SMEAD: A Secured Mobile Enabled Assisting
Device for Diabetics Monitoring
M Saravanan R Shubha and Achsah Mary Marks
Ericsson Research India VIT University
Chennai, India India
m.saravanan@ericsson.com {shubharavi20,achsahmary94}@gmail.com
Abstract -- Wearable health devices, mobile apps and diagnostic
tools revolutionize the medical field by introducing new assisting
devices for patients in a way to create comfort, communication and
augmented intelligence. Internet of Things involved in this
transformation to provide an environment where a patient’s vital
parameters get transmitted by sensor devices via a gateway onto
secure cloud-based platforms where it is stored, aggregated and
analyzed. It also helps to store data for millions of patients and
performs analysis in real time, ultimately promoting an evidence-
based medicine system. Privacy and security are concerns in this
environment. Based on the latest trends, this paper introduces a new
healthcare paradigm named as SMEAD by developing an end-to-end
secured system for assisting diabetic patients. It includes wearables
to monitor different parameters thus observe and predict the diabetes
status of the patient. The proposed system employs a MEDIBOX
which is used to configure the dosage required and provides an alert
to the users reminding them to take medication on time. In this case,
the insulin dosage is maintained at suitable cooling conditions and
is continuously monitored using the mentioned system. To keep all
the data secure and to enable access to this data by the doctor and
other trusted parties, a Blockchain-based disruptive technology is
implemented which facilitates cryptographic security and formalized
data access through smart contracts for medical communities. In
case of an emergency like missing a dosage, abnormal blood sugar
levels or any security lapse, an alert is sent to the caretakers via social
networks like Twitter, Facebook or WhatsApp using mobile as a
gateway which can continuously communicate the data over the
internet that could save patients from fatal effects of the disease.
Keywords: Diabetics Monitoring, MEDIBOX, Blockchain, IOT,
Mobile Phone
I. INTRODUCTION
IoT connects the devices embedded in different systems to
the internet, as it helps to control these devices from anywhere
in the world. IoT has been making a serious impact on different
sectors including healthcare for helping the mankind.
Integrating IoT in medical devices (IoMT) can help improve
the health of patients who need special care and constant
supervision from specialized doctors. IoMT refers to a
collection of medical devices connected to the internet of
things. It has diverse applications in healthcare like remote
monitoring of patients, talking medical devices, smart beds,
medication dispensers and so on. The advent of IoT in
Vishakh Iyer
SRM University
Chennai, India
vish.90@gmail.com
healthcare has increased intelligence, flexibility and
interoperability. With the help of IoT, these devices with
embedded sensors provide timely and proper medical attention
by notifying the healthcare providers.
Due to criticality, continuous monitoring of a patient for
certain diseases is most important and to avoid the cases where
the patients tend to miss regular clinical visits owing to their
busy schedules. To overcome this limitation, a wearable and
medication administration system is essential to perform real-
time monitoring that can manage chronic ailments leading to
reduced doctor visits. To analyze the status of the patient, the
information from the device must be communicated to the
doctor via the internet using a gateway. The gateways that are
available are not cost-effective and encounter network
connectivity issues. According to a recent research [1]
collection of data using a mobile phone is considered to be cost-
effective. Smartphones solve the issue of cloud accessibility
when constantly on the move, further, the network connectivity
issue can also be resolved as both the wearables and mobile can
stay on the same network throughout. The available wearable
solutions perform mere monitoring and do not provide suitable
solutions during an emergency that can be stated as a major
disadvantage of the existing system.
To address the demerits of the existing systems, an end-to-
end secured solution is proposed for the real-time monitoring
of diabetic patients. The system is an integration of Wearable
technology, IOMT, Medication administer and reminder. The
wearables capture the various symptoms exhibited by a diabetic
patient such as polyphagia, polydipsia, skin moisture,
temperature, heart rate, walking pattern and weight loss. These
data from these devices are further transmitted and stored in a
cloud using mobile as a gateway. In very few studies, Machine
Learning algorithms [2] are applied to the data to predict the
severity level of diabetes. During emergency conditions, the
doctor can access the data to provide an appropriate insulin
dosage or other medications that are kept in track by the
MEDIBOX. Depending on the doctor’s prescription,
MEDIBOX can be auto-configured with regards to dosage,
storage and quantity. MEDIBOX features a storage which
maintains the drugs at proper environment required and
provides a reminder about the medication timings. Emergency
situations like skipping dosage and increase/decrease in blood
glucose level, the patient’s caretakers will be notified using
social networks.
