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  Introduction
   Digital Therapeu...
   Current State of...
   Potential of DTx...
  Conclusion
   References
   Article Tables

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  Table of Contents 
EDITORIAL
Year : 2022  |  Volume : 26  |  Issue : 4  |  Page : 205-206
 

Digital therapeutics in diabetes: A significant tool to address employees' health and productivity


1 Office of Chief Executive Officer, Fitterfly Healthtech Private Ltd, Mumbai, Maharashtra, India
2 Office of Head of Advisory Board, Fitterfly Healthtech Private Ltd, Mumbai, Maharashtra, India

Date of Submission21-Nov-2022
Date of Acceptance13-Dec-2022
Date of Web Publication24-Dec-2022

Correspondence Address:
Dr. Arbinder Kumar Singal
Fitterfly Healthtech Pvt Ltd, 503, Akshar Blue Chip Corporate Park, Turbhe MIDC, Navi Mumbai - 400 705, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijoem.ijoem_309_22

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How to cite this article:
Singal AK, Thirumalai R. Digital therapeutics in diabetes: A significant tool to address employees' health and productivity. Indian J Occup Environ Med 2022;26:205-6

How to cite this URL:
Singal AK, Thirumalai R. Digital therapeutics in diabetes: A significant tool to address employees' health and productivity. Indian J Occup Environ Med [serial online] 2022 [cited 2023 Feb 2];26:205-6. Available from: https://www.ijoem.com/text.asp?2022/26/4/205/364935





  Introduction Top


Based on estimates in 2021, 74.2 million people with diabetes resided in India which was expected to rise to 124.9 million by 2045.[1] While diabetes mellitus (DM) continues to reach such “pandemic proportions,” achievement of diabetes treatment targets (specifically ABC targets—HbA1c, blood pressure, and LDL cholesterol) remains suboptimal with only 7.7% of individuals with diabetes in India achieved the targets.[2] This brings forth an urgent need to strengthen diabetes infrastructure and to ensure access to high-quality, affordable, and appropriate diabetes care at primary, secondary, and tertiary levels.[2]

Additionally, the adoption of healthy behaviors including consumption of healthy diet and performing regular exercise continues to remain suboptimal for people with diabetes in India.[2] One of the solutions to this is inspired by the increasing use of mobile phones and other electronic devices which can be used to enable lifestyle and behavioral modifications in people with diabetes during the intervals between healthcare visits. Digital therapeutics (DTx) is one such technology for the prevention and personalized management of DM based on evidence-based therapeutic interventions delivered through mobile applications and remote health coaching by healthcare professionals from different specialties.[3]


  Digital Therapeutics (DTx) in Diabetes Top


According to the Digital Therapeutics Alliance, DTx is defined as a modality to “deliver evidence-based therapeutic interventions to patients that are driven by software to prevent, manage, or treat a medical disorder or disease. They are used independently or in concert with medications, devices, or other therapies to optimize patient care and health outcomes.”[4] The core advantages of DTx along with suitable examples in diabetes management are described in the [Table 1].
Table 1: Advantages of digital therapeutics and examples in diabetes management

Click here to view



  Current State of Employee Health and Diabetes in India Top


As of October 2022, the labor force in India is close to 429.8 million.[8] Seventy-five percent of this huge workforce is estimated to be at higher risk of developing diabetes.[9] In the context of diabetes, the high out-of-pocket expenditure exposes 30% of the Indian population (or more than 400 million individuals who represent the “Missing Middle” not covered by health insurance) to catastrophic spending due to frequent healthcare visits.[10] With respect to employees in India, Social Health Insurance Schemes like the Employees' State Insurance Scheme (ESIS) and Central Government Health Scheme (CGHS) cover only 10% of the eligible population, whereas Private Voluntary Health Insurance (PVHI) covers only 9%.[10] The “Missing Middle” includes multiple sections of the Indian workforce including those who are self-employed in rural areas (agriculture or otherwise) and a broad array of occupations in urban areas (informal, semi-formal, and formal).[10]

Consequently, absence of adequate in-patient and out-patient benefits led to lack of utilization of the primary healthcare infrastructure, limited information sharing across providers and healthcare systems, and suboptimal primordial and primary prevention strategies, further causing delay in screening and management of chronic conditions like DM. Besides, due to resource constraints in the public hospitals, employees often needed to seek treatment in the costlier private sector leading to >7% Indians being pushed into poverty every year.[10] The COVID-19 pandemic has further led to significant changes in employment[8] with reduction in physical activity, changes in food habits, along with stress and isolation. All these factors are detrimental to people with diabetes toward the achievement of the ABC targets.[2]

Efforts are underway through programs like the National Program for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke and the Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) schemes to improve policies for better management of DM.[2]


  Potential of DTx in Diabetes Management Among Employees Top


Diabetes has been reported to result in lost labor productivity due to absenteeism and presenteeism, and loss of laborers from the workforce due to hospitalizations and complications of DM.[5] In the Indian context, this leads to indirect costs of diabetes care in addition to the direct costs of frequent hospital visits.[11] There is a need for affordable and accessible solutions for employees to better manage DM, while making it feasible for employers to invest in such interventions.

