Technology in Diabetes- A glimpse into the near Future

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Technology in Diabetes- A glimpse into the near Future

15 Jul, 2 PM

[Music] hello everyone i extend a warm welcome welcome to everyone who has joined on behalf of netflix for yet another very intriguing session on diabetes by dr um lakanisa dr om lakhani is a consultant endocrinologist working at zeides hospital his qualifications include dmb endocrinology from sir gangaram hospital in new delhi and md and mbbs from maharaja sayajirao gaya hospital university of barola sir has obtained specialist certificate in endocrinology from royal college of physicians in the uk an interesting fact about sir is that he has secured gold medal not only in ug pg but also super speciality studies his areas of expertise include endocrine oncology metabolic bone disease pediatric endocrinology and use of new technology in management of diabetes mellitus who better than sir to talk about technology and diabetes and with staggering technological advancements and research and diabetes it just befits its ever increasing prevalence and incidence so let's hear from sir about this very very evolving and interesting topic over to you sir welcome sir thank you so much for the kind introduction uh and i think you know today well uh you know was supposed to be glimpse into the future okay so today i'm going to give you uh a preview of what we can expect in terms of diabetes technology uh also we'll be looking at uh you know what we as indians would really contribute to the world in terms of diabetes economy so that's going to be my two major uh you know areas which we're going to discuss here it's going to be a very interesting uh session for me as well to present because it's my favorite topic and i think it will be uh you know great for you to listen so you you'll not only learn a few things but i think i'm more importantly looking at how we can inspire and perhaps work together to make a better uh something really meaningful out of this okay so uh you know from now on if you do want to uh you know if you see something interesting on social media uh regarding technology in endocrinology per se not just diabetes then please uh feel free to use the hashtag technocrinology that's the hashtag we have developed with uh you know the endocrine society of india so the idea is that you know we are on the same page uh when we are treating something or when we are you know discussing something on facebook or on linkedin or something like that right so this is a hashtag uh perhaps you could start using uh for uh you know anything related to technology and diabetes or technology and endocrinology in general okay so the outline of what we're going to discuss today uh i'll give you a brief introduction to where do we stand as far as technology diabetes is concerned at present we'll talk about the upcoming technology for diabetes which is available in the west but it's not yet available in india and this is the most interesting part of today's talk we'll talk about a swot analysis of what we can do in terms of technology and diabetes with regards to india will most importantly again have india as a focus and we look at some indians who have done some remarkable work in this week and we'll end with some take-home messages in this area okay so let's start with the introduction to technology and diabetes so you know recently uh i had the opportunity so you know before we go ahead uh we are not going to discuss about the existing technology in india right because uh you know perhaps if the title was misleading or so but you know there are two things only worth mentioning about and i just finished i'll finish that off here as far as technology which is available in india there are only two things which are available one is a continuous glucose monitor cgm which is available in india there are a lot of you know companies which are more interested in developing this and secondly we have certain uh good insulin forms the one which i would deserve a mention is a 780 g pump right so you have the currently the hybrid closed loop 780 g insulin pump which is available in india cost about seven lakh rupees with a monthly running cost about ten thousand we have about four patients currently on this pump and they're doing very well right so it's an expensive thing but for patients especially type 1 diabetes patients it's something which is really really useful okay so that's about what is existing so like i said recently i had an opportunity to go to uh the ada conference uh in new orleans and you know what is very interesting is that in the us they have a separate conference for technology diabetes which is atp uh what was very interesting is that the ada also looked very much like atd right it looked like 80 version 2.0 right and as you can see in the picture here these are real snapshots right most of the so you know generally you go to a conference in india and what do you see you see a lot of stalls of karma companies right you see you know uh zaiders and you see sun farmer and you see no more daughters sanofi what is very interesting is when you go to the when you went to the uh you know the exhibition part in ada most of it was dominated by tech companies right so you had insulated pump companies your cgm companies your software companies uh you had you know emr companies uh 90 of the space especially the bigger stores was occupied by technology now if this doesn't suggest wind of change nothing else friends we are working in a changing environment with the things the diabetes has completely changed now from a disease of uh you know pharmaceutical companies to a disease of technology now it's completely in the hands of technology and this is only going to increase and unfortunately let me tell you we are way far behind we are extremely behind we have a lot of work to catch up to and i think there's a lot of work which needs to be done in this field uh to really take us much more ahead than what we are doing okay so why diabetes is an ideal disease for tech adaptation so diabetes is extremely driven by data right so what do we talk about in diabetes it can be broken down to the minimal data so if you talk about uh blood sugars we talk about cgm uh we are talking about preventive aspects you're talking about ldl levels we talk about triglyceride levels we talk about sgpt levels uh you know even even the uh you know in terms of retinopathy right so you're doing a technopathy screening uh you know you look at you have good classification of retinopathy you have do a diabetic food examination you have you again breaking down into neuroschemical so you know diabetic put at risk so there is you know some classification divisions everywhere as far as diabetes is concerned and the second thing is that the number of patients with diabetes is increasing very fast so you have a large number of patients and remember it's a chronic disease so they have a large patient which requires constant patient participation and that's why for such a scenario technology is extremely good for such problems right these are the problems which are exactly solved and that is where i really feel that you know diabetes is an ideal disease for tech adoptation and that is what you know uh it is really happening across the world so what is the interest in diabetes technology in india so you know right now we are in a stage where we are looking at uh some interest in this we have you know we are like i said we are very far behind so you know there was