“Golimumab” Helps Kids and Youth Newly Diagnosed with T1D

December 3, 2020

 

It might be tricky to pronounce at first, but a human monoclonal antibody, called golimumab (gō-lim-yü-mab), can help kids and young adults with newly diagnosed type 1 diabetes, according to new research. The fact that golimumab has been approved to treat a number of autoimmune conditions in both the adult and pediatric populations, led to curiosity over whether the drug could help patients with type 1 diabetes. The small proof of concept study strongly suggests that golimumab can indeed reduce the amount of injected insulin required by children and youth with newly diagnosed type 1 diabetes by preserving their ability to produce insulin on their own, called endogenous insulin.

 

The study is the culmination of decades of work conducted at the University at Buffalo in New York State and at the Diabetes Center at UBMD Pediatrics and Children’s Hospital. The main goal of the study was to see if golimumab could preserve beta-cell function in newly diagnosed patients, which it does, for as it seems at least a year after diagnosis.

 

Beta cells are unique cells in the pancreas that produce and secrete hormones directly into the bloodstream to regulate levels of glucose. When blood glucose levels start to rise (e.g., during digestion), beta cells quickly respond by secreting some of their stored insulin. This quick response to a spike in blood glucose usually takes about ten minutes. In people with diabetes, however, these cells are either attacked and destroyed by the immune system or are unable to produce enough insulin needed for blood sugar control.

 

In addition to insulin, beta cells also secrete the hormone Amylin and so called C-peptide, a byproduct of insulin production. Amylin slows the rate of glucose entering the bloodstream, making it a more short-term regulator of blood glucose levels. C-peptide is a molecule that helps to prevent neuropathy and other vascular complications by assisting in the repair of the muscular layers of the arteries.

 

The most important finding in the recent study is that golimumab is a potential disease-modifying agent for newly diagnosed type 1 diabetes. The team determined that beta-cell function was preserved based on the amount of C-peptide in patients’ blood during a four-hour mixed meal tolerance test. Because C-peptide reflects only insulin made by the body and not injected insulin, C-peptide levels reveal how well the pancreas is producing insulin.

 

The findings represent a major step forward in the effort to find ways to preserve the insulin-making capabilities of children and young adults with type 1 diabetes. Patients newly diagnosed with type 1 diabetes don’t stop making insulin all of a sudden. During the period just after diagnosis, called partial remission or the honeymoon period, patients are still able to make some insulin on their own. That is the period the scientists targeted with this study of golimumab.

 

Although none of the patients were able to stop taking insulin entirely, the results have important clinical implications. The need for less injected insulin is a major quality of life improvement and carries advantages, including lower rates of hypoglycemia. The scientists believe that the golimumab results represent another tangible step towards achieving the ultimate goal of developing therapies that will one day prevent and reverse type 1 diabetes. “People want a cure, but the fact is, a cure is not available yet. But this is an intermediate step towards a cure” according to one of the lead authors.

 

Based on these promising results, the research team have planned future studies seeking to determine if golimumab can be given even earlier in the disease process to more effectively prevent or delay type 1 diabetes in high risk patients. So, stay tuned for some more exciting news to come.

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Hopeful News for Treating Retinal Diseases

November 4, 2020

 

Scientists in the United States have uncovered a potential new strategy for treating eye diseases that affect millions around the world, often resulting in blindness. A potential treatment based on a natural protein may offer broader benefits than existing drugs.

 

Many serious eye diseases, including diabetic retinopathy, feature an abnormal overgrowth of new retinal blood vessel branches, which can lead to progressive loss of vision. It’s a phenomenon called “neovascularization.” Essentially, it’s the body’s faulty attempt to restore a blood supply that has been impaired by aging, diabetes, high blood cholesterol or other factors.

