How Smartphones May Help Slow the Tide of Diabetes

Apps devoted to helping people prevent or manage diabetes are cropping up as people become increasingly comfortable turning to smartphones for nearly every facet of life.

With about 30 million Americans living with diabetes and another 84 million with prediabetes, the disease’s health effects are taxing our nation’s population and economy.

The American Diabetes Association has estimated diabetes costs the U.S. more than $322 billion a year in excess medical spending and lost productivity.

Several factors are driving these troubling numbers, and some are unavoidable. People develop higher risk for diabetes as they age. As the baby boomer generation continues to grow older, the sheer size of that demographic will make the disease more common.

However, several risk factors — like sedentary lifestyles and obesity — are more manageable. And people with prediabetes — meaning their blood sugar levels are higher than normal and they are at increased risk of Type 2 diabetes — can make lifestyle changes that may delay or prevent the disease’s onset.

“Lifestyle change has a profound impact on preventing diabetes,” says Judith Kolish, a registered dietitian and certified diabetes educator.

But that’s easier said than done.

“Managing diabetes requires a lot of a person, from checking their blood sugar to taking medications to knowing what they need to be eating,” Kolish says. “The process becomes extremely overwhelming for people.”

Support needed

Some approaches have proved effective, though, and new initiatives and innovative tools are making them more widely available.

A large clinical study with support from the National Institutes of Health and other federal agencies showed that lifestyle interventions for people with prediabetes reduced the onset of the disease by 58 percent over three years.

This yearlong curriculum, called the National Diabetes Prevention Program, uses in-person group meetings with lifestyle coaches to help spur and maintain modest weight loss and increased physical activity. The Centers for Disease Control and Prevention has been working with a variety of organizations to expand access to the program.

The YMCA won a federal grant to conduct a nationwide test of the approach for Medicare beneficiaries, which yielded reductions in hospitalizations and emergency room visits. That success compelled Medicare to make the program eligible for coverage as a preventive service.

One limiting factor, though, is that the group sessions and individualized support may not always be practical.

Enter the apps

Apps devoted to helping people prevent or manage diabetes are cropping up as people become increasingly comfortable turning to smartphones for nearly every facet of life.

“The use of technology such as phone apps can help individuals (with diabetes) by serving as reminder tools; they may need prompting to get healthy lifestyle plans completed during the day,” says Kathleen Stanley, a certified diabetes educator with Baptist Health Lexington in Kentucky and the American Association of Diabetes Educators.

Many free and paid apps claim to help prevent or manage diabetes. A search in the Google Play Store reveals hundreds that claim to provide glucose monitoring tracking, diabetes-friendly recipes, exercise tips and more. Some even connect people with live lifestyle coaches who track their health virtually and can provide tips through the app.

When new approaches come to market, we need to test them to see if they work.

But not all apps are created equal.

In a study in the October 2017 issue of the journal Diabetes Care, researchers reviewed 89 free Android and iPhone apps found by searching “diabetes” and “diabetes management.” They evaluated things like the apps’ engagement, functionality and ability to help with diabetes management tasks like physical activity, nutrition, education, blood glucose testing and other activities.

They concluded that “additional work is needed to assess the clinical significance of apps for diabetes self-management.”

Technology “really gives people a new way to interact with their health care,” says Nilima Rajkumar, a divisional vice president of product solutions with Blue Cross and Blue Shield Plans in Illinois, Montana, New Mexico, Oklahoma and Texas. But, she adds, “When new approaches come to market, we need to test them to see if they work.”

Blue Cross and Blue Shield Plans in Illinois and Texas are testing two popular diabetes prevention and management apps among a small population of members to help validate their efficacy.

One of the apps uses smartphones to deliver the National Diabetes Prevention Program curriculum and enable users to communicate with a lifestyle coach. The other app, for people who already developed diabetes, ships unlimited test strips and lancets to users’ front doors and provides online access to coaches and tracking of blood-glucose readings.

The 15-month-long pilot program will track how the use of certain phone apps affect participating members’ health. Does someone with prediabetes stay in that state instead of developing the disease? Does someone with diabetes better control their A1c levels?

If the pilot shows they work, the apps may be made available to more members.

“Technology is making it possible for individuals to get access to information about managing their health in new ways,” Rajkumar says. “We want to see if they’re effective. And if they’re effective, then we want to make them available on a more standard basis.”

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