There’s an App for That. But Should You Use it?

diabetes app, diana isaacs

There is no shortage of diabetes-related apps from food, activity and glucose tracking, to diabetes coaching, medication advice, carbohydrate counting and more. But are these apps worthwhile to use?

Recently, the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Technology Working Group published a consensus report about diabetes digital and health application technology. In this paper, the ADA and EASD performed a review of stand-alone apps and found several issues related to accuracy, validity, interoperability and data security. This paper brings up many concerns about health apps including:

  • A lack of regulations and standardization.
  • A lack of monitoring or minimum standards as with medications, devices or other areas of healthcare.
  • Limited information about the safety and effectiveness of apps.
  • Few clinical trials reviewing safety and effectiveness.
  • Technology issues with apps that can create bugs or problems with interoperability.

The ideal app would have information that can be easily shared with the healthcare team and integrated into the electronic medical record, without using too much phone battery. Since there is a lack of oversight of apps, there is no guarantee that the information is accurate. For example, some may have inaccurate carbohydrate counts for some foods, which can cause a person to over bolus or under bolus for a meal contributing to hypo or hyperglycemia, which then poses a safety concern.

Fortunately, the consensus statement offers some recommendations for the healthcare team, people with diabetes, regulatory bodies, professional organizations and researchers for what they can do to address app concerns. Some of these recommendations include:

  • Regular oversight.
  • Safety reporting.
  • Maintaining a list of endorsed apps.
  • Increasing data security.

They also recommend more clinical trials, although they acknowledge it’s difficult to do since apps are constantly being updated. The healthcare team and people with diabetes need adequate training on what apps are available and how to use them.

For people with diabetes, they recommend discussing the apps with their healthcare team along with giving reviews and feedback on how the apps work. The app should be a supplement to the healthcare team and is not meant to replace medical advice.

Overall, there is a lot of potential in this area, but one should be cautious when using a new app. People with diabetes should discuss health apps with the healthcare team and double-check any medical advice to verify their accuracy. Hopefully, the future will be bright as many of these recommendations are implemented and if regular oversight can be increased.

CGM, Life and Leadership: It doesn’t have to be perfect to be better

I really love continuous glucose monitoring (CGM). I love all of the information it provides- how it connects the dots and lets us know what’s happening to people overnight and in between glucose checks.  What I especially love about CGM is that it doesn’t have to be perfect.  With the A1C test, it seems like a grade. Under 7%, you passed. Over 7%, and you failed this test.  Of course this is not true, but it can feel that way for both the person with diabetes (PWD) and the diabetes educator who was supposed to help the PWD achieve that goal.

But CGM is different. Because there is a wider target range of 70-180mg/dL and the glucose variability becomes more important.  Recently there was an International Consensus on Time in Range from a large panel of distinguished clinicians. They provided standardized CGM metrics and one part that especially stood out a lot for me was the goal of 70% time in range for most people with type 1 or type 2 diabetes and 50% time in range for higher risk or older adults.  The goal for pre-existing type 1 diabetes in pregnancy is also 70% although with a target of 63-140mg/dL. This means that you don’t have to be perfect!  How refreshing to know that it doesn’t have to be perfect to be better.  Pregnancy can especially be such a high anxiety time.  People with diabetes may feel guilt about not always staying under that 140mg/dL after meals. And even I have felt guilt in the past about not succeeding in helping my patients achieve those goals all of the time. How reassuring to know that A. it’s incredibly difficult to achieve 100% time in target and B. it doesn’t have to be there 100% of the time to have healthy outcomes.

I think this is important because it’s easy to fall into the trap of feeling feel like a failure or a sense of guilt if you don’t meet a certain mark. But we don’t need to be perfect.  As leaders, there may be times when we can really inspire change and growth, where our teams work so well together and move mountains. And other times, it’s just an accomplishment to get the work done period.  That’s okay; just as we don’t expect a PWD to be 100% time in range, our leadership, our teams, our colleagues, our work can’t possibly be 100% all of the time.  My hope is that if my fellow leaders can remember this wisdom, we can avoid burnout and find the motivation to keep going even on those harder days. Let’s not fall into the trap of perfection. After all, done is usually better than perfect.

Reference: Battelino R, Danne T, Bergental RM et al. Clinical Targets for Continuous Glucose Monitoring Data Interpretation: Recommendations From the International Consensus on Time in Range. Diabetes Care 2019 Jun; dci190028.