's examination of the impact of two blood monitoring technologies in the UK: Continuous glucose monitoring devices and self-monitoring blood glucose devices, on the management of diabetes. This research will assess the societal, economic, and health implications of these technologies to determine their overall effect on users. This study is essential for both technology developers and individuals living with diabetes in the United Kingdom. It also emphasises how important personalised medicine is to providing patient-focused care, transforming healthcare procedures, and providing specialised solutions in a time when personalised care is essential to better health outcomes. The research will employ a mixed-methods approach, incorporating interviews for primary data collection and drawing from scholarly literature, reports, and databases for secondary data research, which will be discussed in the methodology section.

Diabetes is a chronic, metabolic disease characterised by elevated levels of blood glucose (or blood sugar). (World Health Organization, 2019) It occurs when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Insulin is a hormone that regulates blood sugar, and hyperglycemia, or raised blood sugar, is a common effect of uncontrolled diabetes. Over time, high blood sugar levels can lead to serious damage to many of the body's systems, especially the nerves and blood vessels. Diabetes is a chronic condition that requires consistent care and diligence. Effective diabetes management involves a combination of treatment strategies, including medication, lifestyle changes, and regular monitoring of blood sugar levels. (World Health Organization, 2019)

There are several forms of diabetes, but the two main types are:

1. Type 1 Diabetes: This type of diabetes is characterised by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known, and it is not preventable with current knowledge. Symptoms include excessive excretion of urine, thirst, constant hunger, weight loss, vision changes, and fatigue. (Mayo Clinic, 2023a)

2. Type 2 Diabetes: This type of diabetes results from the body's ineffective use of insulin. More than \(95\%\) of people with diabetes have type 2 diabetes. This type of diabetes is largely the result of excess body weight and physical inactivity. Symptoms may be similar to those of type 1 diabetes but are often less marked. As a result, the disease may be diagnosed several years after onset, after complications have already arisen. (Mayo Clinic, 2023b)

The image illustrates cellular function in three scenarios: a normal cell, type 1 diabetes, and type 2 diabetes. In a normal cell, glucose enters and provides energy. Type 1 diabetes lacks insulin, preventing glucose entry, causing energy deprivation. Type 2 diabetes involves insulin resistance, hindering glucose uptake. This provides a visual representation of how diabetic people experience distinct disruptions in glucose metabolism and cellular energy utilisation, depending on whether they have type 1 or type 2 diabetes.

Explanation of how insulin regulates blood sugar levels in a normally functioning body according to (Morris, 2022):

1. Following a meal- The process of digestion converts carbohydrates into glucose, leading to an increase in blood glucose levels. In response, the pancreas releases insulin into the bloodstream. Insulin acts as a signal to instruct cells throughout the body to absorb glucose from the blood. As glucose enters these cells, blood glucose levels naturally decrease. Some cells utilise this glucose as an immediate energy source, while others, such as those in the liver and muscles, store any excess glucose as glycogen, a stored energy reserve utilised between meals.

2. Between meals- When blood sugar levels begin to drop, the pancreas releases glucagon. This hormone signals cells to convert glycogen back into sugar. Subsequently, the liver releases glucose into the bloodstream, causing blood sugar levels to rise.

This equilibrium between insulin and glucagon ensures cells receive the energy they require while preventing the potential harm associated with persistently elevated blood sugar levels. Maintaining this balance is critical, as disruptions can lead to conditions such as diabetes. Hence why monitoring blood glucose levels is important for diabetic patients as it can lead to long term health problems such as; damage to the large blood vessels of the heart, brain and legs (macrovascular complications) and damage to the small blood vessels, causing problems in the eyes, kidneys, feet and nerves (microvascular complications).

