BUZUD, Fosun Trade Medical Devices launches two-in-one blood glucose and uric acid tester

Source: BUZUD, Fosun Trade Medical Devices. The Safe AQ UG Blood Glucose and Uric Acid Monitoring System enables uric acid levels as well as blood glucose levels to be tested at home.

BUZUD, Fosun Trade Medical Devices, a manufacturer of medical appliances, has made available BUZUD’s Safe AQ UG Blood Glucose and Uric Acid Monitoring System. This dual function test system enables users to measure blood sugar and uric acid levels conveniently and accurately.*

While testing blood glucose levels can commonly be done at home, the conventional way to test uric acid levels is to send a urine or blood sample for testing to a laboratory. This process is costly and it can take up to three days to receive the results.

Certified by government health ministries in many countries, including Singapore’s Health Sciences Authority (HSA), the BUZUD Safe AQ UG Blood Glucose and Uric Acid Monitoring System uses FAD-GDH (flavin adenine dinucleotide-dependent glucose dehydrogenase) technology, coupled with an anti-interference enzyme layer design. This enables more accurate blood glucose tests based on electrochemical glucose measurements without interference from oxygen, blood, ascorbic acid, and other internal and external interference sources in the blood sample.

“People with high levels of blood sugar and/or uric acid often find it challenging to regularly monitor their blood sugar and uric acid levels as it can be a hassle to test quickly and simply,” said Frankie Fan, founder, CEO and CTO of BUZUD, Fosun Trade Medical Devices.

“BUZUD’s Safe AQ UG Blood Glucose and Uric Acid meter is a new generation of bifunctional monitoring system that offers the convenience of testing both blood glucose and uric acid on a single meter, with results detected within 30 seconds.”

According to the World Health Organization, 422 million people worldwide have diabetes and it is one of the leading causes of death in the world. Effectively managing diabetes would depend on patients acting on the results of their blood glucose tests.

And when the kidneys are unable to eliminate uric acid efficiently, causing high uric acid levels, gout as well as permanent bone, joint and tissue damage, kidney disease, and heart disease can occur. Regularly monitoring of uric acid levels is key to effective uric acid management, said the company. When it comes to gout, some 41.2 million people are estimated to have the illness.

The BUZUD Safe AQ UG Blood Glucose and Uric Acid Monitoring System requires a small blood sample to return results at up to 95% accuracy. A lancet is used to prick a finger and a small sample of blood is applied to the relevant test strips. The blood glucose and/or uric acid test strips are then inserted into the Safe AQ UG blood glucose and uric acid meter, after which blood glucose test results will be shown within 5 seconds and uric acid test results within 25 seconds. The test strips are then ejected safely with a one-click system.

The system stores 200 of the most recent results (100 blood glucose and 100 uric acid test results) with date and time stamps for easy long-term monitoring.

The Monitoring System includes the following:

• Safe AQ UG blood glucose and uric acid meter

• Safe AQ UG blood glucose test strips

• Safe AQ UG uric acid test strips

• Blood glucose control solution

• Uric acid control solution

Details:

The BUZUD Safe AQ UG Blood Glucose and Uric Acid Monitoring System is now available for purchase in Singapore, Australia, China, Europe, and Malaysia.

In Singapore the new system is available online for S$243.96 at the Buzud.Roffe Lazada Store, or physically at the BUZUD retail store at:

585 North Bridge Road #01-02,

Raffles Hospital,

Singapore 188770

+65 6518 9959

www.buzud.com

*The BUZUD Safe AQ UG Blood Glucose and Uric Acid Monitoring System should not be used for the diagnosis of or screening of diabetes and hyperuricemia (HUA).

Smart coach for diabetics aims to raise quality of life in the long term

Source: GlycoLeap website. Couple discussing content on a device.

A 'smart coach' service has been introduced to help people living with type 2 diabetes* to adopt healthier habits that can lead to a better quality of life in the long term. Diabetes, especially if it is not well controlled, can lead to problems such as blindness, kidney complications and nerve damage. It has also been implicated in Alzheimer's disease, which is sometimes called 'type 3 diabetes'.

Healthcare costs associated with diabetes continue to be a major concern worldwide. Diabetes affects more than 415 million people worldwide - a number that grows every year, said Holmusk, a digital health and data analytics company, noting that diabetes-related complications are a major cause of hospitalisation.