The small size and limited processing capabilities of the
IoT devices could lead to having fewer built-in encryption and
security measures [4]. With IoT devices collecting and
transmitting personal information, the question of maintaining
privacy and security of this data becomes of utmost importance.
In this paper, to address the privacy of patient’s data, we
developed a Blockchain-based smart contract [3] to secure the
transactions. The solution ensures that the communication and
storage of data is safe by securing the data cryptographically
and using the Blockchain [5] to transmit and store data.
Blockchain uses public key cryptography to authenticate users
and protect data on the network. This allows for secured data
sharing between the doctor and patient. The patient decides the
trusted parties who are allowed to view their vital data
including the doctor and a few close friends and relatives by
sharing the private with them. This shared data also includes
the alerts triggered by the medication and diabetes-related IoT
devices for emergency response by the users.
II. RELATED WORK
Recently, IoT has been revolutionizing the healthcare
sector by enabling medical devices to be embedded with
sensors which act as a source for connectivity to medical
communities. The industry is also making inroads into the
healthcare sectors and assisting in solving the inconveniences
created by hospitals like long wait time for consultation and
inaccurate medical records. Internet of medical things is
providing healthcare with reduced costs away from hospitals,
whereas detailed patient details reach the centralized healthcare
repositories through remote monitoring via medical grade
wearables, virtual doctor-patient interaction and so on. Various
healthcare devices and projects have been developed recently
as part of academics and industries as discussed here.
A survey [6] reviews the different IoT based healthcare
technologies. It analyzes distinct IoT security and privacy
features including security requirements, threat models and
attack taxonomies from the healthcare perspective. Using IoT
as a technology, the study [7] achieves a more efficient machine
to machine communication for healthcare data. The sensors
attached in the system collect the data using a Raspberry Pi and
the data is transferred to the user using apps, which alerts the
patient about the health. With Artificial Intelligence becoming
more advanced, healthcare diagnostics have also benefited.
Another study provides a diagnostics system which monitors
the patient’s heart rate and provides quick assistance when
required. It bridges the gap between patient and the doctor and
in case additional assistance is required, it uses an application
called Docbot for supporting system for both end user’s (doctor
as well as the patient) [8].
Today’s smartphones are readily available and powerful
enough for simple diagnostics. This is particularly useful in
case of chronic diseases like diabetes where the study [9] uses
Android devices to continuously monitor the patient’s status.
The system comprises of an Android App which has two
entities - the user app called client side and a remote server. The
app contains a questionnaire that the patient needs to fill and
the along with this the patient details will also be sent to the
server. It performs data centring in cloud, that helps in copying
the recently updated file into the target location so that the
doctors can access it and diagnose any cardiac-related problem
[10]
Modern smartphones are also capable of collecting basic
health data like heart rate data. This data can be sent to the cloud
for further storage and processing via 3G/Wi-Fi, apply machine
learning algorithms and sends notifications to the physician in
case the heart rate crosses the set threshold [11]. Ultimately the
centralized cloud storage options always leave security
concerns with the users of the service and the entire security of
the system depends on the measures taken at the central cloud
repository. Recently, a system is proposed that uses the
Blockchain to store health records on a data lake and having a
Blockchain access the data through hashed addresses thereby
reducing the chances for data breaches on the centralized
storage [12]. Another discussion published by Deloitte [13]
lists out how the Blockchain could be used to provide
interoperability of data and improve medical data access for
other purposes. Medication reminder and healthcare – an
android application based system uses an android app for
reminding the patient about their medicines [14].
The discussed studies carry out some healthcare tasks while
ignoring some others. All related studies to improve the overall
healthcare data reporting system by constantly monitoring
patients with chronic diseases and securely storing and
transmitting this data to trusted individuals. Only very few
studies were attempted to predict the severity level on real-time
basis and makes the doctor keep track of the patient’s health all
the time and assist him with the proper medication. We have
proposed on the same line by creating a cost-effective secured
assisting device which consider the present status of diabetes
patient and their consumed medicine details. With doctor’s
suitable suggestion on a secured way, it provides an end-to-end
real-time system for diabetics monitoring. Newly designed
devices relevant to the proposed system can harmony with
Mobile phone to communicate the patients details to cloud for
further processing. The Apps developed relevant for
monitoring will impart convenience and make the patients to
understand their status and the reasons for the sudden changes
on health condition.

