Durreesamin Journal (ISSN: 2204-9827)

October Vol 3 Issue 2, Year 2017

The role of a diabetic system (ds) in the management of insulin-

dependent type 1 and type 2 diabetes mellitus, a review
Saad Masood Butt
Computer Science Department
Atlantic International University, USA
drsaad.butt@ieee.org
saadmasoodbutt444@gmail.com

Brunilda Subashi
Research Center for Scientific Research
Universiteti "Ismail Qemali" Vlore
brunasubashi@gmail.com

Zahra Gheidar
Psychometric
Behavioural research ce ter- Shahid Beheshti University
Gheidar@sunir.com

Abstract:
Two main types of diabetes are identified one is Type or TIDM and the other one is T2DM. TIDM
appears when body does not produce sufficient insulin while T2DM happens when body cells are
unable to utilize insulin for cell functioning. 1DM is also called as adult onset diabetes mellitus
and usually appears amongst teenagers. People who suffer from this have to take Insulin for the
whole of their life. In addition to this they also have to monitor their blood sugar levels and take
up effective exercise programs. In this paper we did literature study on how diabetic system (ds)
can help T1DM and T2DM dependent patients.

Keywords: T1DM, T2DM, Diabetic System, Insulin

Introduction
Diabetes Mellitus is a condition that is caused by inefficiency of Islets of Langerhans the cells that
are involved in production of Insulin. Chances of high blood sugar increase because of lack of
insulin production. Second condition can be inability of body cells to utilize insulin and metabolize

Electronic copy available at: https://ssrn.com/abstract=3067344

 Durreesamin Journal (ISSN: 2204-9827)
October Vol 3 Issue 2, Year 2017

glucose. Carbohydrates and starch cannot do enzymatic breakdown because of this body cells do
not get enough energy that is needed by them to continue their function in a normal way. In case
of diabetes the blood has lot of sugar but cells are unable to utilize it because of which optimal
cells functions cannot be facilitated. Effects of this can be observed on body tissues as they fail to
perform their functions properly. Poor control diabetes mellitus can affect vision, cardiac functions
and brain functioning. If diabetes is left untreated for a longer time period it can prove to be fatal
for the patient. Stroke can happen when hemorrhage in brain takes place because of lack of
intracellular adhesion integrity. Almost all cells in the body are affected by diabetes and this calls
for immediate preventive actions. Globally the occurrence of diabetes has increased in the past
decades and patients of this disease can be found in all countries and amongst all nationalities.
Two main types of diabetes are identified one is Type or TIDM and the other one is T2DM. TIDM
appears when body does not produce sufficient insulin while T2DM happens when body cells are
unable to utilize insulin for cell functioning. 1DM is also called as adult onset diabetes mellitus
and usually appears amongst teenagers. People who suffer from this have to take Insulin for the
whole of their life. In addition to this they also have to monitor their blood sugar levels and take
up effective exercise programs.

Literature Study
There is a need to maintain balance between diet and exercise in order to sustain health in case of
diabetes. A list of do’s and don’ts is given to the patient of diabetes and he has to stick to specific
food and exercise regime in order to stay healthy. Food restrictions are also advised by friends and
family because of which the patient becomes unable to enjoy his life. In most of the cases these
restrictions are incorrect and relate to myths or past life experiences. Poor diet and lack of physical
activity can be managed with professional advice. However getting this advice all day long means
a care provider should be allocated to the patient who can assess consumption of sugar and create
link between disease and diet. Such health regime is quite challenge. Moreover, when patients are
asked to count their calories and link their sugar level with diet then they are not always correct.
They also take food from outside because of which it is difficult for them to count the amount of
calories in food.
Now information technology has opened new opportunities for these patients. Growth in mobile
devices and related technology has given rise to the chances of improved communication in the

Electronic copy available at: https://ssrn.com/abstract=3067344

 Durreesamin Journal (ISSN: 2204-9827)
October Vol 3 Issue 2, Year 2017

field of healthcare. Patients can now get a chance to improve their eating habits by communicating
their healthcare provider through social channels and also by networking with their friends. Mobile
health support system can store data and send it to the physician. In addition to this, social
networking groups can also bring a lot of behavioral changes amongst patients. Technical
problems can also be managed thorough this system and socio-technical principles can be designed
that can help improve usability of the system.
A number of diabetes management applications are available but their functionality is required to
be checked before application. This needs patients and physician support as well. They must
become part of the system development so the application can be made according to their needs.
The usability of diabetes apps through mobile devices for patients who are above 45 years of age
is also good. These people mainly try to find apps that offer a small range of function and can pose
less difficulty in usage.
Statistics presented by American Diabetic Association have shown that the overall number of
dietetic patients is increasing. Many people are at pre-diabetes stage and some of them remain
undiagnosed for a longer time period.

