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Written Report

Name of Candidates: Adeline Sim Hui Min (3023/1196) Lau Kah Yeen (3023/1203) Lewis Nam Yi An (3023/1204) Teo Rui Yi Doria (3023/1215) Tilwa Raj Udaykumar (3023/1217) CT: 10S35 Group Index No: VJ041 Project Task Chosen: Task 2 – Alternatives. Title of Project: Insulin Microneedle patch: Lots of gain and no pain! Date of Submission: 11th October, 2010 Name of Supervising Tutor: Tee Wen Ching Alysia Signature of Candidates: Signature of Supervising Tutor:

Contents Page 1

Acknowledgements

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1.

Overview of our project

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Case Study: Traditional Chinese Medicine (TCM) 2.1 TCM pills as an alternative form of medication 2.2 Advantages of TCM pills
2.3

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Disadvantages of TCM pills

3. Alternative to insulin injections for diabetic patients

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3.1 Rational behind our alternative 3.2 Difficulties faced with current insulin injections 3.3 Our proposal: Insulin microneedle patches 3.3.1 Features 3.3.2 Limitations of using our insulin microneedle patches 3.4 Cost and affordability 3.4.1 3.4.2 3.4.3 3.4.4 Current costs of using insulin injections Estimated costs of using the insulin microneedle patch Current healthcare schemes available for diabetic patients Proposed healthcare scheme for diabetic patients

3.5 Marketing strategies for the microneedle patch

4. Conclusion Annex

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Annex 1: Focus interview with Diabetic patients on oral medication Annex 2: Focus interview with diabetic patients on insulin injections

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Annex 3: Interview with TCM Practitioner Ms Chen Kehat Sheng from Yong Her Sin Medical Store and TCM Practitioner Mr. Tan Yu Bing from Ping Wah Chinese Physician and Medical Hall Annex 4: Interview with CEO of Micropoint, Mr Lim Chee Yen Annex 5: Interview with Rose, Nurse Educator from Central Singapore Diabetics Education and Care Centre 48 39 43

Bibliography

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Acknowledgements We would like to thank our Supervising Tutor, Miss Alysia Tee, and the Project Work Committee members for their dedication, patience and guidance. We would also like to thank the following for their assistance in the project: • Diabetic patients from Diabetic Society of Singapore for taking part in our focus interviews • • • • • Diabetic patients at Marine Parade Polyclinic (Singhealth) Ms Rose, Nurse Educator at Central Singapore Diabetics Education and Care Centre Dr. Chen Kehat Sheng, TCM practitioner at Yong Her Sin Medical Store Dr. Tan Yu Bing, TCM practitioner at Ping Wah Chinese Physician and Medical Hall Mr Lim Chee Yen, Chief Executive Officer of Micropoint

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Overview

We will be studying herbal pills as an alternative mode of treatment to the brewing of herbs in Traditional Chinese Medicine (TCM). The main advantage of herbal pills is its greater convenience. Similarly we have come up with a more convenient alternative for insulin delivery – the microneedle patch. This will make insulin administration for diabetic patients more hasslefree than the current insulin delivery method through hypodermic needles. We will evaluate the success of our microneedle patch based on its convenience, affordability, and it being widely used.

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Figure 1: Several Chinese herbs used in TCM (Doggett and Jennings. 6 . The industry's growth of between 5% and 15% a year is set to continue as more people seek safe natural alternatives to chemical drugs” (Picard. Case study: Traditional Chinese Medicine (TCM) There is an increasing interest in TCM. One such way is the usage of herbal pills as an alternative to the original method of brewing herbs as a tonic soup. 2006). companies are seeking new ways to make herbal medication treatment more efficient. 2007). We will be looking at the current shift in medication from the boiling of herbs to ready-to-eat pills in Singapore society. With this rise.2. and it is said that “now is the boom time for herbal medicines.

Herbal pills rather than herbs are the more sellable products in Chinese medical halls. she mentioned that customers today prefer taking syrups and pills. the Bak Foong herbal pills are one of the top three most sellable products at Eu Yan Sang (Eu Yan Sang. 2005). For example. according to our interview with Dr.1 TCM pills as an alternative form of medication Today. Chen.Figure 2: Shows Chinese medicine in its pill form (Malbort. Also. Hence. She also mentioned that she purchases lesser herbs these days due to the rising interest in herbal pills by customers (Annex 3). 2009). 2. 7 . a TCM Practitioner. more people are receptive to the idea of consuming ready-made herbal pills.

more people are making the switch from the boiling of herbs to its alternative.The attractiveness of herbal pills can be attributed to the following advantages. The pills are also compact and patients can carry them around. 8 .2 Advantages of the TCM pill a) Greater convenience Unlike the boiling of herbs into a tonic soup to be consumed.the herbal pill. 2. Time can be saved in the preparation of the medicine. the consumption of pills means that consumers need not spend hours over a stove brewing herbs.

However. As a result. The herbal pills are digested slowly. there will not be a surge of high concentrations of medicine and possible side effects can be reduced. 2. the ingredients in the pills are in fixed proportions and these pills are manufactured at a large scale. it can cause possible side effects. 2001).The pills can also be stored easily and last for a longer period of time. They cannot be customized to suit the 9 . c) Constant release of medication into the body Release of medication is to be kept constant over a period of time. unlike herbs which require proper storage conditions (Gaeddert. b) Pill form has no taste Some herbs when concocted together might not suit the taste preferences of the consumers. 2001). 2009). If sudden high concentrations of medication enter the bloodstream at one time. they will abstain from this medication.3 Disadvantages of the TCM pill a) No customization of pills for individuals Conditions of patients vary and require different herbs in non-standard proportions to achieve effective results in treating them. allowing medication to be assimilated in to the bloodstream over a prolonged period. However. the pill form has no taste and consumers will not hesitate to consume the pill (Tan. With herbal pills. This is unlike the herbal tonic soup where the medication is a solution and absorbed immediately into the bloodstream (Gaeddert.

