Diabetes Apps, are they a happy happenstance – where technology wins over pathology – or a counterproductive hypertrophy of data? This article will open this Pandora’s Box.
The number of Apps (application software) for smart phones has expanded exponentially in recent times: with hardware add-ons that enable glucose monitoring and the recording of data; the storage of data for patient self-care or for upload to the “Cloud” for access by their healthcare professionals. There are Apps that offer advice about diet, lifestyle, and disease management.
But are these Apps of real benefit to the patient and do they augment or retard physician interventions?
For the clinician, data can be sent directly to the clinic allowing many patients to be monitored at one time. For the patient the App can remind them to test their blood sugar and to record it on the phone, along with an alert for readings that are outside normal parameters and the advice to seek medical review. Problems can be dealt with more quickly, efficiently and cheaply than before.
For example, the ideal outreach to IT savvy kids must be fast and it has to be fun. So a program can award points for every reading and they can be used to buy apps or music.
A recent paper reported that structured self-monitoring of blood glucose leads to significant increases in self-confidence and autonomous motivation associated with diabetes self-management, and that changes in self-confidence are linked to changes in glycemic control and share a time-concordant relationship.1
All of the above allow patients to take control of their condition, rather than recoil in despair.
One can immediately anticipate the busy clinician replying that the last thing they want is an App that streamed data demanding an immediately response, especially as the corollary would be ‘real-time litigation’ if they didn’t respond. But of course such responses will always be tailored to workload.
There is also the consideration of the clinical value of the frequency of glucose testing, alongside the marketing pressure for the assimilation of novel technology for meters and smart phones. The attraction to the patient of such technology might outweigh any clinical benefits. The costs of hardware and consumables may also be a factor.
Day-to-day blood glucose testing is more prevalent in type 1 diabetes which suggests that the users of these apps may well be Type 1 patients, although the increasing prevalence of Type 2 diabetes, along with the patient’s thirst for reassurance via the acquisition of data utilising technologically attractive hardware, might induce recruitment of the systems by that group.
And the answer?
Reconciling the discordant views of patient and clinician regarding perceived speed of access and enhanced disease management might prove to be a challenge, and a return-on-investment calculation that only clinicians can, or perhaps must resolve.
Can clinicians and their healthcare provider systems avoid tapping into this unrealised potential? With diagnoses available via telemedicine, and systems that facilitate the medical management of rural populations, the future may have already arrived. With increasing numbers of technologically competent patients discussing their conditions and treatment on social media platforms and Apps, the happenstance may be that your patients are already in the cyberspace waiting room … and they are waiting for you!
1. Diabetes Research and Clinical Practice Volume 96, Issue 2 , Pages 149-155, May 2012. doi:10.1016/j.diabres.2011.12.016