III. SMEAD OVERVIEW
Wearable devices have made it possible for health
providers to monitor a patient’s health remotely using
actuators, sensors and other mobile communication devices.
Measurable benefits of connected medical devices include a
reduction in mortality rates, reduced clinic visits, emergency
and hospital admissions, including a reduction in bed days of
care and length of stay in hospitals. Remote monitoring of
patients leads to more effective and timely treatment and health
management.
Fig. 1 SMEAD Architecture
In this paper, SMEAD which refers to Secured Mobile
Enabled Assisting Device introduces an end-to-end secure
system targeted towards diabetic patients. It consists of three
wearable medical devices and MEDIBOX for reminder and
storage of insulin and other essential medications as shown in
Fig 1. The wearables are meant to measure certain parameters
like weight loss/gain, food intake, walking pattern, skin
moisture that are common symptoms exhibited by a diabetic
patient. A prediction is performed using the data obtained from
different devices to determine whether there is an increase or
decrease in diabetes level. These records of diabetes level and
medicine intake details are communicated to the doctor
regularly using mobile application thus enabling him to keep
track of his patient, leading to reduced clinical visits.
Accordingly, the patient can be alerted about the severity of the
diabetic level and thus directed for proper medication. The
medications especially insulin in this study must be maintained
in proper storage conditions for retaining its efficacy. This is
accomplished using MEDIBOX, which also takes care of
reminding the patients about the medication. In case of
emergency situations such as an increase of diabetic level and
the patient not consuming his daily medications, alerts can be
sent to the respective caretakers and relatives using a social
network. All the data in the system is cryptographically secured
and the Ethereum Blockchain [3] acts as a mechanism to
authenticate the users that have access to the data in Ericsson
AppIOT platform [15]. The following sub-sections describe in
detail the functioning of the individual modules of the proposed
system.
A. Wearables for Diabetics Monitoring
Wearables include three devices, a smart wristband, Smart
footwear and a smart neckband as shown in Fig. 2 respectively.
The smart neckband is an adjustable strap containing vibration
sensor and flex sensor to measure the food intake and water
intake based on the chewing pattern and pressure exerted on
flex sensor while swallowing. Smartwatch monitors the heart
rate, skin moisture and ambient temperature. Temperature
sensor, optical heart rate sensor and galvanic skin response
sensors are used to monitor these parameters. Temperature is
monitored to know the altitude, as the altitude plays an
important role in the blood glucose level; when there is an
increase in blood sugar level the heart rate keeps fluctuating.
Similarly, the skin moisture also varies for diabetic people as
they dehydrate constantly. Smart footwear will monitor the
walking pattern using pressure sensors placed at 4 pressure
points under the foot and detect the gradual weight loss/gain
using weight sensors over a period. If the person has foot ulcers,
the walking pattern will change, and the pressure exerted at the
ulcer area will vary because the patients tend not to exert
pressure in the vicinity of the ulcer. Since the person has
polyphagia and polydipsia he might lose/gain weight which can
be monitored continuously. All this parameter variations can be
used to understand the symptoms of the patient. The data
collected from all the connected sensors embedded in these
devices will be sent to the mobile phone (which acts as a
gateway) via Bluetooth which is then forwarded to the doctor
through the AppIOT platform [15].
Fig. 2 Prototypes of three wearables
B. MEDIBOX
MEDIBOX design is meant to be a user-friendly system
that stores the medications like insulin in a proper environment
and reminds the patients at proper timings to consume their
medications. The box consists of a compact storage system
using a Peltier device, heat sinks to maintain the temperature
inside and silica gel to maintain the humidity. Sensors
embedded in the box continuously monitor the temperature and
humidity and thus keep track of the medicine quality.
Notifications regarding the medicines are displayed on the box
using a display and buzzer. Storage system (SD card) saves the
data for auto-configuring the device to remind at the exact time
and saves the log of the patient details which can later be
communicated to the doctor in case of emergencies. Fig 3
shows the entire circuitry of the MEDIBOX design. NodeMCU
micro-controller and other modules like BME280, Cooling
system, RTC, SD card logger, LCD, battery, buck converter
which are soldered onto a PCB.