This is unlike the boiling of herbs where patients know the exact herbs prescribed and used for their treatment. One such case is the Slim 10 weight loss pills which led to near-death experience in consumers as Nicotinamide and Fenfluramine. This is unlike the boiling of herbs into a tonic soup. where different herbs and their proportions can be prescribed to best treat the patient. which caused the health hazards were not revealed in the list of ingredients. Alternative to insulin injections for diabetic patients 3. Hence. 2002).1 Rational behind our alternative Singapore is among one of the countries with the highest diabetes rates (Soin. The prevalence of diabetes is 9% in Singapore residents between the age of 18 and 69 years. consumers might worry about safety issues like allergic reactions to certain ingredients and toxic substances in pills (Cullen. b) Lack of disclosure of ingredients Not all ingredients in pills are disclosed.conditions of each individual patient. 2010). This 10 . 3.

It will be more convenient and effective than administering insulin injections.figure is much lower than the 32. patients in Singapore administer insulin injections constantly to regulate their glucose metabolism. Polonsky. There is also the danger of injuring themselves by accident if they are not fully aware of the procedure.4% of diabetic patients found in the 60 to 69 years age group (Yeo. 2008). making it more attractive for elderly diabetic patients. 3. Buse. (Eisenbarth. Most people with type 1 diabetes administer these injections two or three times a day.2 Difficulties faced with current insulin injection The elderly require assistance to inject insulin via hypodermic needles as they do not know the proper measures to be taken. generally around mealtime. We hope to find a way of better improving their lives by introducing alternatives to their treatment procedures. 11 . 2001) The alternative we are proposing is insulin delivery through the microneedle patch. Our target audience for our project will be the elderly since the main proportion of diabetic patients in Singapore is them. This is similar to the herbal pills in TCM medication where convenience is the key factor that makes it more desirable as compared to the boiling of herbs. Currently.

3. five out of six patients find it difficult to administer insulin on their own as they tend to forget the correct procedures (Annex 2).1 Features 12 . the markings on the injection syringe might be too small for the elderly to read. In addition. Figure 3: This figure shows markings on the syringe as mentioned above (Williams.3 Our proposal: Insulin microneedle patch 3. Referring to figure 3.Furthermore. the process of injecting insulin might be too complicated for the elderly to remember. 3. due to deteriorating eyesight as a result of diabetes. 2010). From our focused group interview. the elderly may not accurately carry out the procedures of insulin injection such as injecting specific volumes of insulin into their bodies.

Our new alternative. It will pump insulin into the microneedles for it to be injected into the body. estimated length is 50 micrometres (Lim. The tip of the mironeedle is so small that injections with it are made painless as they do not stimulate the patient’s nerve endings. Our microneedle patch will comprise of: a) An array of microneedles. We will incorporate the mechanism of current micropumps sold in the U. Hence. By introducing a pain free alternative in insulin administration. microneedles reduce the trauma and injection bruises on the stomach of patients. In addition. patients will cease suffering from bruises as a result of improper techniques while using hypodermic needles. this makes diabetic patients more receptive to our microneedle patch. market.S. the insulin microneedle patch will serve to be a convenient method of treatment for elderly patients and alleviate the difficulties that the elderly face in the current insulin administration through hypodermic needles. 2008). Figure 4: Tip of a micro-needle through an electron microscope. The amount of insulin to be delivered into the 13 . b) An insulin micropump. From focus interviews conducted. such as Medingo’s micropumps. through which insulin will be administered into the body. five out of six of the patients were very interested in a pain free alternative to insulin injection through hypodermic needles (Annex 2). These microneedles are safe to use and have been patented by Singapore’s Institute of Materials Research and Engineering (IMRE).

patient’s body can be preset using the micropump and the insulin can be delivered with the press of a button. 2005). Thus. 14 . This reservoir contains insulin and needs to be refilled after every three weeks. The units of glucose needed will be reflected on the exterior of the micropump and it is large enough for our elderly patients to see. c) Attached to the insulin micropump is an insulin reservoir. Figure 5: Medingo’s Insulin pump (Yodfat. it is convenient to use as elderly patients will be spared the tedious task of withdrawing exact amounts of insulin for every injection.

This adhesive is waterproof. it is important that our microneedle patch has to be made waterproof so as to allow patients to wear it even under conditions where they come into contact with water. four out of six patients were willing to wear the patch even while bathing as they felt that it will not hinder their movements since it is small and would not pose a problem to them (Annex 2). Based on the focus group discussion conducted with diabetic patients. the patch will not pose as a hindrance to patients but instead serve to be of more help for them. the Chief Executive Officer of Micropoint. In addition Mr Lim. a company which commercializes microneedles. Hence. 15 .d) The microneedle patch has a woven fabric with an adhesive that allows the microneedle patch to be attached to the skin and held in place. mentioned in his interview that he found our microneedle patch to be “a very good idea” and “perfect candidate” for the application of microneedles. To conclude. thus allowing patients to carry out daily activities such as bathing while wearing the patch.