Continuous glucose monitoring devices (CGM) uses biosensor technology to detect and alert user's of high glucose levels. Using the following process: (Kumar Das et al., 2022)

A sensor is implanted beneath the skin, typically within the subcutaneous tissue, to monitor glucose levels in the interstitial fluid. This sensor serves as the first crucial step in the process. Subsequently, a transmitter is affixed to the sensor, enabling it to transmit the recorded glucose level data. This transmitter wirelessly communicates with a receiver or display device, which functions as the final component in the chain. The receiver receives the transmitted data and promptly exhibits it to the user. In this three-step process, glucose levels are continuously and conveniently monitored, aiding individuals in managing their health effectively. CGMs report glucose levels in real-time, alerting the user when glucose levels hit high or low limits and providing insight into glucose trends

Self-monitoring blood glucose devices (SMBG) uses electrochemical technology to detect and alert user's of high glucose levels. Using the following process: (American Diabetes Association, n.d.)

Users begin the blood glucose monitoring process by collecting a small blood sample, usually obtained from a fingertip, using a lancet. This collected blood is then applied to a disposable test strip, which contains glucose oxidase, initiating a chemical reaction when it comes into contact with the glucose in the blood. The resulting chemical reaction generates an electrical current, which is measured by a glucose metre. The strength of this current is directly proportional to the concentration of glucose in the blood. The metre proceeds to convert this electrical current into a digital glucose reading, typically displayed in milligrams per deciliter (\(\mathrm{mg}/\mathrm{dL}\)) or millimoles per litre (\(\mathrm{mmol}/\mathrm{L}\)), which are the standard units for blood glucose measurement. The final step in the process involves the metre displaying the glucose reading on its screen, providing the user with their blood glucose level at the time of the test. This comprehensive process ensures accurate and immediate monitoring of blood glucose levels.

Both of these softwares are designed to assist diabetic people monitor their blood glucose levels and make informed decisions to manage their diabetes effectively and reduce the risk of complications.

"Personalised medicine is a medical model that aims to provide tailor-made prevention and treatment strategies for defined groups of individuals" (European Commission Public Health, 2023). This strategy represents a dramatic break from the one-size-fits-all paradigm, with enormous potential to transform healthcare on a global basis.

Personalised medicine in diabetes tailors treatment plans based on individual characteristics, optimising blood sugar control and reducing complications. Genetic testing can identify those at risk, enabling early intervention and preventive measures. Advanced monitoring and patient engagement further enhance the precision and effectiveness of diabetes management.

I combined primary and secondary data. This approach helped me uncover fresh insights and provide local evidence through primary data. Also, allowing me to gain a deeper understanding of the topic and make comparisons with existing research findings using secondary data.

I gathered data from two separate interviews. Both participants consented to be interviewed, and they were informed that the information obtained from these interviews would be incorporated into this essay. Hence, the involvement of human subjects in this study adheres to ethical standards. To safeguard their privacy, I have used pseudonyms for each individual mentioned.

My first interview was with Dr. Williams, a UK-trained medical professional. The objective was to gain expert insights into the practical use and impacts of blood glucose monitoring technologies in patient care. Dr. Williams shared his experiences and knowledge about their clinical applications, particularly in diagnosing and managing conditions like diabetes. He also discussed how these technologies influence treatment decisions and enhance patient outcomes. This interview was vital as it offered the perspective of a trained medical expert.

The second interview was with Ms. Taylor, who was diagnosed with Type I diabetes at age 10 and is now 25 years old. The primary aim of this interview was to gather insights into her personal experiences and viewpoints on the practical use and long-term impact of blood glucose monitoring technologies. Ms. Taylor shared her journey with diabetes and how it has influenced her daily life, including her dietary choices, lifestyle, and day-to-day activities. She also discussed her use of various technologies that have evolved over the years. This interview was valuable in providing a deeper understanding of how blood glucose monitoring technologies can significantly shape an individual's life.

For my secondary data collection, I carefully selected sources that met the following criteria:

1. Credibility: I ensured that the sources were authored by reputable professionals or well-known institutions in the fields of technology or biological sciences (e.g., WHO, NHS, MIT) and offered expert insights into the subject.

