Few smartphone apps for self-management of type 2 diabetes (T2D) provide sufficient real-time action prompts or education on blood glucose monitoring, according to study results published in JAMA.

To investigate the abilities of smartphone apps to deliver essential features such as decision support and instruction for self-management of T2D, researchers downloaded and evaluated 371 of 5184 available apps (198 Android, 173 iOS). Each app was assessed for criteria including data capture, decision support, and patient education.

Of the included apps, 100% offered the ability to record blood glucose levels and 28.6% to record hemoglobin A1c; 37% allowed users to set goals, 27.8% provided reminders to measure blood glucose, and 10.6% offered educational tools related to blood glucose. In addition, 98.4% had extra features for blood glucose monitoring such as date or time stamps and prompts indicating relationship to a meal.

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Furthermore, users could be alerted to hypoglycemia or hyperglycemia in 58.8% and 58.4% of apps, respectively. This was done through an explicit message, action prompt, color change, sound, or graph. However, only 20.7% and 15.3% of apps provided explicit alert messages with action prompts for hypoglycemia and hyperglycemia, respectively.

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Solutions for hypoglycemia recommended by these apps included intake of food, juice, or sugar (13.9%); seeking medical help (13.9%); or remeasurement (10.2%). Solutions for hyperglycemia included checking ketones (5.1%), seeking medical help (13.4%), close monitoring (3.2%), or using corrective insulin (3.2%).

The researchers noted that they did not assess the appropriateness of patient education and recommended actions provided by the apps.

“[I]n most apps, consecutive low or high blood glucose values did not trigger an escalation of alerts that could prevent severe hypoglycemia or hyperglycemia… [demonstrating] the immaturity of diabetes apps and missed opportunities to improve care and health outcomes,” said the researchers. “Quality assurance mechanisms such as certification of apps are needed to help achieve their potential of supporting diabetes care.”

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Lum E, Jimenez G, Huang Z, et al. Decision support and alerts of apps for self-management of blood glucose for type 2 diabetes. JAMA. 2019;321(15):1530-1532.