2 Limitations of using our insulin microneedle patch 16 .3.Figure 6: A Prototype of Our Microneedle Patch 3.

according to the focus group discussion done on diabetic patients dependent on insulin injections.4 Cost and affordability 17 . However. It is also absorbed most quickly at the abdomen. four out of six of them do not trust our product as they feel that there is no scientific proof to certify that it will be just as effective as insulin delivery through hypodermic needles (Annex 2). the patch is guaranteed to be sleek and discreet for patients to wear it. Therefore.Some people may view the microneedle patch as an obstruction to daily activities as it must be placed at the abdomen to reduce the risk of injecting insulin too close to a large blood vessel or nerve. Some patients from our focus group interview have expressed their concern that the patch may restrict their movement and bulge out from their clothing. more has to be done to inform patients on the research studies done on the effectiveness of drug delivery through microneedles. Also. 3.

In fact. as estimated by Mr. Even though it is more costly.3. since our insulin micro-pumps are made reusable.1 Current costs of using insulin injections Cost S$110 per vial S$2 S$25 Total cost per month: S$135 Insulin Injections Long and fast acting insulin 1 box of 100 alcohol swabs (for sanitization purposes) 1 box of 100 syringes 3.2 Estimated costs of using the insulin micro-needle patch Insulin microneedle patches Long and fast acting insulin 1 box of 30 arrays of microneedles (1 array per day) 30 adhesive pads (1 pad per day) Reusable insulin reservoir and pump Cost S$110 per vial S$2 S$12 S$39 Total cost per month: S$163 From the table above. This might be too expensive for patients to afford. patients will only need to pay for it once. CEO of Micropoint (Annex 5). our patch will bring about more benefits for the patients. all patients found insulin injections painful and two patients said they often hurt themselves as a result.4. An array of microneedles will also be made very affordable and should cost less than S$1. Lim. the patients mentioned that they are unable to administer insulin 18 . According to our focus group interview conducted with diabetic patients on insulin injections. an array of microneedles is said to have the potential to cost less than five cents (Chiarello.4. the insulin reservoir and micro-pump mechanism cost about S$39. 2004). our mode of treatment would still cost about S$28 more per month compared to using hypodermic needles. Also. Nonetheless. However.

patients would be likely to favour the patch over insulin injections (Annex 2). more subsidies would be needed for them since they no longer earn a stable income and are unable to afford this convenient and painless treatment. many patients might still find the S$28 to be a bit too costly. Considering that our microneedle patch is painless and easy to use. The extra S$28 a month is calculated to increase patient’s yearly medical bills by a substantial amount of S$336. For the guaranteed usage of our microneedle patch by the elderly diabetic patients.by themselves. four out of six stated that if subsidies are given. However. they do not mind a more convenient and painless method of treatment (Annex 2). Five out of six of the patients do not want a more expensive method for insulin delivery. 19 . Nonetheless.

b) Health insurance There are various healthcare insurance schemes offered by both the government and private insurers.Understanding Medisave And MediShield.3. a nurse educator. and great eastern. Aviva.3 Current healthcare schemes available for diabetic patients a) Medisave Medisave can be used by diabetic patients to pay a part of their outpatient treatment for diabetes. Rose. 2010) from the patient’s annual bill of insulin injections. However. This offsets a total of S$300 (CPF Board .4. However. she mentions that Lee foundation provides financial assistance for diabetic patients at Diabetic Society of Singapore 20 . c) Financial assistance from organizations With reference to the interview with Ms. they still have to pay a total of S$1320 annually which might still be too costly for elderly patients who do not earn stable incomes. such as NTUC. there have been situations whereby diabetic patients have had their health insurance applications rejected by private insurers.

who do not earn above S$450 monthly (Annex 5). the healthcare schemes are limited as they only cover very minimal medical costs and diabetic patients are still largely dependent on their own savings to pay their medical bills. Hence healthcare schemes providing more subsidies are needed in order to make the treatment more affordable for elderly diabetic patients. glucose meter and test strips. five out of six said their medical bills were not affordable while all felt there were not enough health and medical subsidies for diabetic patients (Annex 2). From the above. 21 . The financial assistance includes provision for syringes. According to the diabetic patients from our focus interviews.

We can introduce a similar plan in Singapore. It requires the enrolled members to pay a premium.4 Proposed healthcare scheme for diabetic patients One such way of providing more subsidies for diabetic patients is by introducing the Medicare Advantage (MA) plan to Singapore. The Medicare is a social insurance program used by the US government. In this manner. the diabetic patients under the Medisave Plus will feel less burdened financially and get better coverage for diabetic medical costs.3. proposed plan. depending on the plan.4. on top of the initial amount that must be paid for basic Medicare plans. By introducing the MA plan into Singapore. The remaining 60% left in the Medisave account is left untouched in case of further complications which all diabetic patients are likely to face. 22 . the Medisave Plus. The MA plan is a subset of the Medicare program. The MA plan covers many treatments for diabetic patients. Medisave can branch out into our specialized. Medisave Plus can cover a greater proportion of the cost incurred by diabetic patients and not limit diabetic patients to the annual cap of S$300 like what Medisave does. The government can allow diabetic patients to channel 40% of the funds in their Medisave account to Medisave Plus to sufficiently cover the cost for diabetic treatments as diabetes treatment is very costly and make up the main bulk of a patient’s medical bills. 2007). middle income diabetic elderly can now better afford their medical bills (Antos. Like the Medicare which branches out to the MA plan. including the usage of insulin pumps.