 

Ophthalmologists have been treating these conditions with drugs that block a protein called VEGF or Vascular endothelial growth factor that promotes the growth of new blood vessels. VEGF forms part of the mechanism that restores the blood supply to cells and tissues when they are deprived of oxygenated blood due to compromised blood circulation. Anti-VEGF therapy have improved the treatment of these conditions, but don’t always work well and have potential safety issues.

 

The new strategy for treating eye diseases based on a natural protein, was introduced by Scripps Research scientists in a study published in the Proceedings of the National Academy of Sciences. The study showed that a new approach that doesn’t target VEGF directly is highly effective in mice and has broader benefits than a standard VEGF-blocking treatment.

 

Although anti-VEGF drugs stabilize or improve vision quality in most patients, about 40 percent are not significantly helped by these drugs. Moreover, researchers are concerned that the long-term blocking of VEGF, a growth factor needed for the health of many tissues including the retina, may do harm along with good. Many cases of retinal neovascularization are accompanied by the loss of tiny blood vessels elsewhere in the retina, and blocking VEGF inhibits or prevents the re-growth of these vessels.

 

There’s a different protein that naturally dials down the hypoxic response and thus might be the basis for an alternative treatment strategy. The protein, CITED2, is produced as part of the hypoxic response, and apparently functions as a “negative feedback” regulator — keeping the response from becoming too strong or staying on too long.

 

For the new study, the team of researchers conducted tests in a mouse model of retinal hypoxia and neovascularization, using a fragment of CITED2 that contains its functional, hypoxic-response-blocking elements. When a solution of the CITED2 fragment was injected into the eye, it significantly reduced neovascularization. Moreover, it did so while preserving, or allowing to re-grow, the healthy capillaries in the retina that would otherwise have been destroyed — researchers call it “vaso-obliteration” — in this model of retinal disease.

 

In the same mouse model, the researchers tested a standard anti-VEGF treatment drug called aflibercept. It helped reduce neovascularization but did not prevent the destruction of retinal capillaries. However, reducing the dose of aflibercept and combining it with the CITED2 fragment, yielded better results than either alone, strongly reducing neovascularization while preserving and restoring retinal capillaries.

 

The researchers now hope to develop the CITED2-based treatment further, with the goal of testing it in human clinical trials. Fingers crossed!

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Shed a Tear or Two for Future Diabetes Monitoring

October 22, 2020

 

Those living with diabetes don’t need to be reminded of the importance of regular monitoring of their glucose levels. It’s essential for diabetes care as it reveals the patterns of glucose changes, and helps in the planning of meals, activities, and at what time of day to take medications. In a previous blog we covered various methods to monitor glucose levels, including using saliva as a pain-free and cheaper alternative to blood for monitoring diabetes. In today’s blog, we’ll explore another emerging alternative – measuring glucose in your tears.

 

Using tears to test for biomarkers is not a new idea. In addition to protecting your eyes, tears contain a variety of large proteins and their composition can change with disease. Indeed, researchers have been exploring their usefulness in finding biomarkers for Parkinson’s disease and diabetic peripheral neuropathy.

 

A new study shows that analyzing the tears of people with diabetes could be a potential method to monitor their blood sugar levels without the need for invasive alternatives that rely on blood testing. In this research, Dr. Masakazu Aihara and colleagues at The University of Tokyo, investigated the correlation between blood and tear glucose concentrations. The team found that the glycated albumin levels in tears and blood had a strong correlation.

 

The researchers recruited 100 individuals with diabetes who had blood and tear samples collected at the same time. Researchers measured glycated albumin levels in tears with liquid chromatography-mass spectrometry. Blood sample levels were measured through an enzymatic method. Significant correlation was found between the glycated albumin levels in tears and those in blood. Statistical analysis showed that this correlation was maintained even after adjustment for age, gender, kidney function and obesity.

 

Glycated albumin is a biomarker that reflects the 2-week average blood glucose. This might make it a greater biomarker for detecting earlier adjustments in blood glucose than glycated hemoglobin (HbA1c), which displays adjustments in blood glucose over the previous 2-3 months.

