Diabetes and Technology, a new battle cry

More than 420 million people worldwide suffer from diabetes. In the US, we have over 30 million with the CDC projecting that by 2050, 1 in 3 Americans will likely have diabetes. All of us know someone who has diabetes. Currently we spend over $ 245 billion annually on the cost of diagnosed diabetes. By some estimates, 50% of the US population might be currently diabetic or pre-diabetic, but many don’t know it. It is fair to say that unless we do something, this disease will reach epidemic proportions in short order.

How is technology impacting the diagnosis, management, treatment and cures for diabetes?

Some of what technology is bringing to bear is truly astounding and game-changing. From genetic software engineering and mapping, to bioinformatics, biotechnology, mobile technologies, wearables and devices in the new “Internet of Things” – a myriad of technology vectors is primed for an attack on diabetes.

Diabetes management with technology

Advances in wearables and mobile technology have made real time self-management tools possible. These devices take readings, capture data, and communicate with medical providers.

Dr. Deng, a UVA graduate who now works in Taiwan, has developed a diabetes management app called Health2Sync that allows patients to download data from their glucometers to a phone and then generates graphs for monitoring glucose levels and even helps analyze blood pressure, food, exercise and insulin injections. He has received millions in funding from Alibaba, China’s largest e-commerce company.

Deng believes that technology and data management plays a key role in solutions for diabetes.

Other mobile solutions include one from Medtronic that also supports patient data connectivity through a Samsung S Health Mobile app. Similarly, WellDoc has an FDA approved product that requires a prescription but allows integration with Samsung and provides data and coaching to people with Type 2 diabetes.

Some radical new developments

Google has a plan to develop smart lenses that when worn, can continuously monitor glucose levels and transmit this information via companion software on a smart phone. Engineers at the University of Washington have recently developed a new technology called “interscatter communication” to allow contact lenses, or even brain implants, to send signals to the phone. Expect Apple and others to produce more apps and tools for monitoring and managing diabetes as well.

Unmanaged hyperglycemic episodes are dangerous, especially while driving. Ford and Medtronic have teamed up to deploy a Bluetooth enabled monitor in the car that can keep the driver informed about glucose levels and prevent chances of a driver blacking out.

Another interesting invention is the flexible skin tattoo that checks glucose levels in the skin and delivers the drug as needed.

Game changing strategies

The development of an artificial pancreas is now a reality. Recently, 16 British women with Type 1 diabetes were provided an artificial pancreas during their pregnancy (a high risk complication for a diabetic) as part of a Cambridge University trial. Each recipient successfully gave birth to a healthy infant. They are the first to use the device which regulates insulin and is controlled from a mobile device.

The next step, which is not too far away, is the delivery of drugs powered by implantable nano-systems. The idea is to use nanoparticles with magnetic cores circulating in the bloodstream with recognition molecules to detect disease. One researcher has been able to cure Type 1 diabetes with such nanobots.

MIT spinoff Microchips Biotech has partnered with Teva Pharmaceuticals to commercialize a wireless, microchip based device that stores and releases drugs to treat diabetes.

One of the challenges has been to deliver treatments for diabetes in areas with poor supply chains. In July 2016, MIT researchers with DARPA funding announced that they have developed a portable device to manufacture and produce individual treatment doses for a wide range of treatments, including diabetes.

Researchers at the University of Texas have designed an affordable “electronic nose” used for detecting chemical molecules in breath. This can be useful for Type 1 diabetes patients who have high concentrations of acetone in their breath.

Genetic clues to the disease are under aggressive investigation. 23andme, a company with a treasure trove of 450,000 customer’s DNA, is providing access to researchers at the drug companies like Pfizer, Genentech and others. Another group of 300 scientists in 22 countries are looking at data on 100,000 patients to understand the genetics roots of diabetes. The study was posted in Nature in July 2016. NIH’s Collins has suggested that this “big data” strategy has already yielded important new insights and genetic clues into diabetes treatment.

At Johns Hopkins, after a decade of work, they have developed a unique computer program that looks at mutations that cause diabetes and is key in advancing treatments for the disease.

Engineers at Oregon State University have used additive manufacturing to create an improved type of 3-D printed glucose sensor for patients with Type 1 diabetes, part of a system that should work better, cost less, and be more comfortable for the patient. The technology would create an “artificial pancreas” using a single point of bodily entry, or catheter, replacing existing systems, which require four entry points, usually packaged in a belt worn around the waist, according to Greg Herman, an OSU associate professor of chemical engineering. “This technology and other work that could evolve from it should improve a patient’s health, comfort and diabetes management,” said Herman.

The Joslin Diabetes Center was able to turn off the fat insulin receptor gene that tells your body to hold on to every calorie in the fat cells. That was a useful function 10,000 years ago when we did not know when we would get our next meal, but obviously no more. Today, this receptor becomes important for an epidemic of obesity, diabetes and heart disease. At the Center, they have been able to turn this function “off” in animals, who are able to eat ravenously and yet remain slim and even lived 20% longer.

