Several new mobile applications and platforms for managing diabetes will be announced at the American Diabetes Association annual scientific sessions in San Francisco this month, and the results of a handful of trials of apps will be reported there. As a prelude, it’s helpful to know what’s been reported about diabetes apps previously.
Diabetes management has been one of the most talked-about goals of app development, given the immense costs in patients’ lives and in health care dollars from the disease. Although there are more than 1,000 specific diabetes apps for iOS and Android devices, only 1.2% of people with diabetes who have a smartphone or tablet use these apps, according to the Germany-based market research and consultancy firm research2guidance. The company expects that to grow to 7.8% (24 million people) by 2018. As of now, few diabetes apps incorporate seven standards for quality and functionality, or include them only at the most basic level, according to a recent report for sale on the company’s website.
German investigators analyzed information for 656 currently available diabetes apps and used a representative 65 of them to evaluate their usability for patients aged 50 years or older. Most were for English speakers (85%), and 54% were free, with no clear differences in user ratings between free and paid apps. The majority of apps offered just one function (54%), and only 5% offered an interface to a measurement device such as a glucometer. For older patients, the usability of the 65 tested apps was moderate to good but worsened if the app offered more than one function, especially documentation or analysis functions (J. Med. Internet Res. 2014;16:e101).
A Cochrane meta-analysis of data from 16 randomized controlled trials of Internet-based self-management interventions involving 3,578 adults with type 2 diabetes found 1-12 months of use reduced hemoglobin A1c (HbA1c) levels by 0.2%, compared with HbA1c levels in control groups. Results were somewhat better, however, in the three trials of mobile phone-based interventions, which reduced HbA1c levels by 0.5%, compared with controls. The other interventions studied were on computers or a touch-screen in homes or clinics (Cochrane Database Syst. Rev. 2013 March 28;3[doi:10.1002/14651858.CD008776.pub2]).
An earlier meta-analysis of results from a variety of mobile phone interventions in 15 studies involving a total of 929 children and adults with diabetes suggested overall benefits in managing blood glucose and HbA1c levels, adhering to medical therapy, and maintaining a healthy lifestyle. The 12 trials that measured HbA1c levels showed an average 0.4% reduction after 1-12 months of the intervention, compared with before (J. Mob. Technol. Med. 2012;1:17-24).
Combining usual care with use of the Glucose Buddy smartphone app and weekly text-message feedback from a diabetes educator significantly reduced HbA1c levels, compared with usual care alone, in a randomized controlled trial of 72 Australians with type 1 diabetes. Among 53 patients who completed the 6-month intervention and 3-month follow-up, HbA1c levels decreased from 9% at baseline to 7.8% in the 25 patients in the intervention group and increased from 8.5% at baseline to 8.6% in the control group of 28 patients (J. Med. Internet Res. 2013;15:e235).
A recent pilot study found that 60 adults with diabetes were enthusiastic about using the free SightBook app to monitor visual acuity changes at home but suggested that improvements will be needed to incorporate such apps into existing electronic medical records if they are to facilitate coordination between patients, diabetologists, and ophthalmologists in managing the risk of diabetic retinopathy (J. Diabetes Sci. Technol. 2014 April 14 [doi:10.1177/1932296814529637]).
Several trials have looked at text message–based interventions, including one that found no significant difference in HbA1c levels but found improved medication adherence in 128 adults with poorly controlled diabetes who often relied on emergency departments for care. The effects were larger among Spanish speakers (Ann. Emerg. Med. 2014;63:745-54). A separate randomized controlled trial found that patients receiving text-message reminders when they forgot their diabetes medication took significantly more doses within 1 hour and 4 hours of the appropriate time (Int. J. Med. Inform. 2012;81:594-604).
Health care professionals who want to guide patients seeking to use diabetes apps may want to consider some key factors, a recent article suggested. These may include the age of the patient, the cost of the technology, the fact that most apps work only on Apple operating systems, and whether the app includes features such as blood glucose logging, nutritional databases or tracking, physical activity trackers, data sharing and social support, and text-message reminders. Patients should try using an app for at least a couple of weeks before judging it and be reminded that these are adjuncts, not substitutes for regular visits with their physician, the authors wrote (Diabetes Spectr. 2013;26:211-5).