 

While the research results of the analysis of tears’ glycated albumin levels are promising, a tear analysis technology that is accurate, inexpensive, and accessible to people with diabetes is still to be developed. Dr. Aihara’s plan, is to optimize measurement conditions, develop appropriate equipment, and verify the effectiveness and usefulness of tear analysis as a non-invasive method for diabetes monitoring. Until then, we’ll have to rely on the traditional methods of blood glucose monitoring.

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New Diabetes Risk Factors Identified – Add Insomnia!

September 23, 2020

 

A new report indicates that insomnia is a novel risk factor for developing type 2 diabetes. The Sweden-based study that appears in the journal Diabetologia identified 19 risk factors for type 2 diabetes. It further evaluated 21 risk factors that had scarce evidence, and another 15 that reduced the risk of the condition.

 

Researchers have long identified factors that increase the risk of developing type 2 diabetes. These factors include family history, weight, fat distribution, inactivity, age and even race. Other suggestive risk factors that have been mentioned but may need to be further studied include alcohol consumption, skipping breakfast, daytime napping, anxiety disorders, urinary sodium, certain amino acids and inflammatory factors, and lack of sleep.

 

Obesity is still the predominant risk factor for type 2 diabetes. But insomnia was the headline maker in the Swedish study — people living with the condition are 17% more likely to develop type 2 diabetes than those without it. Insomnia was also seen as an element in the association between depression and type 2 diabetes.

 

The team used a method called ‘Mendelian randomization’ (MR) to obtain their findings. This technique blends genetic information and conventional epidemiological methods. It also addresses questions related to causality without biases, that could compromise the validity of epidemiological approaches.

 

The Swedish researchers used data from the Diabetes Genetics Replication and Meta-analysis consortium. They evaluated 74,124 cases of type 2 diabetes and 824,006 control participants with European ancestry for the study population. The participants’ mean age was around 55 years, and 51.8% of them were male. The researchers also screened 238 studies before including 40 individual papers in their investigation. Among the 97 factors they looked at, only 19 increased diabetes risk.

 

Daytime napping also appeared to be a risk factor for type 2 diabetes. However, because it’s strongly related to insomnia, it’s unclear whether daytime napping is an independent risk factor.

 

Other risk factors found include:

 

  • depression
  • smoking
  • high blood pressure
  • caffeine consumption

 

The exposures associated with a decreased risk of type 2 diabetes include:

 

  • the amino acid, alanine
  • high-density lipoproteins, or good cholesterol
  • total cholesterol
  • the age when females start menstruating
  • testosterone levels

 

These findings should inform public health policies for the primary prevention of type 2 diabetes. These measures could include lowering obesity and smoking rates and improving mental health, sleep quality, educational level and birth weight.

 

More work is needed in this field, especially in less homogenous populations than Sweden’s, and since major risk factors for type 2 diabetes differ by ancestry. Studies have also found that the chance of developing diabetes is significantly higher for Black people — around 66 more cases of diabetes per 1,000 people — compared with white adults.

 

Ballooning diabetes numbers around the world scream for more testing. According to the International Diabetes Foundation (IDF), 79% of adults with diabetes live in low- and middle-income countries. In Southeast Asia, for example, the IDF says some 88 million adults live with diabetes, with over half undiagnosed.  By 2045, the global diabetic population is expected to exceed 150 million.

 

South and Central America are the two regions presenting an increased mortality trend with relation to diabetes.  The IDF estimated the average prevalence of diabetes there at 8.0%; this is expected to rise to 9.8% by 2045. This underscores the importance of analyzing all the risk factors influencing the disease and putting preventative measures in place.

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Are Smart Contact Lenses the Future for Diabetes Detection?

