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Take a look at a selection of our recent media coverage:

‘Game changer’ wearable technology for type 1 diabetes recommended by NICE

9th November 2023

NICE has recommended the use of ‘game changer’ wearable technology to help patients manage type 1 diabetes. 

Hybrid closed loop systems allow insulin to be delivered automatically to the body, keeping blood glucose at a healthy level. This technology includes a continuous glucose monitor sensor which transmits data to an insulin pump, both of which are worn on the body. 

The final draft guidance published by NICE said hybrid closed loop systems should be offered to people whose current device is not controlling their diabetes.

NICE and NHS England have agreed that this wearable technology will be rolled out over a five-year period in order to allow for trusts to employ the extra staff needed and for specialist training for both patients and staff to be completed.

The technology will be offered first to all children and young people, women who are pregnant or planning a pregnancy, and those who already have an insulin pump. It is also recommended more widely for adults with an average HbA1c reading of 7.5% or more.

The draft guidance on hybrid closed loop systems for managing blood glucose levels in type 1 diabetes, which is due to be published in its final format in December, evaluated clinical trial evidence showing that these systems are ‘more effective than standard care at maintaining blood glucose levels within a healthy range’.

The hybrid closed loop wearable technology allows patients to continue daily life without needing to regularly conduct finger prick testing or insulin injections.

There are around 270,000 people in England and 16,000 people in Wales living with type 1 diabetes, according to NHS data.

Patients will only be able to access this wearable technology with the support of a trained multidisciplinary team experienced in continuous subcutaneous insulin infusion.

Professor Jonathan Benger, chief medical officer at NICE, highlighted the importance of focusing on ensuring best value for money for diabetes technology since the disease takes up around 10% of the NHS budget.

He said: ‘Using hybrid closed loop systems will be a game changer for people with type 1 diabetes. 

‘By ensuring their blood glucose levels are within the recommended range, people are less likely to have complications such as disabling hypoglycaemia, strokes and heart attacks, which lead to costly NHS care. 

‘This technology will improve the health and wellbeing of patients, and save the NHS money in the long term.’

NHS England’s national specialty advisor for diabetes Professor Partha Kar said the NICE recommendation is ‘amazing news’ for people living with type 1 diabetes.

He said: ‘This tech might sound sci-fi like but it will have a dramatic impact on the quality of people’s lives, not to mention outcomes – it is as close to the holy grail of a fully automated system as science can provide at the moment, where people with type 1 diabetes can get on with their lives without worrying about glucose levels or medication.’

Colette Marshall, chief executive of the charity Diabetes UK, said: ‘We’re excited to welcome these recommendations which broaden access to the technology for key groups including children and young people, recognising our comments to the consultation earlier this year.

‘However, funding to roll out this technology to the people that need it is of paramount importance and we reiterate the campaign call we made last month for Government and the NHS to agree this.

‘We’ll also be working with the NHS to help ensure that everyone who could benefit from this technology has access to it as soon as possible in the phased rollout that has been agreed to achieve this.‘

A version of this article was originally published by our sister publication Pulse.

Systematic review finds that cardiac data from smartwatches are potentially less accurate for darker skinned individuals

19th April 2022

A systematic review suggests that cardiac data obtained via a smartwatch is potentially less accurate for those of a darker skin tone

The cardiac data such as heart rate and rhythm obtained from a smartphone watch might not be as accurate for individuals with a darker skin tone. This was the conclusion of a systematic review by researchers from the University of Toronto, Canada, presented at the American College of Cardiology Conference 2022.

Cardiovascular disease is a leading global health issue and associated with an increasingly large economic burden. Technological innovations have become ingrained into everyday life and consumers are beginning to use consumer-grade software, such as smart wearables with numerous sophisticated sensors, to provide health insights

Today, commercial wearables can be used to collect cardiac data through electrocardiography (ECG) or photoplethysmography (PPG) and PPG has become the most popular technique for heart rate measurement.

On the wrist, PPG detects blood flow rates by capturing the light intensity reflected from skin based on LEDs and photodetectors. However, questions have arisen over the accuracy of heart rate monitoring devices based on differences in skin tone.

For example, because PPG detects changes in a beam of green light directed at the skin and since darker skin contains more melanin, it absorbs more green light than lighter skin. Moreover, previous research demonstrated that inaccurate PPG heart rate measurements occur up to 15% more frequently in dark skin as compared to light skin.