According to a 2016 article in the BMC Public Health journal, Singapore's healthcare spending for diabetes rose above S$1 billion in 2010, and is expected to soar beyond S$2.5 billion by 2050. A 2015 study by the International Diabetes Federation (IDF) found that Singapore has the second-highest proportion of people with diabetes among all developed nations - more than 10% of people aged 20 to 79. Three out of every 10 patients with diabetes develop the condition before age 40.

Holmusk points out that the high costs of diabetes - both for the individual and the healthcare system - and the personal nature of diabetes management, presents an opportunity for technologies that can provide scalable and engaging solutions for better diabetes management. The company has an advisory board where two members are medical doctors, and thought leaders in their fields.

"People are most familiar with the traditional model of making clinic appointments, travelling down to the clinic, and seeing the doctor for 15 to 20 minutes every few months. This model, which focuses on the clinic/hospital/doctor, will no longer be sustainable as the burden of chronic diseases rises - we need to move patient care forward, focusing on prevention, and into the patient's homes and community," explained Dr Yau Teng Yan, Chief Medical Officer, Holmusk. Dr Yau practised in primary care for over seven years, managing many patients with chronic diseases in the clinic.

The solution from Holmusk combines human expertise and mobile technology to nudge patients towards healthier habits. Called GlycoLeap, the subscription-based service tracks the user's behaviour with various tools and then delivers coaching advice from human dietitians via a mobile app. Just as a personal coach at a gym can give a person more incentive to stick with a gym programme and reach personal goals, GlycoLeap acts as a lifestyle coach to provide that added push to start and maintain a healthier lifestyle.

"GlycoLeap is transformative for people with diabetes, especially in the way it brings diabetes care out of the clinics and hospitals and into people's everyday lives," said Nawal Roy, CEO and Founder of Holmusk. "We want to contribute towards revolutionising the healthcare experience for people living with chronic disease."

GlycoLeap uses concepts from behavioural science to drive positive health outcomes for people with diabetes. Through small and sustainable lifestyle changes, users can achieve moderate weight loss and improve glucose control (as measured by HbA1c levels in the blood) within six-months of the GlycoLeap programme.

As part of the programme, users take photographs of their meals with the GlycoLeap app for rating by the GlycoLeap team of dietitians. Users are also provided smart devices, including a wireless scale, glucometer and fitness band to track weight, blood glucose and physical activity. This gives the coaching team a 360-degree view of each user's behaviour, allowing them to provide the right feedback and support at the right time on a daily basis.

Dr Yau commented that the GlycoLeap model is based on an outstanding user interface, ease of use and our natural need for human interaction. "Good design is vital. In developing a health intervention for the consumer, it has to look good and more importantly, be intuitive and easy to use. Consumers have high expectations of their apps and they take reference from well-designed apps like Facebook, WhatsApp, and Uber. So if your app doesn’t meet a minimum threshold of good design, no matter how many functions it has, people aren’t going to use it. Our earliest version of the app had a very minimalistic, modern-looking interface, but based on user feedback, we changed it to something a lot more personable and friendly," he said.

The devices in the GlycoLeap system are also designed to be as easy as possible to use. "For example, our wireless weighing scale is synced with your personal account out-of-the-box. Just step on it and your data flows into your account. There is zero setup needed. For those who are not ready or already have their own devices, we also offer them a purely app-based version of the product with the devices, at a lower price," Dr Yau said.

The human connection is also critical in health-related behavioural changes, he added. "We are social creatures at heart, and yearn to interact with other human beings - and not the computer! For us, our users stuck around for a much longer time only after we built in a two-way messaging interface which connected them with a real-life dietitian.

Source: Holmusk. In-app conversation.

"Our dietitians actively reach out to the users and ask questions if they need to clarify something. We see each food photo as an opportunity for highly-personalised health education, and to deepen the relationship with the user. Our goal is not to tell the user exactly how many calories or how many grams of fat they just ate, but rather to reinforce key concepts through direct and timely feedback. This approach opens up a deeper, more honest discussion with our users."

Dr Yau recounted that one user had been eating irregularly and did not like vegetables when she first joined the GlycoLeap programme. "After a little prodding from our health coach through the app, she also shared that she had a poor relationship with her doctor and was fed up that everything she did was ‘wrong’. At the beginning, her meals were full of carbohydrates and low in fibre. But over time, the accountability and the relationship she established with her health coach through our app led her to have a lot more balanced meals and include more vegetables in her diet. She went to her doctor recently, and her HbA1c (a marker of diabetes control) improvement far exceeded even our expectations," he said.