August 20, 2020

 

The exciting global embrace of wearable health technology and the fast-growing demand from consumers to take control of their own health has led to a steady increase in the development of many new devices designed to collect users’ personal health and exercise data. Devices such as fitness trackers, smartwatches and wearable monitors have weaved themselves into society in many countries, with the likes of Fitbit and smartwatches becoming mainstream. Smart contact lenses are one of these up-and-coming wearable devices that are attracting much attention for what they could mean for health care applications.

 

Earlier this year, a team of researchers from South Korea published an article about wireless smart contact lenses that can help detect diabetes and treat diabetic retinopathy just by wearing them. The device relies on chip technology which monitors sugar levels via the users’ blood vessels behind the eyelids and will issue a warning should a health emergency arise.

 

The multifunctional smart contact lens includes a real-time electrochemical biosensor, which is designed to detect glucose in tears – possibly replacing the need for invasive blood glucose tests in the future. Another function is the on-demand flexible drug delivery system, which allows for controlled drug delivery to treat diabetic retinopathy via remote communication.

 

The smart contact lens is made of biocompatible polymer and contains ultrathin, flexible electrical circuits and a microcontroller chip for real-time electrochemical biosensing, on-demand controlled drug delivery, wireless power management, and data communication. When the contact lens is placed onto the eye, chemicals on it bind with tear glucose and trigger an electrical current change that is proportional to the amount of glucose. This electric current is also used to dissolve gold membranes that seal drug reservoirs, triggering the release of a dose of the drug.

 

The lens is about 0.2 millimeters thick as currently made, which is already thinner than the FDA-approved contact lenses for measuring eye pressure in people with the eye disease glaucoma. In the future, the team aims to reduce it to 0.15 mm thick.

 

Like all contact lenses, this breakthrough device fits over the cornea, the clear outer layer which covers the front portion of the eye and focuses most of the light that enters the eye. The surface of the cornea uniquely presents an noninvasive and convenient interface to physiological conditions in the human body – after all the eyes are directly connected to the brain, liver, heart, lung, and kidney and can serve as a window to the body.

 

The research team tested the smart contact lens on rabbits and verified that the glucose level in tears of diabetic rabbits analyzed by smart contact lenses matched their blood glucose level using a conventional glucose sensor that utilizes drawn blood. The team additionally confirmed that the drugs encased in smart contact lenses could treat diabetic retinopathy. According to team leader Professor Sei Kwang Hahn of the Pohang University of Science and Technology, human clinical trials are scheduled to begin in 2021. If everything goes well, the smart contact lens should be commercially available as early as 2023.

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Glucose Monitors – “I Have Got You Under My skin”

August 6, 2020

 

Monitoring glucose levels is an integral part of successful diabetes management. The traditional way is capillary glucose sampling by finger prick – known as self-monitored blood glucose (SMBG). In recent years, less invasive continuous glucose monitoring (CGM) devices have been introduced, which have made a significant impact on how we manage and monitor blood sugar levels.

 

CGMs are placed on the body, often on the arm or abdomen, where the sensors measure the glucose in the interstitial fluid – the fluid in and around your body’s cells. CGMs provide real-time blood sugar readings 24 hours a day and can be used whether you wear a pump or use injections for your insulin delivery. Most CGMs report blood sugar levels every five minutes, for a total of 288 glucose readings per day, as well as blood sugar trends (up, down or stable) and a blood sugar curve covering the past hours.

 

CGMs allow people living with type 1 or type 2 diabetes to closely track blood glucose levels and trends. CGMs can help people with diabetes make informed decisions about food choices, exercise, and other aspects of diabetes management by alleviating much of the guesswork about daily patterns and fluctuations.

 

A key benefit of CGMs is the ease with which they allow people living with diabetes to access information about their blood glucose levels. It helps to detect blood glucose trends, eliminates the need for numerous finger pricks, which may be painful and difficult to manage frequently, and alerts users when glucose levels are too low or too high.

