Diabetes apps evolve to address individual health issues, goals

Diabetes requires active participation by the person living with the condition to optimize treatment and meet health goals. While people with diabetes may work with physicians, diabetes educators and dietitians in managing their disease, but the use of interactive tools can give them an advantage. As mobile applications become a more integral part of daily life, it was intuitive that diabetes apps would increase in prevalence.

However, according to a study published in the Journal of Diabetes Science and Technology, most available apps do not support all the self-care practices advised by the American Association of Diabetes Educators.

“Ideally, the best solutions have four key items: the ability to have two-way communication, use and analysis of patient-generated health data to tailor education, and the opportunity for feedback,” Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE, chief digital research officer for Diabetes at Mytonomy, owner of Deborah Greenwood Consulting and 2015 AADE president, told Endocrine Today. “That’s the perfect world. We saw that apps that had all of these features had the best impact on HbA1c. Most apps don’t have all of that.”

Greenwood discussed the characteristics of a high-quality diabetes app, apps currently available, and strategies for helping users identify the best app for their needs.

Are there any apps that have all the characteristics identified in your systematic review?

Greenwood: There are a few. Blue Star, Livongo, One Drop and My Sugar are the first that come to mind. They have most of these features and are consistently seen as being high quality. They have the data analysis on the back end and create an opportunity for people to get feedback. Most of the apps you can download from the app store are not likely to have all of these features.

How have diabetes management apps advanced from the earliest versions?

Greenwood: The diabetes app started off as sort of an electronic log book. The early apps were mostly a place to document blood glucose by hand. They couldn’t share, synthesize or group the data together like Glooko and Tidepool do. These apps make managing diabetes a little easier by taking away some of the work a person has to do. We don’t want technology to add another thing to do. The goal is for technology to remove some of the things a person has to do, to decrease the burden. We recognize how much work is required in managing diabetes. The benefit of using apps is to make life easier, not harder.

What factors should people consider when choosing a diabetes app?

Greenwood: That really depends on what the person’s goals are and what they hope to gain from the app. There are some apps, like Glooko, for example, in which the main focus is glucose data. Glooko electronically pulls in glucose data from meters. Then people can see patterns and trends in their data. That type of app is also helpful for people who want to share their glucose data with their health care provider. Some apps also help people track their carb intake and manage their medications. If someone wants to lose weight, they may want a different app. That could be something that’s diabetes-specific, or it could be something like the Weight Watchers app, which is for anybody.

AADE has developed a new app review process. What are the potential benefits of this?

Greenwood: This is a good opportunity for endocrinologists and diabetes educators to get more information about the apps that are out there. There are so many apps, and providers and educators can’t know all of them. The way the AADE review is working is that a third party is evaluating apps based on set criteria, in terms of security, privacy, ease of use and user interface. This resource is currently only available to AADE members and is part of a larger project that AADE will be releasing this summer: DANA (Diabetes Advanced Network Access), a web portal that will contain a product clearinghouse of diabetes technology, tech savvy courses, resources and news. This will be valuable as diabetes educators are the central point of sharing this type of information with patients.

Another great way for people to learn about apps is from other people with diabetes. The person who is using the app is often the best person to give guidance. A lot of apps are currently evaluated on popular diabetes websites, like Diabetes Mine or Diatribe.

You mentioned that the best apps are or soon will be able to analyze patient-generated health data. What would that be like?

Greenwood: Some of the more sophisticated apps analyze data and give immediate feedback. After analyzing the data, the app might inform the person that their blood glucose is low and advise them to consume a certain amount of carbohydrates or to check their glucose again in 15 minutes. Today some solutions apps, like Blue Star, Livongo, One Drop, My Sugar and the new Onduo for Diabetes, have algorithms to provide tailored feedback. In the future we should see much more sophisticated evaluation of all different types of diabetes data. This type of evaluation will use machine learning, artificial intelligence, predictive analytics or predictive modeling, with the goal of trying to prevent an event from happening by analyzing the previous data and learning from trends and patterns.