The GlycoLeap model also makes much more effective use of a dietitian's time, Dr Yau said. "Because of the intuitive dietitian coaching system that we've developed, our dietitians can see the user's diet and activity history at one glance and focus on where they can add the most value. This makes the process much more efficient.

"In the clinics, dietitians usually see six to eight patients a day, and spend 20 to 30 minutes per patient just trying to take a proper food history, before going into the more important counselling aspects. By taking the manual, time-consuming parts out of the way, a dietitian on our system is able to handle up to 200 clients on a given day. We have three full-time dietitians, and will hire more according to need."

Dr Yau said the main target audience for GlycoLeap would be people who are at the early end of the diabetes spectrum - those with prediabetes*, newly-diagnosed type 2 diabetes, and early type 2 diabetes.

"We've gone live with GlycoLeap for two months now, and are looking for the right channels to reach out to people who can benefit from this. Because it is a novel model of care, we anticipate it will take some time to educate the market, to understand how digital health can be an important and effective component of medical care," he said.

"It's really about prevention," he added, citing the IDF study on people under 40 developing the condition. "From the public health perspective, it's of greatest cost-effectiveness and importance to manage your condition well as early as possible, before complications start to set in. Also, this group of people tend to be younger, and are more comfortable with smartphones and mobile apps."

Dr Yau added that people with diabetes who also have other conditions such as hypertension can also benefit from GlycoLeap. "Hypertension and high cholesterol are common in the population, and our dietitians have the expertise to counsel them accordingly. With complex conditions, for example late-stage kidney disease, we set expectations that you should always listen to your primary medical team who knows your condition best, while we provide a supporting role," he said.

Holmusk currently provides users with a monthly PDF summary that they can discuss with their doctors. "We are exploring ways to integrate more deeply with the patient's health providers," Dr Yau disclosed. Plans are also in the works to develop tailored programmes for people with prediabetes - as well as other chronic diseases, such as high blood pressure and high cholesterol - in the next six months.

Another milestone will be the introduction of an artificial intelligence (AI)-backed chatbot to provide the first line of support to users. "You can expect to see that live in a few months time - a hybrid human-AI system will enhance our scalability while maintaining efficacy," said Dr Yau.

"After using GlycoLeap for six months, my HbA1c was reduced from 8.7 to 6.2%," said Singapore user Wen Shi. "The feedback provided by the dietitians on food rating has helped me realise what types of food are good at controlling my glucose."

Interested?

Watch the video introduction to GlycoLeap

GlycoLeap is currently available in Singapore, and expected to become available in Malaysia and Hong Kong by early 2017. The app is available for iOS and Android.

The service is available on a monthly subscription. Users begin with a six-month core programme that costs S$69 a month, and then move on to a maintenance programme at S$20 a month. There is no minimum period for the maintenance programme, and users may can cancel anytime.

*People with Type I (or type 1) diabetes are born with the inability to produce insulin, while people with type II (or type 2) diabetes typically develop the disease in later life and produce too little insulin, or cannot make use of the insulin they produce. Problems with insulin are reflected by consistently high levels of HbA1c in the blood. 

Prediabetes refers to elevated HbA1c levels which are high, but not high enough to be considered diabetes. The condition is considered to be an indicator of eventual diabetes if the person does not take steps to lower HbA1c, with lifestyle changes for instance. 

posted from Bloggeroid

New type 2 diabetes medicines to boost market in Southeast Asia

Late-stage pipeline products have the potential to change how type 2 diabetes is treated today, says GBI Research. The business intelligence firm forecasts that the Southeast Asian type 2 diabetes mellitus (T2DM) market, covering South Korea, Singapore, Taiwan, Malaysia, the Philippines, Thailand, Vietnam and Indonesia, will rise from US$1.7 billion in 2015 to US$2.7 billion by 2022, at a CAGR of 7.1%.

Aswini Nath, Analyst for GBI Research, explains: “Unmet needs relating to patient convenience and ease of use will be addressed significantly over the forecast period. Higher levels of innovation are apparent in the early-stage pipeline, which may lead to considerable improvements beyond the existing range of products, in terms of safety and efficacy in the long term.

“In terms of recently approved therapeutics, GLP-1 receptor agonists, DPP-4 inhibitors, and SGLT-2 inhibitors* have already achieved strong market uptake and are all expected to increase their market shares over the forecast period. In comparison with many previously marketed therapies, these new products provide improved weight control and lowered hypoglycemia risk.”

