Interview with Dr. Ben Ong: Manage Diabetes Efficiently Using CGMS

Interview with Dr. Ben Ong: Manage Diabetes Efficiently Using CGMS

Health Matters Part 1

Health Matters Part 2

On Health Matters with Daniel Martin, we are privileged to have Dr. Ben Ong from the Arden Endocrinology Specialist Clinic. Dr. Ong is a renowned endocrinologist with extensive expertise in diabetes management, particularly in the use of Continuous Glucose Monitoring Systems (CGMS). With a dedicated approach to patient care and a keen interest in leveraging advanced technologies, Dr. Ong has been at the forefront of integrating CGMS into treatment plans to enhance patient outcomes. Join us as we delve into the latest advancements in CGMS, their benefits, and practical tips for effectively managing diabetes with these innovative systems.

Transcribed below.

Daniel Martin:

Welcome into Health Matters, everybody. Thanks so much for joining me. You heard in the latest health news, of course, the fact that innovation from NTU researchers. Quite interesting, indeed. The idea of a Band Aid or a pasta like device that somebody, well, not a device, just a piece of material. You put on and it could detect biomarkers in your sweat that could give you information, for example, like the blood glucose level of a diabetic.

Now, remember, diabetes patients, particularly in terms of their blood glucose monitoring, have had to go with, you know, injection pricks on their finger or a wearable device that’s on them all the time. How can an innovation like this make a difference? Make a big difference, especially for diabetics.

We’re going to find out more on today’s edition as I welcome back to the show endocrinologist Dr. Ben Ong out of Arden Endocrinology Specialist Clinic. Dr. Ong, hi, welcome back.

Dr. Ben Ong:

Hi Daniel, how are you doing?

Daniel Martin:

I was very excited when I heard about this innovation. What were your first thoughts actually when you heard about this innovation?

I know you’re not involved in the development of this per se, but when you read about it, what did you think?

Dr. Ben Ong:

I think this was very exciting news. I mean, let’s stop. I think this is not entirely new information. I mean, we’ve always known that, um, I’ll use the possibility of sweat as a biochemical marker, but to see it really coming to fruition and becoming closer and closer as a reality is very exciting as a physician, I think let’s start by saying that.

Why is it exciting? I mean, all of us have taken blood before, isn’t it? I mean, you draw blood from the vein, or you’ve done the finger prick check for your sugar, whether you have diabetes or not, and I think all of us would agree it’s probably uncomfortable at best, traumatic at worst, and it’s really not a nice thing to do.

So, I think these researchers, they are literally looking at several markers. I think if you read through the article there, they talked about urea, lactate, and glucose. But I think out of all of them, certainly from a day to day and a clinical situation, I think the monitoring of glucose would probably be far the most important one because, A, diabetes is so common, And as we know, sugars in people with diabetes can be extremely variable depending on what they eat and what they do.

So I think these are very exciting things here and I really look forward to seeing how this can develop. And the concern, obviously, is whether how accurate they’re going to be and how accessible these things are going to be to the general population in the future.

Daniel Martin:

We spoke to one of our senior reporters about this on our radio show in Singapore today, and we asked, like, is this going to be accurate as a blood test?

And she said researchers said that it could be as close as 100 percent as accurate. As a blood test would be in terms of blood glucose levels, one of my listeners just whatsapped across and said the CNA report mentioned that the result will show a happy face or a sad face, making it user friendly when they actually do the testing of the band aid in the hospital, but will it show the actual sugar reading because that reading is important to know if it is borderline, I don’t have any information on whether or not an actual reading will be given to you after they test or determine Or they take that band and they put it under the device, that scanner as well.

But Dr Ng, is it more important to have a smiley face or an actual number?

Dr. Ben Ong: I think you need an actual number. I think the problem with sugar is this. I mean, there, first of all, everyone has different targets. So, it’s very hard to say, this is a great sugar. I think how great it would be helpful, that’s number one.

And I think this is where the challenge is. If you talk about sweat changes, I mean, we’re trying to monitor changes in the blood. And when we sweat, the sweat, it takes a while for the sweat to, to, to, to realise what the sugar is doing. I think that’s one of the challenges all the researchers are going to have.

I mean, if not, we’ve had these devices around for a very long time already. So I think accuracy is a challenge for everyone. But I think to actually predict a good, accurate number is very, very important because ultimately, when it comes down to sugar, it’s not just a high or is a normal, it’s a high or a low.