5 Marketing Strategies for the microneedle patch Besides worrying about the affordability of the microneedle patch. We can do this by submitting our proposal to the Ministry of Health (MOH) for them to run a series of test to test the viability of the microneedle patch before subsequently approving it. 23 . Patients will be able to enjoy the vast benefits of our alternative mode of insulin administration if they use it. By having the microneedle patch certified safe for use by the government. consumers will have greater faith in it and will definitely be more open to our method of insulin administration. In a bid to increase patient’s understanding and receptiveness to our microneedle patch. The most important step in allaying the fears that consumers face when considering our microneedle patch is to get the government’s support in the microneedle patch. we can introduce it to doctors in hospitals and explain to them the mechanism and how it is superior to the current treatment of hypodermic injections.3. some diabetic patients are apprehensive about its mechanism and reject the idea of placing electronics near their bodies for fear of radiation. These doctors would in turn introduce our microneedle patch to their diabetic patients and these patients will be more receptive towards purchasing it as they are learning about it through their doctor.

We can include interviews with endocrinologists about their views towards our patch. we can increase consumer awareness of our microneedle patch by publishing articles about our newly launched insulin micro-needle patches on newspapers such as Mind Your Body.23 million newspaper readers daily (The Straits Times. 24 . we can ensure that the information will reach out to a large group of readers. by publishing articles through the newspapers. 2009). The Straits Times website shows that there are 1. feel a greater sense of security when using it and become more receptive towards it. consumers will be affirmed of the quality of our microneedle patch. Therefore.Lastly. By obtaining these specialists’ opinion. thus increasing public awareness.

4 Conclusion Drawing parallels from our TCM case study. By effectively promoting our microneedle patch to diabetic patients. This is done by introducing the microneedle patch. Our microneedle patch will be deemed successful if it is affordable. Henceforth. our target for the success of our microneedle patch is high achievable. we can encourage them to use it. five out of six patients are already willing to use our new product (Annex 2). the 25 . waterproof. and easy for elderly patients to administer insulin on their own. Our microneedle patch is made more affordable by the various schemes and implementations as it will ensure that patients will be able to afford their treatment without compromising their access to basic necessities. Subsequently in the following years. Together with the convenience factor in our microneedle patch. which is small and discreet. we have come up with an effective solution to make insulin delivery more convenient for diabetic patients. elderly patients can also be more independent in administering the insulin. Based on our focus group discussion. The success of the implementation of our microneedle patch will also mean that many elderly diabetic patients will be willing to use it and it will be implemented on a broad scale across Singapore. convenient and widely used by diabetic patients. Our microneedle patch will be deemed successful if at least 20% of diabetic patients are willing to use it in the first year. This ensures that our microneedle patch will be widely receptive to elderly patients who have low incomes.

our patch will be of help in future diabetic studies to further improve and better the ways and treatments of insulin administration. Furthermore.usage of our microneedle patch should increase to at least 40% to be considered widely used by the patients. (3035 words) 26 . Combining all the factors above. our patch will be successful in terms of its high receptiveness to diabetic patients if made available in Singapore’s health industry.

I benefit a lot from the consultations from dieticians.Annex Annex 1: Focus interview with Diabetic patients on oral medication A total of 6 patients (Patient A. I know when to take my medication and my dosage as well. I was referred here by my GP. Patient B: Yes there is. 27 . I get most of my information from DSS. C. E and F) from Central Singapore Diabetics Education and Care Centre were interviewed. D. B. podiatrists and nurse educators here at DSS. I know my condition well. Patient C: Yes there is. Their identities have not been revealed due to patient confidentiality. Is there enough information on your diabetic condition provided to you? Patient A: Yes there is. 1. rather than doctors but I think the information they provided is sufficient enough.

50 a month. Patient C: No it’s not. I pay only $4. my children read up on my condition and inform me. Patient B: Yes. The doctors do not have much time to explain in detail to me on my condition and they generally refer us diabetic patients to centres most of the time. it’s affordable for me as my children pay for my medical fees. Do you think your current medical bills are affordable? Patient A: Yes. I participate in online forums online as well. To find out more on my condition. Most of the time I cannot quite catch what the healthcare professionals are saying.Patient D: No there isn’t. Patient E: No there isn’t. I have to read up more on the internet on my condition. leg problems) 28 . 2. Many diabetic patients have further complications and we have to pay more for medical fees that arise because of our diabetic conditions. I have to refer to brochures to find out more on my condition. eye problems. Patient F: No there isn’t. (For example. Instead.

There’s this thing called “medical social worker” scheme I’m under. Patient F: No. It’s a government subsidy I think? 29 . I have heard many elderly complaining that it’s very expensive. For me.50 a month as I’m above 60 years old. We have to pay for our medications and for our consultations and blood tests that can cost $50 each time. Patient E: No it’s not. 3.Patient D: No it’s not. Patient B: Yes there is. it’s affordable since I’m still working. I am not charged for outpatient consultation and some of my medication. Are there enough health subsidies/insurance schemes to cover your medical costs? Patient A: Yes there is. I pay only $4.

Patient C: Yes. 4. Do you face any problems with your current treatment? Patient A: Yes. deep vein thrombosis. I don’t think the elderly who have no family can afford. sometimes I forget to bring my medication out. Also I don’t think means testing is very effective.Patient C: No. I have too many tablets to take. my medication is still expensive and I am not under any subsidy. Patient E: No. Patient D: No. I can’t remember how many pills I eat a day sometimes. I think more should be done especially when there are more diabetic patients around. Some of us can easily become type 1 diabetic patients and our medical fees will increase. 30 . Patient F: No. Patient B: Yes. I have 16 tablets to eat a day due to other conditions I have like heart problems.