Source: American diabetes association (ADA) 2012

Prevalence of diabetes in 2013 was recorded to be high out of total population of the US 29.1
million people in America are having this health problem. This constitutes 9.3 percent of the total
population of this country. This includes children as well. 1.25 million Adult and children are
living their lives with type I diabetes. There are many cases they remain undiagnosed. Data has
shown that out of 29.1 million Americans approximately 8.1 million remained undiagnosed and
 Durreesamin Journal (ISSN: 2204-9827)
October Vol 3 Issue 2, Year 2017

only 21 million were diagnosed properly. Prevalence of diabetes in senior citizen is more.
Americans who are above age 65 years constitute 25.9 percent of the total cases. Every year 11.8
million Americans are being diagnoses and new cases are merging. 1.4 million new cases are
reported annually. Per-diabetes is also reported amongst 86 million Americans and they are of age
20 years or older. In 2010, 79 million patients at pre-diagnoses stage were reported.
According to ADA (2012) diabetes is ranked as seventh leading cause of death in America. About
69,071 patients died of this disease in 2010. Some uncertified deaths would also be present that
have not been reported. Total 234,051 certificates that have listed diabetes as the cause of death in
2010 were reported. 208,000 Americans who are under age 20 are estimated to be diagnosed with
diabetes and this makes 0.25 percent of the total population. In 2008-09 annual incidences of Type
I diabetes amongst youth were 18,346 and with Type II diabetes incidences were reported to be
5,089 amongst youth. High sugar levels are reported because of lack of production of insulin or
inability of body to utilize insulin. In most of the cases, type II diabetes was developed in middle
aged elders but it can appear in youngsters as well.
The economic cost of diabetes a country has to bear is enormous. In the United States total cost of
diagnosed diabetes in 20102 was reported to be $245 and direct meal cost was $176. 69billion.
Millions of USD was lost because of reduced productivity that happens in case of diabetes.
Government has to bear a lot of economic burden. The expenditure of average medical care for the
entire population turn out to be 2.3 times higher than what it would be in absence of this disease.

Information and Communication Technology and glucose self-monitoring:

In different countries of the world the usage of mobile device is increasing. When it comes to
China in 2013 only 1.5 billion users of mobile were recorded in one year. This number grew to 1.5
billion users in 2014. Largest amount of mobile phone users in China are present nowadays and
their number is increasing day by day. Multi-medialization, diversity, popularization and
personalization are some important features that have made mobile phone apps grow faster
globally. This is also the case in diabetes management. Self-management apps of diabetes are
being positively developed all over the world and different regulatory policies are being applied.
In China Biomedical industry Development Plan, Opinions Promoting development plan and
National Strategic Industry Development plan have become popular. Stakeholders are being
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October Vol 3 Issue 2, Year 2017

pushed y policy makers to increase deployment of resources in this area in order to promote the
chances of getting intelligent health information.
World Health Organization has shown through it report on 2014 that prevalence of diabetes
globally is nine percent in adults. In several developed countries diabetes has become fourth largest
diseases that are life threatening. In developing states the number of people having this illness is
growing faster. Main reason for disability and low productivity of patients of diabetes is their
inability to maintain a good health. Health complications that arise as a result of diabetes are
sometimes difficult to manage individually because of which serious effects are experienced.
Several clinical studies have demonstrated that when glucose levels are kept in suitable limits of
health the chances of development of serious complications in diabetes become low. However,
this needs continuous monitoring of glucose levels. Self-monitoring is essential because a
caregiver cannot made available day and night. This self-monitoring is the best way to help
maintain levels of blood glucose. Self-monitoring blood glucose apps or SMBG apps are supposed
to be highly effective for patients as they can help in comprehensive management of this disease.
Patients should practice SMBG but there are chances that it can affect the decision of physician
and if not measured properly then wrong glucose level prediction can prove to be life threatening.
SMBG self-monitoring system of technology is useful as patients can manage it in home. Patients
record their data, save it and then transmit it to the healthcare provider in order to get their checkup
online.
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October Vol 3 Issue 2, Year 2017