a time when we were far behind as far as as far as power to pharmaceutical you know uh things was concerned but now we are in fact way ahead i would say in terms of farmer we are ahead of the west right we have some of the best medicines available in the world at a price which which uh nobody the west can compete right so we can we get the best of the world at a cheaper price right the same thing actually needs to be done as far as technology is concerned we need to have the best technology but at a cheaper price and that is definitely possible in india but now there is some interest emerging so there are a lot of companies right now you're looking at making continuous glucose monitor cgm there is a lot of interest in healthcare startups right so just recently there was a conference called the dtec con right there were a lot of startups which were uh you know interested now there is a pro and con to this we'll discuss this now both the endocrine society of india and rssbi are taking interest in this in fact in the endocrine society of india the textbook which is there which they're going to publish there is a section specifically meant for technology in diabetes or technology and end of gravity so there is a lot of interest in this like i said there was a conference for the detect con which was specifically organized for the purpose of our technology and that is what is really very interesting right so you know this was the conference which was recently organized where they looked only at the specific area of technology with regards to regards to so we are there right but unfortunately if you see in terms of where do we stand we are still i would say in stone age with regards to diabetes so we are moving there we are starting we are generating interest but we are still really far away right and uh unfortunately what i find is really very concerning is that we are not unfortunately moving in the right direction there are a lot of challenges that come to this also uh where we are going wrong uh we are we are still far away and we are not moving the right direction so that is these are the challenges and i think that is what we really need to again consider changing okay so what are the upcoming technologies that are this is the second part of my talk this is where i'll discuss some upcoming technologies which are available in the west they're not yet available in india but i hope that will be available in india very soon one or two of them are going to be available in india but unfortunately what it looks like is that these technology companies are not interested in making these products available in india for whatever reasons and you know what i feel i think i always see this as uh this is not as a problem but as a challenge or as perhaps a solution right if these companies are not looking at making these products in india perhaps you could look at these products reverse engineer these products and make them in india right right now you know make in india which is very popular i mean these are very simple technologies you know if anybody from the biotech field wants to really look at this it's very easy to reverse engineer in fact this is what china has been doing for so many years why not india right so really something that we need to look at right so the one very interesting product that i look uh found very interesting was this uh something called as a smart pen cap so this is from a company called bit brick right so it's a smart pen cap so you have the insulin pen and this here this cap which fits on top of the insulin pen right now what this pen does what this cap does is so it fits with any pen so any insulin pen you have this this cap attaches to that and this is a smart cap so it does couple of things so first of all it reminds you that you need to take the insulin at the right time right so let's say you are due for a pre-data instrument shot it will give you a reminder secondly you can it will connect to your continuous glucose monitor so this patient is wearing a cgm it will connect to your cgm and based on the cgm reading it will recommend the insulin dose that you need to take right so let's say your blood sugar is 200 then it will suggest that you need to take like for example eight units of short acne so it connects with the cgm and by connecting with the cgm it can recommend the suggested insulin dose right and also it stores all the data so when you go back to your doctor your doctor can see how many doses of insulin you have taken how many doses you have missed and what are the consequences of that so all these things is available with this smart pen cap uh from the company called again this is very simple technology and anybody listening it could be a simple project it's just a summer project for somebody who is working in the biotech team it's very simple so i think uh you know in that regards it's a simple technology that can be easily adopted now there is one another company which is working in a which already has a product which is similar which is called the in pen now the difference here is that this in pen basically is uh you know same as uh it's a pen in itself so it's not a cap the pen itself so all you need to do is you need to put the cartridge inside and this is from metronic again this also communicates with the medtronic cgm device uh the same thing what we looked at everything else same thing can be done with this implant also so it can it can give you reminders that you need to take insulin it can suggest the insulin dose all these things can be done through the infant and this implant is going to be very interestingly available next year in india so the metronomic company saying that this infant is going to be available so in that sense you know it's a it's a good thing and i think you know you can have this product very soon in india and i'm looking forward to using this in india then of course you have so you already have instrument from india but uh there are two forms which are really exciting uh which i feel uh should be in india and one very important formula this has been you know in my mind for many years is omnipot so omnipod is a very interesting pump it's it's a tubeless pump right it doesn't have any tubes so it has two parts so it has one part which is which is the uh which is called a pod which they like to call it is a wall so this is a pond which contains insulin right so it restores about 300 units of insulin right so one pot so this pod you can attach to your skin right and this pod is attached to your skin and then you have earlier they used to have a device which would control the pod but now it just comes with an app so you don't need to have a separate device you just need to install an app which is there on your on your mobile phone and this app communicates with this pod and it gives instruction to the pod to deliver the instrument so this is what is known as the omnipod right so earlier only three and four they used to have separate uh you know device controller device which used to control the uh you know the pod but now you can do that via your uh you know mobile phone and this is a very simple way and it's a tubeless way so you just need to attach the pod and it will deliver the instrument right so it's a tubeless way of uh using in fact one of the person involved in this is dr viral shah now dr viral shah has become a big name in diabetes technology he's an indian he's done his uh mbbs uh i don't know but his name is md from uh i believe from israel is from the gujarati there is mbps from japan right so again