31 . 5. Patient D: Twice. It’s very scary as I’ve seen how they have left scars on my brother. Patient B: Once. Patient C: Twice. Patient F: No. my daughter will remind me. Patient E: Twice. I’m so glad at least I do not have to take any insulin jabs. I have a problem remembering when to take my medication. How many times do you have to consume your medication a day? Patient A: Once. I do not need help with remembering how many tablets to eat a day. Patient E: No.Patient D: Yes.

there’s blood so my daughter helps me now. 1. I. It’s still painful though. J. Patients identities have not been revealed due to patient confidentiality. Annex 2: Focus interview with diabetic patients on insulin injections A total of 6 patients (patient G. It’s very painful and sometimes when I inject myself. Don’t ever go on insulin injections and it’s always best to stick to oral medication. K and L) from Central Singapore Diabetics Education and Care Centre were interviewed. I wish the doctor still let me take medication orally (with tears in her eyes). Injections are very scary.Patient F: Twice. Compared to the past it’s less painful now as the needles are more fine. how painful are the injections for insulin delivery? (5 being the most painful) Patient G: 4. 32 . On a scale of 1-5. H. Patient H: 5.

33 . It is best to avoid insulin injections. Patient K: 4. And it also hurts a lot. Patient J: Yes. Patient L: 5. The technique is very hard to master and I often get bruises. I always hurt myself. I am used to it but it stills hurt quite a lot. It is very painful and I often get bruises. I am scared of the pain. I’ve already gotten used to the pain as I have been diabetic for 30 years already. I feel very scared whenever it is time for me to self-administer the insulin injection because the needles always look so thick. 2. Patient I: Yes. Patient J: 5.Patient I: 5. The injections are so unbearable that I dread every moment I have to inject myself. Patient H: Yes. I would be absolutely willing to try any other form that is painless. Would you be interested in a painless way of insulin administration? Patient G: No.

I cannot remember the steps in carrying out the injection correctly. Sometimes I forget to bring my pen filled injection mechanism out. Patient H: 5. I also have to use and throw my pen filled injection mechanism and have to buy new ones every three months. Also. I have had enough of suffering. Patient L: Yes. 3. Patient I: 5. how inconvenient is your current insulin administration? (5 being the most inconvenient) Patient G: 4. 34 . it’s very troublesome for my children as they have to inject me with insulin and I cannot do it on my own. when I get back I have to place my pen filled injection mechanism back into the fridge. On a scale of 1-5.Patient K: Yes.

Patient L: 5. it’s a simple process and I have been doing this for 30 years now.Patient J: 5. I cannot do it on my own. Patient I: Yes. Patient H: Yes. 35 . Do you require any help with insulin administration? Patient G: No. I have to bring my syringes and insulin solution wherever I go. It is very inconvenient. My eyesight is failing and it is too demanding a task for me. 4. Patient K: 4. Very tedious and exact amounts have to be extracted.

36 . But it is very hard to learn the correct technique. Patient H: Yes. the doctors provide information. Patient I: Yes. 5.Patient J: Yes. the people here at DSS provide information too. But I am still unclear about the exact steps. Patient J: Yes. Is there enough information on insulin administration provided to you? Patient G: Yes. But I’m still unable to inject insulin by myself as I always use the wrong technique and end up injuring myself. Patient K: Yes. The doctors will teach you how to use the insulin syringes. Patient L: Yes.

Patient H: No. Mainly. 6. Patient I: No. it’s still expensive.Patient K: Yes. But even with subsidies. My doctor is very helpful in teaching me the correct technique. Patient J: Of course not. 37 . it’s the pens which are expensive. I have stopped working a few years back and the medical bills are eating into my savings. as I struggle to pay even in installments. I spend about $200 without subsidies. I spend about $300 a month on all my medication. Do you think your current medical bills are affordable? Patient G: Yes. including the buying of pens which are use and throw. Patient L: No. my children refuse to support me in paying my medical bills and I always default on my payments. that’s because I’m still working.

Will you go for a more expensive but less painful and more convenient method for insulin delivery? Patient G: Yes. 38 . it is very expensive. I cannot even afford the current bills. Are there enough health subsidies/insurance schemes to cover your medical costs? All said no. Patient L: No. my fees are already to expensive and I do not want to be more of a liability to my children. I would say yes if I had the money but I do not have money. Patient I: No. I wish that I was still on oral medication. because I am still working and can afford it. 7. (did not state reason) 8. Patient H: No. Patient J: No. It’s cheaper and more convenient. it burdens my family and I cannot even pay part of the bills as I have no money.Patient K: No.

insulin cannot be exposed to sunlight and your product might be exposed to sunlight. it’s just like wearing a pacemaker. I am a poor person. Patient I: Yes. as long as it is painless and I can administer myself with insulin on my own. I find it quite inconvenient to wear it at my abdomen area. I do not want to go through anymore suffering. Also. it hasn’t been proven to be effective right? Also. Patient L: No. 39 . 9.Patient K: No. I do not want to trouble my children. I do not want to be a burden to my family anymore. Patient H: Yes. I don’t like the idea of placing electronics near my body. Are you willing to use our product if subsidies are given? Patient G: No.

Patient K: No. 40 . As long as it is more convenient and cheap. How often do you have to administer yourself with insulin? Patient G: 4 times a day. it has no scientific proof right? Patient L: Yes. Since it will not burden my children. 10.Patient J: Yes.

Patient I: 3 times a day Patient J: 2 times a day Patient K: 3 times a day Patient L: 3 times a day 11. Patient I: I cannot master the correct technique. Patient H: I cannot inject myself with insulin on my own. I forget to bring my insulin pen along. 41 .Patient H: 3 times a day. as long as you know how to schedule your time well because sometimes when I’m rushing. What are some of the difficulties you face with insulin administration? Patient G: No difficulties.

