Saturday, November 14, 2026

Beyond Blood Sugar: A Journey Towards Healing Through Food, Movement, Forgiveness, Mindfulness and Spirituality

Beyond Blood Sugar: A Journey Towards Healing Through Food, Movement, Forgiveness, Mindfulness and Spirituality

On World Diabetes Day — 14 November

There are days when we need to pause, look beyond the numbers on our laboratory reports and ask ourselves a simple question: Are we truly living, or are we merely going through the motions of life?

World Diabetes Day reminds us of a condition that affects millions of lives across the world. We often speak about diabetes in the language of medicine — fasting blood glucose, HbA1c, insulin resistance, medications, complications and dietary restrictions. These are undoubtedly important. They help us understand the disease, monitor its progression and protect ourselves from its consequences.

But there is another dimension to diabetes that deserves equal attention: the human being living behind those numbers.

A person with diabetes is not an HbA1c value. They are someone with dreams, relationships, disappointments, anxieties, memories and aspirations. They are someone who wants to enjoy a meal without guilt, walk without exhaustion, sleep without worry and wake up with a sense of purpose.

Perhaps, therefore, the conversation about diabetes should extend beyond medication and dietary charts. It should include how we eat, how we move, how we think, how we forgive and how we find meaning in our existence.

Because healing, in its deepest sense, is not always about curing a disease. Sometimes, it is about learning to live beautifully despite it.

1. Healthy Diet: Nourishing the Body, Not Punishing It

Food is one of life's simplest pleasures. It connects us to our childhood, our families, our cultures and our memories. The aroma of freshly cooked rice, a favourite homemade dish, a Sunday breakfast or a meal shared with loved ones — these experiences are woven into the fabric of our existence.

Yet, for someone living with diabetes, food can gradually become a source of anxiety.

Every meal becomes a calculation. Every sweet becomes a temptation. Every dietary indulgence is followed by guilt.

But healthy eating should never feel like punishment.

The objective of a diabetic diet is not to take away the joy of eating. It is to rediscover a healthier relationship with food.

A balanced diet built around vegetables, whole grains, pulses, legumes, adequate protein, healthy fats and fibre can help regulate blood glucose, improve metabolic health and support overall well-being.

A few simple principles can make a remarkable difference:

  • Choose whole grains and fibre-rich foods more frequently than refined carbohydrates.
  • Include adequate protein from pulses, eggs, fish, lean meat, dairy or other suitable sources.
  • Eat a generous variety of seasonal vegetables.
  • Prefer whole fruits over fruit juices.
  • Limit highly processed foods, sugar-sweetened beverages and excessive refined carbohydrates.
  • Be mindful of portion sizes and meal patterns.
  • Stay adequately hydrated.

And perhaps most importantly, learn to eat mindfully.

Slow down. Notice the taste, texture and aroma of your food. Avoid eating mechanically while scrolling through your phone or worrying about tomorrow.

Food is not merely fuel. It is nourishment, culture, comfort and connection.

We do not have to abandon the pleasure of eating to become healthy. We simply have to make choices that allow us to enjoy food while respecting the needs of our bodies.

Let food become an expression of self-care rather than a source of guilt.

2. Regular Exercise: Every Movement Is an Act of Self-Love

Our bodies were designed to move.

Unfortunately, modern life has gradually transformed movement into an optional activity. We sit at our desks, travel in vehicles, spend hours looking at screens and postpone physical activity until some imaginary tomorrow.

For people with diabetes, physical inactivity can make an already challenging metabolic situation more difficult.

Regular exercise improves insulin sensitivity, helps muscles utilise glucose, supports cardiovascular health, improves body composition and contributes to better mental well-being.

But exercise need not begin with an ambitious gym membership or an exhausting fitness programme.

It can begin with a simple walk.