The company named Novo Nordisk’s NN-9535 (semaglutide subcutaneous formulation) and OG-217SC (semaglutide oral formulation) and Eli Lilly’s Trulicity (dulaglutide), which are GLP-1 receptor agonists; as well as Merck’s ertugliflozin and Theracos's bexagliflozin, which are SGLT-2 inhibitors; and Merck’s omarigliptin, which is a DPP-4 inhibitor, as products close to commercialisation which "stand out as offering superior safety, efficacy, and patient compliance".

Of these products, GBI Research believes that OG-217SC, being a first-to-market oral formulation in the GLP-1 agonist class of drug, has the most potential to change the treatment paradigm due to its improved administration route compared to other drugs in the same class.

However, Nath added that popular treatment metformin (Glucophage) will continue to dominate treatment options. “Although increased uptake of branded drugs is expected, metformin – a low-cost generic drug – will maintain its pivotal role in the T2DM treatment algorithm in Southeast Asia. Due to its well-characterised safety and efficacy profiles, wide availability and low cost, metformin will continue to be prescribed as the first-line pharmacotherapy and also remain the favored option for use in combination therapies,” he said.


Interested?

Buy Type 2 Diabetes Mellitus Therapeutics in South-East Asia Markets to 2022 – Increasing Usage of Newer Therapies and Expanding Treatment Population to Encourage Robust Growth

*GLP-1 stands for glucagon-like peptide-1 and DPP-4 is short for dipeptidyl peptidase 4. Both GLP-1 receptor agonists improve glycemic control while reducing body weight while DPP-4 improves glycemic control. Both also improve systolic blood pressure in patients with type 2 diabetes. Read more about GLP-1 receptor agonists in Diabetes Care.

SGLT-2 or sodium-glucose linked transporter refers to the SGLT for the proximal convoluted tubule, a part of the kidney system, as opposed to SGLT-1, which affects the proximal straight tubule. Read more about SGLT-2 inhibitors in Diabetes Care.

Seven guidelines for a healthy gut

The US-based non-profit Physicians Committee has released several guidelines for maintaining a healthy microbiota, following the No Guts, No Glory: the Microbiome in Diabetes continuing medical education presentation at the International Conference on Nutrition in Medicine (ICNM). 

The seven guidelines are:

Build meals around plant-based foods: vegetables, fruits, whole grains, and legumes
This plant-based foundation supports symbiosis, or microbial harmony, in our gut. A thriving microbiota helps maximise absorption of nutrients and vitamins, while regulating immune function, inflammation, hormones, mood, and behaviour.

Aim to consume at least 50 to 55g of fibre each day
Historic populations consumed nearly three to four times as much fibre as we do today. Increasing dietary fiber intake by at least 14g a day decreases net energy intake by 10%.

Consume at least 5 to 8g of plant-based prebiotics each day
Good sources include Jerusalem artichokes, chicory root, raw dandelion greens, leeks, onions, garlic asparagus, whole wheat, beans, bananas, oats, and soybeans.

Add fermented foods, or probiotics, to the diet
Dietary sources include kimchi, sauerkraut, miso, tempeh, soy sauce, water kefir, and kombucha.

Avoid red meat, high-fat dairy products, fried foods, food additives, and advanced glycation end products (AGEs). AGEs include proteins and fats exposed to high heat and sugar molecules, like sausages and candy bars.

Limit fat intake, especially if there is a risk for type 2 diabetes
Instead, opt for healthful sources, including an ounce of nuts or seeds or a small amount of avocado.

Use antibiotics only when necessary and avoid using for viral illnesses
Overexposure to antibiotics destroys good gut bacteria, along with the bad.

The microbiota, composed of 1,000 different species, weighs between 1.8 and 2.7kg and helps maintain internal homeostasis. What we eat feeds beneficial bacteria that respond to changes in just 24 hours. This influences both immune function and our risk for chronic disease.

“The microbiome is a complex field, but we can manipulate our dietary choices to create colonies where beneficial bacteria flourish,” says Meghan Jardine, Associate Director of diabetes nutrition education for the Physicians Committee for Responsible Medicine. “Whether you want to treat diabetes, reduce the risk of a heart attack, or bolster athletic performance, you can start by building meals around colourful, plant-based foods.”


Interested?

Download Seven Dietary Guidelines for a Healthy Microbiota

Hashtag: #ICNM16

FairPrice empowers healthier choices, fights diabetes

• A 5% discount is offered on all FairPrice housebrand wholegrain rice for three months
• A 5% on all 1,000 products carrying the Healthier Choice Symbol is available for two weeks

NTUC FairPrice (FairPrice) announced a 5% discount on all FairPrice housebrand wholegrain rice for the next three months. In addition, all its Healthier Choice Symbol certified items, which comprise about 1,000 products, will also be offered a similar discount for the next two weeks, across its 133 supermarkets islandwide. This is the start of a series of initiatives by the organisation this year to promote healthy eating and drive awareness on diabetes. Total savings from these discounts are expected to amount to more than half a million dollars for FairPrice’s customers.