DTx has the potential to achieve both these goals through enabling a healthier lifestyle among employees while reducing the effect on absenteeism, presenteeism, and loss of employees from the workforce, as well as boosting employee productivity. According to a publication by Omada Health, employees who participated in their digital diabetes prevention program had a reduction in all-cause healthcare spend of US$1169 per participant relative to the comparison group driven by fewer inpatient hospital admissions and shortened length of stay.[5] Similarly, an analysis conducted by Center for Disease Control and Prevention showed that the return-on-investment break-even point for digital behavioral counseling in patients with prediabetes or cardiovascular disease was 3 years with the potential to reduce diabetes incidence by 33% and stroke by 16% over 5 years.[12] These results will enable better engagement among people with diabetes and promotion of healthy behaviors in employees that can help in driving conversations with payers and employers regarding insurance coverage for DTx.


  Conclusion Top


While diabetes mellitus continues to be an important healthcare problem among employees in India, digital therapeutics can help in developing healthy behaviors among people with diabetes through evidence-based, personalized care within the context of limited healthcare coverage in the country.



 
  References Top

1.
Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan B, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract 2022;183:109119. doi: 10.1016/j.diabres. 2021.109119.  Back to cited text no. 1
    
2.
Anjana RM, Unnikrishnan R, Deepa M, Venkatesan U, Pradeepa R, Joshi S, et al. Achievement of guideline recommended diabetes treatment targets and health habits in people with self-reported diabetes in India (ICMR-INDIAB-13): A national cross-sectional study. Lancet Diabetes Endocrinol 2022;10:430-41.  Back to cited text no. 2
    
3.
Verma R, Bhardwaj S, Lathia T, Kalra S, Ranadive R, Tanna S, et al. Personalized glycemic response led digital therapeutics program improves time in range in a period of 14 days. Int J Diabetes Dev Ctries 2022;1-8. doi: 10.1007/s13410-022-01111-1.  Back to cited text no. 3
    
4.
Digital Therapeutics Alliance. Digital Therapeutics- Definition and Core Principles. 2022. Available from: https://dtxalliance.org/wp-content/uploads/2021/01/DTA_DTx-Definition-and-Core-Principles.pdf. [Last accessed on 2022 Nov 18].  Back to cited text no. 4
    
5.
Sweet CC, Jasik CB, Diebold A, DuPuis A, Jendretzke B. Cost savings and reduced health care utilization associated with participation in a digital diabetes prevention program in an adult workforce population. J Health Econ Outcomes Res 2020;7:139-47.  Back to cited text no. 5
    
6.
Verma R, Khader MA, Malde F, Lathia T, Tanna S, Kothari S, et al. 703-P: Significant weight reduction and improvement in glycemic control among people with T2D after participation in diabefly digital therapeutics program. Diabetes 2022;71(Suppl 1):703.  Back to cited text no. 6
    
7.
Verma N, Lathia T, Vasan P, Gupta N, Lathia T, Verma R, et al. 601-P: Participation in diabefly program and significant reduction in diabetes distress and improvement in motivation and attitude towards changing health among people with type 2 diabetes. Diabetes 2022;71(Suppl 1):601.  Back to cited text no. 7
    
8.
Center for Monitoring Indian Economy. Employment falls in rural India. 2022. Available from: https://unemploymentinindia.cmie.com/kommon/bin/sr.php?kall=wtabnav&tab=4080. [Last accessed on 2022 Nov 18].  Back to cited text no. 8
    
9.
Economic Times HR World. 75% of India Inc workforce at higher risk of developing diabetes: Study. Available from: https://hr.economictimes.indiatimes.com/news/workplace-4-0/employee-wellbeing/75-of-india-inc-workforce-at-higher-risk-of-developing-diabetes-study/95303549. [Last accessed on 2022 Nov 18].  Back to cited text no. 9
    
10.
NITI Aayog. Health Insurance for India's Missing Middle. 2021. Available from: https://www.niti.gov.in/sites/default/files/2021-12/Health%20Insurance%20for%20India%E2%80%99s%20Missing%20Middle_08-12-2021.pdf. [Last accessed on 2022 Nov 18].  Back to cited text no. 10
    
11.
Oberoi S, Kansra P. Economic menace of diabetes in India: A systematic review. Int J Diabetes Dev Ctries 2020;40:464-75.  Back to cited text no. 11
    
12.
Su W, Chen F, Dall TM, Iacobucci W, Perreault L. Return on investment for digital behavioral counseling in patients with prediabetes and cardiovascular disease. Prev Chronic Dis 2016;13:E13. doi: 10.5888/pcd13.150357.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1]



 

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