 

An interesting example is a software called Sugar IQ, developed in partnership with Medtronic and IBM Watson. When a person enters information in the app about their lunch — say that they are eating a tuna sandwich — the feedback they may get at that time is, “I see you’re eating a tuna sandwich. The last time you ate a tuna sandwich, your blood glucose went low. You might want to take less insulin than you have in the past.” That’s the holy grail of what we will see in the future. I believe Sugar IQ is still in research and not available yet, and it will be part of their closed-loop insulin pumps, so it’s not going to be an app that is freely available, at least not to start.

Why do you think existing apps do not incorporate all the AADE7 Self-Care behaviors?

Greenwood: The lack of ability to analyze data on most of the current apps is part of the reason they are not incorporating all the AADE7 self-care behaviors. Most of the apps are addressing only a few of those health care behaviors, such as healthy eating, being active or glucose monitoring. Some address taking medications, but they don’t often address the higher-level behaviors, like problem solving, healthy coping and reducing risk. Apps that support healthy eating and being active can be effective by helping people collect and document data whereas problem solving, healthy coping and reducing risk require a more complex app and the analysis of data. As apps evolve, they are starting to address these more complex skills and the key behaviors that really help people manage their diabetes. – by Jennifer Byrne

Reference:

DANA app review. Available at: www.diabeteseducator.org/practice/educator-tools/the-dana-app-review.

Diabetes Mine. Available at: www.healthline.com/diabetesmine.

Diatribe. Available at: diatribe.org/.

Greenwood D, et al. J Diabetes Sci Technol. 2017;doi:10.1177/1932296817713506.

Ye Q, et al. J Diabetes Sci Technol. 2018;doi:10.1177/1932296818754907.

For more information:

Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE, can be reached at 7315 Wisconsin Ave, Ste 400, Bethesda, MD, 20814; email: deborah@mytonomy.com.

Disclosure: Greenwood reports no relevant financial disclosures.

 

Diabetes requires active participation by the person living with the condition to optimize treatment and meet health goals. While people with diabetes may work with physicians, diabetes educators and dietitians in managing their disease, but the use of interactive tools can give them an advantage. As mobile applications become a more integral part of daily life, it was intuitive that diabetes apps would increase in prevalence.

However, according to a study published in the Journal of Diabetes Science and Technology, most available apps do not support all the self-care practices advised by the American Association of Diabetes Educators.

“Ideally, the best solutions have four key items: the ability to have two-way communication, use and analysis of patient-generated health data to tailor education, and the opportunity for feedback,” Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE, chief digital research officer for Diabetes at Mytonomy, owner of Deborah Greenwood Consulting and 2015 AADE president, told Endocrine Today. “That’s the perfect world. We saw that apps that had all of these features had the best impact on HbA1c. Most apps don’t have all of that.”

Greenwood discussed the characteristics of a high-quality diabetes app, apps currently available, and strategies for helping users identify the best app for their needs.

Are there any apps that have all the characteristics identified in your systematic review?

Greenwood: There are a few. Blue Star, Livongo, One Drop and My Sugar are the first that come to mind. They have most of these features and are consistently seen as being high quality. They have the data analysis on the back end and create an opportunity for people to get feedback. Most of the apps you can download from the app store are not likely to have all of these features.

How have diabetes management apps advanced from the earliest versions?

Greenwood: The diabetes app started off as sort of an electronic log book. The early apps were mostly a place to document blood glucose by hand. They couldn’t share, synthesize or group the data together like Glooko and Tidepool do. These apps make managing diabetes a little easier by taking away some of the work a person has to do. We don’t want technology to add another thing to do. The goal is for technology to remove some of the things a person has to do, to decrease the burden. We recognize how much work is required in managing diabetes. The benefit of using apps is to make life easier, not harder.

What factors should people consider when choosing a diabetes app?

