On Friday 18 March, the Netherlands is celebrating National Diabetes Day ('Nationale Diabetes Dag'). Many Dutch citizens have diabetes, some of whom are unaware they have the condition, or run the risk of developing the illness. A body that suffers from diabetes is no longer able to keep an equilibrium in its blood sugar levels. TNO is developing computer models that help the patient and doctor to predict the course of type 2 diabetes. Aided by this prediction, they can take the right measures to prevent the development of the condition.
More than a million Dutch citizens have diabetes. According to the Dutch Diabetes Fund ('Diabetes Fonds'), this figure increases by thousands of people every week, and almost 90% of cases concern type 2 diabetes. In the early stage of the condition, the body becomes less responsive to the insulin it produces. This can cause the blood sugar value to increase slightly, meaning the pancreas must produce extra insulin.
Insulin-dependent diabetic patients
In early-stage diabetes, medicines as well as changes to lifestyle can help patients to regain a healthy blood sugar regulation. However, in the more advanced stages of the condition, the pancreas has been overexerted and is no longer able to produce insulin. In this case, the patient has become 'insulin-dependent' and must administer themselves with an injection of insulin.
'The problem is bidimensional, as it involves both volume and severity,' says Gerrit Beumer from TNO. 'Whether somebody develops type 2 diabetes is heavily dependent on their lifestyle. Particular risk factors include being overweight, getting insufficient exercise, and a person's hereditary disposition. The physical consequences are often serious: patients may suffer for their lifetime, or the condition may even cut their lives short. 40 to 56% of diabetics suffer from one or more chronic complications, such as cardiovascular illnesses, loss of kidney functions, problems with their sight, problems with wounds healing, and depression.'
"40 to 56% of diabetics suffer from one or more chronic complications"
Predicting the development of the condition
Addressing type 2 diabetes has been one of TNO's long-term priorities. Within the framework of the 'MISSION-T2D' project, co-funded by the European Union, TNO developed models that predict the progress of type 2 diabetes. These models were further developed and applied to the recently initiated'POWER2DM'project, which is co-funded by the European Commission and Horizon 2020 (the EU Framework Programme for Research and Innovation). The models act as a guideline for the prevention and treatment of the condition in its various stages, as well as the prevention of complications. They help patients, doctors, and care providers to effectively manage the disease burden. Moreover, they are applicable to individual patients, a group of patients, or a specific population group.
Tool for the most effective treatment of diabetes
TNO is joining forces with companies to develop programmes for digital decision support in cases of type 2 diabetes. Beumer explains: 'For instance, we are developing a tool that helps the patient, doctor, medical practice assistants, dieticians, physiotherapists, and pharmacists to select the most effective treatment for type 2 diabetes based on the individual's needs, home situation, and the course of the condition. This aims to raise the patient's awareness about what they can do to manage the course of the condition, as well as to regain control of their own health. Within this context, we support the guideline advice module from the Dutch GP information system (Huisartsinformatiesysteem, HIS) in combination with scientifically-underpinned lifestyle advice and our own predictive models.'[quote]
'We are developing a tool that helps the patient, doctor, medical practice assistants, dieticians, physiotherapists, and pharmacists to select the most effective treatment for type 2 diabetes.'
Access to data
Upon permission being given by the patient, the aim is for the so-called 'clinical decision support tool' to integrate personal data from the GP information system, such as the patient's case history, changes to lifestyle, and how the patient's body responds to these with the professional Dutch guidelines for the treatment of diabetes. This produces information with regard to the treatment and course of the condition and prognoses, all of which can be relayed to the patient and care providers. These scenario outlines can relate to a period of days, weeks, months, or even some years.
For the patient
The tool will feature functionalities such as accessible advice on the number of meals, what these meals ought to contain, and the time indication for when to take medicines, which aim to provide at-home help for the patient – both prior to and following medical consultation – in order to support them on their journey of improving their lifestyle and effectively using medicines.
MISSION-T2D and POWER2DM
The development of the tool connects to the POWER2DM project, as part of which TNO is joining forces with European partners to develop a personalized care system for patients with type 1 and type 2 diabetes. Beumer explains: 'Comparing results from MISSION-T2D with those from POWER2DM enables us to work as efficiently as possible with general practitioners, medical practice assistants, patients, and patient and care providers associations. The next step is to find financiers such as financial backers, health insurance providers, municipalities, and banks. We hope to achieve this in the course of 2016, so that we can introduce the tool onto the market in 2017 or 2018.'
Contact and information
If you would like more information on the tool, the European collaborative projects, or follow-up steps, then please contact Gerrit Beumer. TNO is also involved in the Early Research Program (ERP) Complexity. Within this context, it focuses on developing models which better understand how complex systems work in order to predict them as effectively as possible.