Apps Designed for People With Type 2 Diabetes Disappoint

Miriam E. Tucker

April 16, 2019

When it comes to providing decision support and education, most apps designed to help people with type 2 diabetes don't measure up, new research suggests. 

The findings from an analysis of 371 type 2 diabetes-related apps were published online today in JAMA by Josip Car, MD, PhD, chair of the Health Services and Outcomes Research Program at Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, and colleagues. 

"We were disappointed to find that the majority of diabetes apps did not provide real-time decision support or situation-specific education on blood glucose self-management...Clinicians need to be aware of both the potential benefits as well as the shortcomings of these apps and also be aware if their patients are using apps for self-management of diabetes," Car told Medscape Medical News.

The authors evaluated the apps, which were those listed on the database through 2018, based on diabetes standards of care, including goal-setting and flagging high or low blood glucose levels outside target ranges, and patient education about blood glucose management.

Apps associated with continuous glucose monitoring were not included.

"Diabetes apps should support self-management in a way that aligns with usual care from health providers," Car said.

The authors found that blood glucose levels could be recorded in all apps, including some that allowed direct blood glucose monitoring via an attachment to a smartphone. However, goal-setting was available in only 37% overall, with more iOS apps having this function than Android.

Reminders to measure blood glucose were available in just 27.8%, and only 28.6% allowed for HbA1c recording.

Messages alerting users to hypoglycemia and hyperglycemia were included in 37.0% and 32.4% of apps, respectively. Such messages were accompanied by either action prompts in 20.7% for hypoglycemia and 15.3% for hyperglycemia, or a color change in 26.7% for hypoglycemia and 24.5% for hyperglycemia.

Small proportions of the apps provided suggested actions for hypoglycemia such as intake of food, juice, or sugar (13.9%); seeking medical help (13.9%); or remeasuring (10.2%). For hyperglycemia, suggestions included checking ketones (5.1%), seeking medical help (13.4%), monitoring closely (3.2%), or using corrective insulin (3.2%).

Just 10.6% of apps offered blood glucose-related education.

Car said that professional organizations such as the Canadian Medical Association and UK Royal College of Physicians have released guiding principles for clinicians in selecting and/or recommending apps.

"Clinicians should be invited to contribute to the development of health apps," Car said.

The study was funded by the CePHaS, Lee Kong Chian School of Medicine, and Ageing Research Institute for Society and Education, Nanyang Technological University. The authors have disclosed no relevant financial relationships.

JAMA. 2019;321:1530-1532. Research letter

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