something to really be proud of and then you have the uh you know what is known as the t slim pump which is very similar to omnipot it's a slim pump it's a very small pump again uh which you can carry in your pocket uh but it's not a tubeless pump right so it still requires a tube and it connects to your system which is slim and again it can be controlled via your smartphone so these are some pumps available then you have of course better cgm devices available in the west so in india you have libre you have the freestyle library one in the uk you have library two in the us now you have library three which is big which is smaller and better compared to the earlier libraries and in the us you already have the uh implantable uh you know cgm device which is called eversense this is a implantable cgm so this you implant under your skin and it stays for six months right so you just implant the chip for six months and then we give you the glucose readings these are some very interesting cgm devices available in the investor then you have the uh you know ir system the similar devices are available in india also so this is what is known as a this is the ai technology for diabetic cryptanography so what you do is that you send the fundus photograph uh to this system the system will detect any kind of uh your lesion which is there and if there is a lesion present if you give you a warning and it can then you can you know consult your ophthalmologist ah so it makes the system very simple and this similar system is available in india also so the ai based system is available in india in fact there are studies done on that we'll show you that also in the later part very interesting thing which is available which is now become big is something known as a glucose glucose is a diabetes management system so it's basically a piece of hardware and software so what it does is it communicates with all your available uh devices for example if you communicate with your cgm and communicate with you with a glucometer if you communicate with the pump it should communicate with all these devices and it will give input all this input will go to a central console right so whether it's from a cgm or whether it's from a farm right or whether it's from your smart pen right all these things will go into a centralized system and this system what it does is it can it can store the data and you can then analyze the data so you know as soon as a patient enters the cabin uh at the reception they give all the devices all the devices are loaded into the system and then you have a unified interface where you can look at all the data from that again you can do remote monitoring of the patient so the patient is having the device at home and then you know let's say patient or hypoglycemia or something you can do a remote monitoring also or let's say you are a parent of a type 1 diabetic child and then you know uh gone for a camp summer camp or a child lives in a hostel and then you can monitor the child sitting at home right so this is where the gluco device is very interesting in fact similar products are under development in india but uh you know they are still far away uh because it will require development testing and so on it will take at least another five years before any such product is available in india but this glucose platform is already available in the best and i find this very uh interesting now another interesting device it's quite simple it's actually a clicker so this is this is basically something similar to the pod that we saw but this is this is a low tech version of that so it's it's basically uh you know this one holds insulin short acting insulin so you attach this to your skin and just when you click on the sides over here right it will deliver two units of incident so let's say you want to take six units of insulin you click three times and it will deliver uh six units of insulin right so this is what is known as a uh it's a it's known as a secure device uh which is an insulin delivery device so again if the patient you know does not have to take the insulin along with them right they can just attach it to the skin let's say you're going out for dinner you know before you do that just click two times and it will be allowed four minutes of insulin so that's what is known as secure so i love this because it's a very simple device and again very simple technology i think you know you give this to a smart engineer and they'll develop this within i think within a budget of 10 15 000 rupees they can easily do this demand right so it's not very difficult i think you know it's something which can be easily developing ah another interesting product which is which is again going to be available in india soon a similar product is available from medtronic in india this is the neuro hfx it's a spinal cord stimulation mainly used for painful diabetic neuropathy so you implant electrodes into the spinal cord which will uh which will have as a gating system uh which delivers uh you know a neural stimulation which reduces the neuropathic pain so anybody who suffers from painful diabetic neuropathy this is a very interesting device uh which can be available then of course you have clinical decision making uh which are available uh these are mainly software so one software which was developed by you know proudly we demonstrated this app at this uh the american diabetes association ada uh so it's an indian presence in the ada and of course there's similar uh products in the west as well there's something called endo digital which is a ai based decision support system for physicians to manage patients and diabetes better okay uh then you have of course a lot of there is a lot of interest in precision medicine i think precision medicine is the thing which is going to be uh around very soon and a lot of interesting machine learning algorithms ah so you know in the context of time we will not be discussing these in detail but this is something which are really uh very interesting and in fact i think you know perhaps in the future if we have the time on this platform we'll discuss in detail about precision precision medicine i think precision medicine is the immediate future of diabetes and i think that is something which we really need to uh learn and discuss in one of the future events so this was about the technology which is available in the west and uh which uh you know we can consider importing to india uh it's not available in india yet but i'm sure with good uh you know uh enterprising people and a lot of you listening to this if anybody's interested we can develop this right and if anybody has a family member who is an engineer or who works in this field i think you know we can get in touch and we can develop this so then let's look at you know uh some swot analysis as far as diabetes technology in india is concerned so what is the biggest strength of india so i've been focusing on now on india right so what is the biggest strength so see the biggest strength of adopting technology in india is that remember technology is a very democratic thing and it solves problem at a larger scale which is needed in india for example let's say you know uh right now we are on a platform where i am able to communicate with about you know 60 or 70 people uh just sitting at my home right so how is this enabled is enabled through technology the same way we have a large number of diabetes patients and we cannot cater to all these patients you know no matter how hard we try you know we see 30 patients a day 40 patients a day how