We have sometimes forgotten that low sugar can sometimes be equally or even more dangerous. Then someone with high sugar, because your brain is dependent on sugar all the time. If you deprive your brain of sugar, you will actually have pretty significant consequences like loss of consciousness and seizures.

So I don’t think a smiley face is good enough. You need a pretty good number so you can potentially act on it.

Daniel Martin:

It’s fascinating to know that this is not new information. People have been trying to research this. It’s the Holy Grail in many ways, if we can get that accurate, best way to measure your blood glucose levels from your sweat in an accurate and timely fashion as well.

And I’m just wondering, like, The advantage is, like, what if we put it into somebody’s smart watch and then the sensor at the bottom is just measuring the sweat coming off your skin all the time and you’ve got a reading that’s real time and you don’t have to wear a device that’s implanted on you. That could be fascinating and powerful.

Why is it so important to have continuous monitoring on your blood sugar or blood glucose level?

Dr. Ben Ong:

I think there are many reasons. I think the most obvious one is to allow the person to know what their sugars are. I mean, if you do the conventional finger pricks, you know your sugars now. So, oh, it’s 7.1, it’s great, but the problem we don’t know is, is it going up or down?

We don’t know the impact of that. You’ve just eaten something, so you think, oh, my sugars are 7.1 in 10 minutes, it’s going to hit. 15 for example, and you think it’s okay. So I think this will allow people to monitor your sugars real time And that will in turn allow them to adjust medication adjust lifestyle and so forth to really um To suit and improve their blood sugar control So I think that’s helpful It’s helpful for clinicians to see the impact of certain things and adjust medications help the patient understand diet and so forth But I think another important aspect is about the low blood sugars now the not only for the many of these devices Imagine you’re wearing a watch that It monitors your sugar.

Not only does it monitor your sugar, imagine it can send an alert if your sugars are low, especially when you’re asleep. This is a huge concern, especially for many elderly people where, you know, they may not be.

Daniel Martin:

Your blood sugar can drop when you’re sleeping?

Dr. Ben Ong:

Absolutely. I mean, it’s actually more dangerous.

Assuming you’re on medication that can lower sugar. Most of us, we get a warning. So the blood sugar doesn’t drop just like that. You get a bit tired, you get a bit hungry, you run out and get food. And that’s how you correct it. But imagine you’re asleep, you have about 8 to 10 hours of no food. And, so you’re asleep, you’re very tired.

You may not realise it, and the danger you have, which is very real, is A, you don’t get up, because your blood sugars drop overnight, and that can be potentially extremely dangerous. Or, in the elderly, you wake up, and you try and reach for something, and you, you’re, because you’re a bit older, your eyesight’s not so good, your balance is not so good, and you fall down, and you break something.

So, the ability to monitor the sugars. Not only to alert the person’s blood whose blood sugar is being measured but to alert the carers to say hang on a second mom’s blood sugar is dropping now, let me go to mom now, give her something to drink, correct the low sugar and I think that can be potentially life saving in many situations.

Daniel Martin:

It seems like we’re just We’re very close to that, potentially, and it could happen, in the next couple of years, we’re hoping, in terms of medical research, because, like you said, your, your, your carers can be notified, the middle of the night situation, and you can see that pattern, that long term pattern, and the doctors can hopefully establish some, if you were able to see a, a daily pattern of somebody real time, what could that help you do in terms of treating them?

Dr. Ben Ong:

I mean, I think, let’s start by saying, actually, we do have something like that already. We don’t measure sweat, though. We do, we measure what we call institutional fluid. So, it’s just underneath the skin. The advantage of the sweat patch is that you just put it over the skin. It doesn’t puncture the skin at all.

All devices at the moment, there’s a little, plastic tubing that goes underneath the skin and it measures the the sugar in the water underneath the skin so we do have something like that, but obviously it is still slightly invasive, but being able to look at this data we can it really helps us by a educating the patient to say listen, you know, you ate this look at how high your sugar went.

Let’s try to avoid that or if your sugars go too low, listen, you’re taking too much medication. We need to adjust it accordingly or you need to adjust your meals and so forth along the way. Just one thing to add though, I think at the moment the concern we have is that, what I don’t want people to think is, oh, this is the era where we need to throw away the finger prick sugars.