With the help of this system patients are able to monitor their glucose with the help of a gateway
device that includes a measuring system. A remote server and mobile phone is used in order to
record health related data. Continuous glucose monitoring and blood glucose monitoring are some
common devices used for this purpose. Personal health record is present in the remote server.
Connectivity is established between measured instruments and health gateway and instructions
from the service provider are received. These instructions come to the patient with the help of a
downlink. This is the best device that can help physician and patient to access their record anytime.
Certain data driven strategies are included in the system and external partners such as HIS or
hospital information system and social networking sites are included. This system is being widely
adopted by the designer in the US and UK as well. Management of other diseases along with
diabetes is also being done is developed countries through such apps. Such systems can easily help
patient to maintain life style changes. This also helps in declining the reliance of patients over
doctors and service providers. Healthcare practitioners can get patient’s information anytime.
Economic outcomes are also being appreciated and along with that adoption is also increasing
because of the clinical effectiveness of the system. The efficacy of mobile powered SMBG system
has been highlighted by some other studies as well.
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October Vol 3 Issue 2, Year 2017

Fast growing development in physical activity monitoring help track calories, walking distance,
steps a person takes and fat burnt in this process. Sleep cycle can also be tracked only with a little
effort. The physical monitoring devices can connect to Smartphone, personnel computer and tablet
with the help of Bluetooth. The progress of the patient can also be tracked by family members and
friends through the mobile devices. Friends group can also be created to motivate life activity
changes and social activity support is also gathered (Tran et al., 2012).

Some people do not like to wear bulky devices when they are at work or outside for recreation.
For them choice of small devices is also present. Even these have powerful activity monitors in
them. Most of them are made from light material such as aluminum and can be fitted with body
parts like band clip or necklace. People can wear monitor anytime so the activity level can be easily
recorded. Tracking of activity can also be done under water and Smartphone can be used to
synchronize its data. GPS receivers are installed in some cases in order to find if the person is on
outdoor activity. Measuring of acceleration is done with the help of vibration identification. Other
hardware that are used in them are Bluetooth, MP3 players and Wifi radio. With the help of these
features the need for carrying out multiple devices reduces and everyday activities can be made
simpler.

Another related app is diabetes and B.P health tracker app shown in the figure below.

Diabetes and BP health tracker is an app that involves sugar logbook. It is flexible and fast that
has spreadsheet and web report generation capacity. It can save email and data with ease. Full
customization, easy track and labor values that can be recorded by the physician. This app is known
to be more multidimensional. It is not just a diabetes blood sugar tracker instead it can track other
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October Vol 3 Issue 2, Year 2017

categories too including food, supplement, blood pressure, body metrics, glucose, medicine, lab
report and temperature. It is highly individualized form, of data recording app that can help patient
live a balanced life. All the user has to do is setup terms and go in the live menu to use counter
widget. It has a unique intuitive streamline data input system that can pick up categories from the
main menu. Colorful icon can help elderly users choose the right option. Entry log is useful in
getting updates about the useful data and the user can adapt to the app or learn automatically. It
has a calculator in hand that can make patient able to count his calories and number of time he has
taken food. Android chart is given that has fully customized content in it. Extreme value
highlighting, data time, editing and infinite scroll support system is present. It has a seamless text
search system and dynamic time layout as well. Users can choose the font size they want and adjust
it according to their preferences. Categories are edited sub-edited and in ranges such as high, low
and extreme values. Automatic conversation data storage is possible that can greatly help.

In addition to above nutrition apps are also present. A lot of progress has been done by
incorporating hardware devices in these apps. More progress is underway that can help merging
powerful devices. In this context, one app that is used include camera phone or photograph food.
Analysis of nutrition content is done by sending food picture to the expert. This becomes helpful
to find whether or not patient is eating meals that fit to his health condition. This app can prove to
be highly effective for patients with diabetes. Other glucose monitoring apps are also emerging
that have gathered a lot of attention in previous years. Patients do not need to go and check their
blood sugar levels write the results and send it to their physicians. Small size blood glucose
monitors are present that come in different versions including 3G, 4G and 4S and I-pod. They are
compatible with I-phones and other devices. Through them seamless and discrete daily life can be
passed without sacrificing safety. Data is displayed on the phone that is attached to it. These
devices are of a USB size and their data is displayed on the phone screen to which they are
connected. Maps graph, data, exercise and other activities can be recorded. There are devices that
can even integrate this data to the medical record of the patient so they can reach to the healthcare
provider and he can check them on regular basis. Evaluation of such patients can be done.
Continuous glucometer is becoming famous for this feature. It helps a person stay connected to
physician to get advice about his health fluctuations.