Patient J: I cannot remember the steps. Patient L: I cannot extract exact amounts of insulin. Are you willing to use our product while bathing? Patient G: No Patient H: Yes Patient I: Yes Patient J: Yes Patient K: No 42 . 12. Patient K: I cannot remember the time to self-administer insulin.

the TCM industry had been largely using the traditional grind-and-boil method of preparing medical remedies from herbs. Tan: Yes.Patient L: Yes Annex 3: Interview with TCM Practitioner Ms Chen Kehat Sheng from Yong Her Sin Medical Store and TCM Practitioner Mr. Is it accurate to say that there has been a recent shift among practitioners to using remedies in the form of pills? What could have brought about this shift in policy? Ms Chen: Yes. People are more inclined towards more convenient forms of treatment. 1. For decades. Boiling is generally more troublesome and consumers these days do not have the time to boil medicine and would prefer taking syrups and pills which are much more convenient. 43 . Tan Yu Bing from Ping Wah Chinese Physician and Medical Hall. Mr.

Tan: The limitation of the pill form is that it is a ‘one for all’ solution and does not cater to the individual’s needs. hence making this form of treatment less flexible. 4. Are there any limitations of the pill form? For example. What is the greatest advantage of the pill form? Is it in terms of lesser production costs. Mr Tan: Yes. Fibroids or ‘zheng jia’ in which case pill forms are slower in effectiveness) Ms Chen and Mr. This is possible only if they are willing to complete the whole dose of medicine. or less time spent on short term/long term treatment as a whole? Ms Chen and Mr. by using the pill form.2. This is because the herbs used in the pills are in fixed compositions and cannot be tailored to an individual’s needs. less hassle like in explaining to consumers. Customers these days want everything to be convenient and do not have the time to boil their medicine and look after the flame. more patients will be willing to consume Traditional Chinese Medicine. 44 . 3. Hence. Could such an the TCM pills maintain TCM’s viability and adaptability along with time in the face of increasing customer trend towards the western medicines? Ms Chen: I use the pills not to attract more customers but in the hope of curing patients more effectively. Tan: The greatest advantage of the pill form is its convenience.

e positive/ negative)? Have there been any customer objections/ insistence on the old grind and boil form? If yes. Mr Tan: The pill form has obliterated the traditional method in my shop and I no longer purchase herbs to prescribe to my patients.5. How has the customer response to the new pill alternatives been (i. Tan: Customer response has been good. these pills can now help one avoid the cold altogether. a common cold can now be prevented by a consistent usage of Yin Qiao San pills. if any? Has it been significant? For example. Only a few patients insist on the old grind and boil form. I now purchase less herbs form the supplier as compared to before. I would write a prescription for them if they 45 . what reasons do they give for their preference? Ms Chen and Mr. 6. How has the pill form affected the general treatment methods of patients by TCM practitioners. However. due to falling demand for herbs. Most of them are used to the method and have enough free time to boil the herbs. Within the first 24 hours of cold symptoms. Ms Chen: Not to a great extent as I still prescribe herbs for the patients if I feel that it is better for them.

It is much more convenient for the patients. with the pill form of Chinese medicine now. without the pill form of Chinese medicine. Tan: Yes. This is because boiling is a hassle. From the point of view of an existing/budding TCM practitioner/ researcher. 46 . do you prefer the new pill form? Why? Ms Chen: Yes. However.insist on using the traditional methods but they would have to go and buy the herbs from another shop. Being a doctor. Mr. In the past. Demand for the herbs is low. I feel more assured as patients are more likely to finish the course of medication. my main aim is to cure the patient’s illness. some patients were reluctant to complete the full course of medication and would stop if they felt slightly better after a few doses of the medicine. 7.

it is the reliability issue. Specifically. via transdermal drug delivery. So people need to try and select those which work well with micro-needles. i. Mr Lim Chee Yen 1. but at present there is no commercial micro-needle product on the market. not all drugs or vaccines are suitable for micro-needles. There have been research groups and companies who try to obtain clinical evidence.e. And. What are some of the limitations of the micro-needle? Mr Lim: It is a new medical device so people will need a lot of evidence on its effectiveness and safety. Since the size of the micro-needles is so tiny. there exists a risk where they may not be inserted into the skin every time a vaccine or drug is delivered. 2. We need to see 100% reliable and safe and effective micro-needle products. what are the constraints faced when manufacturing/marketing this product? Do you expect the public/hospitals/pharmacies to be receptive to this product? 47 .Annex 4: Interview with CEO of Micropoint.

it is a very much sought-after product by the public. If drug A is proven. but ultimately they should cost below a dollar. we cannot assume that drug B is good. so all the difficult parts in commercializing micro-needles is to prove that this particular drug is effectively and safely and reliable delivered via micro-needles. So when they are out on the 48 . 4. 3.The constraints are mentioned above. hospitals and pharmacies. It is the final possible solution for micro-needles. safe and effective with sufficient clinical evidence. However. the micro-needle device is associated with a drug. Provided someone comes out with a micro-needle device that is 100% reliable. The production costs may reduce for plastic micro-needles. What are the costs like for an array of micro-needles (for 150 micro-needles on a patch of 25mmx25mm)? Mr Lim: It could be a couple of hundred of dollars for a prototype. What are some of the safety precautions that has to take before marketing this product? Are there any safety hazards for plastic/metal/silicon micro-needles? Mr Lim: All medical products have to undergo proper design and development procedure according to ISO standards or other equivalent guidelines.

