Personalised Care in Metabolic Health: Insights from Fitterfly’s Expert Discussion

Personalised care in metabolic disorders has been one of the most-discussed topics among healthcare professionals in recent years. This concept is a part of the modern medico-academic culture and aims to bridge the gap between patients’ expectations and physicians’ services (Indian J Endocrinol Metab. 2014 Jan-Feb; 18(1): 4–6). Personalised treatment also enhances patients’ engagement and involvement in their own therapeutic journey.

Fitterfly explored personalised care in metabolic disorders during its latest webinar led by Dr. Sanjay Kalra (Endocrinologist at Bharti Hospital, Karnal and President, South Asian Federation of Endocrine Societies) in conversation with Dr. Neelesh Bhandari (Vice President-Physician Partnership, Fitterfly) on July 19th, 2023.

Here are the key points advocated by the panellists during the interactive webinar.

Fig 1: Dr. Sanjay Kalra [MBBS, MD (Medicine), DM (Endocrinology)]

Personalised Care in Ancient Indian Medicine

Dr Kalra stressed that even ancient Indian physicians were proponents of person-centred care. The Ayurvedic textbook Charaka Samhita written by legendary scholar Agnivesha and later revised by Charaka outlines the ‘Quadruples of Atreya’ (Indian J Endocrinol Metab. 2017 Mar-Apr; 21(2): 268–270).

Here Atreya proposed that a successful therapeutic process requires equal involvement of all stakeholders (physician, patient, drugs, and attendants). 

Even Thiruvalluvar’s Tamil classic Tirukkuṟaḷ (verse 950) outlines that for good health outcomes, physicians need to strengthen their patients, drugs and attendants.

So, ancient Indian medicine followed the correct approach of involving patients as part of the therapeutic team. They practised personalised treatment by respecting the patients’ emotions and accepting the fact that patients have the right to have an opinion in their treatment.

Anatomy of an Ideal Personalised Care Plan

The first step of personalised care is focussing on an outcome based on patients’ priorities and preferences. The second step involves charting out the roadway to reach the outcome. Finally, physicians need to emphasise the Biomedical-Psychological-Social-Environmental status of patients and follow an effective treatment plan to achieve the pre-decided outcome.

They should first respect the patient for whatever he/she is, understand their Biomedical-Psychological-Social-Environmental perspective, determine the outcome, and finally create a  person-centred care plan affirmed by both the patient and the doctor.

Challenges of Implementing Personalised Care

Though personalised care seems a simplified concept theoretically, it is a mammoth task to implement it practically. Physicians experience multiple challenges while practising person-centred care in their clinics, including time constraints, biomedical-psychological-social health of the doctor, communication skills, compassion fatigue, and emotional fluidity.

Yet, with effective time management and by asking patients relevant questions, it becomes possible to address these challenges. This approach enables healthcare providers to delve into patients’ biochemical complaints and their psychological and social health, all within the allotted consultation time.

Impact of Smart Gadgets and AI on Treatment

Dr. Kalra believes that smart gadgets, such as smartwatches, smartphones, health apps, and AI, will positively impact person-centered care. Patients now receive real-time updates on various aspects of their health, like the distance they’ve run, calories burned during exercise, and calories consumed from specific foods, all through smart devices.

In addition, advanced CGM devices offered by DTx platforms like Fitterfly benefit diabetic patients by recording their blood sugar levels multiple times a day and matching them with their food intake within that time frame.

These smart gadgets and AI not only educate and raise patient awareness but also foster a sense of responsibility toward their treatment. Furthermore, physicians have the opportunity to concentrate on the treatment process and its outcomes.

Fitterfly conducted a real-world effectiveness evaluation of its AI and ML-enabled Diabetes CGM Digital Therapeutics Program for Glycemic Control and Weight Management, which was published in the JMIR Diabetes journal (JMIR Diabetes 2023;8:e43292). The study analysed the data of 109 T2DM participants and showed excellent outcomes at the end of 90 days.

• HbA1C levels decreased significantly by 1.2% in 85% of the members.

• Average 2.6% reduction in HbA1C levels in members with >9% HbA1c levels at baseline. 

• Higher levels of engagement with the Fitterfly wellness app were linked to increased weight reduction, suggesting a positive relationship between program engagement and successful weight loss.

Fig 2: Process flow of the Fitterfly diabetes CGM digital therapeutics program. AI: artificial intelligence; CGM: continuous glucose monitoring; ML: machine learning.

Newer Parameters in Measuring Glycaemic Control

Traditionally, doctors primarily focussed on the HbA1c level of patients to measure the success of their treatment. It was a part of the glycaemic triad, which considered the HbA1c level along with fasting and post-prandial (PP) blood sugar.

Slowly, it expanded into glycaemic pentad, with three action-oriented targets (HbA1c, fasting and PP) and two caution-oriented targets (minimising hypoglycaemia and glycaemic variability). 

Glycaemic pentad led to glycaemic sixer, which added nocturnal hypoglycaemia to the earlier targets. It addressed the variations in pathophysiological complications of the glycaemic index during day and night. Currently, doctors focus on the glycaemic spectrum, which also considers ‘time-in-range’ along with earlier targets.

Additionally, there are also metabolic pentads and metabolic hexads for diabetes management, which also emphasise multiple other factors like lipid profile, blood pressure, body weight, vitamin D, and uric acid.

Attaining Information Equipoise with Patients

Successful treatment depends considerably on attaining information equipoise among physicians and patients. To attain the information equipoise, a certain degree of self-awareness and education regarding own health conditions is required among patients.

However, Dr. Kalra stressed that there is a difference between general literacy and numeracy and health literacy and numeracy. Information equipoise can be achieved by asking questions by both patients and doctors. 

The above are some important factors doctors can consider while practising personalised care for metabolic disorders. Dr. Kalra also discussed person-centred care in diabetes in one of our earlier blogs, Top 5 Takeaways of Person-Centred Care in Diabetes. You can watch the complete discussion in the video below.

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By partnering with Fitterfly, you can save time in your clinics, ensure continuity of care for your patients, get research publications and also enhance your revenue. To know more, please fill out the form below or call us at 080-47093933.