Greenwood: That really depends on what the person’s goals are and what they hope to gain from the app. There are some apps, like Glooko, for example, in which the main focus is glucose data. Glooko electronically pulls in glucose data from meters. Then people can see patterns and trends in their data. That type of app is also helpful for people who want to share their glucose data with their health care provider. Some apps also help people track their carb intake and manage their medications. If someone wants to lose weight, they may want a different app. That could be something that’s diabetes-specific, or it could be something like the Weight Watchers app, which is for anybody.

AADE has developed a new app review process. What are the potential benefits of this?

Greenwood: This is a good opportunity for endocrinologists and diabetes educators to get more information about the apps that are out there. There are so many apps, and providers and educators can’t know all of them. The way the AADE review is working is that a third party is evaluating apps based on set criteria, in terms of security, privacy, ease of use and user interface. This resource is currently only available to AADE members and is part of a larger project that AADE will be releasing this summer: DANA (Diabetes Advanced Network Access), a web portal that will contain a product clearinghouse of diabetes technology, tech savvy courses, resources and news. This will be valuable as diabetes educators are the central point of sharing this type of information with patients.

Another great way for people to learn about apps is from other people with diabetes. The person who is using the app is often the best person to give guidance. A lot of apps are currently evaluated on popular diabetes websites, like Diabetes Mine or Diatribe.

You mentioned that the best apps are or soon will be able to analyze patient-generated health data. What would that be like?

Greenwood: Some of the more sophisticated apps analyze data and give immediate feedback. After analyzing the data, the app might inform the person that their blood glucose is low and advise them to consume a certain amount of carbohydrates or to check their glucose again in 15 minutes. Today some solutions apps, like Blue Star, Livongo, One Drop, My Sugar and the new Onduo for Diabetes, have algorithms to provide tailored feedback. In the future we should see much more sophisticated evaluation of all different types of diabetes data. This type of evaluation will use machine learning, artificial intelligence, predictive analytics or predictive modeling, with the goal of trying to prevent an event from happening by analyzing the previous data and learning from trends and patterns.

 

An interesting example is a software called Sugar IQ, developed in partnership with Medtronic and IBM Watson. When a person enters information in the app about their lunch — say that they are eating a tuna sandwich — the feedback they may get at that time is, “I see you’re eating a tuna sandwich. The last time you ate a tuna sandwich, your blood glucose went low. You might want to take less insulin than you have in the past.” That’s the holy grail of what we will see in the future. I believe Sugar IQ is still in research and not available yet, and it will be part of their closed-loop insulin pumps, so it’s not going to be an app that is freely available, at least not to start.

Why do you think existing apps do not incorporate all the AADE7 Self-Care behaviors?

Greenwood: The lack of ability to analyze data on most of the current apps is part of the reason they are not incorporating all the AADE7 self-care behaviors. Most of the apps are addressing only a few of those health care behaviors, such as healthy eating, being active or glucose monitoring. Some address taking medications, but they don’t often address the higher-level behaviors, like problem solving, healthy coping and reducing risk. Apps that support healthy eating and being active can be effective by helping people collect and document data whereas problem solving, healthy coping and reducing risk require a more complex app and the analysis of data. As apps evolve, they are starting to address these more complex skills and the key behaviors that really help people manage their diabetes. – by Jennifer Byrne

Reference:

DANA app review. Available at: www.diabeteseducator.org/practice/educator-tools/the-dana-app-review.

Diabetes Mine. Available at: www.healthline.com/diabetesmine.

Diatribe. Available at: diatribe.org/.

Greenwood D, et al. J Diabetes Sci Technol. 2017;doi:10.1177/1932296817713506.

Ye Q, et al. J Diabetes Sci Technol. 2018;doi:10.1177/1932296818754907.

For more information:

Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE, can be reached at 7315 Wisconsin Ave, Ste 400, Bethesda, MD, 20814; email: deborah@mytonomy.com.

Disclosure: Greenwood reports no relevant financial disclosures.