A 20–30-minute walk, gradually building towards at least 150 minutes of moderate-intensity aerobic activity per week, can be a meaningful starting point for many adults. Resistance training two or more days a week can further improve muscle strength and metabolic health.

Take the stairs. Walk after meals. Dance to your favourite music. Cycle through a quiet road. Practise yoga. Work in your garden.

Find a form of movement that makes you happy.

Remember, exercise is not about punishing yourself for what you ate yesterday. It is about preparing your body for the life you wish to live tomorrow.

There will be days when you feel energetic and days when even a short walk seems difficult. Do not allow occasional setbacks to become permanent excuses.

Start where you are. Respect your limitations. Celebrate small achievements.

For someone living with diabetes, exercise plans should be individualised, particularly when insulin or glucose-lowering medicines that can cause hypoglycaemia are being used. Foot problems, cardiovascular disease and other complications may also require specific precautions.

But the underlying message remains simple:

Every step you take towards movement is a step towards a stronger, healthier and more independent life.

3. Forgiveness: Healing the Wounds We Cannot See

This is perhaps the most overlooked aspect of health.

We spend considerable time worrying about what we eat and how much we exercise. We monitor our blood pressure, cholesterol and blood glucose. Yet, we often ignore the emotional burdens we carry for years.

Anger. Resentment. Regret. Disappointment. Unspoken grief. Relationships that ended badly. Words that should never have been spoken. Words that we desperately wished someone had said.

We carry these experiences silently.

Sometimes, we become prisoners of our own memories.

Chronic emotional distress can affect sleep, behaviour, eating habits and our ability to care for ourselves. Stress-related hormonal responses can also influence blood glucose regulation.

This does not mean that forgiving someone will lower your HbA1c or reverse diabetes. Forgiveness is not a medical treatment. But emotional well-being is an important part of living a healthy life.

And forgiveness can be profoundly liberating.

Forgive someone who hurt you, not necessarily because they deserve another chance, but because you deserve peace.

Forgive the person who disappointed you. Forgive the friend who walked away. Forgive the family member who failed to understand your struggles.

And, perhaps most importantly, forgive yourself.

Forgive yourself for the mistakes you made, the opportunities you missed, the relationships you could not save and the days when you were not strong enough.

If you are living with diabetes, forgive yourself for the occasional dietary indiscretion, the missed exercise session or the imperfect glucose reading.

You are human. You are allowed to have difficult days.

Forgiveness does not mean accepting abuse, abandoning boundaries or pretending that painful experiences never happened. Sometimes, forgiveness simply means deciding that the past will no longer dictate the quality of your present.

There is an extraordinary freedom in putting down the emotional baggage we have carried for so long.

A peaceful heart may not change every circumstance of life, but it can change the way we experience life.

4. Mindfulness: Learning to Live in the Present

We spend much of our lives trapped between two imaginary places.

The past, which we cannot change, and the future, which we cannot completely predict.

We regret yesterday. We worry about tomorrow. Meanwhile, the present moment quietly passes us by.

Mindfulness is the art of returning to the present.

It is the ability to experience life without constantly judging, resisting or running away from what is happening within us.

For someone living with diabetes, mindfulness can be particularly valuable.

Consider the simple act of eating.

Instead of rushing through a meal, pause. Observe your hunger. Recognise when you feel satisfied. Become aware of emotional eating and the circumstances that trigger it.

Consider the act of walking.

Instead of thinking about your unfinished work or tomorrow's responsibilities, notice the movement of your feet, the rhythm of your breathing and the world around you.

Consider the act of checking your blood glucose.

Instead of treating an unexpectedly high reading as a personal failure, see it as information. Understand the possible reasons, discuss patterns with your healthcare professional and make appropriate adjustments.

A glucose reading is feedback, not a judgement of your worth.

Mindfulness can also be cultivated through meditation, breathing exercises, journaling, yoga or simply spending a few quiet minutes without digital distractions.

