Which Diabetes Management Mobile Apps Are Best for Your Patient With Diabetes?
In this podcast, Jennifer Smith, RD, LD, CDCES, discusses different mobile apps for diabetes management that she would recommend to people with diabetes, including women, women who are pregnant, adolescents, athletes, and more. She also provides insight into some of the features included in each app.
For more diabetes technology content, visit the Excellence Forum.
TRANSCRIPTION:
Jessica Bard: Hello everyone and welcome to another installment of Podcast360, your go-to resource for medical education and clinical updates. I'm your moderator, Jessica Bard with Consultant360, a multidisciplinary medical information network. Registered dietician and certified diabetes care and education specialist, Jennifer Smith, is here to speak with us today about the use of mobile apps in diabetes management. Jennifer, thank you so much for joining us on the podcast today. If you don't mind, please introduce yourself for the audience.
Jennifer Smith: It’s a pleasure to be here again. My name is Jennifer Smith. I am a registered dietician, certified diabetes care and education specialist, the director of lifestyle and nutrition for integrated diabetes services. We see patients worldwide and educate people all about the intensive management of diabetes. A good part of our population has Type 1 diabetes, but we also see people with Type 2 Diabetes, some people with gestational diabetes, and pre-diabetes. I work a lot with women's health specifically in our practice and with women who are navigating pregnancy, preconception, postpartum, and all the fun stuff in between. I work with a lot of athletes, so a lot of navigation with diabetes in all ages.
Certainly, we've got, thankfully, a lot of new technology in the past 5-to-10 years that helps with that. And it's great to be sort of the first person that somebody can talk to to be able to provide some insight and use.
Jessica Bard: And that's exactly what we're talking about today in diabetes technology. Favorite mobile apps for different populations. We'll touch on all of the populations that you just mentioned essentially, but to start, what apps are your favorite that you might recommend to a patient with diabetes? Say a woman who has diabetes?
Jennifer Smith: That's a great question. So, it depends on the age of the woman. But since I work with a lot of women in that preconception and pregnancy period, there is a lot of really good period-tracking apps, and why is that important to a woman who has diabetes? Mainly because there are so many changes and fluctuations that can happen in terms of blood sugar and medication needs based on hormonal changes that happened through the, you know, typical 30-day monthly cycle. Right? And so being able to track your month-to-month changes, it helps to bring together or give some insight into where your medication needs may need to go up, when your sensitivity changes, and what your gut health might feel like at different times of the month. Period Tracker is a really nice one. I personally have used it for years. It's very user-friendly. There are so many new apps that are on the market for period tracking. Some actually allow you to use tools like ovulation test kits that it connects with. And so then it gives you data and feedback on things like your monthly temperature and all of the things that you might be tracking if you are in that preconception time of life. But I think period trackers are, are an excellent one for somebody who is trying to figure out all the pieces that can, you know, fluctuate in, in a month.
Jessica Bard: That's certainly something to think about and to track. How about adolescents?
Jennifer Smith: Yeah, adolescents. In terms of diabetes specifically, adolescents have a lot of stuff that they're trying to keep together and to think about, and they are almost a mindset of the task here, do it task here, do it, take care of it, and kind of move on. And the juggling part of that can be really difficult. So when we talk about apps for the adolescent with diabetes, um, definitely tracking apps that put a lot of the pieces together in their own management and that may be some of the new technology, insulin pumps that work with continuous glucose monitors that all sync together in one app to collect the data, Dexcom is excellent, Tidepool and Glooko are all really nice web-based apps that can also share data with clinical counterparts, with caregivers that can help them to stay safe. There could be somebody behind the scenes getting alerts and reminders and all of that kind of stuff for that brain that's focused on so many things. It’s kind of nice to have somebody who is watching from the background because food is just a really big part of society and certainly is a social piece of being an adolescent. You know, the nibbling and the snacking and “let's go out after basketball practice for this meal or whatever to celebrate the game.” Looking up information is really important in terms of blood glucose management because, especially for adolescents who are taking insulin, it helps them navigate that insulin dosing appropriately and safely. And so, when we look at the apps, (1) they have to be really useful for the age (2) they have to be accurate and provide some kind of safe component to them. Food-based apps, things like CalorieKing allow somebody to look up data and get the right information. There's also Figwee, which is a really nice app that actually allows you to look at a particular portion of food on a plate and then all of the nutrition facts are below that photo. So, rather than looking at lists and trying to determine what three ounces of mashed potatoes look like you can see a portion of mashed potatoes and compare it to, well this is what's on my plate. It looks about the same, it must be this many grams of carbs. And so, again, from a precision standpoint, that can make it a little bit easier for that age group.