Chairman of NTUC FairPrice, Bobby Chin, said: “FairPrice serves to make lives better by offering greater value on healthier daily essentials. Rice is a commonly consumed staple in Singapore and by promoting wholegrain rice as a healthier alternative, we are taking a proactive approach in the prevention and management of chronic diseases like diabetes. Beyond rice, we also support the government’s call in advocating a holistic approach towards healthy eating by also providing quality and value for all our Healthier Choice Symbol products.”

Tackling diabetes with wholegrain rice

With the 422 million diabetic adults in the world expected to double in the next 20 years*, the war against the disease continues to grow. Locally, Singapore has also been found to have the second-highest diabetes prevalence among developed nations, after the US**, where one out of nine Singapore residents are affected by diabetes*** and one in three have a chance of getting diabetes in their lifetime.

As an alternative to white rice, wholegrain rice has been shown to lower the risk of developing diabetes while containing more fibre, vitamins and minerals. The 5% discount for all FairPrice housebrand wholegrain rice serves to encourage customers to consume these healthier alternatives. The discount is applicable to FairPrice Thai Brown Unpolished Rice, FairPrice Thai Red Unpolished Rice and FairPrice Thai Rice Blend, which is a mix of white and brown rice.

Gladys Wong, member of the Management Committee of the Diabetic Society of Singapore commented: “Diabetes is a chronic disease. Prevention methods, such as maintaining a healthy body weight, increasing physical activity, and eating healthily can help to prevent or delay its onset. We continue to advocate the replacement of refined staples with wholegrain varieties and the reduction of sugar sweetened beverages as priority efforts to enable Singaporeans to combat such chronic diseases.”

Since 2014, FairPrice has advocated the consumption of brown rice through its annual Walk for Rice event by donating brown rice to low-income families. FairPrice has also seen the sale of housebrand brown rice increase by 25% in the first quarter of this year compared to the year before.

Healthier Choice Symbol items

The 5% discount for Healthier Choice Symbol products, which include popular named brands and housebrands, will apply to the close to 1,000 items that FairPrice carries, for the period of two weeks. These products are generally lower in total fat, saturated fat, sodium and sugar, while some are higher in dietary fibre, calcium and whole grains compared to similar products within the same food category. Over the past year, FairPrice has seen sales for Healthier Choice Symbol products grow by 5%.

Zee Yoong Kang, CEO of the Singapore Health Promotion Board (HPB) added that sales of Healthier Choice Symbol products are growing 9% annually. "This is a very encouraging sign that more and more Singaporeans are taking steps to select healthier options when grocery shopping. We encourage more food and beverage (F&B) retailers to join in this effort so that together we can increase the pervasiveness of healthier options for Singaporeans.”

*http://www.who.int/campaigns/world-health-day/2016/en/

**International Diabetes Federation

***National Health Survey 2010

Diabetes disproportionately affecting senior members of the workforce

Source: IDF.

The International Diabetes Federation (IDF) estimates that around the world over 70% of type 2 diabetes cases can be prevented or delayed by adopting healthier lifestyles, equivalent of up to 150 million new diabetes cases by 2035.

“In terms of national growth and development, health means wealth,” said Dr Petra Wilson, CEO, IDF. “It is vital that governments realise that the rising number of diabetes cases negatively impacts on development and has the potential to bankrupt healthcare systems. Making small and effective investments around healthy eating and living makes economic and social sense.”

"Diabetes is a serious epidemic facing not only our nation, but the world," said David Marrero, PhD, President, Health Care and Education, American Diabetes Association in a separate statement commemorating World Diabetes Day, November 14 - the birthday of Sir Frederick Banting, the co-discoverer of insulin.

"We can make progress in the fight to Stop Diabetes by helping people with healthy ideas they can put into action, including resources to help people make the right choice when it comes to what they eat."

The Association says that preparing a healthful meal can help fight expanding waistlines, low energy and the rising rates of type 2 diabetes and obesity-related illness. To this end it had teamed up with five chefs and cookbook authors—Ronaldo Linares, Ingrid Hoffman, Aviva Goldfarb, Barbara Seelig-Brown and Jackie Newgent to create healthy recipes people can use whether they are looking to prevent, delay or manage diabetes, or to simply maintain a healthy lifestyle.