You do not need to meditate for an hour every morning. Even five or ten minutes of intentional stillness can become a meaningful daily practice.

Learn to recognise your emotions without becoming overwhelmed by them.

Learn to observe your thoughts without believing every negative thing they tell you.

Learn to accept that some days will be difficult, and that difficult days do not define your entire life.

The present moment is the only place where life actually happens. Do not spend it entirely worrying about moments that have not yet arrived.

5. Spirituality: Finding a Purpose Beyond the Physical Body

Beyond diet, exercise, medication and mental well-being lies another dimension of human existence — spirituality.

Spirituality does not necessarily mean religion, rituals or belonging to a particular faith.

It can mean discovering a connection with something greater than ourselves.

For some, it is God. For others, it is nature, humanity, the universe, compassion or the simple mystery of being alive.

It is the ability to find meaning beyond material achievements, professional recognition and physical appearances.

When we encounter a chronic illness, our understanding of life sometimes changes.

We begin to recognise how fragile the human body can be. We become more conscious of time. We realise that health is not something we should take for granted.

But illness need not become the centre of our identity.

A diagnosis of diabetes does not take away our ability to love, create, travel, sing, write, laugh, dream or contribute to the world.

Spirituality can help us rediscover these possibilities.

Practise gratitude. Appreciate the people who stand beside you. Spend time with nature. Listen to music. Read something meaningful. Help someone who is struggling. Spend a few moments in prayer or silent reflection.

Learn to appreciate ordinary experiences.

The warmth of morning sunlight. The sound of rain. A familiar song. A conversation with an old friend. The smile of someone you love.

These moments may appear insignificant, but they are often the very things that make life worth living.

And perhaps spirituality teaches us the most important lesson of all:

We are more than our physical bodies. We are more than our illnesses. We are more than our successes and failures.

Our existence has a meaning that cannot be measured by a laboratory report.

A healthy life is not merely about adding years to our existence. It is about adding meaning, compassion and gratitude to the years we have.

The Five Pillars of a Healthier Life

Healthy eating nourishes the body.

Regular exercise strengthens the body and restores vitality.

Forgiveness releases emotional burdens.

Mindfulness brings us back to the present.

Spirituality gives our lives meaning and direction.

These five dimensions are interconnected. None exists entirely in isolation.

When we eat better, we often feel better. When we move regularly, our confidence improves. When we forgive, we make room for emotional peace. When we practise mindfulness, we become more conscious of our choices. When we nurture our spirituality, we begin to understand that our lives are about much more than our daily struggles.

Of course, these practices do not replace evidence-based diabetes care.

Regular medical follow-up, appropriate medication, blood glucose monitoring, HbA1c assessment, blood pressure and lipid management, kidney evaluation, retinal screening and foot care remain essential.

Diabetes is a complex metabolic condition, and every individual requires an appropriate, personalised management plan.

But medical treatment and a meaningful lifestyle are not competing philosophies. They complement each other.

Medicine helps us manage the disease. Healthy habits help us protect our bodies. Emotional well-being helps us navigate our struggles. And spirituality can help us find meaning in the journey.

A Message of Hope: You Are More Than Your Diagnosis

To everyone living with diabetes, I want to leave you with a thought.

Do not allow your diagnosis to become the definition of your life.

You are not your fasting blood glucose.

You are not your postprandial blood glucose.

You are not your HbA1c.

You are a person who deserves happiness, dignity, love and hope.

There may be mornings when your glucose readings disappoint you. There may be days when you struggle to follow your diet or find the motivation to exercise. There may be moments when you feel exhausted by the constant demands of managing a chronic condition.

That is alright.

You do not have to be perfect.

You only have to keep trying.

Make peace with your body. Feed it with kindness. Move it with gratitude. Forgive yourself and others. Give your mind the gift of stillness. Allow your spirit to find its own meaning.

And remember that even the smallest positive change, repeated consistently, can transform the way you experience life.