How long can we keep the micro-needles inserted in our skin? (such that it will not be of harm/safety hazard to patient) Mr Lim: For bio-compatible materials. success of drug delivery. safe and effective. There is a fear or remote hazard that these micro-needles will break from the users’ perception. etc. 49 . Are the current microneedles developed by Micropoint breakable/fragile? Under what circumstances do they break? Will it be possible to come up with microneedles that will not break when inserted into the skin? Are there any of such micro-needles? Mr Lim: All micro-needles are not supposed to break when used correctly. 6. 5.market. Some of the key concerns are breakage of the micro-needles in the skin. less than 72 hours (non-implant grade). which can be changed over time. they are reliable.

wherein the vaccines are delivered to the antigen-presenting cells in the skin. which include minimum trauma. etc. How have the microneedles been designed such that they have better efficacy of drug delivery compared to hypodermic needles? Mr Lim: The key advantage established so far is in immunization. This is claimed to be the fastest way to trigger an immune response.7. How viable is it for microneedles to be incorporated into diabetes patches? What. 50 . Next is to come out with a design that satisfies the design requirements. in minutes or hours. safe and effective. it is viable to make microneedles into insulin patches. provided it can be proven clinically that it is reliable. yes. The advantages over the hypodermic needles are numerous and apparent. 8. again. direct delivery to the capillary network (instant effect of insulin). coming back to our old issue. this is important but not essential if it does not work). In short. are some of the advantages? (Will this prove to be a more convenient method compared to hypodermic needles?) Mr Lim: First we need to find out is there an advantage to deliver insulin to the skin (apart from being painless. Then we need to look at the duration of the drug delivery. to you.

For side-ported microneedles. The short answer to this question is microneedles have been made much smaller to reduce pain and to reach the shallow layers of skin for effective drug delivery. This delivery bypasses the stomach so prevent degradation or digestion of the drug before reaching the body system. How would you expect such a technology to change 20 years down the road? 51 . 10. the key advantage is to deliver the drugs to the capillary network under the skin. We understand that the microneedles also come in a variety of designs. 9. they will penetrate the skin and deliver some drug. So long as they are sharp and small and strong enough. some designs are suitable for specific purposes. Mr Lim: All microneedles work well. the key advantage is the location of holes allows the tip to be sharp. It’ll be great if you could elaborate on the other designs as well. which the hypodermic needles cannot do.For non-immunization applications. like those with side-ports that allow for smoother drug delivery and bodily fluid extraction as opposed to regular microneedles that have only a single opening at the tip.

and this really improves the quality of life of parents. and microneedles are one of the perfect candidates for such application. What is the most common way in which insulin is delivered to diabetic patients? Do they find insulin jabs tedious and inconvenient? 52 . what are your views on modifying an insulin pump. We will expect vaccines to be delivered to infants in a more humane way. 11. Nurse Educator from Central Singapore Diabetics Education and Care Centre 1. Assuming that the insulin patch is reliable.Mr Lim: I think the most relevant application is vaccination. do you think this is workable in the future and would microneedles be suited for such an application? Mr Lim: This is a very good idea. a pump reservoir that delivers insulin through a small tube? In this case however. In your opinion. we would be substituting the small tube with microneedles. Annex 5: Interview with Rose. safe and effective.

especially for those who travel.Rose: Most of our diabetic patients use syringes. 4. the units on syringes are too small for the elderly to see. Of course. Which part of the body should insulin be injected to? Why? Rose: The stomach. Also. For example. though not advisable. Insulin can be delivered faster and the muscles around stomach area are not that thick. It’s possible to inject at the arm and the thigh. 3. here at our centre. syringes are inconvenient. 2. However there are some financial assistance around. Insulin is given to them by the hospitals. That’s because old people cannot afford the insulin pens as they are expensive. so there’s faster absorption. the Lee foundation provides some funds and those who earn not beyond $450 will be provided with free syringes. How many times in a day does a patient need insulin dosages? Rose: That depends on each individual and there are a wide range of sugar levels. Do patients find it hard to afford insulin jabs? Rose: Yes. 53 . stips and glucose meters.

6. Retrieved September 11.bok 54 .adhesive patch manufacturers. Some elderly might be forgeful to press the button too. (releases insulin once blood sugar levels are high) Bibliography Non-print sources: • Adhesive patch.). Do you think our product is feasible and can be implemented? What are some of the limitations you foresee for our product? Rose: It’s definitely feasible however more research needs to be done for it. (n. Limitations could be patients might feel uncomfortable wearing it and they may not know how to use it. I know of some micropumps which are automatic and very convenient. suppliers and exporters. so it’ll be good if you make it automatic. 2010.5.com/-strseInsulin-Pump-Supplies-cln-Cartridges--fdsh--Reservoirs/Categories. They do provide these micropumps at Mount Elizabeth hospital. Some might also face hypoglycermia.d. from http://www. Hmm.americandiabeteswholesale. What are the precautions for insulin jabs for patients? Rose : Some have bruises and lumps because they use the wrong technique or inject themselves at the wrong side.