IDF’s Diabetes Atlas, released on World Diabetes Day, shows that diabetes now affects 387 million people, results in close to 5 million deaths annually and consumes US$612 billion in health-related expenditures.

The figures also show that diabetes is still disproportionately affecting people between 40 and 59 years old - the experienced, senior members of the workforce - with repercussions for global productivity.

Interested?

View the Atlas
View the recipes

posted from Bloggeroid

Abbott study identifies worrying trends among Indian diabetics

Special thosai set.

Seven out of 10 people with diabetes in urban India seem to be paying little attention to what and how much they eat, according to the findings from the Abbott Food, Spikes and Diabetes Survey*.

Abbott commissioned Ipsos India to reach out to over 4,100 people with diabetes (Type 2, diagnosed for over eighteen months) between the ages of 36 to 65 years, across socio-economic classes. The objective was to gain insights on what they eat, the meal plate's role on blood sugar variability and impact on overall diabetes management.

Through in-depth interviews, respondents shared details of their diet, monitoring and exercise. The frequency of meals and the quantity was measured through customised bowls, glasses, which was then converted to grams and calories**.

Key findings:

Six in ten (62%) of people with diabetes are overweight or obese with a BMI reading in excess of 22.9 (the normal cut-off for Indians). Nearly half (46%) of people with diabetes are classified as obese***. Men had an average BMI value of 24.1, which is classified as overweight and women had an average BMI of 25.3, indicating obesity.

Slightly over half (55%) were diagnosed below age 45 years and a substantial number (17%) were diagnosed at under 35 years.

Nearly two thirds (65%) have uncontrolled blood sugar levels, with their last blood sugar readings out of the target range**** for fasting or post-prandial (post meal) situations. Blood sugars are also seen to be impacted by the kind of food that is eaten and the intervals at which it is consumed.

Six in ten (62%) also suffer from other medical conditions. Hypertension (40%) comes out as the most common co-morbidity. Almost 70% of respondents having diabetes for more than five years reported one or more co-morbidity. Eye disorders (retinopathy) and nerve disorders (neuropathy) are relatively high in this group.

Monitoring apathy: While the recommended manner to monitor blood sugar is to do fasting and two-hour post-meal tests, close to 40% of respondents prefer to do only one test and this is usually fasting.

The average interval between meal and post-meal testing is 58 minutes, against the recommended time interval of two hours****.

Dr V Mohan, Chairman and Chief Diabetologist of Dr Mohan's Diabetes Specialities Centre, Chennai says, "Testing of both fasting and post-meal blood sugars are important because the fasting blood sugar tells us about the liver's glucose production, while the post-meal blood sugar tells us about the glucose disposal. Controlling both of these is therefore important. However, the post–meal is even more important because the post-meal blood sugars have been linked to cardiovascular disease in many studies."

"Unlike in the West, where fasting blood glucose is important, in India post-meal blood glucose is more important due to higher glycemic load in the Indian diet," says Professor Shashank R Joshi, President, Indian Academy of Diabetes & Senior Endocrinologist, Lilavati Hospital, Mumbai.

Typical diets of people with diabetes: seven out of 10 respondents are eating meals that are imbalanced in carbohydrates. The average meal plate for all respondents comprised 68% carbohydrates, significantly higher than the recommended guideline of 60% carbohydrates*****.

While the average calories consumed per day (men - 2,534 Kcal and women - 2,634 Kcal) are generally in line with the National Institute of Nutrition (NIN) recommendation for sedentary to moderate activity******, the source of the calories is a concern. Most of the calories come from simple carbohydrates that are low in fibre.

"The STARCH study that we published last year shows that India is a carbohydrate country across the regions. Indians consume both simple and complex carbohydrates. The current Food, Spikes and Diabetes Survey confirms the findings of the STARCH study where cereals, roti and rice are the primary source of carbohydrates in the Indian meal plate," says Professor Shashank. 

Roti and rice are two main sources of carbohydrates in the Indian meal plate. Upma, observed to be a popular breakfast item particularly in South India, is seen to add the maximum amount of calories, compared to other regular breakfast items.

Dr Mohan said, "In our epidemiological studies, we find that polished white rice comprises 48% of all the calories consumed by people in Chennai and this is one of the drivers of the diabetes epidemic. Controlling carbohydrate is extremely important because excess carbohydrate can lead to post-meal spikes of blood glucose. Since Indians eat carbs with every meal they get huge post-meal surge in blood glucose which abnormally increases the insulin secretion. Gradually the insulin levels dry up due to beta cell exhaustion and severe diabetes sets in."

