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For teens with type 1 diabetes, apps offer connectivity, but with limits
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ORLANDO, Fla. — Apps for smartphones and tablets offer a personalized way for teens with type 1 diabetes to manage their disease, but it is important to consider several limitations when developing the technology, according to a speaker here.
“Despite the huge number of apps that are available and downloaded, the number that people actually use is quite small — about 30 per month and 10 per week,” Sarah S. Jaser, PhD, associate professor of pediatrics at Vanderbilt University School of Medicine in Nashville, Tennessee, told Endocrine Today before her presentation. “People may also be surprised to learn how low the usage is for health-related apps designed for teens, even when they include all of the features that teens, parents and providers say they want in an app.”
A 2018 survey on teens, social media and technology conducted by the Pew Research Center shows that 95% of adolescents overall and 93% of lower-income teens have access to a cellphone — an increase from 73% of adolescents overall and 61% of lower-income teens in the 2015 survey. Additionally, more than 197 billion overall app downloads are projected for 2018, Jaser said.
However, of the more than 318,000 health-related apps that are available for download, only a small fraction are downloaded, with about 40,000 apps making up about 90% of downloads, according to Jaser. Referring to the “30/10 rule,” Jaser said most people use about 30 apps in a month and 10 apps in a day.
“So, when we’re thinking about trying to get our diabetes apps onto people’s phones, it’s hard to get into that limited real estate,” said Jaser, speaking during a mini-symposium at the American Diabetes Association’s 78th Annual Scientific Sessions.
Among teens, the most popular app is YouTube, followed by Instagram, Snapchat, Facebook and Twitter, according to the Pew survey, and developers must find a way to engage teens with diabetes management apps in a similar way, Jaser said.
“When we think about the overlap between health-related apps and these popular apps for teens, there isn’t much,” Jaser said. “The challenge for us, as researchers, is to try to get our health-related apps into that overlap.”
Early data caveats
A recent meta-analytic review found that app interventions for adults with diabetes resulted in improvement in HbA1c by about 0.4%, Jaser said; however, many of the included analyses were pilot studies with short follow-up periods and small numbers of participants.
Jaser cited the Bant app, a diabetes management app aimed at teens developed at The Hospital for Sick Children in Toronto. Named for Frederick Banting, who discovered insulin, the gamified app includes blood glucose trend analysis and decision support, as well as a private social media community — “Banter” — and includes incentives to purchase music on iTunes. In a pilot study with 20 teens over 12 weeks, the app was associated with increased frequency of blood glucose monitoring and a high rate of satisfaction, Jaser said.
However, in a randomized controlled trial with 92 teens over 12 months in which the intervention was compared with usual care, researchers observed no between-group differences in the primary outcome of change in HbA1c, as well as no between-group differences in the secondary outcomes of frequency of blood glucose monitoring, quality of life, self-care or hypoglycemic events.
“What do we make of this, when the pilot study looks so promising and the randomized trial doesn’t have the intended results?” Jaser said. “The authors of the study suggest that it could be related to the low level of usage.”
In the study, 37% of the participants had “very low” usage of once every 14 days, 28% had “low” usage of less than once per week, whereas only 9% were using more than 3 days per week, Jaser said.
“That means over half the participants used it less than once per week,” Jaser said. “Our challenge is to figure out how to get kids to use the apps that we are developing, even when they have all of the features they say that they want.”
Two other apps also offer possible positive approaches to engagement, Jaser said: Type 1 Doing Well, which prompts parents to praise teens and reinforce diabetes strength behaviors, and MyT1DHero, which share blood glucose values between the teen and parent and allows users to earn points.
Important considerations
Apps are most valuable for people seeking information or resources, Jaser said, but teens with diabetes are often trying to avoid thinking about their disease. Additionally, many teens, especially those in rural areas or from lower-income households, have limited access to Wi-Fi or restricted Wi-Fi access while in school. Teens are also often sharing data plans with other family members, meaning a diabetes app could potentially not be prioritized when a user is forced to choose which app they make time for, Jaser said.
Still other barriers to use, such as requiring a password or a complicated interface, further reduce uptake in this age group, Jaser said.
“We may be unintentionally widening a disparity by creating apps for this population when we know that they are more likely to be used by people with higher education, higher resources and maybe are already the most engaged with their diabetes care.” Jaser said.
Potential solutions
For teens who may not be motivated to use diabetes apps, texting may be a preferred alternative, Jaser said. Through texting, it is possible to tailor messages to provide a sense of connection, and studies have suggested that personalized messages resulted in higher rates of engagement.
Another solution may be to leverage existing apps for teens and “meet them where they are at,” using YouTube, Instagram or, for lower-income teens, Facebook, Jaser said.
Jaser said it is also key to give teens the information they are seeking: things like carb counts, videos on how to hide an insulin pump under a prom dress or a bathing suit, and videos on sensor placement are just a few things teens are seeking out related to diabetes.
Jaser also said pilot testing, while critical for establishing app feasibility, cannot establish efficacy.
“We need to be cautious when recommending apps for people,” Jaser said. – by Regina Schaffer
Reference:
Jaser SS. The value of apps, or lack thereof, for teens with diabetes. Presented at: American Diabetes Association 78th Scientific Sessions; June 22-26, 2018; Orlando, Fla.
Disclosure: Jaser reports no relevant financial disclosures.