Daniel Martin:

I was gonna say maybe we should, doesn’t it lead to, I’ve done interviews with diabetics who say like they’ve lost sensation in their finger because they pricked so much over the years. I’ve spoken to young diabetics who say that when they do this in school they get bullied because their friends are like, oh, you’re doing something illegal, like you’re taking an illegal substance, you know that kind of thing?

Like it’s got stigma, it’s got pain attached to it, maybe we should do away with it.

Dr. Ben Ong:

Well, we can’t at the moment. I wish we could, to be honest, but the problem is that these devices, although they are accurate in their own right, there are many circumstances where they may not be. It’s just like the sweat that you have.

Imagine you’re sweating a lot when you’re exercising. My concern is how accurate it is or in a case where there’s huge temperature differences where the blood supply reaches up to the tissue, the superficial tissue may be impacted, your blood sugars, your sensor may not be reading this as well.

So during times where you’re not quite sure, I think you still need to check your finger prick. It’s not, we haven’t reached that level of technology where we can say, let’s throw this out the window, let’s embrace this. But I think the time is coming. I think the time is coming where these things are becoming more accessible, more accurate, and more importantly, as more people start to use it, cheaper.

So soon, I believe that most patients with diabetes will be using these devices to really monitor and control their sugars.

Daniel Martin:

Now this particular innovation for NTU, again, the idea is it’s not something that the consumer will be able to use so easily because you still need a machine or device at the hospital to, to, to reveal the result in that sense.

Do you think there’s a space for something like that? Quick, real time monitoring, especially at a hospital level. It could shorten queues, shorten waiting times, and potentially help.

Dr. Ben Ong:

Absolutely. I think the, the, I think this is the beginning of things here. You know, even looking at the level of colours, I mean, you can get a machine to put that.

If you can correlate the shade of colour to the level of sugar, then you’re really going somewhere here. I think this is, this is again very exciting and just like all research, I think this is the beginning of something where we need to build on the ability to show a smiley face and all that, more or less tells you that the, the, the sugar levels, they are accurate enough to know what is good and what is bad.

Now the question then is, can we, how good is good and can we put a number to that? Because if we can put a number to that, we are really moving forward and really getting things done here. And so the next step is, how do we make it available to the normal population or even in the hospital, where we just do that and we don’t need a finger prick anymore.

Daniel Martin:

I also think we’re getting closer to what you have spoken to my listeners about so often on my show, which is that it’s about very bespoke treatment. You are treating your condition. It’s not diabetics as a whole. It’s You’re, you’re, you’re knowing your pattern, you’re knowing your blood glucose levels, and you’re treating yourself in that right way that’s very bespoke to you.

Dr. Ben Ong:

Yeah, I think because it’s educational, I think what these sensors actually do, which I think is very, very important, is to understand, because last time what people did was they just pricked your finger and there was no reason, there was no thought behind it. Imagine if you had a device which tells you your sugar and you went out today, you drank some bubble tea, some char kway teow, and you saw your sugars in, you know, skyrocket.

Subconsciously, you think, oh my goodness, this is not something I’m going to consume again. And this is something you learn. And research has shown us we don’t actually eat more than 30 different kinds of food when you’re not on holiday. So, if you really break that down psychologically, oh, this is bad, this is good, and this will actually create real behavioural change, not someone that, hey, you don’t eat this, you don’t eat that.

People, it’s hard to convince someone of that.

Daniel Martin:

Because you see it for yourself, on your device, it’s like, Oh wow, I just ate that and this just happened.

Dr. Ben Ong:

Yeah, exactly. So that will promote behavioural change because all you need is to actually talk from a medical perspective, to talk to the patient, listen, this is how you interpret it.

You look at it before you go and eat, you do this, you exercise and so forth. What is the impact of this activity or food on your sugar? And if it’s good, adopt it more. If it’s bad, think very carefully if you need to do it again. So, the ability to monitor sugars, or anything, your impact of activity and lifestyle on this is, is incredible.

Daniel Martin:

It could be a huge game changer. It really could. I gotta, we gotta leave things there because we’re out of time. Dr. Ben Ong, a pleasure. Thanks so much for your time. Dr. Ben Ong, the endocrinologist at Arden Endocrinology Specialist Clinic.

Before making any decisions based on the information in our program, please consult a medical professional.

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