How people with diabetes eat: 80% of the respondents eat three to four meals per day. The gap between meals ranges from four-and-a-half to seven hours.

The survey also showed that the first meal of the day, breakfast, occurs a substantial time after waking up. The average time gap between waking up and breakfast is three-and-a-half hours.

"The biggest challenge for a patient with diabetes is the huge variation in the time interval between meals. Typically, Indians have a three to four hour gap between wake-up time and breakfast, which is detrimental for these patients. Therefore, they should have a shorter time gap with breakfast comprising whole grains or balanced meal replacements with diabetes-specific nutrition powders," says Professor Shashank.

Dr Mohan added, "It is essential to have the breakfast quite early as having a long gap after the dinner can lead to triggering of the counter-regulatory hormones. For a person with diabetes, it is always better to have small frequent feeds rather than having infrequent large meals."

Source: Abbott infographic. Cities covered: Mumbai, New Delhi, Kolkata, Chennai, Lucknow, Bengaluru, Hyderabad and Trivandrum.

Festive feasting and fasting: Indians take festive occasions seriously and people with diabetes also seem to follow the trend – 30% of surveyed respondents claimed to go easy on their diet during festive occasions. Sweets, rice, potatoes and ice creams rank as the top items that people with diabetes have during festivals. These additional carbohydrate-rich foods, over and above a regular diet that is already laden with carbs, indicate how difficult it is for Indians suffering with diabetes to manage diet properly.

On the other extreme are those respondents who observe fasts. A tenth of the survey respondents stated that they observe fasts, mostly once a week. Thrice as many women reported to observe fasts as compared to men. Nearly half (45%) of those who fast skip diabetes medications during fasting and 54% of those who fast eat only one meal that day.

"Indians also fast and feast which is leading to spikes and variances in glucose levels," commented Professor Shashank.

Only 40% of the surveyed respondents claim to do any form of exercise. Walking seems to be the most popular, with 93% saying that they walk regularly.

"Diabetes is one of the major conditions affecting people's health and lifestyle in India. Through its continuum of care approach, Abbott in partnership with various stakeholders is seeking to advance understanding and drive greater awareness around effective diabetes management. Greater insights on people's behaviour are needed to effectively manage the condition. Insights from this study will allow people to Take Back Control of their diabetes, helping them live a full life," says Bhasker Iyer, Vice President, Abbott.

Interested?

Take Back Control: While there are multiple sources of advice on elements of managing diabetes, diet management can get confusing. People with diabetes can now give a missed call to 0777 1003 003 in India to get free professional diet advice specific to Indian food.

View the associated infographic

*About the Abbott Food, Spikes and Diabetes Survey:
Ipsos India covered eight Indian cities [Mumbai, New Delhi, Kolkata, Chennai, Lucknow, Bengaluru, Hyderabad and Trivandrum] and through random listing interviews, spoke to 4,148 adult, Type 2 diabetics in the age group of 35 to 65 years. The survey covered 1,867 men and 2,281 women and the selected respondents were those diagnosed with diabetes for at least eighteen months. Through personal interviews based on a structured questionnaire, Ipsos collated information about the dietary habits and patterns, monitoring aspects and factors influencing diabetes management. The Ipsos team measured the quantity of food consumed through custom-sized bowls, plates and glasses that they showed to the respondents. Through this, grams of food and calories were subsequently determined, based on Dr Mohan's Atlas of Indian Foods.

**Conversion and classification of the meal plate done with the support of Dr Mohan's Atlas of Indian Foods (First ed., 2013). The book features more than 200 foods eaten across regions in various portion sizes along with main nutritional values. 

***Normal BMI: 18.0-22.9 kg/m² , Overweight: 23.0-24.9 kg/ m² , Obesity: >25 kg/m² : Consensus Statement for Diagnosis of Obesity, Abdominal Obesity and the Metabolic Syndrome for Asian Indians and Recommendations for Physical Activity, Medical and Surgical Management (February 2009) : A Misra, P Chowbey, BM Makkar, NK Vikram, JS Wasir, D Chadha, Shashank R Joshi, S Sadikot, R Gupta, Seema Gulati, YP Munjal for Consensus Group 

****Target range: fasting blood sugar - 70 – 130 mg/dl; post-prandial sugar, done after two hours – less than 180 mg/dl: American Diabetes Association. Diabetes Care 2013;36(1):s11-s66 

*****National Institute of Nutrition – Dietary Guidelines for Indians (Second ed., 2011); page 15 – 'What is a balanced diet?.....a balanced diet should provide up to 60% of total calories from carbohydrates, preferably from complex carbohydrates'. 