many patients you see there'll be a limit to how many patients you can see right so that is where technology is a great enabler and by using technology we can in fact the job of the doctor becomes easier and you can disseminate uh things at a larger scale and we know the population of india is so large right and we have so many people with diabetes i think that is where technology is really helpful i think india should be leading the way as far as technology is concerned because we would be able to do a much better job and we would be able to of course you know solve the problem at a larger scale but you know the problem is initially it requires a lot of capital expenditure so it is expensive right i would say it's expensive for me in india but at least overall it is expensive and traditionally problem with indians are that you know we are generally not early adopters of anything it is at a mass level you know a lot of us i mean a lot of people uh you know i'm sure who will be listening to this are early adopters i'm not talking about you but people in general are not early adopters right that is one of the challenges in india and unfortunately because of that a lot of people a lot of companies are not interested in investing in india as far as damping technology is concerned this is a challenge so that's one of the weakness then of course you know every weakness has an opportunity right so again a big opportunity you have a large pool of engineering challenges this is where i feel india can really you know you have so many engineering colleges so many engineers are produced in india i think more engineers are produced for you know for every doctor who is produced there are five engineers of different fields right so we have a huge engineering talent pool we need to harvest this pool to basically reverse engineer the products which you develop and make this faster cheaper and better there is no there is no shame in reverse engineering was the west is completely reverse engineer or indian technology right if you talk about anything if something was invented in india which went to the west and then they reverse engineered it now it's time for us to take that back and then whatever they have developed we can easily reverse engineer and make it in india right of course there are patent laws there will be ip regulation all these things will keep it with respect right but it's always it's not a bad idea to reverse interior in fact china has been doing this for many years so i think that is where we really need to work and i think you know again biotechnology people we need to really look at these products and they can make this at their own labs and it's not very difficult to find funding for this right so this is something which you really really should be looking at right so your huge energy direct pool and we should be really exploiting this right the threat of course is ah unfortunately and this is where i really uh feel is that technology is moving the wrong direction see the problem is the biggest challenge is that a lot of these technology companies uh either do not have any doctors on board or they don't understand the problem right that is the biggest problem and some of them are actually dangerous right for example you see so many ads about diabetes reversal programs right it's like putting a card before the first the problem is that every day i see patients with experience 10 percent 11 percent reversal sort of control even if you control it's a big thing unfortunately you know these companies they product market this product and what happens is that gullible patients call for it and then it gives a bad name to technology it's not the technology problem it's a product and then you have all these cheap surgery aggregators you know all these aggregators who say that you know it's a very dangerous trend so i think the biggest problem is that a lot of these technology companies do not understand the reality of medical practice in india and they need to connect with the doctors and the doctors need to work with this technology company to make better products all this cheap you know uh sustaining surgery which is promoted by rithik roshan and all that i think that is a very dangerous problem right it is not a solution it's a it will create more problems and solution right so i think we need to create more solutions and problems and that is what we really need to be looking at so we need to move it move the right direction and who is the right direction you need somebody who is a medical person and the head of this companies to really move that in the right direction so just like you have you know in a company you have ceo right so your chief executive officer your cfo chief financial officer your cto chief technology officer you need to have chief medical officer or chief health officer also in these companies who really need to give the right direction to these companies then of course you know what do you do so you need to bridge the gap right so you need doctors to be more uh to improve their understanding of technology and for technology companies to work with doctors so you need right both the technology and medical field to work together right so this is where this is where you will create measure right so we need to improve tech literacy in doctors and in fact you know a lot of i'll talk about this no coding thing right in the next few slides so i'll come back to this point right so we need to bridge this gap so one of the work which indians have done so let's appreciate what we've already done right and let's let's give credit where credit is new okay so what work has been done as far as diabetes technology is concerned by indian people right so this one person i'd really like to uh you know really acknowledge is a person called dr rajiv singha uh and he's a very you know uh non-assuming simple kind of person he's not very uh you know you're not finding me too many forums but he's silently working very strongly in this i have been watching this right uh you know why i am often you know out on the stage and talking about this he's the worst guy who's doing a lot of remarkable work so this is a very interesting article very published about artificial intelligence and machine learning in diabetes care it's available in indian journal of endocrine metabolism and this is something you know you should be uh reading right uh and looking at right uh there's another uh there are a lot of products there is develop a product which is uh again a decision making tool uh using machine learning for type 2 diabetes strength management right this is a device that developed in fact published a study for this again in ij em what is very interesting is that the west is also developing similar products right i think rajiv has been ahead of them right so i think we need to again like i said you've credited with reddit is new i think it acknowledged the work which is done by doctor sinclair in fact there's another thing here they have done they have developed automation of insulin boneless doses in type 1 diabetes patient and this was again a study which was published in international journal of diabetes and development countries the rssdi journal uh where again i would say this is something which is really interesting uh again you know another option who has been silently and uh aggressively working in this field is dr jyoti dev uh dr judy there is from uh and also dr v right both of them have been working very strongly in the speed of diabetes and they have been of course pioneers a lot