Digital health support for prediabetic community

In 2020, the Health Ministry stated that approximately one in five Malaysian adults has diabetes. A survey conducted that year revealed that an estimated 3.9 million Malaysians aged 18 and above are suffering from the disease. Diabetes is a major concern in the country, with seven million Malaysians projected to have the disease by 2025.

There is an urgent need to provide support to the high-risk community (prediabetes) to prevent the development of diabetes. Studies have shown that digital health can augment the implementation of lifestyle modification/diabetes prevention program. With this in mind, Dr Chong Chun Wie from the School of Pharmacy has partnered with scientists across different schools within Monash University Malaysia and experts from Monash University Australia and industrial partners, Caring Pharmacy and Bionime (Malaysia) Sdn. Bhd. to address the disparity in the burden of type 2 diabetes mellitus (T2DM) in Malaysia.

The project "Addressing disparity in diabetes prevention through Digital health supported PRe-diabetes Intervention, Management and Evaluation (PRIME) program based in Malaysian community pharmacies" will target prediabetic individuals with a high risk of progressing into diabetes. The project is aligned with the "Digitally Enabled Care Models of the Future" and partially addresses the "Cardiovascular Health and Wellbeing" under the Monash NEED initiative. Additionally, the project also contributes to Monash's research priorities under the "non-communicable diseases and population genomics in Asia" cluster.

"Participants will be introduced to a specially designed lifestyle modification program, managed by pharmacists at the community setting. They will also be monitored (e.g. biomarkers and physical activities) and engaged using a combination of internet of things (IoT) devices and mobile apps. The program is designed to allow remote consultation, self-monitoring, real-time intervention and help alleviate the load off highly congested government healthcare facilities," Dr Chong shared.

Getting the public to look after their own health can be challenging. The team will focus on combining digital health technology with pharmacist engagement. As such, pharmacist engagement will form an integral part of the project, serving to provide coaching, interaction, and motivation to the participants. The data obtained from the digital health devices will help the team understand the prediabetics' behaviour and improve the practicality of the lifestyle program. The project will also evaluate the program's cost-effectiveness from the perspective of the government and to understand the overall healthcare cost saving from early diabetes intervention.

The study will be the first community pharmacy-based prediabetes intervention program in Malaysia. Currently, diabetes intervention programs such as Diabetes Medication Therapy Adherence Clinic (DMTAC) are restricted to selected healthcare facilities under the Ministry of Health. Although some success was seen, the uptake is limited due to the need for in-person consultation during working hours, challenging especially for the urban poor. There is also a lack of real-time monitoring and reminder systems to ensure the patients' adherence.

"In our study, we plan to leverage the spatial coverage of community pharmacy for patient recruitment. IoT devices will be used for real-time monitoring of the patients, which precludes a frequent in-person visit. Further, counselling and advice will be provided by trained pharmacists. We believe that this may be developed into a full-scale private driven program that may reduce the burden of the public healthcare system," Dr Chong stated.

Caring Pharmacy will arrange a special health promotion program to recruit prediabetes subjects. The pharmacy will also prepare its pharmacists' to implement the lifestyle intervention program. Separately, Bionime (Malaysia) Sdn. Bhd. will sponsor glucose strips and share their mobile app development and data analysis expertise. The two companies' commitment reflects a vital interest of the industries to work together with academic institutions to address health issues.

"We will develop software meant to monitor blood glucose reading into smartwatches and pass them on to participants for free. This way, we will be able to give consultations via the mobile apps when needed," Dr Chong said, adding that participants will be monitored for six months. Once the monitoring period is over, the team will continue to check on the participants for another six months to understand their living habits and changes they have made to control their blood glucose levels.

The team aims to share their study results with various stakeholders, including the public, relevant government agencies and industrial players through outreach programs and forums.

"We hope that this will facilitate a public-private collaboration to reduce the burden of diabetes in Malaysia," Dr Chong said.

The project was scheduled to start in March this year. However, due to the pandemic and Movement Control Order, the team hopes to implement the plan as soon as they are able to.

Dr Chong is currently involved in studying the gut microbiome of Type 2 diabetes mellitus patients in Malaysia. The earlier study will provide some insight into the design of the diet recommendation of the lifestyle program. Separately, he hopes his experience in multivariate statistical analyses will help identify the trend and potentially develop a predictive model for the progression to diabetes from prediabetes.