Shah et al. (2015) writes adherence, feasibility and satisfaction with self-management activities of
diabetes devices are discussed in many studies but reaching to a solid conclusion still needs a lot
of research. The degree of compliance to particular self management devices is necessary to be
analyzed. In addition to this, it must be seen how these interventions are helping patients improve
their lifestyle. In most of the cases healthcare providers and their patients are satisfied with the
level of monitoring they achieve through self care devices but appropriate use of technology,
adherence to the protocol and getting regular feedback is important. Usability of devices affects
adherence and sometimes encouragement, support and regulatory measures are needed to assure
appropriate monitoring.
 Durreesamin Journal (ISSN: 2204-9827)
October Vol 3 Issue 2, Year 2017

Latest mobile devices such as Smartphone have become some most powerful inventions in recent
years. They have a tendency to collect, store and share data wirelessly and hence they can be said
to maintain promise for new ways of managing chronic illnesses such as diabetes and blood
pressure. The ultimate purpose of the use of these mobile devices is to induce change in the
behavior of patients and bring improvement in his health outcomes. Healthcare cost is also reduced
with such initiatives. The value of such devices is increasing and they are supposed to reduce the
number of visits a patient has to make to a medical practitioner. Effortless gathering of patient data
can also be done with the help of thee apps. Less time and energy is wasted and focus is maintained
on the care of patient. Health coach and physicians monitor changes in patient’s health condition
and advise them accordingly.

Ristau et al. (2013) write that traditional manual input deployment can produce negative impact
over the usability of the system. They present barriers to the process of integration when
connectivity measuring instruments are not present. Traditional mindset of domestic app
developers has also effected the growth and development. In most of the cases, these people
completely focus on device centric system. They maintain app centric thinking and forget the
nature of the user who has to use the kit. In order to leverage the process it is important to automate
the process through simplification. Apple i-phone work on this principle of automation and
simplification,. Consequently its devices are considered as user friendly. Market players only adopt
functionalities that fit the domains the user.

Healthcare app developed need to work on specific agenda that can help them enhance the usability
of mobile applications. Technological adaption should be done in a way that can help keeping
track of the goals and facilitate social shared as shown in the above figure.

Fitness and nutrition tracker app for diabetes self-care are managed with the help of fluid trackers.
Glucose monitors are connected to this app wirelessly and other GPS activity trackers are also
brought in place. Weight scales, blood pressure monitors and activity trackers are attached to it.
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October Vol 3 Issue 2, Year 2017

Data is connected through different devices and apps and is brought to a central hub. This central
hub presents healthcare provider a complete picture of the status of patient. Other systems present
more complete mobile devices that give online education for patient’s self-care. The ultimate
purpose of this system is to get patient linked with the system and make them able to take
advantages of ongoing diabetes care programs. These patients come to know about the lifestyle
choices that can make them healthy. Studies have also revealed that people who use such systems
and devices are in a better position to adopt lifestyle that is helpful for them. Average blood glucose
level of these patients is lower than those who are involved in achieving usual care.

Mobile AR application technique is now focusing on other aspects of the research in order to create
system that can help generate user interaction. Research focus from technical to interactive form
is taking place. In this context AR technology is becoming popular the purpose of which is to
create integration with user environment. Computer generates images are produced in 2D and 3D
forms and video overlap with real time is done. Webcam mobile phone camera sensors are also
used so the user can have experience of real-time interaction. This phenomenon is being used in
medicine, food and human computer interaction. It undertakes research on everyday activities.
Human-food interaction is further being done and significant improvement is expected in years to
come that will also aid in eating and cooking food in a sustainable environment.

Conclusion

Fast growing development in diabetic application and system can help T1DM and T2DM patients.
In several developed countries diabetes has become fourth largest diseases that are life threatening.
In developing states the number of people having this illness is growing faster. Main reason for
disability and low productivity of patients of diabetes is their inability to maintain a good health.
 Durreesamin Journal (ISSN: 2204-9827)
October Vol 3 Issue 2, Year 2017

Latest mobile devices such as Smartphone have become some most powerful inventions in recent
years. They have a tendency to collect, store and share data wirelessly and hence they can be said
to maintain promise for new ways of managing chronic illnesses such as diabetes and blood
pressure. The ultimate purpose of the use of these mobile devices is to induce change in the
behavior of patients and bring improvement in his health outcomes

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About the Author

Dr. Saad Masood Butt had a Bachelor’s Degree in Software Engineering and
Master of Science in Software Engineering from Bahira University, Pakistan.
His Doctorate of Philosophy in Computer Science from (Atlantic International
University, USA) in Human Computer Interaction focusing on Health
Informatics.

Email: saadmasoodbutt444@gmail.com