Jessica Bard: And we spoke about preconception, how about mobile apps for patients with diabetes for patients who are pregnant?
Jennifer Smith: Those mobile apps would be relative to glucose management. Not anything necessarily that's going to be pregnancy-specific. They're all very good in terms of navigating where you are in pregnancy. I mean many baby types of apps are out there, but specific to diabetes, the apps that help you to track data again and especially keep a good look at where your blood sugar is heading at that point in the day because glucose levels, the targets for blood sugars, are much tighter in pregnancy–63 to 140–and time for excursions in blood sugar tend to be in the aftermath of meals in pregnancy. Not that they don't outside of pregnancy, but we're just a lot more resistant as pregnancy goes on. And so apps can give alerts that your blood sugar is rising or your blood sugar is now at the upper target, those help when you're trying to navigate all the other pieces of control that it takes during pregnancy time.
There are many, many different types of continuous glucose monitors on the market now. I mean there's Dexcom, Libre, Medtronic, and Eversense has one, they all have apps that go right along with them, so they're excellent products. Again, those alerts are the biggest benefit to the woman who's trying to navigate really tight blood sugar control during pregnancy.
For a little bit extra, for those who are using insulin, some of the different types of insulin pumps that also allow tracking and collection of data to put it all together for their caregivers to take a look at that information, those can be another advantage. And for those who might be using insulin but don't necessarily want or don't have an insulin pump, there are insulin pens that are available that are also connected to an app such as the InPen by Medtronic and their device is really quite nice because it takes some of that calculation work out of dosing and it does it through the app. The app records the insulin that was dosed, it tracks the insulin timeline of action and it makes it a lot safer for women in pregnancy then to be able to keep track of when was their last dose, when can they dose again, how much they need to take, where is their blood sugar? So it puts it all together in one place. So, those would be some really good tracking apps and just data collection apps that would help to keep things together in that period.
Jessica Bard: Another population that you mentioned that you work with a lot is athletes. Do you have any mobile app recommendations for athletes?
Jennifer Smith: Sure. I mean, gosh, there are so many that are great for athletes. Strava, MyFitnessPal even does tracking. It's not necessarily an athletic app, but um, Noom helps to track not only exercise but also food intake. There are lots and lots of different ones that collectively put everything together. So as an athlete, if you're trying to track macronutrient intake for example, to be able to achieve a specific outcome in your exercise of choice, each of these different apps really provides the ability to see that information in the way that you want to. A lot of the different watches too, I mean Apple has a lot of different apps that connect. Garmin has a lot of different exercise components. They all track in some way your heart rate, your exercise output, and what you've done. Maybe you're looking at a cumulative on a weekly basis of trying to track this many steps or this many miles in a week. And so the nice thing about these apps is again, that they kind of collect all of that and put it together in a database that you can pull and look at. Some of them also from the person with diabetes as an athlete, they may also link together, which allows you to see all of your data also in one place or track it as kind of a side note, you know, the apps on many of the smartwatches today allow you to track where your glucose is going along with the mileage that you're putting in and your heart rate and everything all in one place. And so, today's technology is, is fantastic for being able to see all of that in multiple different platforms but to make it easy to see it all together.
Jessica Bard: Are there any other populations that you work with that I missed that we want to talk about and touch on? Some mobile apps?