 

Despite the positives, the use of CGMs has some reported drawbacks. The main complaints include users reporting various glitches and frustrations arising from using CGM, including difficulty inserting and/or removing the device, finding a comfortable and discrete place for it on the body, occasional loss of signal and the cost of buying and operating the device. There´s also the need to calibrate the device at regular intervals, since although the CGMs deliver glucose readings automatically at short intervals, twice-daily finger pricks are needed to ensure accuracy.

 

There are two main types of CGMs. The so called “Flash” displays current blood sugar levels as well as values from the past eight hours every time the sensor is scanned. The other type connects the sensor to a receiver, a smart phone or a smart watch that displays real-time blood sugar levels. Here you can find an overview of some of the CGMs currently on the market.

 

The world of diabetes devices is evolving at a fast pace, and CGMs are at the heart of that evolution. A Belgian-based startup called Indigo Diabetes is creating a continuous glucose monitoring sensor that is designed to go under the skin to monitor a patient’s glucose levels. The nano-sensors are expected to last for up to two years and will measure ketones as well as glucose. Unlike the CGMs on the market today, the sensor will be invisible. When linked to an insulin pump, people living with diabetes would no longer have to intervene or adjust anything at all. The aim is to make finger pricking and visible patches on the skin for glucose monitoring things of the past.

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Saliva-Based Glucose Test for Diabetes Management

May 5, 2020

 

Monitoring is a critical aspect of diabetes self-care. Careful control helps people living with diabetes to know if they are meeting recommended treatment goals to keep healthy. But taking care of diabetes includes more than just monitoring blood glucose levels. It involves the individual’s overall health, such as blood pressure, weight, cholesterol levels, heart health, sleep, mood, medications, as well as eye, kidney and foot health.

 

Anybody living with diabetes does not need to be reminded of the importance of regular monitoring of glucose levels. It is necessary to prevent hyper- and hypoglycemia, both of which can cause immediate and long-term complications in individuals with diabetes. How frequently one needs to monitor the glucose depends on the type of diabetes but also the use of oral medication or insulin. Some only need to monitor their glucose levels a few times a week, while others monitor it up to three times a day. Those who wear a continuous glucose monitor, can continuously observe their glucose reading and follow the direction it’s headed.

 

The current standard for diabetes monitoring is blood glucose testing, which can involve multiple daily finger-prick blood tests. This can potentially result in calluses and difficulty obtaining blood. According to some reports, up to 60% of people with type 1 diabetes and 67% of those with type 2 diabetes do not monitor blood glucose as often as recommended. Fear of needles and pain of finger-pricking are often cited as the key barriers to people monitoring their blood glucose levels.

 

New research suggests that saliva could be utilized as a pain-free and cheaper alternative to blood for the monitoring of diabetes. The research, led by the University of Strathclyde, in collaboration with researchers from universities in Brazil and Canada, showed promising results for monitoring diabetes and demonstrated that lab tests of the saliva process had an accuracy rate of 95.2%.

 

According to Dr. Matthew Baker, the lead researcher, saliva reflects several physiological functions of the body, such as emotional, hormonal, nutritional and metabolic, and so its biomarkers could be an alternative to blood for robust early detection and monitoring of diabetes. Saliva is easy to collect, non-invasive, convenient to store and requires less handling than blood during clinical procedures, while also being environmentally efficient. Dr. Baker also stressed that it contains analytes with real-time monitoring value which can be used to check a person’s condition.

 

The team identified two biomarkers that had a strong correlation to glycemia and were able to differentiate between hyperglycemic and normal conditions. The two markers were utilized to distinguish between the non-diabetic, diabetic and insulin-treated diabetic rat models with 95.2% accuracy. While additional research – including studies using human participants – are needed, it is hoped that this novel approach could form the basis of a cost-effective, non-invasive approach to diabetes monitoring in both type 1 and type 2 patients.