of things and there's a very interesting article that published on digital health and diabetes experience in india from india and you can read this uh in fact i gained a lot of knowledge reading this article so this is something you really again could be worth your time consider reading and again uh dr muhammad's group this is what i talked about earlier they talked about they made this automated diabetes renovating screening using smartphone condos photography using artificial intelligence so we talked about ir this similar technology is available in india and like that is what i'm saying see that product in the in the west is very expensive this is very easy to do and very cheap and i think you know again a big hand to these people who have really walked in this field here right uh we have a friend of mine uh dr abhijit uh you know uh dr abhijit is the ceo of seven sugar technology right again you can uh they are working on very interesting products and they are making a whatsapp based uh diabetes technology platform uh which i think is very interesting and i'll talk about this once that you know product is developed uh we'll discuss this in one of the future lectures so again dr abhiji uh from bangalore is somebody you should be really uh you know following and he's again uh done some interesting work there of course you also i'll tell you a little bit about uh what i understand in technology so i am a fully functional low code app developer so i can develop almost literally uh most apps right i would say you know i would i would develop a netflix app regularly make some small apps uh which are functional using something called a no coding technology right so there's a there's a big revolutionary technology called low coding so i'll you know again uh as a point of inspiring new people uh this is what i like to talk about so earlier if you remember uh many years back uh we used to we'll take the questions in the end i'm sorry if uh you know uh don't repeat the flow uh so you know earlier if you remember uh if you wanted to develop a website you would require somebody to do html coding somebody drew a javascript right so you require some coding but nowadays you have some sites like wix or you know wordpress so just with simple clicks of a view button you can make a website on your own you don't need any anybody's help you know don't need to know for me same thing is now also happening in the field of apps so these are native apps so now you can make an android app and you can make make a ios app very simply using just basically drag and drop features of course you need to know some basics right to understand some basic specially you need little bit of database thing you need to understand but if you understand all this you can easily develop on your own you don't need a you don't need to hire somebody you know it's it's not you need to hire you know pay 10 lakh rupees to somebody to develop an app right a very basic level app you can develop and my first experiment which i did which was very successful and it is very successful is something which we developed for nodes in endocrinology app this app is available on both the android and ios uh here we upload very interesting notes in endocrinology and diabetes you can download this is completely free of charge it will always remain free of charge right now we have about 2 000 users on this app i think it makes me very proud to say that it's a successful app and it's been around for almost more than a year then of course you have another app which we developed called the centurion insulin app so again this is free of charge it's available uh on both ios and the apple app store and what this does is uh this you know you put in some data here and it will tell you whether your patient needs insulin or not what type of insulin should you start and what those of insulin and this again like this is all developed by me uh i know a little bit of coding so i'll say you know i would say slightly i am ahead of the cow i can do coding in python i can do coding in javascript i can i started learning coding in a few other languages also but i can do a bit of coding but this app is developed without any coding right so it's a no coding app completely level up uh without any line of code right so you can do that yourself right uh if you are interested uh and the third app which is going to be launched very soon uh is the hypothyroidism in pregnancy app and this is one of my i think my favorite they made a very very good app with a lot of evidence-based backing so here you can you know if your patient is either planning for pregnancy or already has hypothyroidism and she's pregnant this is the app you can use and you can make good use of this app right and this will be launched very soon uh 24th july is when we're going to launch this app so again watch out for the switch you can follow me on twitter uh and and you can on facebook and twitter and linkedin uh and you know uh we will announce the uh you know launch of this app and this is again again like i said this is made uh we have made a backup version of this using coding but this is a no code app so this this one is actually developed without writing a line of code so you can do this yourself uh you know using the platform that we use for making our own apps is right so you can use this uh you know so adano is the app and right now we are using another uh thing called rental flow which is more advanced uh it requires a little bit of knowledge of programming also so i think pluto flow may be for more advanced results but adalo is very simple to use and you can easily develop your own app using this platform okay uh we also have developed something called we have developed our own hospital diabetes management system this is not commercially available it's not going to be so in-house use only uh but we are you know perhaps going to develop a commercial version of this as well in the future right so just to give you some take home messages so the first thing is these friends remember technology is here to stay and the world is moving towards it why are we in the stone age we should be leaders in technology indians should be we have so much see one thing we have apart from our big population is our big brains we are very intelligent group of people we are very smart intelligent people i think you know we can be leaders in this we should be ahead of the coffee right instead of following the best we have a large talent in engineering and we need to work with these people to create a difference of course endocrine society and esi members and rssc and rssp members are again working with this area and a lot of them like a few of them their names are shown and we need to support them right and this one thing see one i just end by this and which is i think my favorite quote a lot of people are concerned that ai and all this you know uh will take away the job of a physician or take a job of a clinician it will not right it will not see so many instruments have come in the field of pathology right or in biochemistry you still need a person who is who is emptying biochemistry don't you right there is so much technology available in aeroplane in fact right now airplane can fly on its own without requiring a pilot it's that advanced but still you need a pilot right so this line i really like and the line says ai will not cure cancer or you can replace cancer with diabetes but ai will not treat diabetes but diabetes patients and their endocrinologists sharing their data with artificial intelligence can