2. Currency: I focused on sources published within the last five years (2018-2023) to guarantee the information's up-to-date relevance.

3. Relevance: I specifically sought information related to blood monitoring technologies, particularly their use in the UK or other developed countries, to maintain alignment with my essay's focus on the impact on diabetic patients in the UK and prevent straying off-topic.

The first research article is "Continuous Glucose Monitoring in Type 2 Diabetes: A Long-Term Cost-Effectiveness Analysis in the United Kingdom" by S. R. Heller, et al. (2020) assesses the cost-effectiveness of continuous glucose monitoring (CGM) versus self-monitoring of blood glucose (SMBG) in UK-based type 2 diabetes patients treated with insulin. Using a Markov model, the study indicates that CGM leads to better glycemic control, reduced hypoglycemia risk, and enhanced quality of life. This particular study was really important as it allowed an in depth analysis of two different glucose monitoring technologies widely used in the UK.

The second research article is "Patient Satisfaction With a New, High Accuracy Blood Glucose Metre That Provides Personalized Guidance, Insight, and Encouragement" published in the Journal of Diabetes Science and Technology in 2019 assesses patient satisfaction with a novel blood glucose metre equipped with personalised guidance features. The study involved 100 diabetes patients using this metre for 90 days and evaluated their contentment, metre accuracy, ease of use, and its influence on patient outcomes, particularly glycemic control and quality of life. This research however not directly linked to the context of my research was significant in providing quantitative data for my essay as it highlights the positive impact of advanced technology on diabetes management, though a cost-effectiveness evaluation is lacking. While both of these research papers delve into the evaluation of various blood glucose monitoring devices, my study is specifically centred around the personalised medicine aspect of diabetes management.

Diabetes has notable societal impacts, resulting in increased healthcare costs and health disparities. It places financial burdens on individuals and families, affecting work, productivity, education, and overall quality of life, particularly for marginalised populations, emphasising the urgent need for comprehensive diabetes management and support.

Diabetes treatment costs in the UK vary depending on the type of diabetes and the required treatments. According to a study, the annual cost of inpatient care to manage short and long-term complications of diabetes is estimated to range from \(£1,800\) to \(£2,500\) per patient, while annual outpatient expenses, including medication and monitoring supplies, are estimated to be between \(£300\) and \(£370\) per patient. The overall expenditure for diabetes treatment and its complications is estimated at \(£14\) billion per year, with the treatment of complications representing a significantly higher cost. (Singh, 2022) However the cost can be reduced through the implementation of personalised medicine.

Personalised medicine plays a pivotal role in optimising healthcare spending and reducing long-term expenses associated with diabetes management. This approach involves various strategies, such as customising treatment plans based on an individual's genetic profile and health attributes. By tailoring interventions, it minimises the risk of therapy failures and complications. (Kleinberger & Pollin, 2015) Early detection and preventive measures are also part of this paradigm, targeting high-risk individuals for timely interventions to mitigate diabetes development, ultimately lessening the costs of managing the disease. Furthermore, personalised medicine enhances patient outcomes by tailoring care to specific needs, thus lowering the risk of complications and improving the overall quality of life. These comprehensive strategies result in reduced healthcare costs, as complications are prevented, lessening the need for expensive hospitalizations and interventions. (Sugandh et al., 2023)

Personalised medicine enhances the quality of life for individuals with diabetes by tailoring treatment plans to their preferences and lifestyles. Customised interventions, based on individual characteristics, enable more effective diabetes management. For instance, medication selection can align with patients' preferences for administration methods and frequency, leading to better blood sugar control and reduced complication risks. (Sugandh et al., 2023)

In terms of societal awareness and education, personalised medicine's focus on prevention and early detection complements awareness and education campaigns, reducing the burden on healthcare systems. By identifying high-risk individuals and offering personalised interventions, personalised medicine helps prevent diabetes onset and empowers patients to actively manage their condition, ultimately leading to improved health outcomes and cost savings. (NowPatient, 2023)

Moreover, personalised medicine recognizes the importance of psychosocial support, acknowledging that each individual faces unique challenges in diabetes management. This approach provides access to support groups, counselling, and resources to help individuals address the emotional and psychological aspects of diabetes. By overcoming barriers to self-management, such as motivation and social support, personalised medicine contributes to improved health outcomes and a better quality of life, especially considering the significant financial strain diabetes management can place on families, particularly those dealing with type 1 diabetes diagnosed at a young age.