The biggest of the “big data” processors, IBM Watson (of Jeopardy fame) is also playing a role to identify susceptible, potential patients. IBM research is building a “cognitive assistant” that uses artificial intelligence and advanced multi-media capabilities to detect disease. In June 2016, IBM announced they envision an online tool specific for early detection among demographics at risk of eye problems common for diabetic or even pre-diabetic patients.

Technologists are also finding untapped data sources. MIT researchers are sending Mario and Luigi, two sewer robots to inspect waste and collect data on city residents. They hope to use data to help map health, including diabetes, in different city sections to inform health policy. The EPA has suggested that this is a “pioneering” effort and if successful, represents a “seminal advancement in the prospects for monitoring public health in real time”.

Maximizing the capacity of the phones that we automatically attach to ourselves is an obvious avenue, but some applications can be truly unexpected. According to a recent study from the University of Leicester even Pokémon GO diabetic users benefit from the increased physical exercise involved with playing the game. Playing Pokémon GO as a diabetes management recommendation? The times are truly changing.

A new era in combating diabetes using technology is upon us. For those that suffer from this malady, better management is already here. But for those that are diabetic, know someone who is, or others who may be afflicted, a new era, driven by exponential technology solutions holds the promise of radically altering the landscape for beating the disease before it reaches truly epidemic proportions.

Are you ready for Coach IBM Watson

Rapid changes in technology may be leading to some “Wild and Cwazy” new professions and changes. It is not out of the realm of possibility that you might encounter some or all of these in the future.

Coach “Watson”: The new NFL season is upon us. Starting this year, NFL players will have RFID chips embedded in their shoulder pads. These will provide a wealth of data on every player’s movement on the field. To consume and use this information, enter Coach IBM Watson. Imagine if your team’s coach knew every formation, every players’ strengths and weaknesses, the impact of the partisan 12th man, the weather conditions – and then called the best plays! IBM’s Watson may indeed be able to do that. There is a Coach Watson for hire in our future. This is not one that the puritans will like.
Data Hostage Negotiators: With the exponential growth of enterprise and personal data – and the hacks and leaks we hear about every day, a new breed of negotiator may be emerging. A Data Hostage Negotiator will assist you in retrieving your data back from those who are holding it for ransom. You may even have Data Integrity Specialists whose job it is to determine if someone has altered your data, the newest threat vector in the information security space. Since cyber-crime is not likely to go away anytime soon, these jobs might be in high demand.
Skyways Controller: With the inevitable proliferation of drones andskycars (cars that fly and drive like the Terrafugia shown below), we will need a different kind of controller, one who helps manage the lower skies (the middle skies being for planes and higher skies for spacecraft). Someone better take charge before we are all under threat of falling objects from the sky.
Uber Fleet Commander: The scenario here goes like this: Uber will soon have self-driving cars and these will deliver passengers, groceries, laundry and anything else that needs transporting (perhaps including Amazon and UPS packages?) A Fleet Commander is in charge of making the best utilization of those vehicles and making sure you or your merchandise is delivered on time.
Robot Personality Designers: As robots invade our professional and private spaces and take on more of our workloads, we are likely to get a little picky about the personalities of these assistants. Personality Designers would ensure a robot is suitably aligned with appropriate personality and cultural adaptation for its environment. Not just diction and accents, but humor, response rate, interpretive latitude, even visual integration. Want to change your robot’s personality? That may require another visit to the RPD (Robot Personality Designer).
Robtors or Robotic Actors: Robtors have no egos, don’t demand high salaries, work as long as you want them to, do their own stunts, don’t throw temper tantrums, memorize their lines instantly – and never even need a bathroom break! Add in the proper robot personality designer, pepper with a million facts beyond any method actor’s capacity to intake in role research – and voila, a Robtor is born. Did we care if the tall purple-people in Avatarwere humans or not? I predict the era of a superstar Robtor is around the corner.
Smart Fabric Designers: As fabrics are embedded with electronics and getsmart, we are likely to need a new kind of designer-engineer, one who will be able to re-imagine the use of clothes, shoes, hats etc. ‘Wardrobe malfunctions’ could evolve beyond our current conception. Beyonce, Niki Minaj and others are already planning tours with smart clothes. I would like my shoes to have embedded GPS maps so that I know where to go. Just kidding, but not by much. How about self-coordinating clothes, socks, shoes etc. “Computer, I want to wear what Matt Lauer is wearing this morning!
Custom Implant Organ Designers and Gene programmers: Each day in the US, 21 people die waiting for transplants that can’t take place because of a shortage of donated organs. Many potential recipients succumb before the right match can be found. The creation of organs outside the body, using 3D printing of tissues, creates a need for a new genre of experts to custom design an organ with the right gene sequencing for implantation.
Weather-Crafters: With far better knowledge and understanding of how weather works, we should at some point be able to customize weather in small areas, whether that is more rain on a farmer’s farm or clear weather at Wimbledon during the tennis tournament (and we are not talking about a roof). Someone will have to be able to work the computations and create the modelling and delivery of such localized weather. “I would like to order dry and sunny for my golf this weekend”.
Robo-Authors: This is not about obituary writing. That has already been automated, as are an increasing number of news reports that we think are written by human correspondents. No, here we are talking about a Robo-Author who will pen the first New York Times bestseller. Personalized books are next. I would like Budapest Hotel with a dash of James Bond.