so ai will not replace physicians but physicians who use ai will replace the physicians who don't using it and that's the word that's the thing you really i want you to take home please remember this so remember if you are not ahead or if you are not moving with the curve you will be left behind right and that should be your concern rather than technology thank you for a wonderful talk sir i personally love your rap endocrinology notes and much of my enthusiasm for diabetes as a young doctor comes from there the pathogenesis that you've explained the finer aspects of screening and diagnosis it's wonderful and you all should download it because it's free and it's wonderful information um we can take questions or if any of you have put questions uh sir if you i i can ask my question uh if uh we don't have any questions uh sir uh sir as you rightly mentioned precision medicine is the new age uh approach or mix whether it's genomics metabolomics proteomics that approach and as we all know diabetes is a heterogeneous disease with multi multiple factors multiple risks for every patient and now we have a spectrum it's not type 1 type 2 it's a spectrum of patients so what do you think as an experienced endocrinologist is the feasibility for application of on mix approach of precision medicine in diabetes management and which area of management you see being affected the most in coming five years yeah so i think that's a great question see i think that is where i really feel uh the change is really happening so again if you see uh you know ada or recent conferences and international conference and diabetes there's a lot of focus on precision medicine but there's a lot of focus one step ahead of that and that is trying to sub classify type 2 diabetes like you said very rightly said into a different buckets or different you can say categories if you can do this successfully then you can apply precision medicine method for example right now there are proposed six clusters of type 2 diabetes right six clusters so there are certain patients who tend to have more of insulin resistance and less of beta cell dysfunction there are certain patients who have more of intestinal dysfunction there are certain patients who just have mild obesity related diabetes some people have mild age-related diabetes right so there are now different clusters of fat now if you can identify let's say a patient with a mild age related diabetes and do very well with the dpp4 animator right so if you can recognize this patient so a patient comes to you you recognize that the patient is in the right cluster and if the patient is in the right cluster you can give the right medicine to the patient right this is this is where so one step ahead of precision medicine is actually trying to sub classify type 2 diabetes into smaller clusters and then to know how to identify this cluster in your patients so to see where your patients and if you can then market your patient with the right cluster you can give the right type of medicine to that patient and hence the patient would remain in a good situation for a long time so this is where really the change is really happening i think this is the biggest change which i've seen the last the next five to ten years happening as far as that is concerned see you would have we already have many medicines now i don't think that there is much more advanced advancement as far as new medicines are concerned or new approaches are concerned i think that now is now you take all these medicines and you see which medicine you will give to the to which group of patients that is what is really important i think you know uh if you take at a fine granular level if you see a mix level i think that would still be very far away as far as diabetes is concerned because type 2 diabetes is a multi-factor there are many genes involved there are many you know again it's mixed with the lifestyle factors also right so maybe somebody has a very strong genetic predisposition to develop diamond but this lifestyle is so good that he or she doesn't development on the other hand somebody who has a very low risk technically from a genetic perspective to develop diabetes but has a very poor lifestyle so the problem with diabetes is that it's more complex than we think and because of that i think a fine granular level may never be achieved but at least we will be able to sub classify patients with diabetes better and if you are able to do that that is where precision medicine is really going to come into picture thank you so much sir uh we'll take the questions which have come now uh sir uh dr moog joshi has asked thank you for a wonderful lecture uh he is told and he wants to ask you what do you have do you have any experience with beat or curve bsl monitoring strips is it accurate okay so just two people who are not aware uh veto is a again a indian startup so what they do is they they have a you know a device which adapts to your mobile phone uh and you can directly measure the blood sugar uh with that device you don't need a glucometer and this uh you know the glucose value directly is spread into your smartphone application so again you can store this data uh look i will not uh unfortunately uh you know talk specifics of this company because i don't think it would be right at least on this platform uh in my experience uh the accuracy of veto has not been good right they still need to work on that right the idea is great i would really support the idea which they're developing but as far as accuracy is concerned my personal experience has not been good right so again i am not saying based on any data which i have and since this question was also asked from my personal experience i think in my first person experience has not been good but i think you know i'm not aware whether they've made any changes and made it more accurate or better but i think the biggest challenge is where again you know the thing comes about uh you know uh using a doctor's inputs when developing technology i think there are a lot of cgm companies a lot of startups which are working in this space unfortunately they are missing one very key element is that accuracy is extremely important for any medical device right i cannot make a device which is uh you know 50 inaccurate right a blood sugar cannot be ranging from 50 to 150 it has it can it is acceptable that it is if the blood sugar is 100 if it is somewhere between 90 to 100 is acceptable but you cannot have a 100 blood sugar being reported as 50 or a 50 blood sugar reported as 100 right both of these are extremely dangerous so i think you know uh all these devices need to first work on their accuracy i like the thing but i'm still not very sold on the technology on the on the accuracy and i think you know that is where i think again the drug controllers and the bcgi needs to be really careful about which products they give approval to uh and again you know because sometimes it could lead to disastrous problem consequences i think that is where you need to be really careful uh thank you sir uh there's another question by dr viveka m uh what can be disadvantages of these tech technologies in india if any yeah i think like i said the biggest technology biggest biggest disadvantage is putting the cart before the horse that is what is happening a lot of places right see uh you know in india what is happening right now is that there is a start-up ecosystem there are a lot of investors who are interested so what happens somebody starts a startup it is halfway it doesn't it's not a complete idea