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Most diabetes apps fail to meet all AADE self-care criteria

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February 7, 2018

An analysis of diabetes self-management apps available for smart devices shows that most do not support all the self-care behaviors recommended by the American Association of Diabetes Educators, according to findings published in the Journal of Diabetes Science and Technology.

“This study revealed that, compared to AADE7, there was an unbalanced feature development of current [diabetes self-management] apps,” Qing Ye, MS, of the University of Missouri Informatics Institute in Columbia, and colleagues wrote. “We found that many [diabetes self-management] apps provided features related to healthy eating, monitoring, taking medication and being active behaviors, which were positive aspects. However, few apps offered features related to problem-solving, reducing risks and healthy coping behaviors, which need to be developed in future [diabetes self-management] apps.”

Ye and colleagues assessed eligible apps out of 1,050 retrieved from two major app stores, identified during November 2015 (n = 173) and December 2017 (n = 137; 71% of apps free; median app price, $2.99). For 3 months, a multidisciplinary team (a usability expert, a diabetes education researcher, an endocrinologist, an epidemiologist and a mobile health intervention developer) analyzed and discussed the features and functionality of each app, creating user accounts if required, and entering typical diabetes self-management information, such as glucose level, weight and medications. Researchers then created a list to categorize app features according to the seven self-case behaviors outlined by AADE. Features related to diabetes self-management but not listed as AADE self-care behaviors were classified as “others.” Additionally, researchers interviewed six diabetes physicians and educators for their opinions on the distribution of the features of diabetes self-management apps.

Researchers found that 77% of apps were designed to support healthy eating behaviors, 76% supported monitoring, 58% supporting taking antidiabetes medications and 45% supported being active. However, only 31% of eligible apps in 2017 were designed to provide features that support problem-solving, 10% supported healthy coping and 5% supported reducing risk.

In interviews with diabetes educators and diabetes physicians, the researchers noted that features related to problem-solving and reducing risks are more likely to be based on qualitative information rather than quantitative data, making the features difficult to incorporate into a mobile app. Healthy coping support can also be difficult to incorporate, they added, noting that different cultures have different attitudes toward healthy coping, and a support network might better meet those needs.

“Future diabetes apps should incorporate balanced features from the AADE7 to better support changing self-management behaviors of people with diabetes,” the researchers wrote. “More research is needed on how we can target future app development to include features that support qualitative data entry rather than limiting apps to quantitative data.” – by Regina Schaffer


AADE. AADE7 Self-Care Behaviors: Available at:

Disclosures: The authors report no relevant financial disclosures.

itj+ Perspective

Deborah Greenwood

It did not surprise me that the researchers found that problem solving, healthy coping and reducing risk were the AADE self-care behaviors that were least emphasized in most diabetes apps. Those three, in particular, are more complex topics. There are some apps that do address these behaviors, but they tend to be higher level and may have a subscription model, giving a person with diabetes access to a diabetes educator.

Part of the problem of why we are not seeing apps engaging in those areas is because you need a whole tech-enabled, self-management model. You really need two-way communication, which is not often found in mobile apps. To help someone problem solve, you need to give them feedback on how they are doing and answer questions. The more basic apps do not provide that feedback.

Studies like this one can help diabetes educators evaluate which of the seven self-care behaviors these apps are addressing and how are they addressing them. However, these apps get modified and changed all the time, so it is difficult to keep up. A new AADE initiative, called DANA app review, is designed to help educators to sort through these apps as they come out and help people with diabetes.

Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE

Chief Digital Research Officer, Diabetes
2015 President, American Association of Diabetes Educators

Disclosure: Greenwood reports she is an employee of Mytonomy.