Advances in Diabetes Technology Part I: Analysis of Diabetes Self Management Apps

Transcription

1 Advances in Diabetes Technology Part I: Analysis of Diabetes Self Management Apps Jennifer Trujillo, PharmD, FCCP, BCPS, CDE, BC ADM Associate Professor University of Colorado School of Pharmacy Andrew Bzowyckyj, PharmD, BCPS, CDE Associate Professor Pacific University Oregon School of Pharmacy Annual Meeting & Exposition Seattle, Washington March 22 25

2 Disclosures Presenter: Jennifer Trujillo, PharmD, FCCP, BCPS, CDE, BC ADM serves on advisory boards for Sanofi and BD Pharmaceuticals Presenter: Andrew Bzowyckyj, PharmD, BCPS, CDE has no relevant conflicts of interest or relationships to disclose. 2

3 CPE Information Target Audience: Pharmacists and Pharmacy Technicians ACPE#: L01 P Activity Type: Knowledge based 3

4 Learning Objectives At the completion of this knowledge based activity, participants will be able to: List the most useful diabetes related mobile applications currently available. Discuss the relevance of these applications to diabetes care. Explain the role a pharmacist can play in enhancing diabetes care using these applications. 4

5 Assessment Questions 1. Scientific evidence suggests that the use of commercially available applications (apps): A. May improve some short term diabetes related outcomes such as A1C B. Are only effective when combined with frequent support from a healthcare provider C. Improve quality of life but do not improve other diabetes related outcomes such as A1C D. Improves A1C in patients with type 2 diabetes, but not patients with type 1 diabetes 5

6 Assessment Questions 2. A patient with type 2 diabetes (on oral medications only) is looking for an app that can help her track her calories and exercise. She would like something that is easy to use and free and doesn t want or need extra features. Which app would be most appropriate to discuss with her? A. KingFit B. MyNetDiary Diabetes Tracker C. Insulia D. MyFitnessPal 6

7 Assessment Questions 3. A patient with type 2 diabetes is started on insulin glargine U 300 at 10 units once daily. Which of the following apps can help him titrate his basal insulin dose to a safe and effective dose? A. Fooducate B. Glooko C. My Dose Coach D. Glucose Buddy 7

8 Assessment Question 4. Which of the following accurately describes the role a pharmacist can play in enhancing diabetes care using applications? A. Advise patients to avoid using apps that are not approved by the FDA B. Evaluate your current workflow to determine how to integrate apps C. Recommend the 3 4 apps that are your personal favorites to patients D. Refer patients to apps that solely rely on automated feedback from the app 8

9 Think Pair Share Do you use any apps currently to help you with your overall health? Have you in the past? How did you decide which one to use? What do you like? What do you dislike? How do you determine whether an app is good or not? How do you find the best app for a certain topic? What apps to you recommend to your patients with diabetes? 9

10 Strategies for Finding the Right App Peer reviewed scientific literature App clearinghouse websites App store(s): descriptions, user ratings, and reviews Social media query within professional and/or patient networks Pilot test the app Elicit feedback from patients Transl Behav Med. 2014;4(4):

11 Example App Clearinghouse Websites imedicalapps AppScript Diabetes Advanced Network Access (DANA) NHS Apps Library Access: imedicalapps.com No login required Developer: Independent online medical publication Collaboration with MedPageToday Content: Expert reviews written by healthcare professionals Access: appscript.net Free, but login required Developer: IQVIA Content: AppScript Score (1 100) Based on 6 weighted domains: Professional Patient Functional Endorsement Developer Clinical Access: danatech.org& danaapps.org Membership required Developer: American Association of Diabetes Educators (AADE) DHX Labs Content: Privacy and security scan App performance Functionality Usability & design Consumer appeal Content quality Clinical evidence Access: apps.beta.nhs.uk No login required Developer: United Kingdom National Health Service (NHS) Content: App pricing Prescription requirements Description / Photos Ideal candidates Overview of operating instructions Transl Behav Med. 2014;4(4): ; Individual websites 11

12 Factors to Consider When Finding an App Purpose / area of focus Device compatibility App usability Cost (initial & ongoing) User ratings Update frequency Privacy / security policy 12

