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Do apps add value to diabetes management?
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Apps can be a useful tool for diabetes management.
Apps can give you more objective data in near real time. Those data can help people manage their diabetes, or more specifically, manage their behavior, to result in more effective diabetes management. Their utility can be increased when they are used as part of a comprehensive management plan that users can deploy with the help of their health care providers and also with the support of social media. People can find that social support to be helpful, and critically, having these data go to their health care provider and fit within a more comprehensive plan is helpful.
We ultimately want to utilize apps to do more with less. What that means is we want to help people obtain the most benefits, and therefore they would be most effectively managing their diabetes with as little data input as possible. One of the “rabbit holes” we sometimes go down with these apps is we find ourselves tracking or producing too much data, and the disease management piece gets lost. The endpoint being tracked should be used for a specific purpose with a specific goal in mind. If you want to monitor glucose levels, you should use an app that does that. Then, a maintenance plan is put in place that may or may not rely on the data from the app.
Sometimes we use apps sparsely or for limited periods of time. It is fine to track an endpoint for a period of time, get it in the desired range, and then focus on other health behaviors using a different app. Most clinicians, including me, sometimes simply ask our patients to do too much. It’s not realistic, for example, to have patients use an app to track food intake 24 hours a day every day for a year, but I can have them track food intake for a few days a week, preferably on the weekends, and I can use that smaller amount of data to make specific behavior and dietary recommendations to help them live a healthier life.
Corby K. Martin, PhD, FTOS, is director of the Ingestive Behavior, Weight Management and Health Promotion Laboratory at the Pennington Biomedical Research Center in Baton Rouge, Louisiana. Disclosure: Martin reports his institution has interest in the intellectual property related to the SmartIntake app, and he is an inventor of the technology.
Apps can serve as a useful tool, but the person with diabetes needs additional support.
As the world of telehealth improves, diabetes apps could offer an avenue to open up better accountability and communication between providers and patients, but we’re not there yet.
A variety of diabetes apps are available. Some have a single purpose, such as logging blood sugars. Others are now more multidirectional and include real-time advice and tips based on patient input. But one of the biggest things providers have focused on over the last decade is individualized, patient-centered care. When a person with diabetes turns to an app, that app does not know the patient’s history, medical conditions and other potential concerns that the patient might have and that can bring risks. We might be trying to fix one thing, but we’re hurting another thing because we’re not looking at the whole person.
App fatigue also is a real issue, particularly for people with diabetes. I find that many of my patients initially report that certain apps are great, even fun and engaging, but by the second or third visit in, they will report that they are not using the app anymore. Often, it becomes one more thing to keep track of.
The key to using apps for disease management is to consider them tools for the health care team as a whole — the provider, the CDE, the dietitian — to use together. The health care team should discuss with the patient how to use apps to better work on the care plan or meet individual goals. This can result in more buy-in and greater success. If you have an app you are using all the time, but no one else is really looking at it, then what does it really mean? Instead, if you have a patient come in and show the provider an app, the provider can look at it and say, “Let’s see how you’re doing with X, Y and Z,” now, it’s a different level of engagement. It’s part of your health care plan.
In a perfect world, apps would allow the provider to have easier conversations and communication with patients. This way, patients’ level of engagement is higher with the health care team they are already comfortable with vs. a new team in the app. Until then, communication with patients’ own providers is key, with an app being one possible tool.
Candi Possinger, MS, RD, CDN, CDE, is a certified diabetes educator and registered dietitian and the owner of Personalized Health Nutrition PLCC. Disclosure: Possinger reports no relevant financial disclosures.