******National Institute of Nutrition – Dietary Guidelines for Indians (Second ed., 2011); Annex 3 - Recommended Dietary Allowances for Indians (Macronutrients and Minerals): Man – 60 kg body weight: 2,320 – 2,730 Kcal/day; Woman – 55 kg body weight: 1,900 – 2,230 Kcal /day

Abbott brings Freestyle Libre Pro System for glucose monitoring to India

The prevalence of type II diabetes is increasing in young adults in Asia, according to research from the Asia Diabetes Foundation (ADF). The ADF has funded research* together with Merck showing that 18% of the people recruited into its Joint Asia Diabetes Evaluation (JADE) study from nine Asian countries and territories were under the age of 40 when they were diagnosed with diabetes, a condition called young-onset diabetes.

While Merck offers a drug called Janumet XR to address type II diabetes, Abbott is tackling the treatment of the disease with a wearable that offers doctors more insights into patients' blood glucose levels over the long term.

Source: Abbott website. The FreeStyle Libre System at work. The FreeStyle Libre Pro System is designed to be used by healthcare professionals, rather than by patients themselves.

"India now carries 20% of the global burden of diabetes," said Robert Ford, Senior VP, Diabetes Care, Abbott. "There is an immense need for people in India to better manage their diabetes, enabling them to live healthier lives. Abbott's FreeStyle Libre Pro System is designed to empower doctors in India to help their patients through rich data and actionable insights."

The FreeStyle Libre Pro Flash Glucose Monitoring System consists of a small, round sensor—slightly larger than a 10 rupee coin (the size of a US quarter). A healthcare professional applies the sensor on the back of the patient's upper arm. The sensor is held in place with a self-adhesive pad and remains on the back of the arm for up to 14 days, requiring no patient interaction.

When applied to the skin, the sensor continuously measures glucose in interstitial fluid through a small (5mm long, 0.4mm wide) filament that is inserted just under the skin. It records glucose levels every 15 minutes, capturing up to 1,340 glucose results over 14 days, giving doctors comprehensive data for a complete glycemic profile of their patients. After 14 days, the person returns to the doctor's office, where the doctor uses a FreeStyle Libre Pro reader device to download the glucose results that are stored in the sensor in as quickly as five seconds.

"Diabetes is already at epidemic proportions and there is an urgent need to manage it better," said Dr V Mohan, Director and Chief of Diabetes Research at Madras Diabetes Research Foundation. "Current diabetes monitoring tools are limiting for doctors because they don't reveal a complete picture of the glucose variability that a person goes through during a day. The revolutionary flash glucose monitoring system will be very useful for doctors in getting complete glucose profiles of their patients. This will help us in our clinical decision making as well as in personalising treatment plans for better outcomes."

"Current systems for continuous measurement of glucose are cumbersome and require regular finger-pricking to ensure they are calibrated correctly for accuracy," said Jared Watkin, Divisional VP, Technical Operations, Diabetes Care, Abbott. "Based on insights from our customers, the focus for our design team has been to innovate for these challenges, while also providing affordability. We're proud that FreeStyle Libre Pro System achieves that for people with diabetes."

Abbott's FreeStyle Libre Pro system will be available to doctors in coming weeks in six Indian cities including Mumbai, Delhi, Chennai, Bangalore, Pune and Trivandrum.

According to the International Diabetes Federation, India today has a diabetes population of 65.1 million compared to 50.8 million in 2010**. A recent survey conducted by the Association of Physicians of India (API) and sponsored by Abbott*** showed that 90% of people surveyed with uncontrolled diabetes in India, defined as HbA1c levels higher than 7%, continue to believe that they have control over their glucose levels, despite facts suggesting otherwise. 

The Diabetic Society of Singapore has estimated that over 400,000 people or 11.3% of the population suffer from diabetes, while Singapore's Khoo Teck Puat Hospital has found that two-thirds of its diabetes patients under 30 have the type II form. 

*Metabolic profiles and treatment gaps in young-onset type 2 diabetes in Asia (the JADE programme): a cross-sectional study of a prospective cohort, The Lancet Diabetes & Endocrinology, e-publication July 2014, print publication December 2014.

**http://www.idf.org/BRIDGES/map/india

***The Abbott Sugar Survey, February 2015