David Kerr: Will smart pills help improve patients’ compliance?

David KerrIn a recent YouTube video the NHS Confederation highlighted that by 2050 one quarter (18 million) of adults in the UK will be living with a long-term medical condition. In my own speciality of diabetes, people living with this condition are prescribed multiple classes of medications including drugs and injections to control glucose levels, two or three that lower blood pressure and cholesterol, as well as one to deal with the effects of diabetes complications and the psychological distress it causes. In addition, self-monitoring of blood glucose levels on a daily basis is encouraged especially if they are at risk of hypoglycaemia as a side effect of their treatment.

For individuals prescribed lots of medicines to take every day on a long-term basis is not easy especially if the disease itself causes few symptoms such as is often the case with type 2 diabetes. It is no surprise therefore that compliance with medication is relatively poor. The clinical implication of this is that instead of increasing doses, changing the medication, or adding a second drug when glucose levels are high, clinicians should consider strategies to improve medication adherence.

In an attempt to improve compliance, a pill has been developed which sends an SMS text alert once ingested. Here a small sensor the size of a grain of sand made from copper and magnesium is embedded within the medicine. The sensor generates power when in contact with moisture which is picked up by a small detector patch worn by the patient.  This in turn triggers an SMS text alert to a smart phone. As well as checking patient compliance the information about tablet taking can be sent to clinicians and relatives. In 2013, the US Food and Drug Administration approved this ingestible biosensor and its companion patch as the world’s first “smart pill” system. This concept has the potential to be developed further to collect other information such as heart rate and blood pressure and perhaps even glucose levels in the future. Unsurprisingly this has attracted the interest of major pharmaceutical and medical device companies.

This smart pill idea is part of a more general concept called “The Internet of Things” which in essence means that we are more and more going to be connected by objects embedded with sensors which can communicate over the internet. In a recent report, the Internet of Things was one of 12 technologies that are expected to transform our lives in the next five years with a value in excess of $36 trillion.

From a medical perspective it remains to be seen whether a “smart pill” will improve medicine compliance. Around 30% of the time problems with compliance are due to “forgetfulness” and I guess this type of novel technology is likely to be beneficial (Am J Manag Care. 2011;17 (7): e277-e287).  It is less clear whether it will impact on the other common reasons for non-compliance such as lack of information, other priorities, and emotional factors, and it may not deal with 10% admitting that non-compliance is due to a deliberate decision to omit a dose.

David Kerr wears many hats, sometimes at the same time—diabetologist, editor of Diabetes Digest, researcher, and founder of VoyageMD.com, a free service for travellers with diabetes and Excarbs.com focusing on exercise and insulin. You can follow him on Twitter (@GoDiabetesMD) and Linkedin.