Fig. 3 PCB design of the prototype and cooling system
C. Security and Blockchain
Security in the system is entrusted using public key
cryptography and Blockchain [5]. The data in the system is
sensitive patient information that cannot be compromised by
transmitting it openly on the internet. A Blockchain stores a
continuously growing list of transactional data with a collection
of transactions comprising of a block. Each of these blocks
contains a reference to the previous block and through the
consensus mechanism; only one chain of transactional blocks
remains ensuring data is verified and non-tamperable. SMEAD
uses the open source Ethereum Blockchain [3] which allows for
the definition of “Smart Contracts”. These smart contracts
contractually govern the data access in the system. Fig 4 shows
the data access architecture of the system. The system uses a
private Ethereum Blockchain to manage the access and
permissions. The smart contracts govern the data access and
maintain a clear log of the data accessed.
Fig. 4 Blockchain Architecture
D. AppIoT Framework
Ericsson’s AppIoT framework [15] is a computational
engine for IoT enabled systems. AppIoT enables the creation of
scalable IoT systems while remaining highly secure and allows
for storage of computation of critical data like healthcare
records. The platform is based on the cloud and that can provide
support for any sort of IoT based network from small to hyper-
sized networks. It provides real-time monitoring and
connectivity and allows for full duplex communication
between the cloud and the devices. SMEAD is developed in
such a way that the data from the wearable devices and
MEDIBOX is relayed to AppIoT via the mobile gateway for
further data analytics and predictions that can be sent to the
doctor or the trusted relatives and friends.
E. Merits of SMEAD
• The system continuously monitors the diabetes level using
wearable technology which would be helpful to the elderly
people who require constant care.
• Use of IoT and wearable technology results in reduced
number of clinical visits and only virtual doctor-patient
interaction is required for treatment.
• The system makes sure that the patients adhere to their
medication at right time and the right dosage.
• An alert mechanism for when the patient misses his
medicines and faces any medical emergency
• It maintains the e-health records, which can be accessed by
both patient and the doctor securely; this would help them
during clinical visits.
• During emergency situations, caretakers will be informed via
social networks.
• Interoperability with other healthcare providers and doctors.
• Data sharing and emergency alerts for authorized users.
• Well defined smart contracts to manage access to data and
Ethereum’s custom API to define these contracts.
• Build in an Intelligent AppIOT platform, so it can be
extended for various other purposes.
IV. DISCUSSION
The system mainly focuses on monitoring the symptoms
that a diabetic person exhibits using various sensors embedded
in the neckband, wristband and the footwear and then using the
MEDIBOX to direct the patient to consume the medications on
time. Fig 5 shows the sequence of events in SMEAD system.
Fig. 5 Sequence of events
 Let us take a scenario of a diabetic patient, for example, components used, an alert system for both patient and doctor
Alex who works on a very busy schedule and must travel and its relevant visualization.
around the world as a part of his job. Regular clinical visits and
As per the earlier discussion, Fig 6 shows the hardware
interaction with the doctors are quite difficult for him. Here he
module interfacing of all three components - Smart neckband,
adopts compact SMEAD system by using the wearables. The
Smart Wristband and Smart footwear with the controller and a
data collected from the sensors embedded in the wearables are
Bluetooth module to provide the required data for initial testing
transmitted via Bluetooth to his smartphone which he carries
and validation.
with him all the time. Alex needs to carry his medicines
especially insulin all the time. He uses a MEDIBOX for this
purpose which stores all his medication in the proper
environment suitable for his medicine and alerts him at the
exact time to consume his medication. He will also be notified
in prior before the medicine gets over to collect his medications
Fig 6. Interfacing of three modules
because missing an insulin injection can be detrimental to his
health condition. Alex can also use an insulin dosage calculator A mobile app is developed to generate an alert message on
in which the machine calculates the insulin needed for the body. the patient’s mobile. Fig 7 shows the display of the application
But it is always wise to take the advice of a doctor which is which has the slot for all three wearables. It will help the patient
possible through this comprehensive system. Let us take three view his vital parameters at any point in time. It also contains a
possible emergency situations and actuation that happen in Bluetooth configuration page to connect the devices to transfer
SMEAD system relevant to this case: data. Further, the patient can get to know the severity of the
disease with a single click on the button icon created in the App.