13 Strategies to Activate Patients Using Mobile Apps The Commonwealth Fund, February

14 What s in a name? Self monitoring Social outlet 2 way communication 14

15 March 2018 Systematic Review 21 trials (n=1550) A1C in Type 1 Diabetes: A1C in Type 2 Diabetes: Overall: No HCP Feedback: HCP feedback Overall: No HCP Feedback: Low HCP feedback High HCP feedback 0.49% ( 0.94 to 0.04%) I 2 = 84% 0.77% ( 1.16 to 0.38%) I 2 = 40% 0.37% ( 0.94 to 0.20%) I 2 = 82% 0.57% ( 0.82 to 0.32%) I 2 = 77% 0.24% ( 0.49 to 0.02%) I 2 = 0% 0.33% ( 0.59 to 0.07%) I 2 = 47% 1.12% ( 1.32 to 0.91%) I 2 = 0% Diabetes Obes Metab. 2018;20: A1C = hemoglobin A1C; HCP = health care provider 15

16 July 2018 Systematic Review Limited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short term diabetes related outcomes. J Gen Intern Med. 2018;33(7):

17 Category: Calorie Tracking & Meal Planning 17

18 Category: Calorie Tracking & Meal Planning App User Ratings (as of Dec 2018): Price General Functionality (varies by app) MyFitnessPal (itunes: #5 in Health & Fitness) SparkPeople Calorie Tracker (Calorie Counter & Diet Tracker) My Diet Diary Calorie Counter Fooducate Nutrition Tracker (itunes: #110 in Health/Fitness) Apple: 4.7 out of 5 (494K) Android: 4.6 out of 5 (1.96M) Apple: 4.6 out of 5 (8K) Android: 4.5 out of 5 (33K) Apple: 4.6 out of 5 (911) Android: 4.1 out of 5 (19K) Apple: 4.7 out of 5 (29K) Android: 4.4 out of 5 (15K) Basic version is free Premium version: $9.99/month $49.99/year Basic version is free Premium version: $4.99/month Free Basic version is free Premium version: $ /month $ /year Log: Meals Exercise Weight Water Internal nutrition lists & calorie database Customized meal plans Sync with other apps & devices Social element Articles Fitness videos 18

19 MyFitnessPal 19

20 MyFitnessPal Testimonials Pro I started using this app as part of my lifestyle change to lose 100 lbs... It is very convenient to be able to sync this with my Garmin so I don t have to add my activities or calories burned. I love that I m able to scan the things I eat and easily add things that do not have a barcode Being able to add my own recipes that have been passed down from family which have always been hard to keep track of is no longer a problem Con "This app claims to be comprehensive, but has a huge gap in its user experience for people with diabetes. There is no way to input blood sugar readings in real time or to integrate readings from glucose monitoring We need either a setting to add our readings with a timestamp that then can be read as part of the diary; or integration with the most popular glucometer apps 20

21 SparkPeople Calorie Tracker 21

22 SparkPeople Calorie Tracker Testimonials Pro I enjoy this app. I get good information and motivation from the blog. It would be nice if I could enter my own recipe for something instead of having to enter each individual ingredient I used and guessing the portion size of each of them. It syncs with my Fitbit which is helpful " Con Nutrition information seems to largely come from user input and user review of accuracy. This leaves a HUGE margin for error in calculating daily intake of nutrients. The rest of the interface is irrelevant if the nutrition part is not validated by Sparkpeople itself for accuracy and consistency. calorie tracker/id

23 My Diet Diary Calorie Counter 23

24 My Diet Diary Calorie Counter Testimonials Pro This app is convenient to use. It has the ability to scan barcodes of foods purchased at the store, and many items are automatically listed to select when searching for foods that did not come with barcodes This app also includes positive reinforcement by using encouraging phrases. It s great! Con I lost 60 kg in 6 month from this app, and I will be forever grateful. However, after a year hiatus, I m trying to lose another 5 kg and I m using the app faithfully, but the lag. drives. me. insane. This is such a simple, elegant app; it should be fast to click buttons but it takes 30 seconds to add one piece of ham diet diary calorie counter/id