Jennifer Smith: Kind of touched on it already in terms of just the caregiver aspect. In terms of adolescents, I work with a lot of kiddos as well who may not be to that teenage age yet, but there are really nice tracking apps for parents and school systems, like BlueLoop. That's a really nice one that allows caregivers to essentially put data in that the parent and the nurse or the tracker at school can be able to keep notes. They can see things all together. Kids with diabetes, and their parents are often using things like Sugarmate to, again, be able to track data and to be able to put notes in to be able to make sense of the data that's there. Again, all of the different continuous glucose monitors allow apps that have follow components to them so that the caregiver who is not with their child at school, for example, can see and get alarms even though they're not near to them and be able to address that low glucose alert or that high glucose alert or a missed bolus alarm or something like that.
And it just paints a picture of more complete coverage so that the child with diabetes doesn't ever feel left alone in their own management. So those are some of the ones that might be an advantage for the younger population.
Jessica Bard: It seems like no matter the population there is probably an app that can help. What would you say are the overall take-home messages and if you could just sum it up on the reasons why a patient might want to use an app? I know you mentioned making sense of the data and seeing everything in one place, but if you could sum it up for us?
Jennifer Smith: Yes, absolutely. So again,, from the person with diabetes angle and then from maybe the clinical angle, I think they're both relative to each other. As I said earlier, apps have to have a component of benefit, right? What's the benefit for the person living with diabetes and then what is the outcome benefit for the clinician who recommends something, the app gets used, and it actually improves their clinical outcomes for their clinic cases but also for the person with diabetes outcome. Something should also help communication between the person with diabetes and the care provider, really. And as far as the person with diabetes and how they talk to their clinical team, you have to remember that you want to come up with a lot of really good questions. And from a clinical standpoint then how do you help somebody with diabetes get to know what you might be recommending?
And that takes a little bit of work in your office space, right? If you're the person helping somebody to figure out what kind of app is going to be an advantage in their personal life, you have to get to know the person. Maybe it means that you end up downloading the app and playing with it or downloading the app with the person in your office so that you can help them figure out what parameters to use. You have to also pay attention to what might need to be personalized. All apps start out as default settings, where do you want your settings, and what's going to be very applicable to your life? Do some of the apps integrate with your smart diabetes devices? This app might work really well with these devices but if you're not using them it may not be purposeful for you to consider.
Do some of the apps allow you to share the data? These are some things to pay attention to. You can test drive some things. Maybe this one has some features you love, but this one doesn't. And then establishing both from the person with diabetes as well as their clinical support team, kind of an establishment of how is the support going to look. I'm going to send a message to you, are you going be able to send a message back and give me some information and feedback so that I can change something? So again, do these apps have an actual outcome that's a benefit to the person with diabetes? And if it does, you're likely going to see continued use of it then. So those are just some of the big, I guess, end considerations from both angles.
Jessica Bard: Now we're just about at time here, but I do have one more question. Is there anything that you can see or that you would like to see in the future that could be available in app form for patients with diabetes?
Jennifer Smith: I mean, apps have come really far, and I've been excited about what we had so far. You know what I really would like to see? I'd really like to see apps that have more learning to them. You know, what we're looking at now is AI, right? It takes historical information and it can give you some feedback about the last time you ate here or the last time you took a 20-mile run or whatever and it can say last time this is what happened, you made these adjustments, this next step might be a good adjustment to have accomplished this better. Right? So I look forward to more appropriate apps, AI that are more learning and looking back and saying, “Hey, I'm going to give you this advice or this notification comes up to enable this piece or to have this type of a snack maybe before I even think about it. So, it gives you peace of mind that something is paying attention for me and it's keeping track of some things so that I can clean out a little bit of my head space that isn't necessarily all devoted to diabetes anymore. So that's what I look forward to.
Jessica Bard: Absolutely AI learning. Well, Jennifer Smith, thank you so much. We appreciate you joining us on the podcast today.
Jennifer Smith: Of course. Thank you.
Jessica Bard: For more diabetes technology content, visit the Resource Center at Consultant360.com.