Perhaps the greatest achievement is not simply living longer, but living better — with a healthier body, a calmer mind, a forgiving heart and a grateful soul.


A Final Reflection on World Diabetes Day

Let us eat to nourish, not merely to satisfy.

Let us move to celebrate our bodies, not punish them.

Let us forgive to release ourselves from the weight of yesterday.

Let us practise mindfulness to experience the beauty of today.

And let us embrace spirituality to find hope in tomorrow.

Because life is too precious to be reduced to a number on a glucometer.

This World Diabetes Day, let us make a promise to ourselves: to care for our bodies, be gentle with our minds, keep our hearts free from bitterness and allow our souls to remain hopeful.

We may not always have control over the diseases that affect us, but we can learn to make choices that enrich the lives we live.

Beyond blood sugar, there is a beautiful life waiting to be lived.

Happy World Diabetes Day. Let us choose health, happiness, compassion and hope — every single day.

Saturday, July 12, 2025

Hope & Weekly Pill: Trelagliptin in Focus

Hope in a Weekly Pill: A Doctor’s Reflection

The life of a doctor on a 24‑hour shift is like being caught in a storm. My duty starts at 9 a.m. and ends at 9 a.m. the next day. There’s barely a quiet moment. It’s a continuous loop of emergencies, decisions, and caring for people on the edge. By 5:30 p.m., even though the night lies ahead, the tiredness sinks deep into the bones. There’s no real break — not even for 30 minutes. This life, though meaningful, slowly chips away at health, sleep, and sometimes, the spirit.

In the emergency room, we often see patients with longstanding diabetes. Many have struggled for more than a decade. They are tired. Tired of taking pills — morning, noon, and night. They say it out loud: “Pills, pills, and more pills!” This fatigue leads to missed doses, rising sugar levels, and eventual organ damage—a painful cycle we see too often.

But even in this chaos, there's a quiet thread among us—shared knowledge. It’s not formal. It’s just someone sending a message, a link, a photo on WhatsApp, hoping to keep colleagues informed.

Yesterday, in a rare moment of pause, I checked my phone. A senior had sent a picture of a new medicine — Trelaglip. The words jumped out: “Once Weekly Oral DPP‑4i.” My heart skipped a beat. Could this be real?

I read the message: “Same day, every week. Trelaglip tablets.” That was it. A once-weekly oral medicine for type 2 diabetes. No more three-times-a-day routine. One tablet a week. Like Vitamin D. Simple. Manageable. Revolutionary.

If it works as promised, it could change everything. Patients might finally stick to treatment. That means better sugar control, fewer complications, and possibly, a better life. We’ve had weekly injections before. But a pill? That’s far more acceptable.

Of course, cost remains a question. But if the drug is effective, prices may fall. It could reach many, not just a few. For public health, it could be a game‑changer in our fight against diabetes.

It’s strange—how during a hectic shift, a colleague’s simple message can feel like a small light in the dark. These moments remind me why we keep going, even when exhausted. We’re all striving to improve patient lives.

Sometimes, hope arrives not in big discoveries, but in a small tablet taken once a week — and in a brief moment of shared belief.


Once‑Weekly Oral Antidiabetic Therapy: A Public Health Perspective for India

Introduction

The rise of once‑weekly oral antidiabetic agents, such as Trelagliptin (a DPP‑4 inhibitor), could represent a breakthrough in managing type 2 diabetes mellitus (T2DM). In India, where diabetes prevalence is escalating, this innovation may reduce long‑term complications and improve adherence.

The Public Health Burden

Diabetes is a chronic disease with serious complications affecting both individuals and health systems:

  • Microvascular: Retinopathy, nephropathy, neuropathy.
  • Macrovascular: Heart attack, stroke, peripheral artery disease.
  • Infections: Increased susceptibility due to reduced immunity.
  • Quality of Life: Chronic disability and loss of productivity.