 

There are others who also believe in this new approach. An Australian-invented Saliva Glucose Biosensor is a novel non-invasive, saliva-based glucose test for diabetes management that measures glucose in saliva, not blood. The users of this new technology, which is still to receive regulatory approval, will bring the Saliva Glucose Biosensor in contact with saliva and move the biosensor to a smart device where the glucose levels will be displayed. The digital application provides real-time comparisons against historical data and can transmit information remotely to points of care

 

Using saliva to monitor diabetes can potentially free the 463 million strong global diabetic population from having to use painful and invasive blood monitoring devices to manage their condition, giving them a better quality of life.

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´Real-Life´ Use of RetinaRisk – A New Scientific Article

April 20, 2020

 

In a previous blog we discussed how “One Size Doesn´t Always Fit All” when it comes to screening for diabetic retinopathy, one of the leading causes of blindness in the global working age population. This is what our founders had in mind when they designed the RetinaRisk algorithm that calculates the individualized risk of people with diabetes of developing sight-threatening eye disease. They proposed a variable interval screening, based on each patient’s risk profile, instead of a fixed screening interval for all. This can ensure that the right person receives the right treatment at the right time – truly personalized medicine.

 

The RetinaRisk algorithm was developed following extensive international research on risk factors known to affect the progression of diabetic retinopathy, such as the type and duration of diabetes, gender, blood pressure and HbA1c levels, as well as a diagnosis of retinopathy. Clinical validation in over 20.000 diabetic patients in five countries has confirmed that the RetinaRisk algorithm can predict the risk of retinopathy progression with a very high precision (ROC curve with AUC over 0.8).

 

We are very pleased to now present a five-year real-life use of RetinaRisk. A recent article in Acta Ophthalmologica describes the use of the RetinaRisk algorithm in a diabetic eye-screening programme in Norway between 2014 and 2019, where screening intervals were individualized, and clinical outcomes, safety and cost-effectiveness documented. The diabetes cohort was divided on a voluntary basis into two groups: one with variable screening intervals based on their personal risk profile and the other group with conventional fixed interval diabetic eye screening.

 

The key findings of this ´real world´ study was that the RetinaRisk algorithm was safe and effective in an ophthalmology clinic´s diabetic screening program. It showed that the use of RetinaRisk reduces the mean frequency of screening visits and liberates valuable time in the ophthalmic practice. This time savings can be used on high-risk diabetic patients or other patient groups, since they otherwise would have been screened at fixed annual visits. RetinaRisk helps to summarize the clinical data for each patient and makes it easier to find the high-risk diabetic patients. These patients can then be screened at shorter intervals.

 

The Norwegian experience demonstrated that patients appreciate the focus on the relevant risk factors and the way that RetinaRisk can visualize the risk profile for each patient. The RetinaRisk app helps to increase the interest and motivate patients to improve their risk profile.

 

Overall, RetinaRisk was found to be a valuable tool for improving the quality and economics of diabetic retinopathy screening. We thank Dr. Estil for sharing his invaluable experience with using the RetinaRisk algorithm and look forward to our continued fruitful collaboration in eliminating preventable diabetic blindness.

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Brainwashed While We Sleep

December 16, 2019 - Silla Jónsdóttir

 

Most of us are very aware of the importance of sleep. We have been told this since we were kids. Some say a good night’s sleep contributes towards longevity. Others claim it improves our memory, spurs creativity, sharpens our attention, improves our athletic performance, and even helps us steer away from depression. Over the years, scientists have gone to great lengths to fully understand the true benefits of sleep. In various studies, they have suggested that sleep plays a critical role in immune function, metabolism, memory, learning, and other vital functions.

 

A recent study from Boston University suggests yet another role sleep may play – that our brains are taking a bath in a watery liquid called cerebrospinal fluid (CSF) while we are in deep, non-REM sleep, cleaning away toxins and waste products. Does this mean that tonight while you sleep, something amazing will happen in your brain? According to the study, blood will flow out of your head when your neurons go quiet, and cerebrospinal fluid will flow in, washing through your brain in rhythmic, pulsing waves. During the day, people apparently have small, gentle waves of CSF that are mainly linked to breathing patterns but when the night falls, the sleep CSF waves turn into tsunamis.

