Diabetes Among Children (DAC)

Project - Exploring Opportunities with Support from Mobile Applications in

a Cross Cultural Indo-Swedish Study

Jenny Lundberg

, Soniya Billore

and Clara Axelsson

Department of Mediatechnology, Linnaeus University, PG Vejdes väg, Växjö, Sweden

Department of Marketing, Linnaeus University, PG Vejdes väg, Växjö, Sweden

eHealth Institute, Linnaeus University, Bredbandet, Kalmar, Sweden

Keywords: Diabetes, Indo-Swedish, Global Health, Quality Assurance Systems, Metronics, Open Systems.

Abstract: In this paper we present opportunities and challenges to meet the worldwide challenge of diabetes. Diabetes

has devastating long-term complications that cause very great personal suffering and social costs locally and

globally. The prevalence of diabetes is increasing globally as an epidemic and affects 415 million people

today, which is expected to increase to 642 million in 2040. In this paper we explore possibilities to join in

Indo-Swedish R&D collaboration. We present and motivate the research purpose. Furthermore we present a

research framework for mobile application development between Sweden and India. The scientific framework

is elaborated and this paper ends with specific challenges and further work.

1 INTRODUCTION

According to the International Diabetes Federation

(2015), 415 million in the world have got diabetes and

it is estimated that by 2040, 642 million will be

diagnosed with diabetes. Probably no other condition

constitutes a challenge to the patient as diabetic, as

glucose levels is dependent on the content of each

meal, and the physical activity before and after that

time, all the time, and every day. Level of emotional

stress also affects sugar levels via the hypothalamic-

pituitary-adrenals (HPA) cortisol-producing systems

(Melin, 2015). Too little insulin is a threat in the long

term, due to the risk of complications, and too much

can lead to serious symptoms, mental and physical

impact, in the worst cases, coma or death within

minutes-hours. Patients should preferably combine

information on food intake, especially the amount of

carbohydrates, and previously scheduled and physical

activity, and the current stress level, to calculate the

optimal dose of insulin before each meal, several

times per day.

Diabetes has two main types. In type 1 patients are

dependent on insulin injections several times a day, to

survive; in type 2 are many dependent on insulin for

control, and to minimize the risk of complications

(Forbes, 2016) (Thunander et al., 2012). Diabetes

means risk of death in the short term, if not cared for,

and the high risk of long term complications such as

macrovascular (myocardial infarction, heart failure,

stroke and peripheral arterial insufficiency, if not heal

foot ulcers and amputations) and microvascular

(retinopathy / blindness, kidney failure with dialysis

or transplantation, and nerve problems).

Diabetes puts high demands on the individual

when it comes to individual care, and in the case of

children it puts higher demands on the family and

especially the parents. Complications can occur and it

is commonly known that this creates difficult health

conditions and high social costs. Potentially this can

be handled with support from not only medical

science but also the latest developments in mobile

devices and sensor technology. The measurements

obtained from the close interaction of the mobile

applications with the patients, here the children, and

the consequent big data can be used to handle some

of the issues in this area. Given that diabetes in

children is a growing concern all across the world,

this pilot project aims to look at the development and

use of mobile applications designed specifically for

them. As part of the background motivation for this

study a focus group was conducted in India among

paediatricians and diabetologists to inquire about the

knowledge and usage of mobile applications for

Diabetes. It was observed that the doctors were aware

Lundberg J., Billore S. and Axelsson C.

Diabetes Among Children (DAC) - Project - Exploring Opportunities with Support from Mobile Applications in a Cross Cultural Indo-Swedish Study.

DOI: 10.5220/0006231804070412

In Proceedings of the 10th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2017), pages 407-412

ISBN: 978-989-758-213-4

407

of such applications on a global level but these were

not used commonly by the diabetic children in India.

Also it was not an established practice yet for the

doctors to recommend any mobile application to the

parents or the children to support their lifestyle in

dealing with this challenge.

2 BACKGROUND

In this background we present the situation related to

diabetes from the two countries specific perspectives.

This presented within the three subsections India,

Sweden and motivation for the Indo-Swedish

research study.

2.1 India

The presence of Diabetes among children is a

growing concern in India. According to a recent

report (The Times of India, 2014) there are almost

70,000 cases of children with Type I and nearly

40,000 cases with type 2 diabetes. Obesity and the

fast food fad is a common factor coupled with the fact

that nearly 68% of urban children do not engage in

regular exercise (type 2). Praveen and Tandon (2016)

discuss the incidences of type II diabetes among

children in India and underline that obesity is the

leading cause of the situation. It is also of concern that

parents, caretakers and schools emphasise the need

for a healthy lifestyle among the children so that type

II incidences can be curbed and brought under

control. One of the possible influencers could be the

digital support systems such as mobile technologies.