com/2009/5/19/standing-on-two-legs • Gaeddert.php?id=27700 • Hakim.• Antos.51/category_id. 2010. (2007.33/ • CPF Board .).euyansang. (n. H.htm • Eu Yan Sang : Caring For Mankind.Members Home. from http://www. from http://blogs. (2009.php/product/flagship-products/gold-label-bakfoong-pill • Eu Yang Sang's net profit increases 195% to S$38 million in Q3 FY2009. Retrieved August 10. (2007. 2010.13/blog_id.8/action. May 20). 2010. 2010. Medishield coverage for all newborn singaporeans and permanent residents. from www.d.com/insurance/medishield-coverage-for-all-newborn-singaporeansand-permanent-residents/ 55 . Retrieved September 11. Retrieved October 9. Retrieved September 11.pdf • Feng. The Straits Times Blogs.sg/CPF/mycpf/Healthcare/PvdHC3. When do you use teas? when do you use tablets?.com/mpacms/at/article. from http://www. 2010. Standing on two legs . Y.gov. Retrieved October 7.acupuncturetoday. Products.org/component. Acupuncture Today.R. Eu Yang Sang. J. (n. from http://helmihakim. Retrieved October 7.cpf.6/ty pe. from http://mycpf. Retrieved September 11. 2010.).). October 30). 2010. CPF Board .d. The Facts: Medicare Advantage. from http://www.com/sc/images/stories/pdfs/latestnews/may_09/Press %20Release.Understanding Medisave And MediShield. (n.d.galen.straitstimes. (2001). 02(04).com/index. A.euyansang. March 22).show_content/id.

Retrieved July 21.cz/insulin-pen.d.). (n.mte.gov. (2007. from www.americandiabeteswholesale.asiaone.. (2009. 2010.com/Health/Alternative %2BMedicine/Story/A1Story20070609-13046. Retrieved August 10. 2010 from http://www.pdf • Solo Micropump Insulin Delivery System. 2010.com/-strse-Insulin-Pump-Supplies-clnCartridges--fdsh--Reservoirs/Categories.bok • Jeremiah.).gov.).sg/mohcorp/mediaforums.medicare. 2010.gov/navigation/medicare-basics/medicare-benefits/part-c. Ministry of Health: Medisave. April 14). THE RISE of traditional Chinese medicine. January 07). Medishield .aspx?id=308 • Picard. (n. from http://www.d.htm Insulin pump supplies. D. from http://www. Asiaone. from http://www.d. from http://www. 2010.• • Insulin pens. August 15).d. from http://www.asp? File=Micropoint-Microneedles. 2010.solo4you.sg/mohcorp/hcfinancing. (n.aspx?id=18074 • Medicare Part C Medicare Advantage Plans and must cover all medically needed services. (2008. Retrieved October 6.html • Singapore research produces plastic microneedles that can be mass produced more easily and cheaply for painless injections and extraction of bodily fluids.).sg/downloads. Retrieved August 8. Retrieved September 11.imre. from http://en.com/ 56 .edu.aspx? AspxAutoDetectCookieSupport=1 • Ministry of health: Medifund. 2010. S. 2010..a-star. Medicrisis? . (n. Retrieved July 21. (2007). Retrieved September 11. Retrieved July 9.moh.moh.

Retrieved September 11. How to give an Insulin Injection.4. (n. Asia's killer diet pills. L. (2009. (2007.com/traditional-chinese-medicine/ • The Straits Times .cfm? id=451&action=detail&ref=44476 • Takeuchi. August 05).gov/medlineplus/ency/article/000305. September 1). from www. 2010 from http://www.diabetes. from http://www.). Retrieved October 7. Traditional Chinses Medicine.). (n. 2010. from http://www.org/body_teens.com/time/magazine/article/0.com/About%2BUs/About%2BUs.d. Retrieved August 20.sg/resources/jan08-24-26. Diabetic Society of Singapore.2: • Adhesive Patch.time.org.Alibaba. K. The Straits Times. MD.333902 • Tan. 2010. Retrieved September 11.d. June 25).sg/2010/07/why-you-should-opt-for-a-plant-based-diet/ • Yeo. 2010.About Us.4.d. 2010. from http://www. from www.aware. Retrieved September 9. (n. Retrieved October 7. The Global Need for Screening in Retinopathy and the Singapore Experience.nih.).alibaba.nlm.com/showroom/adhesive-patch. (2010.d.pdf Sources for tables 3.9171. 2010. 2010.).• Steven Dowshen. from http://www.html 57 .straitstimes. July 28).asiahotels. 2010. Initials. Time. A.1 and 3. from http://blog. (2002. T.htm • Why you should opt for a plant-based diet. Retrieved October 7. Traditional Chinese Medicine. Retrieved October 7.devoschildrens.org. (n.html • Type 1 diabetes: medlineplus medical encyclopedia.

1047-1053.• Chiarello. Microneedles open new doors for transdermal drug delivery. (2004). S35-S39. (n. & Lee. R. 2010. January 01). (2006. K. & Roglic. Diabetes Research and Clinical Practice. Sicree. Retrieved from http://pharmtech. W..com/pharmtech/data/articlestandard/pharmtech/022004/80 733/article. from http://www.ehow. S.com/-strse-InsulinPump-Supplies-cln-Cartridges--fdsh--Reservoirs/Categories.pdf • Cost of Diabetes Treatment. Retrieved September 12. Green.). G. H. eHow | How To Do Just About Everything!.com/about_5462949_cost-diabetestreatment.. from http://www. (2004. 58 . The changing demography of diabetes mellitus in singapore. 27(5).bok Print Sources: • Rhen. (2000).Diabetes Care. 50(2). Raffles Health News 1-15. 2010.findpharma.).. W.html • Insulin Pump Supplies. Retrieved September 11. A. March).d.. Global Prevalence of Diabetes. Wild.Diabetes Testing Supplies & Products. Pharmaceutical Technology. • • TCM Clinic Opens in Raffles Hospital. King.americandiabeteswholesale.d. (n..