it's not a problem which which it needs to be solved in a healthcare space suddenly gets funding suddenly it starts you know moving in the wrong direction and it changes the market right this has happened in many other many other fields also in the past unfortunately if this happens to help can it be very dangerous for example you know there are platforms i'm not name platforms which will say that you know uh uh we will do a package of these investigations for a very cheap cost again it's not important to do more investigations it is important to do small number of investigation in the right way right with more accuracy so i think the biggest disadvantage here is that if the technology people do not work with the medical doctors or with the medical field you will develop products which could have disastrous consequences again you are seeing a lot of these diabetes reversal systems and not which are completely you know i don't see uh you know they're completely wrong i would say you know to that extent so i think uh we need more expertise in this i mean to just you know realize that you can't really jump ahead of the cuff and you need to really you know be careful of where you're going otherwise you'll end up with power thank you so much sir uh dr hari s has asked previously there was a warning about insulin pumps being susceptible to hackers is this true yeah i think uh that was it was a challenge at one point of time uh especially so the problem was that uh that actually i had a consequences also so earlier there was uh jdrf was very interested in developing open source platforms for using forms uh so where you know what is open source open source is basically a lot of people can collaborate to make solution right for example let's say uh you know uh i i come up with an idea that let's make a new insulin form for india and then i get you know i just put a github page on that and then somebody who is working at iit mumbai says that you know i am an expert in uh making uh you know microprocessors so i can help you uh somebody is good at programming you know they help me out somebody is good at doing clinical trials you help me out so the idea with jdrf was to make more open source platforms but unfortunately there were a lot of systems got hacked and because of that this idea completely got you know washed away the existing proprietary insulin pumps and cgm devices cannot be had so a metronome device cannot be had omnipod cannot be hacked the t-stem cannot be had right generally they cannot because generally most of these do not some of them do but most not take inputs from a cloud right they give only output right so they just upload a data there but they don't take uh you know inputs from there right so that is the difference right ah so that's why you know you cannot unfortunately you cannot hack the pump to what you're thinking at of course the data can be breached which can happen with anything but uh you know that of course these are it's up to the company to make the data safer uh but again i'm sure the companies which are there already existing they're big players in this market and they're very safe data but the problem really happened when you know they were trying to develop a more open source platform which i think was the challenge and that is where you know which is vulnerable to us but again in future i am sure this will come back again when you again you uh make this that you know uh safety more robust and make it more pro more proof from hackers you will come back to this open source development again so yes partly this uh rumor or whatever that was was true but it was not true for the uh proprietary forms which are available both in india and elsewhere so if you are using the pop don't worry about it your data is not going to go off thank you sir uh since dr samuel wesley has asked something on the lines that uh you just answered before how precision medicine is going to revolutionize diabetes medicine management uh do you have anything to add on that yeah so i think you know if you remember this uh you know one slowly where you know somebody uh there was some ship and it was not the ship would not move right a huge uh oil tanker and you know uh they they got all these you know local experts who solve the problem and nobody could solve it and they called an international expert you know who was thrown into a charter plane and you know he came in and he said that i'll charge you this many million dollars okay you know we need to start this get this tanker moving so let's do that this guy comes all you know in his suit he just goes he analyzes the problem he just changes one screw right and suddenly the tanker is working right and then they say that you know we paid you so much money uh you know uh for this and all you did was just turn a screw so you know uh we will pay you what you ask for so you give us a itemized bill of you know why we should pay you a million dollars for doing what you did so his answer was very simple one dollar for turning the screw and then rest of the million minus one is to know where which screw to turn and grab where to turn it right so the point here is same thing is about precision medicine right now if you can exactly point out which screw of yours is defective right you can just turn that screw efficiently and your problem is small right so that is how broadly precision medicine is going to change medicine first and not just diabetes right if you can specifically recognize the sub type of a breast cancer at the sub fine granular level and you have a very specific drug that works for that patient that will you know solve your problem right so that is what is really happening and should be happening in the diabetes field as well that you know you recognize the patient's specific issue and then you use a drug which works in that patient for example a patient is a mild obesity type diabetes you give them an hdlt the patient reduces the weight the blood sugar becomes normal right so very simple you don't need to use another you know expensive drug or you need to add four drugs in this way you just one drug so that is how precision medicine is really going to work and that is how it's going to be thank you so much sir uh we have two uh requests for uh questions and uh i will let you in dr camraj you can join the video and ask her your question hello dr kamraj you can join your request has been approved i think there's some issue we can take another request for now dr kostav dr kostavkar i'm accepting you please join the video and uh ask a question hello yes you're audible dr costner i want to ask that for um clinic or website uh designing any type of host or domain purchasing is required or not yeah so very simple after that you can go to wix w i x right uh you can go there uh it's a one site uh you know stock for everything so you just see the templates you can design your own website you don't require any coding experience uh you can then of course connect that to a domain also so you can purchase the domain also from them uh you can connect that to your domain everything will do it for you of course it is not free of charge you know take some money for that but it's much cheaper than you you know ask somebody to design the website and everything for you so yes you will require so you require three things when you want to make a website you need a domain name for example netflix dot app is a domain right dr is a domain so these are domains so you need to purchase the domain then you need to have a web hosting so something which