Through the use of Continuous Glucose Monitoring (CGM) technology, individuals like Taylor, who have diabetes, can closely monitor their blood glucose levels in real-time. This technology provides a continuous stream of data, offering insights into how their glucose levels change throughout the day, which helps them make timely decisions about medication and lifestyle adjustments to maintain optimal control.

Taylor claims that the CGM technology she uses, which is the Abbott Freestyle Libre Pro, is very helpful and easy to use. She has never faced any challenges with its functionality or accuracy. Although she did say it is quite time consuming sometimes to maintain it as she has to visit the clinic at least once every three months in order for her doctor to be able to download her data and create trends based on her current and past blood glucose levels. During the other times she uses an app called "Glucose Blood Sugar Tracker" this app connects to her device and provides her with real time tracking of her blood glucose levels.

The image illustrates the application of Continuous Glucose Monitors (CGMs) on the patient's body and the accompanying mobile app used for tracking blood glucose levels. The app plays a crucial role in presenting recommendations based on the provided data, offering insights into dietary adjustments and other relevant factors. It serves as a valuable tool for real-time monitoring and personalised guidance in diabetes management.

Dr. Williams shares a similar perspective, emphasising the convenience and reduced discomfort of CGM technologies compared to frequent fingerstick tests. This aligns with the principles of personalised medicine, offering patients a less invasive approach to monitoring their blood sugar levels, enhancing their overall experience. Moreover, the accompanying app linked to CGM devices provides tailored recommendations based on individual results, a crucial component of personalised medicine. Furthermore, CGM technologies play a pivotal role in minimising the risk of hypoglycemia, offering immediate alerts to patients about low blood sugar levels, thus averting potentially dangerous episodes. However, certain negative aspects must be considered. CGM can be costly and may not be covered by all insurance plans, limiting accessibility and highlighting the need for personalised healthcare solutions. Technical issues like sensor errors and connectivity problems can occasionally affect data accuracy, necessitating a personalised approach to troubleshooting. Lastly, patient comfort with wearing CGM devices, another aspect of personalised medicine, plays a vital role in technology acceptance and usage. Overall, these facets underscore the significance of a personalised approach in diabetes management. (Didyuk et al., 2020)

The most frequently used method of blood glucose monitoring is self-monitoring blood glucose (SMBG) with a glucometer. Taylor mentioned that she used to use the Care Touch Blood Glucose Monitor Kit for a few years before she made the switch to the Abbott Freestyle Libre Pro. Which she claimed was simple and efficient as it would only take 5 seconds to receive the results back. However she has always been terrified of needles so every time she pricked her finger at least once daily. People with type 1 diabetes who use insulin should perform SMBG at least four times per week, including at least two fasting and two postprandial values. Additional measurements at bedtime and before meals can also be obtained. (Benjamin, 2002)

According to Dr. Williams, his recommendation for blood sugar monitoring methods differs based on diabetes type and individual needs. He suggests that individuals with type 1 diabetes should consider using Continuous Glucose Monitoring (CGM) devices due to their ease of use and cost-effectiveness. In contrast, for those with type 2 diabetes who may not need frequent monitoring, lancet glucometers utilising the finger-pricking method are a suitable option.

For elderly individuals, Dr. Williams advises CGM usage, as it enables healthcare providers to remotely monitor their blood glucose levels. This approach reduces the reliance on family members or self-monitoring for data, ensuring that elderly patients receive consistent and thorough care. Dr. Williams' recommendations take into account both the type of diabetes and the specific needs of each patient, offering a tailored approach to blood sugar monitoring.