25 Fooducate Nutrition Tracker 25

26 Fooducate Nutrition Tracker Testimonials Pro Hands down this is the best diet app out there. As long as you are completely honest with the portions and source. Also helps you with alternative choices that are healthier. This app should be implemented in every doctors recommended weight loss and education towards food conversation. Con I purchased this to help me navigate food allergens and to track my caloric intake. In my experience, the app doesn t have a wide database of items so you re left looking at the label anyways and inputting all the nutrition info manually into the app, or you have to rely on data another user has input nutrition tracker/id

27 Other Calorie Tracking & Meal Planning Apps Lose it! (4.7/5 stars; #13 in health/fitness) Calorie counter by FatSecret (4.7/5 stars; #180 in health/fitness) CRON O Meter (3.7/5 stars; #11 in health/fitness) My Macros + (4.7/5 stars; #6 in health/fitness) Calorific (3.2/5 stars; pictures of 200 calories of each food) 27

28 Category: Logging Glucose & Other Data Photo by Mike Tinnion on Unsplash 28

29 Category: Logging Glucose & Other Data App User Ratings (as of Dec 2018): Price General Functionality mysugr Sugar Sense Diabetes App Health2Sync Diabetes Care Apple: 4.7 out of 5 (1.9K) Android: 4.6 out of 5 (23.8K) Apple: 4.6 out of 5 (4.1K) Android: 4.2 out of 5 (1.2K) Apple: 4.7 out of 5 (69) Android: 4.6 out of 5 (6.4K) Basic version is free Premium versions: $ /month $ /year Free Basic version is free Premium versions: $2.99/month $7.99/3 months $14.99/6 months Log glucoses, meals & meds Reports estimated A1C (ea1c) Motivating challenges & feedback Syncs with Apple Health, Accu Chek devices, & continuous glucose monitoring (CGM) Log glucoses, meals & meds Reports ea1c Syncs with Apple Health, ihealth glucometer, My Diet Diary Calorie Counter & fitness trackers Log glucoses, meds, exercise, meals Upload readings from meter (special cable required) Upload photos of meals Track BP, weight, A1C Social support (designated partners) 29

30 Category: Logging Glucose & Other Data 30

31 Category: Comprehensive Diabetes Apps App User Ratings (as of Dec 2018): Price General Functionality Glucose Buddy Apple: 4.8 Android: 4.4 Basic version is free Premium version: $14.99/month $59.99/year Log glucoses, insulin, & meals Provides insights into daily trends Tracks carb intake, steps, and activity Scans food labels for carbs Syncs to others like Apple Health Import/export capabilities MyNetDiary Diabetes Tracker Apple: 4.5 Android: 4.6 $9.99 Log glucoses, insulin, & meals Provides insights into daily trends Tracks carb intake, steps, activity (GPS tracker) Syncs to others like Apple Health Import/export and reminder/target capabilities Offers help/motivation from friends/community Diabetes:M Apple: 4.6 Android: 4.6 Basic version is free Premium versions: $4.99 per month $49.99 per year Log glucoses, insulin, & meals Calculates insulin bolus doses Provides insights into daily trends Tracks carb intake, steps, and activity Scans food labels for carbs Syncs to other devices through Apple Health 31

32 Category: Comprehensive Diabetes Apps App User Ratings (as of Dec 2018): Price General Functionality Glucosio Apple: not rated Android: 4 free Logs glucoses, weight, ketones, ea1c, cholesterol, BP, insulin Sets reminders to take meds, exercise Can share data anonymously if desired Glooko Apple: 3 Android: 4 Free Optional subscription Logs glucose Sync multiple devices Search food or medication databases See trends and share data Diabetes Connect Apple: 4.5 Android: 5 Free Optional in app purchases Logs glucose, meals, insulin, medications Sync to multiple devices See trends and share data PredictBGL Insulin Dose Calc Apple: 3.7 Android: 3.5 Free Optional upgrade Insulin dose calculator with predictive analytics Calculates insulin dose, tracks insulin on board Predicts blood sugar; alerts warning of predictive low Can integrate with CGM Coaching and just in time education 32