These complications heavily burden India’s healthcare resources and economy due to loss of productive life‑years.

The Role of Once‑Weekly Therapy

1. Medication Adherence

  • Pill Fatigue: Reducing dose frequency simplifies treatment.
  • Compliance: Less frequent dosing supports more consistent use and delayed progression.

2. Complication Reduction

  • Microvascular: Better control reduces risks of blindness, dialysis, amputations.
  • Cardiovascular: Stable glucose lowers heart attack and stroke incidence.
  • Healthcare Demand: Fewer complications reduce hospital and specialist burden.

3. Quality of Life

  • Self‑Confidence: Simpler regimens boost patient empowerment.
  • Mental Health: Reducing daily reminders of illness eases stress.
  • Productivity: Healthier patients support economic activity and relieve caregiver strain.

Challenges for Integration

  • Cost‑effectiveness: Sustainable pricing and generics/essential medicine inclusion are needed.
  • Rural Accessibility: It must reach primary health centers and NCD programs.
  • Provider Training: Community doctors and health workers need education and support.

Trelagliptin: Pharmacology and Clinical Profile

Introduction

Trelagliptin is a once‑weekly oral DPP‑4 inhibitor approved in Japan (March 2015) and India (December 2024) for T2DM management. It enhances incretin activity to improve glycemia with low hypoglycemia risk.

Mechanism of Action

  • Inhibits DPP‑4, preserving GLP‑1 and GIP to enhance glucose‑dependent insulin and suppress glucagon.
  • Slows gastric emptying; may support β‑cell health.
  • High specificity (IC₅₀ ≈1.3–5.4 nmol/L).

Pharmacokinetics

  • Oral bioavailability high; peak levels ~1–1.5 h post‑dose.
  • Long elimination half‑life (38–54 h) supports once‑weekly dosing.
  • Mainly renally excreted; minimal hepatic metabolism.

Pharmacodynamics

  • Sustains ~70–80% DPP‑4 inhibition for a week.
  • Phase 2/3 trials show HbA₁c reductions of ~0.5–1.0%.
  • Weight‑neutral, low hypoglycemia risk when used alone.

Clinical Efficacy & Safety

  • Monotherapy: dose‑dependent HbA₁c reduction similar to daily DPP‑4 inhibitors.
  • Phase 3 trials show non‑inferiority versus alogliptin; good tolerability.
  • Add‑on to insulin: ~0.63% greater HbA₁c reduction without severe hypoglycemia.
  • Pilot studies: increased adiponectin; no endothelial compromise.
  • Side effects: mild nasopharyngitis, headache, upper respiratory symptoms.

Clinical Implications

  • Once‑weekly dosing boosts adherence, especially in low‑resource areas.
  • Safe for diverse populations due to weight neutrality and low hypoglycemia risk.
  • Effective as adjunct therapy with insulin.

Precautions & Dosing

  • No dose adjustment in mild/moderate hepatic impairment.
  • Renal impairment: dose reductions per eGFR recommendations.
  • Use caution with insulin or sulfonylureas to avoid hypoglycemia.

Safety Profile and Complications of Trelagliptin

Introduction

Trelagliptin is generally well tolerated, but distinguishing common side effects from rare serious complications is essential.

1. Hypoglycemia

  • Monotherapy: low risk due to glucose‑dependent mechanism.
  • Combined therapy: risk increases with sulfonylureas or insulin; adjust doses accordingly.

2. Pancreatitis

  • Meta‑analyses show slight increase in acute pancreatitis risk (OR ~1.7).
  • Rare cases (~0.3%) in clinical trials.
  • Discontinue drug if pancreatitis suspected.

3. Bullous Pemphigoid

  • Possible 2–4× increased risk, particularly in people >70 years.
  • Discontinue if suspected; refer to dermatology.

4. Arthralgia

  • Severe joint pain reported; typically resolves after stopping drug.