Forbes, 2016 reports that the mobile penetration is

India has reached nearly a billion subscribers and the

market has the third largest smartphone users in the

world. This opens immense opportunities for using

the mobile technology for health related benefits. The

first diabetes app named Diabeto was launched only

recently in 2015. This application connects to

glucometers of 30 different types and helps to keep

track of the sugar levels, insulin levels including

Bolus and Basal. Further it keeps the data stored in

the cloud and presents visual representations of the

patient’s data for further, more efficient diabetes

management. There is growing awareness about this

application for Diabetes management in India and

there is also growing interest among health and

technology entrepreneurs to develop more

applications for Diabetes.

Figure 1: The Diabeto application. Photo credit:

www.startupexplore.com.

Figure 2: The synchronisation of the app with the

glucometer. Photo credit: http://www.medgadget.com/

2015/01/diabeto-to-sync-glucometers-with-smartphones-

video.html.

In the next section, the situation related to diabetes

in Sweden is presented.

2.2 Sweden

Sweden has the second highest presence of diabetes

among children in the world approximately 7-8000

individuals and 800 are diagnosed every year. But

there are some popularly used applications such as

Triabetes, a CE marked medical software (iTunes,

Triabetes). Research, development & innovation

related to diabetes are ongoing and mature enough

with rich data material to do further analysis on.

Different quality assurance systems where devices

related to diabetes are included exists. CE markings

(Läkemedelsverket, 2016) and other initiatives as for

example Diabetesappar.se are a collection of apps

related to diabetes developed in cooperation with the

Swedish health care professionals and Swedish

application providers to facilitate and improve

everyday life for patients and healthcare. Modeling of

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diabetes (Marmarelis and Mitis, 2014) are considered

in essence in regular technical issue, with glucose -

insulin regulations. Furthermore, there are national

approaches towards open quality assured databases

such as the National Diabetes Registry, NDR with a

specific open registry for children, Swediabkids. In

the pictures below, figure 2, an example of a diabetes

kit for children in Sweden is presented. Furthermore,

continuous monitoring (CGM) like for example the

automatic insulin pumps are examples of additional

products in use.

Figure 3: Example of children's “diabetes kit” in Sweden.

Photo credit: Jenny Lundberg.

2.3 Motivation for the Indo-Swedish

Study of the DAC Project

For children and adolescents diagnosed with diabetes

lifelong lifestyle changes are inevitable to ensure

quality of life. Dietary regulations, sound exercise

and monitoring as well as medication need to be

obtained regularly every day (Barndiabetesfonden,

2016). This is an immense task for the young and their

family who all need to be highly motivated to succeed

long term. Cafazzo et al., 2012 have shown that

motivation for self-monitoring can increase with the

help of specialised mobile applications.

It is believed that the experience of healthcare and

researchers Sweden could be used to explore the use

of similar applications for the diabetic children in

India. An Indo-Swedish cross cultural study of the

lifestyles of diabetes among children can provide

sufficient data and enable a higher level of

generalization that can be translated to create more

efficient and open mobile applications for the young

generation.

3 RESEARCH PURPOSE

This research will conduct the following exploratory

steps to have a deeper insight of the situation

regarding e-initiatives and specifically mobile

applications for Diabetes among children.

1. Explore the possibilities for designing e-

initiatives with a study of the child patients and

the level of adjustments and adaptations needed to

deal with Diabetes as a health condition

2. Explore the personal needs of the patients in order

to obtain a personalized and microscopic look to

their needs and wants for the e-initiative

3. Utilise information portals and big data sources to

study the possibilities of building an interactive

mobile based empowerment platform for virtual

coordination

4. Design mobile based solutions to empower and

assist the children and their parents to deal with

the presence of this diagnose.

5. Connect the results of the above to health industry

entrepreneurs for mobile app. creation and

development. This includes connecting Swedish

entrepreneurs to the ones in India so that

collaborative efforts on technology and user needs

can be optimally utilised for creating market

specific mobile applications.

4 SCIENTIFIC FRAMEWORK

As seen from the framework, the research attempts to

explore in depth the situation of the children suffering

from Diabetes type I and II in the countries of Sweden

and India. The research will be done for mainly 2

aspect, A: the lifestyle of the children and the

requirements that the children have given their health

condition. By requirements it can mean a number of

parameters such as access to health and medical

advice, infrastructure support in terms of access to

sports and other facilities that can help keep their

body healthy and active, emotional support from

families and friends, and access to other children who

suffer from the same health situation through a

network or group either online or otherwise where

they and their families could meet and support each

other. The other parameter is B: systems that support

diabetes management in children such as the quality

of awareness regarding the condition among the

families, schools and local society and the

relationship between them and the local health care

units. Also this will explore the technological support

that children have access to as they themselves want

Diabetes Among Children (DAC) - Project - Exploring Opportunities with Support from Mobile Applications in a Cross Cultural

Indo-Swedish Study

409

to know more of their health condition and how best

they could manage it. For example , the use of mobile

applications that can be used to bring the knowledge

, awareness and management of the diabetes related

health situation closer to the children suffering from

it as well as making the platform user friendly.

