If you’re a diabetes patient in Japan, the gods may be watching over you. The country is struggling with rising numbers of diabetics, but a novel approach to managing Type 2 diabetes mixes a bit of psychology with Internet of Things (IoT) devices, as well as seven lucky gods from Japanese folklore. It’s part of a broader trend in which Japan is deploying cutting-edge technology to grapple with an aging population.
As developed countries around the world cope with demographic changes, Japan is in a position to lead the way. It has a rapidly greying society, a wealth of high-quality health data, and novel approaches to using that data and the latest technology to improve the lives of its citizens.
A growing health challenge
Some 10 million adults in Japan are suspected of having diabetes, according to a 2016 survey by the Ministry of Health, Labour and Welfare. The survey of 11,000 adults from about 24,000 households chosen at random yielded a result that was 500,000 higher from the same survey in 2012. Some 6.9 million Japanese were suspected of having the disease in 1997. According to a 2015 study of 160,000 Japanese adults that was published in the Journal of Diabetes Investigation, researchers at centers in Japan and overseas concluded that “a substantial increase in diabetes prevalence is expected in Japan during the next few decades, mainly as a result of the aging of the adult population.”
“Japan is a super-aging society and many older people don’t know how to take care of their health,” says Kohjiro Ueki, director of the Diabetes Research Center at the National Center for Global Health and Medicine (NCGM) in Tokyo. “It’s still unclear to what extent we can get them improve their blood glucose levels. However, Japan is most likely leading other countries on this issue.”
Costs associated with the disease are growing. Some 16,000 people are newly put on hemodialysis annually, and the total increase in the cost of hemodialysis due to diabetic kidney disease is 8 billion yen ($70 million) every year, according to Ueki. The silver lining, however is that diabetes can be managed effectively with lifestyle changes. To rein in both the financial burden and the progression of diabetes, Ueki and his colleagues launched a randomized controlled trial called Prevention of Worsening Diabetes Through Behavioral Changes by an IoT-based Self-Monitoring System in Japan (PRISM-J).
Managing diabetes with the gods
Diabetes patients participating in the study measure their weight, activity level, number of steps taken, and blood pressure on a daily basis. To do that, they’re using blood pressure monitors, pedometers and body composition monitors that send the data to their smartphones and an app called Shichifukujin (The Seven Deities of Good Luck). Kazuyo Tsushita, director of the Comprehensive Health Science Center at the Aichi Health Promotion Foundation, developed the app and took inspiration from Japanese mythology. Known to all Japanese, the seven gods are responsible for seven aspects of the program, including the self-reporting of eating habits and sitting times. Fukurokuju, the god of wisdom and longevity, oversees data recording; Ebisu, the god of wealth, crops and food, watches over step counts; Bishamonten, the god of fortune and war, looks after physical activity; Daikokuten, the god of commerce and prosperity, is in charge of diet; Hotei, a guardian of children, is responsible for body weight; Jurojin, the god of the elderly and longevity, looks out for blood pressure; and Benzaiten, the goddess of wisdom and a patron of artists, oversees the patient’s total performance.
The data generated by users is uploaded to the Shichifukujin cloud, where patients’ physicians can monitor their progress. Two thousand patients aged 20 to 75 are participating in the two-year PRISM-J study, which began in January 2018. Supported by the Japan Diabetes Society, PRISM-J is the longest study of its kind in the world.
“Patients in their 20s have an easier time getting adjusted to the devices used in the study,” says Ryotaro Bouchi, a diabetes researcher at NCGM who recruited patients. “Older users can do well if they get enough explanations. The exit rate has been less than 1%, which is much lower than similar studies.”
Users can interact with cartoonish illustrations of the gods and get automated feedback from them twice a week. If users miss updates, the gods express disappointment—there are no pressure tactics involved. The idea is that the prompts will keep users interested in controlling their diabetes, and perhaps lose excess pounds, by eating right and exercising more.
The unprecedented ability for physicians to track vital patient data between clinical visits is made possible through IoT. Researchers hope to develop more sophisticated IoT data algorithms that would send users messages about increasing their activity or seeking further help. Meanwhile, the technology could also be used to study other lifestyle diseases such as hypertension and hyperlipidemia.
“Our goal is to prove that using IoT devices can produce better blood glucose scores for diabetes patients,” says Ueki. “If patients can visualize how they’re doing, it could help them make positive changes in lifestyle habits and keep them motivated. The improvement in the data per se is a reward for patients.”
Spinning fiber into sensors
Japan is rolling out various kinds of IoT devices to help society better deal with aging. For instance, smart tags inserted into shoes and bags can help track dementia patients who repeatedly wander off, while washable UHF tags in hospital bed sheets can alert administrators about when it’s time for disposal.
At Tokyo-based smart fabric company Mitsufuji, IoT sensors are being integrated into clothing. Founded by a traditional Kyoto textile company, Mitsufuji is now focused on the development and manufacture of silver-metalized conductive fiber under its AGposs brand and wearable IoT products under its hamon smartwear brand, which was commercialized in 2016.
Stretchable and flexible, AGposs is nylon covered with silver, so that it acts like both thread and metal. It’s electrically conductive, and when incorporated into hamon smartwear, it can be used to monitor biometric information such as breathing rate and heartrate, as well as temperature, humidity, acceleration and gyroscopic data. With a transmitter attached to the smart fabric and other devices, data can be sent to mobile devices and cloud platforms.
Detecting heatstroke and heart attacks in the near future
The technology can be applied to various sports uses, such as yoga and weightlifting, as well as industrial purposes such as the uniforms of construction or factory workers. But healthcare applications are drawing attention amid Japan’s aging population. For instance, hamon smartwear could help keep tabs on elderly people during Japan’s torrid summers: of the 105 people who died of heatstroke in Tokyo in July and early August 2018, 80 were aged 70 or above. Mitsufuji has worked with university researchers to develop algorithms that work with the hamon smartwear to detect when heat stroke may occur.
“Hamon can monitor heart rate in a more stable fashion than existing wristband-style wearables,” says Mitsufuji CEO Ayumu Mitera. “We will be able to detect heat stroke by using this technology, and it can also send alerts to care managers about heart attacks.”
Mitera says hamon users have been impressed with the accuracy of the sensor data, and the company wants to meet their various needs by continuing development. The company has also created disposable hamon smartwear for use in care facilities. In September 2018, it completed construction of a manufacturing facility in Fukushima Prefecture to meet demand for hamon products.
“Aging populations are a global problem and Japan is a frontrunner that can provide solutions—we have no choice in this because everyone is getting old,” says Mitera. “While traditional large families that would care for elderly are a thing of the past, with remote medical technology caregivers who monitor patient data can act as their family. I think that by 2040 or so, people will not need to go to hospital anymore because diseases and symptoms will be detected in advance. We’re now beginning to cross this threshold.”
This article was originally published on Forbes.