In addition, pulse oximeter technology, which is also employed in smartwatches can be less accurate in darker skin as shown in one study, where Black patients had nearly three times the frequency of occult hypoxaemia, that was not detected by pulse oximetry as in White patients.

With smartwatches being used for health monitoring, for the present study, the team undertook a systematic review to determine the accuracy of cardiac data by wrist-worn wearable devices for participants of varying skin tones.

They included studies in which heart rate and rhythm data were stratified according to the participant’s race and/or skin tone, which was measured using the Fitzpatrick score, which ranges from 1 to 6, with higher scores reflecting darker skin.

Cardiac data and skin tone

The literature search identified 10 studies with a total of 469 participants and the frequency-weighted Fitzpatrick score was reported in 6 of these studies, with 293 patients and the overall mean score was 3.5 (i.e., from the range of 1 – 6).

In 40% of studies, the researchers found a significant reduction in accuracy of heart rate measurements with a wearable device in those with darker skin compared to individuals with lighter skin tones and/or the gold standard measurements such as an ECG or a chest strap.

Interestingly, one study found that wearable devices recorded significantly fewer data points for people with darker skin tones, despite no discrepancy in heart rate accuracy. A single study assessed ECG changes and noted a significant reduction in the accuracy of the R-R interval measurements in people with darker skin compared to ECG data (r = 0.98, p < 0.05).

Commenting on these findings, the lead author, Daniel Koerber, said “People need to be aware that there are some limitations for people with darker skin tones when using these devices, and the results should be taken with a grain of salt,” 

He added that “algorithms are often developed in homogeneous white populations, which may lead to results that are not as generalisable as we would like. Ongoing research and development of these devices should emphasise the inclusion of populations of all skin tones so that the developed algorithms can best accommodate for variations in innate skin light absorption.”

Citation
Koerber D et al. The effect of skin tone on accuracy of heart rate measurement in wearable devices: A systematic review. J Am Coll Cardiol 2022

Wearable devices can accurately predict clinical laboratory measurements

1st June 2021

Measurement of vital signs such as temperature, heart rate and the electrical properties of skin with a wearable device can be used to predict clinical laboratory results.

The routine measurement of parameters such as body temperature, heart and respiration rate, although non-specific, are of value in the overall assessment of a patient’s general wellbeing. In addition to the assessment of physical signs, further information can be gathered from laboratory analysis of blood or urine. However, all of these evaluations require that the person attends a clinic appointment. In recent years, the development of wearable technology has enabled the measurement of some vital signs such as heart rate and temperature but there has been limited research into the value of this longitudinally collected data. Nevertheless, it is possible that wearable technology has the potential to provide useful data for managing health conditions. But in order to fully utilise the data captured by wearable devices, it is necessary to determine whether these data are able to accurately mirror the results obtained in a clinic. This was the idea behind a study by a team from the Department of Genetics, Stanford University, US, which set out to determine if the vital signs collected from a wearable device (wVS) could be used as a non-invasive proxy measurement of clinical laboratory data using models of the relationship between wVS and clinical labs.

Findings
A total of 54 participants with a mean age of 56 years (44% male) were monitored for an average of 3.3 years. The wearable device measured heart rate, skin temperature, accelerometery and electrodermal activity (EDA). This latter measurement of the electrical properties of the skin, can assess skin hydration. Using heart rate, the researchers found that the wVS recordings was identical to the clinic-based measurements (both 71 beats per minute). Using machine learning models, the researchers extended their work and observed a high correlation between changes in wVS data and haematocrit, red blood cell count, haemoglobin and platelet count. For example, a higher body temperature and lower levels of movement (as assessed by accelerometery) tended to indicate illness, which matched up with a higher white blood cell count.

Commenting on their findings, the authors suggested that the continuous data collected by a wVS could be used to detect deviations from normal and thus serve as a means of identifying the need for further clinical laboratory evaluation. Although more work needs to be done, these initial results suggest that wearable devices have the potential to assess clinical parameters that, at present, can only be measured in laboratories.

Citation
Dunn J et al. Wearable sensors enable personalised predictions of clinical laboratory measurements. Nat Med 2021

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