Diabetes is an extremely common disease that can lead to serious long-term complications such as cardiovascular disease, kidney dysfunction, neuropathy, diabetic retinopathy, foot ulcer or infection, and even tinnitus, if not properly managed with medication and lifestyle adjustments Treatment recommendations include insulin for type 1 diabetes and various classes of drugs for type 2 diabetics such as biguanides, sulfonylureas, thiazolidinediones, sodium glucose cotransporter-2 inhibitors (SGLT-2), dipeptidyl peptidase-4 inhibitors (DPP- 4). and glucagon-like peptide-1 (GLP-1) receptor agonists.2 Since the main indicators of well-controlled diabetes include blood sugar and A1C levels, it is imperative for patients to have a thorough understanding of self-monitoring and periodic monitoring Values. They should also be able to recognize symptoms of hypoglycemia and / or hyperglycemia.
Although patients are able to check their values during routine doctor visits, frequent monitoring can provide a more complete understanding of whether or not their current treatment plan is effective. With advances in technology, easy self-monitoring and access to tools via phones and computers has enabled patients to routinely monitor blood sugar and A1C levels from the comfort of their homes. In the last few years in particular, several mobile apps have been introduced that provide easy ways to track and monitor relevant laboratories, as well as diet and exercise habits.
Apps and wearable devices
The Bluetooth function has increased the expansion of the apps for the healthcare sector and made it possible for one main platform to contain all relevant health information of a patient. For example, the OneTouch Verio Flex glucose meter automatically syncs its data with the corresponding OneTouch Reveal app, which patients can use to track their average blood glucose, food intake, medication dosage and activity data. They can also set lifestyle goals, receive notifications of low and / or high blood sugar levels, and even share their data directly with their healthcare providers. Similarly, the Accu-Chek Guide, Guide Me, and Aviva Connect meters can connect to the mySugr app so that patients can enter relevant diet and medication information, get an analysis of glucose levels, and predict A1C levels. Other similar apps are the iHealth Smart Meter and the One Drop Mobile App. 3
Medtronic’s Guardian Connect app allows patients to receive instant alerts and predictive alerts for hypoglycemia and / or hyperglycemia up to 60 minutes in advance. The collected data, including current glucose levels with trends and glucose history, can be passed on to healthcare providers
Patients diagnosed with type 1 diabetes may need more extensive monitoring of their insulin and blood sugar levels. Apps like Diabeo and Diabetes Interactive Diary include a self-glucose recording option and an insulin bolus calculator. The calculator is comprehensive and uses an algorithm to take into account self-monitored blood sugar levels, carbohydrate intake and physical activity. It also takes into account parameters set by the doctor for the insulin-to-carbohydrate ratio, the correction factor and the basal insulin dose. If patients routinely check their blood glucose levels with the Accu-Chek meter, they can download the Accu-Chek Connect app, which synchronizes readings and results directly from the meter. Patients can also use the insulin bolus calculator and the photographic food diary, which are provided in App.4
Technological advances in recent years have provided incredibly innovative ways that patients can monitor their own health. In 2017, the FDA approved the FreeStyle Libre Flash glucose monitor, a disc-shaped sensor that is inserted into the upper arm and worn there for up to 14 days. Once the sensor is in place, a reader can be swiped over it, which in some versions of the monitor shows real-time glucose levels, trends, and even alarms for dangerously low or high glucose levels
Glucagon App
Patients who routinely administer insulin are at high risk of developing hypoglycemia. As a preventive measure, glucagon kits can be given to those who are prescribed insulin. Eli Lilly has created and published the Lilly Glucagon Mobile App, which shows users how to administer glucagon correctly, provides frequent reminders to practice and prepare to use glucagon, and provides information and advice on drug safety. Since glucagon is generally only used in emergencies, this app can be helpful in reminding patients and their caregivers how to properly manage it if necessary
Lifestyle apps
In addition to drug therapy and medical management of diabetes, certain lifestyle changes can be made to help patients better manage their symptoms and long-term results. Similar to the various apps that patients can use to monitor their blood sugar levels and current medication, there are lifestyle management apps that provide insights into diet and exercise (see Table 1) .3
Works with the Livongo Blood Glucose Meter, Livongo Blood Pressure Monitor, and Livongo Scale to get a more detailed picture of overall health
- New recipes
- Insights into glucose patterns with real-time support and professional coaching from diabetes specialists
- Daily tracking of the number of steps
- Allows users to order unlimited test strips and lancets at no additional cost
Diet and nutritional management; contains a database of over 10 million foods for tracking
- Nutrient and exercise tracker
- Restaurant reviews
- Barcode scanner for packaged food
- Adjusting the weight goal
Records and tracks blood sugar levels
- Records and tracks A1C levels, blood sugar, medication, exercise, blood pressure and weight
- Contains a database of carbohydrate foods
Improves patients’ understanding of the relationship between their diet and treating diabetes by providing information on how the foods they eat can affect their blood sugar levels
- Personalized nutrition plans
- Tracking Food and Exercises
Converts glucose data across multiple apps into standard glucose statistics, providing valuable insights into glucose trends and how well-controlled patients are adhering to their current medication regimen
- Entering blood sugar, meal, bolus insulin, basal insulin, correction insulin, basal rates, temporary basal rate changes, exercises, medication, blood pressure, pulse, moods and notes
Provides a bolus insulin calculator for use with an insulin pump or an insulin regimen with multiple daily injections
- Includes a logbook, food database, and basal insulin tracker that can be converted into day passes to share with healthcare providers
Designed for patients with newly diagnosed diabetes to provide tips on managing blood sugar, facts about diabetes complications, and treatment options using modern medicine and Ayurvedic practices
- Shares lists of the best and worst foods for diabetes
- Diet recommendations based on the American Heart Association’s diet and lifestyle recommendations
The past year was associated with unique challenges. The technology has allowed us to stay connected through various platforms that have been instrumental in healthcare. We’ve seen telehealth grow, and mobile apps like the ones mentioned in this article have enabled patients and their healthcare providers to communicate with one another on a regular basis. For patients with diabetes, improved accessibility for self-monitoring and regular communication with their providers can help optimize their treatment plans and reduce the risk of long-term complications.
About the authors
Sandhya Vijapurapu is a PharmD candidate at Duquesne University School of Pharmacy in Pittsburgh, Pennsylvania, expected to graduate in the spring of 2021.
Jonathan Ogurchak, PharmD, CSP, is CEO and co-founder of STACK, a platform for pharmacy information management. He also serves as a lecturer for a virtual rotation of advanced pharmacy practice for the specialty pharmacy.
References
- National Diabetes Statistics Report, 2020. CDC. August 28, 2020. Accessed April 1, 2021. https://www.cdc.gov/diabetes/data/statistics-report/index.html. Last checked
- American Diabetes Association. 9. Pharmacological Approaches to Glycemic Treatment: Standards of Health Care for Diabetes – 2021. Diabetes Treatment. 2021; 44 (supplement 1): S111-S124. doi: 10.2337 / dc21-S009
- Doyle-Delgado K, Chamberlain JJ. Use of diabetes-related applications and digital health tools by people with diabetes and their health care providers. Clin Diabetes. 2020; 38 (5): 449- 461. doi: 10.2337 / cd20-0046
- Shan R, Sarkar S, Martin SS Digital Health Technology and Mobile Devices for the Treatment of Diabetes Mellitus: State of the Art. Diabetologia. 2019; 62 (6): 877- 887. doi: 10.1007 / s00125-019-4864-7
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