1) Alex misses his medications for more than 2 days - He
will be alerted at exact times to consume his medicines but in
case he doesn’t take his medication this will be notified to his
caretakers via social networks like WhatsApp, Facebook etc.
2) Diabetic level tends to increase/decrease even after
taking regular medication because of his busy work schedule,
travel etc. - Alex forgets his diet and consumes food which he Fig 7. Mobile Application Display
is not supposed to take or he might be living in a temperature
not suitable for his body condition. This can lead to an Initial configuration of the MEDIBOX is done within the
irregularity of blood glucose level which should be existing app designed for maintaining diabetic patients. The
communicated with the doctor immediately. The doctor can timings at which the patient has to be reminded about his
verify his health records to know his vitals like BMI, the medicines are entered using the app as shown in Fig 8a. The
frequency of food water intake, heart rate, temperature etc. He temperature required for the medicines are set as shown in Fig
can then analyze the cause for increase/decrease in severity 8b. The timings that are entered will be stored in the SD card
level and prescribe the suitable insulin dosage. When Alex module and will be compared with the RTC time to send the
faces any discomfort, the information is communicated to his notifications. The storage conditions also can be set using the
friends and family via social networking sites so that he can be app and the cooling system is actuated accordingly.
hospitalized/treated before any complications occur.
3) An attacker tries to access Alex’s personal health
records - If a person tries to access Alex’s data without consent
from Alex, this would result in immediate rejection by the
system because the attacker doesn’t have access to Alex’s
private key. The data is stored on a secure private Blockchain
with Alex having full power to control who can access the data Fig 8 (a)configuring timing in the mobile app (b) configuring the
where he can limit it to his close family and friends and his required temperature
physician.
Fig 9 shows the interface present at the Doctor’s end to
Thus, a secure and complete end-to-end monitoring system monitor the patient’s status securely. The gateway
helps Alex to prevent the fatal effects of the diabetic disease. communicates the information and generates an alert at the
As well as it helps him secure his health records from doctor’s end in case of any irregularities. The doctor can then
unauthorized users. Now we will consider the hardware
enter the private key sent by the patient to access the
information and then prescribe remedies based on it.
Fig 9. Doctor's Interface
From the above implementation for the specific healthcare
solution, it’s evident that the proposed system satisfies all the
criteria required for a secured end-to-end system for diabetes
monitoring. The sensors used are of low cost providing better
accuracy, the solution proposed in this paper comprises of
required wearables whose design cost is less. The sensors will
last over a long period, unlike the disposable strips used in
many techniques. The overall manufacturing cost is less and
hence even the common public could afford it. As a result, the
overall expenditure spent per person will be minimized. This
cost-effective solution mainly concentrates to provide an end-
to-end system using the IoMT assisting devices, intelligent
platform and addressing security issues and also to establish a
communication with social networks. After the sufficient
clinical trials, we found that our solution gives promising
outcomes and proves an outstanding IOT-based system which
is useful for diabetes monitoring. We also found that the total
cost of the entire system will be approximately around USD
250 per person.
V. CONCLUSION
In today’s world where people are busy with their schedule
have few expectations from the healthcare sectors such as the
use of wearables for monitoring, medication adherence and
virtual doctor-patient interaction as they are less time to
consume and cost-effective. The proposed comprehensive
system mainly emphases on these three key entities to design a
complete mobile based secured health care system in an
intelligent AppIoT platform that can predict the diabetes status
in real-time. The doctor can access the patient’s e-health record
at times of emergency in a secured manner and prescribe them
with suitable dosage. Medicines suggested by the doctor must
be consumed at an appropriate time for their well-being. Missed
dosage can be more harmful than the disease itself. Thereby the
system also reminds the patient regarding their medications and
creates a suitable environment for storage of medicines. During
emergency conditions, the system possesses an alert
mechanism that will notify the caretakers of the patient via
social networks. The proposed system shows the intelligence in
building various required components, but in future, it can be
extended to act as a generalized system irrespective of the
disease by adding other wearable devices and sensors in the
same platform. The blockchain model employed can also be
used as an example to store healthcare data on a larger scale and
securely connect with various other third parties.
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