stores the website it's called hosting and the third thing you require the website itself the design and all the elements of the website so the website when is when it is made it is stored on the host and this post is then uh goes to the domain right so when i search when i go to www dot buckle oh it it that's the domain then the website which you see is designed by me or whatever and then it is hosted on a server so all the three things you have to pay you can do it separately or you can buy a package which is available from something like mix or there's something called squarespace also you can buy it from there as well right or many other companies so you can go there you can design yourself you can host it yourself you can choose your own domain everything of course has a fee right you have to pay for it but if you pay for it it's very easy but it's much cheaper than hiring a professional okay thank you sir or my another question is that how to reach more people uh for promoting my website or any clinics uh videos and how to reach me which website i can purchase yeah i think that's a good question but i think it's a question for a completely different discussion on social media i think that that would require a more intense uh discussion but keep it simple i think you know end of the day i i very strongly believe that content is the king right if you have good content whether your youtube channel or whether you have uh you know a website or whether you have your personal blog if you make good content people will visit your site people will come to your site because see all these algorithms google algorithms and youtube algorithms are made to help the consumer reach the right content right so if you're let's say making something on on uh thyroid right then if you are if you are making videos on the questions which people are asking then they are more likely to be searched and more likely to appear in the search results right so the simple thing is the simple solution is to make good content if you copy from somewhere and you know copy and paste and put it on your website or put it on your blog then you know it's not going to work as effectively on a search engine but if you make original content which is good quality which is which is you know which solves the patient's problems then you know people will automatically come to your website you don't need to pay anybody you don't need to you know hire any experts with that right that is it wants to make you know seo and all that irrelevant by just making good content right sir there is any promoting option in google play store or app store uh dr costa i think uh if yeah i think we can discuss that in our separate video okay okay thank you sir thank you so much thank you thank you yes uh thank you dr costa please we can move ahead and uh the next uh there are a few questions so dr surya prakash has expressed his concern about uh being afraid of quarks and quarks may misuse these apps may become hazardous to patients us anything you'd like to see yeah i think i agree with you uh obviously any system developed is uh prone to use and misused right i think misuses as much part of the system as the use of it is so it's not something we can completely avoid but i think you know uh to avoid cracks really the qualified people need to you know be more proactive that is the only solution see to fight misinformation you need to give correct information you cannot say that you know somebody is spreading this information all the time right see somebody spreading misinformation because there is a void and then void they are trying to finish if qualified people don't give correct information then they will also i think the idea is like netflix or you know any other platform more opportunities you get either to other doctors or to general public you should disseminate more information the more information you give less people will be vulnerable to facts that's the problem all right so uh dr samuel wesley has a question as ai is going to be part of disease management decision making how much importance has to be given to ai and doctor's knowledge yeah so it's a combination of the two right so ai cannot work in isolation and doctor's knowledge cannot be nicely right you cannot say that i will practice medicine how i like i forget the evidence and a i cannot say that you know whatever decision i give has to be wrong right so i'll give you the best example of this is we are already using ai in our day-to-day life for example you are using google maps right so let's say you want to go from here to bannon right i'm living in amdable i want to go to baroda uh you know i switch on the google maps and i see the you know right so they'll show you show me that you know you take this and you take take a left take a right right so that is ai giving me direction but i know that because i go to baroda quite a few times you know i know that perhaps this road is more likely to be congested or perhaps you know there could be you know it's raining right now and there could be some you know a lot of potholes and lot of puddles in certain area so that is where i sometimes override the decision which is given by google by saying that you know because i will avoid this road and rather take the other road so ai is to assist a doctor it is not to replace a doctor that is one very important here to understand when i am using a clinical decision making tool for example you talk about hypothyroidism and pregnancy it will suggest that so-and-so patient requires so-and-so dose of neurothyroxine for so and so period of time right now it is your you are the ultimate authority you can say that whatever this software said is wrong i will lose my own clinical judgment or you can say that i agree to what they said and you know i would then use what they're saying in my clinical practice to make my clinical practice better in fact to tell you so this app was developed fully by us but even today you know when i am sitting in the opd sometimes i am not very sure what to do i myself open the app which i made to check what you know is the right decision and then based on that so see it is like using the second brain right so that's certain information i can keep everything in my brain so certain things i have put it on an app or are putting in another system as a second brain and i access that second brain whenever required and i take that information in my own thing and then use my technique right so that is where ai is really broadly going to work all right thank you sir thank you so much for your time and expertise on this topic it was an absolute pleasure to have you on netflix and we hope to have you again uh and thank you for graciously being there for answering all these questions as well uh thank you so much you we look forward to having you and thank you all of you for joining


The growing incidence of type 2 diabetes (T2D) is a significant health concern, representing 90% of diabetes cases worldwide. Over the past decade, the rise of diabetes technologies, including dosing advisors, continuous glucose monitoring systems, insulin pumps and automated insulin delivery systems, has led to great improvements in the therapies available, particularly to those requiring insulin. As we look to what’s ahead in new diabetes technology for 2022, many may experience a sense of déjà vu. Join us for another interesting session as Dr. Om Lakhani discusses about currently available diabetes technologies as well as future prospects.


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