The image provides a visual guide on the correct utilisation of a Self-Monitoring of Blood Glucose (SMBG) glucometer. It outlines the essential steps for precise blood glucose monitoring, from preparing the glucometer and cleansing the testing site to collecting a blood sample, awaiting results, and recording and interpreting the readings. This illustration serves as a practical reference for individuals looking to maintain accurate and effective diabetes management through SMBG.

Self-Monitoring of Blood Glucose (SMBG) is a valuable tool for enhancing glycemic control in both type 1 and type 2 diabetes patients, aligning with the principles of personalised medicine. This approach provides immediate feedback on blood glucose levels, enabling individuals to make timely adjustments to their personalised treatment plans. Additionally, SMBG empowers patients to identify patterns within their blood glucose data, which is essential for personalising medication dose adjustments and recognizing individual factors that influence their glycemic levels. While SMBG offers these advantages, it can pose financial challenges, especially for those who require frequent testing. It also entails multiple daily fingersticks, which can be somewhat time-consuming and inconvenient. Moreover, the potential for data misreporting, whether accidental or deliberate, underscores the importance of precise data collection and interpretation. (Katz et al., 2019)

This is an issue of digital divide as the access to technologies to monitor diabetes across The UK is different for people in different economic classes. This is a limitation of the product as the digital divide in the United Kingdom's context poses a significant challenge, especially for underserved populations such as immigrants and those with limited access to technology or digital literacy. High costs and unequal access hinder healthcare equity. To address this issue, tailored strategies are necessary. Subsidised devices and internet access initiatives can make technology more affordable and accessible. Community education programs focused on digital literacy can empower individuals to utilise health technology effectively. Telehealth services and remote support ensure that those facing digital barriers still receive personalised healthcare. In the UK, public-private collaborations and mobile clinics can further enhance accessibility. Bridging the digital divide is vital for ensuring that everyone can benefit from personalised medicine and digital health tools for effective diabetes management

Furthermore, issues of privacy can be a concern. As the devices are constantly tracking the personal information of these patients, they may not know where exactly this information is being used and what for. In the case that malicious individuals gain access to the data of those individuals, this will invade the user's privacy and develop a bad reputation for the creators of the programs. The data from the patients records can be used for research without their consent which would be unethical. To ensure this does not happen the creators of such technologies need to be transparent to ensure that users know exactly how their information is being used.

However there may be challenges there are also positives as the development of these technologies have made it much easier to personalise medicine and cater to specific patients and their needs along with ensuring they manage their diabetes appropriately according to Dr Williams.

In conclusion, the prevalence of diabetes, both globally and within the United Kingdom, remains a significant public health concern with far-reaching implications for individuals, healthcare systems, and society. Blood glucose monitoring technologies have emerged as crucial tools in personalised medicine, offering patients more precise control over their condition and potential improvements in their quality of life. While these technologies, such as Continuous Glucose Monitoring (CGM) and Self-Monitoring of Blood Glucose (SMBG) devices, provide distinct advantages in terms of real-time monitoring, personalised recommendations, and risk reduction, they also bring challenges like financial accessibility and privacy concerns. Moreover, the digital divide poses a barrier to equitable access, particularly among underserved populations. To address these challenges, subsidisation, digital literacy initiatives, and transparency are essential components of a more inclusive healthcare landscape.

Looking forward, the advancement of technologies like the artificial pancreas holds great promise in further revolutionising diabetes management, providing a potential breakthrough in treatment and monitoring. Additionally, future research and investigations will continue to refine our understanding of personalised medicine in diabetes care. Overall, it is evident that embracing these technologies within the context of personalised medicine is essential for the effective management of diabetes, reducing societal and economic burdens, and enhancing the lives of those living with this chronic condition in the United Kingdom.

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