 

This is not the first time that the theory of ‘brainwash’ while we sleep is put forward. In 2013, a study by Maiken Nedergaard and colleagues at the University of Rochester in New York, was published in ‘Science’ about the “first direct experimental evidence at the molecular level” for what could be sleep’s basic purpose: It clears the brain of toxic metabolic byproducts. The study found that CSF flowing into mice brains could carry away amyloid-beta, a sticky protein that accumulates in Alzheimer’s disease. When mice were asleep, more CSF came into their brains, and more amyloid-beta got cleared away, the study suggested.

 

Scientists have long debated the exact reason for humans devoting nearly a third of our lives to sleep, but all seem to agree about its manifold benefits. Sleep is known to play a key role in controlling blood sugar levels and it is believed that sleep disorders can disrupt diabetes control and contribute to type 2 diabetes. Sleep deprivation is an often overlooked but significant risk factor for type 2 diabetes.

 

Sleep disordered can upset blood glucose levels, and erratic blood glucose levels can disrupt sleep leading to a vicious cycle. Fortunately, if sleep deprivation lasts only a few days, these effects can be reversed—and insulin levels can improve—with as little as two full nights of sleep (nearly 10 hours per night). In the long run, it’s best to try to get seven to nine hours of uninterrupted sleep on a nightly basis so you can feel and function optimally and reduce your risk of developing type 2 diabetes and other health problems. And don’t forget, your brain gets a good wash at the same time!

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A Selfie of Your Retina? India Shows It Can Be Done

December 9, 2019 - Ray Snider

 

According to a recent article in the Indian National Medical Journal, India is the diabetic capital of the world, and diabetes mellitus is an enormous burden on healthcare resources there. Diabetic retinopathy (DR) is a serious complication of the disease and the leading cause of blindness in the global working age population. Every person living with diabetes should go for a regular eye screening as DR can be prevented in 95% of the cases with early detection and timely treatment.

 

The currently available methods of screening for DR depend on the availability of healthcare professionals and technology. The high prevalence of diabetes in India, and the need to repeatedly screen such patients for DR and treat them, presents an enormous economic and logistical burden.

 

But all is not gloom.  There are promising trends in imaging for DR screening and emerging technologies that show potential for improving upon current screening approaches. While most screening programs employ mydriatic or non-mydriatic color fundus photography and trained image graders to identify referable DR, new imaging modalities offer significant improvements in diagnostic accuracy, throughput, and affordability. As we covered in a previous blog, smartphone-based fundus photography, macular optical coherence tomography, ultrawide-field imaging, and artificial intelligence-based image reading will come into play as DR becomes more prevalent.

 

India is setting the stage for even more progress in this field. The  Sharma Lotus Eye Hospital and Institute in Tamilnadu has led in the development  of an inexpensive smartphone-based fundus camera device (MII Ret Cam) for screening for DR.  It’s a device that has slots to fit a smartphone (built-in camera and flash) and a 20-D lens. With the help of the device and an innovative imaging technique, high-quality fundus images have been captured. The MII Ret Cam overcomes multiple shortcomings of existing fundus cameras, including the possibility to image the peripheral retina, reducing cost and increasing portability.

 

Few months ago, the Indian National Medical Journal reported on the concept of screening for DR with ‘selfie retinal imaging’ where three patients captured retinal images themselves and transferred to a grading centre for further deliberation. A ́selfie of the retina´ could in the future obviate the need for trained healthcare professionals in screening for DR as images could be captured by the patients, stored and transferred to a grading facility for interpretation and treatment advice. Follow-ups could be scheduled without expensive travel and emergencies could be dealt with in a timely manner. With the ever increasing penetration of smartphones worldwide and rapid evolution in smartphone technology, photography and app-based platforms, it is likely that ́selfies of the retina´ can be hugely beneficial in preventing loss of vision due to diabetes.

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