Figure 4: Research framework for mobile application

development between Sweden and India.

It is known by our initial secondary research on

the topic that Sweden has been using a number of

mobile applications for Diabetes management but the

situation is not the same for India. It will be

interesting to further see how the applications in

Sweden are customised to children patients if any.

By knowing the situation for parameters A and B

described above we can have a list of factors that need

to be tested against the presently available

applications and explore the possibility of including

new ones in them. Further on, the research will take

the next step of bringing these observations to the

world of entrepreneurship by building a link between

the mobile app developers in the health industry of

Sweden and India. It is believed that since Sweden

and India have increasing number of diabetes affected

children in very varied social and cultural settings, the

knowledge created through the study will help

generalise some important human and disease related

elements that could be used on a wider context for

Diabetes management among children on a global

level.

5 SPECIFIC OPPORTUNITIES

AND CHALLENGES

Novel technology with sensors / actuators, Internet of

Things (IoT), micro sensors and open socio-technical

systems, e.g. Internet-of-Things have unique

opportunities to produce scientific data on e.g.

diabetic patient's situation occurred. From here, and

directly from the electronic medical record can be

models based on real data and large data sets over

time be developed and on contributing to a more

secure basis for informed decisions in everyday life,

such as about insulin doses, for patients and

caregivers. The second area of this project concerns

the so-called Big Data management. Much

information is available today in the electronic

medical record, but not available. Output data must

be retrieved by experts in analysis departments, in e.g.

Excel. Basic facilities required, for example. standard

reports, for everyday recurring purposes. Most

diabetic patients are and will be in developing

countries, with type 2 diabetes, with more

sophisticated technology the so-called artificial

pancreas will not be an option, but there techniques

that can be used with smart phones are more

accessible. A combination with the automatic

biological data, as pulse rate, as visualized in parallel

with glucose levels and insulin doses, would provide

additional information, e.g. about symptoms

associated with hypoglycaemic events.

Hypoglycaemia is still the biggest obstacle to

achieving ideal blood glucose control, incl. fear of

hypoglycaemia. Many factors influence the outcome

of doses of insulin in diabetes, such as age, sex,

duration of diabetes, type of insulin used (short- and

Sweden

A: Explore

needs

and

lifestyle

requiremen

of the

children

suffering

from

Diabetes

B: Explore

support systems

that assist

diabetes

management in

children

1. Family

2. Schools

and

Society

3. Health Care 4.

Technological

support e.g.

mobile

apps.

India

Children

with

Diabetes

type 1

and

their

families

Mobile

applications for

Diabetes

management in

Sweden and

India and

possibilities for

collaboration

between

Swedish and

Indian

health

Knowledge creation on generalisations

of important human lifestyle related

parameters that

can be included in the

technological

support system, in this

case mobile a

lications.

HEALTHINF 2017 - 10th International Conference on Health Informatics

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long-acting types), the patient's body composition,

physical activity, why automatic data collection via a

"bio-bracelet", which such as Smart Band, and

practical visualization of these complex tasks, and

their interactions, both can be helpful for patients and

their advisers or assistants in clinical settings, and

provide information to be analysed at the graduate

level, can provide new information that can be

converted into new clinical counselling. Analyses of

data for glucose levels and insulin doses with details

of HbA1c levels, over time, longitudinally, can

provide both new insights into the relationship

between glucose variability (i.e., frequency and

amplitude of the high and low values) and the level of

HbA1c (and over time relation to the development of

diabetic complications), and in the patterns of glucose

levels, frequency of episodes of hypoglycaemia,

relationships actually taken insulin doses, etc. are not

available today, and not for larger groups of real

patients outside of clinical trials, and put them in the

with bias (s) involved. The complex situation of

diabetes care is a major global challenge (Guariguata

et al., 2014) and is a good example of the area where

the development and utilization of techniques to

facilitate better target fulfilment can spread easily

benefit both individuals and society (Sundström,

2016), (Hu et al., 2015), (Lundberg, et al., 2015),

(Eriksén, 2015).

6 FUTURE WORK

Collaboration between different expert domains are

of interest to battle the challenges related to diabetes.

Closer collaboration between stakeholders, with care

institutions and related partners for a healthy lifestyle

among children are desired.

ACKNOWLEDGEMENTS

To the system-cross organisation at Linnaeus

University giving us this unique opportunity to

initiate a small scale R&D cooperation. Furthermore

to the paediatric clinics, endocrinologists in Växjö

and Kalmar hospitals for support.

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