33 Category: Comprehensive Diabetes Apps 33

34 Category: Comprehensive Diabetes Apps 24 week, multi center, randomized, controlled trial in 172 patients with type 2 diabetes Patients were randomized to Diabetes:M group or paper logbook group Reduction in A1C from baseline 0.40% Diabetes:M group 0.06% Paper logbook group Patients who achieved an A1C < 7% without hypoglycemia 31.1% Diabetes:M group 17.1% Paper logbook group Kim EK, et al. Diabetes Care 2018; Published online Oct

35 Category: Basal Insulin Dose Titration Apps App My Dose Coach (Sanofi) Insulia General Functionality Personalized recommendations for basal insulin dose adjustments Quick data collection Blood glucose (BG) trend charts Dose explanations Treatment plan 35

36 Category: Basal Insulin Dose Titration Apps My Dose Coach 36

37 Category: Basal Insulin Dose Titration Apps Insulia 37

38 Category: Unique Apps KingFit Mobile diabetes education Bite sized videos to provide diabetes education in smaller doses in a format that is easy and convenient to patients 38

39 Category: Unique Apps Connected Devices with Online Coaching Virtual management of chronic diseases Tech enabled companies that offer a combination of connected devices with online coaching Livongo Omada Health Canary Health OneDrop MySugr WellDoc Blue Star Important to evaluate issues such as validity, FDA approval, liability, reimbursement, workflow, responsibility 39

40 Category: Unique Apps WellDocs Blue Star C Diabetes 40

41 Category: Unique Apps WellDocs Blue Star C Diabetes Comprehensive app (tracking, weekly progress, instant, personalized feedback with in app coach, food diary, meds) Syncs with other trackers, devices Clinical evidence 30 publications show % reduction in A1C and estimated cost savings of $254 $271 per user per month Being evaluated in clinical study for use in Primary Care Population Health The Ambulatory Practice of the Future (APF) at Massachusetts General Hospital 41

42 Think Pair Share Which tools or technology strategies seemed most helpful or promising to you today? What do you see as the biggest barriers to using apps for diabetes management? Biggest benefits? What is the pharmacist s role in enhancing diabetes care using these applications? 42

43 Closing remarks/conclusion There are many apps out there! Get familiar and be flexible, but you can t know it all! Apps have been shown to help improve short term diabetes related outcomes May be positively correlated with healthcare professional interaction for T2DM Highlights of apps from today: Calorie tracking & meal planning Logging glucose & other data Titrating doses of basal insulin Comprehensive diabetes apps 43

44 Assessment Question 1. Scientific evidence suggests that the use of commercially available applications (apps): A. May improve some short term diabetes related outcomes such as A1C B. Are only effective when combined with frequent support from a healthcare provider C. Improve quality of life but do not improve other diabetes related outcomes such as A1C D. Improves A1C in patients with type 2 diabetes, but not patients with type 1 diabetes 44

45 Assessment Question 2. A patient with type 2 diabetes (on oral medications only) is looking for an app that can help her track her calories and exercise. She would like something that is easy to use and free and doesn t want or need extra features. Which app would be most appropriate to discuss with her? A. KingFit B. MyNetDiary Diabetes Tracker C. Insulia D. MyFitnessPal 45

46 Assessment Question 3. A patient with type 2 diabetes is started on insulin glargine U 300 at 10 units once daily. Which of the following apps can help him titrate his basal insulin dose to a safe and effective dose? A. Fooducate B. Glooko C. My Dose Coach D. Glucose Buddy 46

47 Assessment Question 4. Which of the following accurately describes the role a pharmacist can play in enhancing diabetes care using applications? A. Advise patients to avoid using apps that are not approved by the FDA B. Evaluate your current workflow to determine how to integrate apps C. Recommend the 3 4 apps that are your personal favorites to patients D. Refer patients to apps that solely rely on automated feedback from the app 47

48 Advances in Diabetes Technology Part I: Analysis of Diabetes Self Management Apps Annual Meeting & Exposition Seattle, Washington March 22 25