Why we need technology timeouts?

Manoj Saxena is a man heavily immersed in technology. For many years he ran IBM’s famed Watson project. Today he is a successful venture capitalist and seeds many more technology companies encompassing the next wave of technology and innovation.

So, why then is he advocating that in the tech companies he now runs, staff have mandatory unplug days? A technologist preaching technology time outs? Blasphemous!

On the face of it, this may appear strange. But it is really not. In fact, it appears surprisingly well thought out. On predetermined holidays/dates his companies go into electronic silence. No emails, no texts, not even phone calls for work. Just time to relax, rejuvenate and reconnect with family and friends. Manoj postulates we – all of us – are rapidly approaching an electronic saturation point. Like others, he believes that the always-on and connected mantra is no longer the panacea it may have appeared to be. It is taking a toll. He wants to go even further and extend the technology moratorium to at least one of the weekend days, if not both.

This sentiment is shared with many other technologists including none other than Steve Jobs. Steve was apparently a self-described “low-tech” parent who restricted his own kids’ access to technology for some of the same reasons. In fact Jobs had such strong reservations about allowing his kids unfettered and perpetual access to technology that he confessed that his wife and kids accused him of being a fascist! The man who may have single-handedly brought touchscreens into our lives, had serious concerns about the long-term effects of engaging in touchscreen technology for extended periods of time. According to Walter Isaacson who spent many hours in the Job’s household while writing his book, face-to-face family time came before any screen time. No iPads were permitted at the dining table.

The always connected life-style takes many tolls – from cost to productivity to creativity. Every economics student knows that switching involves cost. Today, when multi-tasking with technology has become a virtual epidemic, why would we think it has no adverse effect?

Erica Fox, the best-selling author and Harvard professor recently wrote an excellent piece titled “Is Never Offline, good for business and life?” where she was reacting to the recent Time Magazine cover “Never offline”. She rightly points out that those who are never offline spend too much time reacting and not enough solving problems. They make decisions in a “frenzied and buzzing state of mind”. They are also becoming less and less familiar with focused attentive work and face-to-face relationships.

In a landmark report, Gloria Mack of the University of California at Irvine, found that typically a person in an office experiences a paltry 11 minutes before an interruption. And it then takes an average of 25 minutes before that person can return to the original task! What is the quality of work with such rapid and incessant switching generally driven by technology?

New research from the Carnegie Mellon University’s Human-Computer Interaction Lab shows that if you try to do two things at the same time, both things suffer! They found that the distraction of an interruption turned test takers in their lab to become on average of 20 percent dumber. It was enough to turn a B-minus student (80 percent) into a failure (62 percent).

According to Stanford sociologist, Clifford Nass,who conducted some of the first tests into the effects of multi-tasking, those who cannot resist doing two things at the same time are “suckers for irrelevancy”. Apparently, we are not just suckers for that new text message or email, but it is actually making us stupid.

All this should concern organizations of every type. According to the WSJ, distractions cost companies money. One survey in 2011 found that businesses might be losing as much as $ 10,000 per employee every year due to distractions and poorly designed technology. Many among us answer every instant message, email or text at the very moment it arrives. And yet, how many companies have programs where employees are being counselled on the impact of multi-tasking and its effect on the company’s bottom line? Or how to manage the multiple avenues for interruption we all face in any office today?

In a recent book just released this September, “The Organized Mind”, Daniel Levitin (a professor of psychology at McGill University) explores many facets of our lives under the stress of information overload and multi-tasking. According to Prof. Levitin, multi-tasking puts us into a dopamine-addiction loop which is similar to cocaine addiction. Each time we do a new small task, our brains reward us with a tiny shot of dopamine, which is the chemical in our brains responsible for pleasure. He quotes a famous study in the 1950s where rats were given the opportunity to press a bar to get a shot of dopamine. Soon they were pressing the bar to the exclusion of everything including eating, drinking, sleeping and even sex! They died of starvation and dehydration. Levitin strongly suggests that we spend time away from our devices otherwise it will become like any other addiction.

So should we all abandon our devices? Not exactly.

According to Marshall Van Alstyne, an associate professor at Boston University and MIT, be very cautious about technologies like social media and those which interrupt you constantly, because that interruption dramatically reduces productivity. The solution, according to him, is to batch time and tasks. So, rather than checking your email every time the notification appears – turn the notification off, and check email once every hour or couple of hours. Don’t interrupt your research paper or memo every time the phone dings and informs you that someone has sent you a text. Turn the ding off.

Manoj, Steve Jobs (and many other technology luminaries) are right. They were involved with the creation of the technologies which may have resulted in our distracted way of life. Many now recommend we need to adjust, and are calling for technology time-outs and less multi-tasking. They should know. And unlike many of us, some of them are actually doing something about it.