5. Hypersensitivity

  • Rare angioedema, urticaria, anaphylaxis, especially in first 3 months.
  • Discontinue immediately; manage supportively.

6. Heart Failure

  • Saxagliptin and alogliptin showed heart failure risk, but no strong signal for Trelagliptin.
  • Monitor in heart disease patients.

Other Observations

  • Renal impairment: no major issues, but dose adjustments may be needed.
  • Gallbladder events: slightly increased in meta‑analyses.

Summary & Abbreviations

Summary: Trelagliptin is a once‑weekly oral DPP‑4 inhibitor offering simplified therapy, sustained glycemic control, and strong safety. It reduces pill burden, enhances adherence, and lowers complication risk. Rare but serious effects—pancreatitis, arthralgia, bullous pemphigoid, and hypersensitivity—require vigilance. While care is needed when combined with insulin or sulfonylureas or in comorbid conditions, the drug’s convenience and tolerability make it a promising option in diabetes management and public health.

Abbreviations:
DPP‑4 = dipeptidyl peptidase‑4 | GLP‑1 = glucagon‑like peptide‑1 | GIP = glucose‑dependent insulinotropic polypeptide | T2DM = type 2 diabetes mellitus | HbA1c = glycated hemoglobin | eGFR = estimated glomerular filtration rate.


References

  1. Seino Y, Kuwata H, Yabe D. Incretin-based drugs for type 2 diabetes: Focus on Takeda's trelagliptin and alogliptin. Expert Opin Pharmacother. 2015;16(16):2583–2596.
  2. Yabe D, Seino Y. DPP-4 inhibitors – their potential in the treatment of type 2 diabetes. Expert Opin Investig Drugs. 2011;20(3):343–360.
  3. Yasuda N, Inoue T, Nagakura T, et al. Trelagliptin, a novel once-weekly oral DPP-4 inhibitor: preclinical and clinical pharmacology. Diabetes Obes Metab. 2016;18(6):627–634.
  4. Monami M, Dicembrini I, Mannucci E. Dipeptidyl peptidase-4 inhibitors and pancreatitis risk: a meta-analysis. Diabetes Obes Metab. 2014;16(1):48–56.
  5. Singh S, Chang HY, Richards TM, et al. GLP-1 therapies and risk of acute pancreatitis. JAMA Intern Med. 2013;173(7):534–539.
  6. Ujiie T, Muramatsu K, Ozeki T, et al. DPP-4 inhibitors and bullous pemphigoid: a disproportionality analysis. Br J Dermatol. 2020;183(6):1121–1123.
  7. US FDA. Drug Safety Communication: DPP-4 inhibitors may cause severe joint pain. 2015.
  8. Scirica BM, Bhatt DL, Braunwald E, et al. Saxagliptin and cardiovascular outcomes in T2DM. N Engl J Med. 2013;369(14):1317–1326.
  9. White WB, Cannon CP, Heller SR, et al. Alogliptin after acute coronary syndrome. N Engl J Med. 2013;369(14):1327–1335.
  10. Yamada Y, Nishida T, Yamada Y, et al. Once-weekly trelagliptin in Japanese patients: phase III trial. Diabetes Obes Metab. 2016;18(3):249–257.
  11. Zuventus Healthcare Ltd. Efficacy and safety of once-weekly Trelagliptin vs vildagliptin in Indian patients. 2025.
  12. American Diabetes Association. Standards of Medical Care in Diabetes—2024. Diabetes Care. 2024;47(Suppl 1):S1–S207.

Tuesday, August 13, 2019

SOP - Hip Circumference


Hip circumference measurements are taken in some sites as an expanded option to measure overweight and obesity.


To take hip circumference measurements we need : 
  • constant tension tape (for example, Figure Finder Tape Measure)
  • pen/pencil
  • chair or coat stand for participant's to place their clothes.

