Detailed directives based on proven practice for hypoglycemia and hyperglycemia treatment are not always features of diabetes apps, which means people with type 2 diabetes must be careful when selecting apps to help manage their diabetes, according to findings published in Diabetes/Metabolism Research and Reviews.
“We uncovered two important problems regarding the capability of apps to support diabetes self-management. First, less than one-fifth of apps provided evidence-based steps to guide patients through hypoglycemia and hyperglycemia,” Elaine Lum, PhD, MClinPharm, BPharm, Adv Prac Pharm, senior research fellow at the Centre for Population Health Sciences of Lee Kong Chian School of Medicine at Nanyang Technological University in Singapore, and colleagues wrote. “Second, the majority of apps failed to provide just-in-time bite-size diabetes self-management education to prevent frequent or severe episodes of hypoglycemia and hyperglycemia.”
Lum and colleagues tested 371 smartphone applications — some free, some with required purchase — that were designed for diabetes management and required users to enter their blood glucose levels. All apps were listed in the 42Matters database; the researchers used recent updating as evidence of user support and app maintenance.
When the researchers entered blood glucose levels below 70 mg/dL to simulate hypoglycemia, they found that 217 apps provided a “hypoglycemia” notification and 45 of these apps (20.7%) included instructions or “action prompts” to address the condition. The researchers noted that suggestions that incorporated American Diabetes Association guidelines, such as consuming carbohydrates or waiting 15 minutes to measure blood glucose again, were presented by 39 of the apps (86.7%) that provided instructions. In contrast, 11 of these apps (24.4%) featured vague or unhelpful instructions when hypoglycemia occurred.
Detailed directives based on proven practice for hypoglycemia and hyperglycemia treatment are not always features of diabetes apps, which means people with type 2 diabetes must be careful when selecting apps to help manage their diabetes.
When the researchers entered in blood glucose of 180 mg/dL or more to simulate hyperglycemia, they found that 216 apps provided a “hyperglycemia” notification and 33 of these (15.3%) included an action prompt.. Suggestions that incorporated ADA guidelines, such as testing glucose more often and measuring urine ketones, were presented by 32 of the apps (97%) that featured action prompts. Alternatively, 11 of these apps (33.3%) featured vague or unhelpful instructions in these situations.
“Developers of diabetes self-management apps should involve diabetes specialists at the codesign stage so that educational evidence-based action prompts are triggered when out-of-range blood glucose values are recorded,” the researchers wrote. “If appropriately designed, action prompts could play a role in augmenting patient education of blood glucose management, which may translate to improved HbA1c without incurring severe hypoglycemic episodes.” – by Phil Neuffer
Lum E, et al. JAMA. 2019;doi:10.1001/jama.2019.1644.
Disclosures: The authors report no relevant financial disclosures.