“We as diabetes care and education specialists need to be aware of what apps are out there and support our patients using apps, just as we do for other diabetes technologies,” Rachel Stahl, MS, RD, CDN, CDCES, staff associate in medicine in the division of endocrinology, diabetes and metabolism at New York Presbyterian Hospital, Weill Cornell Medicine, told Healio. “However, we also need to caution them about concerns, such as safety and privacy issues.”
Diabetes technology has evolved and dramatically improved care, and apps are a part of the evolution, Stahl said during a virtual presentation at the Association of Diabetes Care & Education Specialists annual conference. Apps, introduced with the first Apple iPhone in 2007, are still a new concept to some, but adoption is rapidly growing, Stahl said. Today, there are more than 318,000 mobile health apps available for download, covering general wellness and health management, displaying or downloading health data, or functioning as standalone medical devices.
“What started out as an interest in apps, soon became a necessity,” Stahl told Healio. “I get questions all the time from patients asking me about what apps I recommend or coming to me already using apps.”
Diabetes apps bring with them many benefits, such as reducing friction for gathering health data, providing decision support, driving patient engagement and enhancing care through more collaboration between the person with diabetes and the diabetes care and education specialist or other providers, Stahl said. Apps also provided advanced analytics, allowing for personalized insights based on retrospective food or insulin data, and pattern recognition to avoid high or low glucose values.
Apps also can bring disadvantages, such as privacy, security and safety concerns.
“Unlike a medical device like a [continuous glucose monitor] or an insulin pump, the majority of apps are not regulated by a governing body, like the FDA,” Stahl said. “Without oversight or regulation comes higher risk. The app may not perform the advertised function, it may present potential cybersecurity risks, or it may lack safeguards to prevent harmful mistakes from operational error.”
Additionally, Stahl said, simply recommending an app may not be helpful.
“In fact, one study showed that over 75% of apps are used once after being downloaded, and then never used again,” Stahl told Healio. “This underscores the need for the diabetes care and education specialist to not only assist the patient in app selection, but to support its use through ongoing education and follow-up to help improve outcomes.”
The diabetes care and education specialist can play a role in the successful use of apps by following four steps:
- Assist with app selection and individualize recommendations. “Just as with all diabetes care, recommending apps requires an individualized, patient-centred approach rather than a one-size-fits-all philosophy,” Stahl said. “Consider the health literacy and numeracy of your patient.”
- Onboard “live” or remotely. “Support the person to download, register and customize the app,” Stahl said. “Maybe it helps them enter their goals or connects with one of their diabetes devices. Taking those extra moments to set them up shows we care and can help them get the most out of it.”
- Discuss potential privacy and safety concerns. “Patients need to be aware of risks,” Stahl said.
- Provide ongoing education, training and follow-up.
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