A private area is necessary for this measurement. This could be a separate room, or an area that has been screened off from other people within the household. Hip measurements are taken immediately after waist circumferences.
  • This measurement should be taken without clothing, that is, directly over the skin.
  • If this is not possible, the measurement may be taken over light clothing (Must not be over thick or bulky clothing. This type of clothing must be removed)

This measurement should be taken:
  • with the arms relaxed at the sides
  • at the maximum circumference over the buttocks

Steps of measurement:
  1. Stand to the side of the participant, and ask them to help wrap the tape around themselves.
  2. Position the measuring tape around the maximum circumference of the buttocks.
  3. Ask the participant to: 
    • stand with their feet together with weight evenly distributed over both feet;
    • hold their arms relaxed at the sides.Check that the tape position is horizontal all around the body and snug without constricting.
  4. Measure hip circumference and read the measurement at the level of the tape to the nearest 0.1 cm.
  5. Record the measurement on the participant’s instrument.

SOP - mid upper arm circumference (MUAC)

  • The major determinants of MUAC are muscle and subcutaneous fat, both important determinants of survival in malnutrition and starvation. 
  • MUAC is less affected than weight and height based indices (e.g. Body Mass Index) by accumulation of fluid (i.e. nutritional oedema, periorbital oedema and ascites). 
  • So MUAC is a good predictor of mortality. 
  • It is recommended for identifying young children with, or at risk of, severe acute malnutrition and adults with acute energy deficiency.
  • In children between 6-59 months old, MUAC <110 mm indicates severe acute malnutrition and is recommended as a criterion for admission to therapeutic feeding programmes. 
  • Values between 110 and 120/125 mm indicate moderate malnutrition. 
  • Values below 250 mm in adults indicate severe wasting. 
  • (Note that MUAC is not sensitive enough to routinely monitor growth at young child clinics)








SOP

It's been quite a while since I posted something on my blog. Today while cleaning up the junk accumulated on my hard drive I came across several useful articles that I had prepared during my PG- ship.

SOP or standard operating procedures.

Sharing here are some of the articles that I found useful for public health purposes.


  1. mid upper arm circumference 
  2. waist circumference 
  3. hip circumference 
  4. height
  5. weight
  6. pallor




Monday, October 9, 2017

ECG monitoring using mobile device - when engineering met medicine

Innovativeness and creativity has always been a part of science. In this ever developing world, Science has made our lives easier. With every passing day a new development strikes the market and leaves it's imprint behind.

Mobile Technology has affected every aspect of the human life all over the world. Not only has mobile technology made connectivity easier, it has also positively impacted Healthcare services. In this regard and new development that caught my attention in recent times was the use of a smart phone to monitor ECG.

I came across such device on a Facebook Post. The interface uses ECG leads connected on the chest wall of the patient and transmitting data via cable directly to the mobile device. Once connected, an app installed in the mobile can recognize the electrical activity and display the graph. it can be used for continuous monitoring and also a graph can be printed. The best part of the system is that it can be used by Healthcare providers in Periphery (like in Sub Center or PHC) and the information can be transmitted to a higher setup.
In this manner even a health worker who has been trained to connect the leads on the patient's chest and run the app on mobile can take out an ECG from a patient who complains of cardiac or similar symptoms within moments. The data thus obtained can be analysed by doctor positioned more centrally and the health worker may be guided to take the best course of action which he may be unable to take himself otherwise.

For example, a patient visiting a sub Center located in a remote village complains of sudden onset chest pain. ECG taken out by the health worker may be immediately sent to the higher center to the consultant whereby a diagnosis of Acute Myocardial Infarction is suspected. Accordingly the health worker can be guided to provide the immediate care(like Morphine, Oxygen, Nitrate, Aspirin) and shift the patient as early as possible to a better equipped center for further management thus improving the chances of survival of the patient and bringing down the cost of therapy as well. This system may also help in avoiding unnecessary referrals.