Smart Management of Diabetes

By Hillary Hoppock
January/February 2018

By integrating mobile technology, diagnostics and behavior change science, the Aina device aims to aid the fight against diabetes.

Diabetes is a serious medical condition afflicting over 400 million people worldwide. The World Health Organization reports the global prevalence of diabetes among adults has nearly doubled since 1980, rising from 4.7 percent to 8.5 percent in 2014, with the heaviest burden resting on middle- and lower-income countries. Known as the diabetes capital of the world, India has an estimated 70 million people with diabetes.

Applying mobile technology to the fight against diabetes offers a bright spot in this grim picture. Early detection, medication and lifestyle modifications are key to successfully managing and controlling the disease. The biggest challenges, until recently, were accessible and affordable blood tests, especially for people in remote areas. However, current advances have brought health care to the patients’ fingertips through a mobile glucose monitoring system, which tracks blood glucose and syncs instantly with a smartphone. Developed and produced by Jana Care Inc., the Aina blood monitoring system has become one of the largest chronic disease screening programs in the world.

“Fifty percent of patients with diabetes in the developing world are not diagnosed,” says Sidhant Jena, co-founder and chief executive officer at Jana Care Inc., which is based in Boston, Massachusetts, and has an additional office in Bengaluru. He, along with his Harvard MBA classmate Stephen Chen, recognized the acute need for a low-cost and portable system to diagnose and manage diabetes in the developing world. They applied and received a grant through the U.S.-India Science and Technology Endowment Fund (USISTEF) to develop a mobile diagnostic platform to screen and manage diabetes. The Aina device, Jana Care Inc.’s cost-effective, easy-to-use diagnosis and monitoring system for diabetes, grew out of this grant. The device can be placed in clinics and hospitals or be carried by health workers, going door-to-door in the field.

The U.S. Department of State and the Indian Department of Science and Technology established the U.S.-India Science and Technology Endowment Fund in 2009 to support joint applied research and development, and the commercialization of technology developed through partnerships between U.S. and Indian researchers and entrepreneurs. The fund’s activities are administered through the bi-national Indo-U.S. Science and Technology Forum.

Jana Care Inc. handles research and development at its Boston headquarters and manufactures the Aina device at its facility in Bengaluru. The company partners with large public and private health institutes and medical centers in India as well as with the Massachusetts General Hospital in the United States.

“The current diagnostic systems were expensive, bulky and inadequate for addressing this public health problem,” says Jena. “Considering you are dealing with a population pool in the millions, it was logistically impossible to go to a community, get them to all fast together, go to the clinic in the morning to get a blood glucose test, eat something and wait two more hours before taking a second test. The traditional method was to test for an average glucose level over six to eight weeks versus using mobile technology to test once and, in three minutes, being able to tell the patients whether they have diabetes, prediabetes or that they are free and clear.”

Applying technology-based diagnosis, at a very low cost, to areas that really need it goes a long way in expanding diabetes screening worldwide.

Blood contains biomarkers that indicate disease progression. Jana Care Inc. develops paper-based test strips for these biomarkers. These are then read by smartphones, as they are turned into diagnostic platforms using the Aina device optical reader. Equally important, the software allows field health workers from any location to transmit data to remote specialists for decision support.

Of course, detection is only the first step in helping patients with this condition. The company’s post-diagnosis management program, aptly named Habits, uses smart algorithms to provide patients real-time feedback and insights on glucose variations with diet and physical activity, via their smartphones. It is also a virtual diabetes coach that helps patients reach their diet goals through personalized daily checklists and care plans, which include tips, tasks, lessons and quizzes.

The company took the core curriculum of the Diabetes Prevention Program from the Maryland-based National Institutes of Health, one of the world’s foremost medical research centers, and adapted it in collaboration with academic and medical centers in India. “It’s a lifestyle intervention program, with an emphasis on early intervention. After a pre-diabetes or diabetes diagnosis, the patient gets a text message right away with suggestions for lifestyle changes—eat better, exercise more, etc. The first line of therapy is always behavior, and the idea is to empower patients to self-monitor and take ownership of their treatment,” says Jena.

In 2016, the Aina device was used by over 250 clinics and 1,500 health care workers to screen, diagnose and give treatment to 250,000 patients with diabetes in India. The company projects it will reach double that number in 2018.

The cost of the traditional diabetes test was $15 (approximately Rs. 980) per test in 2011. “Now, an individual test costs about $1 (approximately Rs. 65), no matter whether it’s an Android phone hooked up to the Aina device in a clinic or the Aina mobile device used by a family health worker in a remote region. Applying technology-based diagnosis, at a very low cost, to areas that really need it goes a long way in expanding diabetes screening worldwide,” says Jena.

The major market for the Aina device is India, with a product roll-out in Singapore and a pilot program in Kenya planned for 2018. Michal Depa, co-founder and chief technology officer at Jana Care Inc., expects U.S. Federal Drug Administration approval by mid-2018. Commercializing the Aina device in the United States will enable the company to act on current requests from health care providers and public health organizations to use the product.

Hillary Hoppock is a freelance writer, former newspaper publisher and reporter based in Orinda, California.