Empowering Patients With Diabetes Using Mobile Health Technology

By Greeshma K. Shetty, MD and William Hsu, MD

Living with diabetes is a full-time job. The amount of information people with diabetes need to keep track of their diabetes can becoming overwhelming. Patients who want more advice from their healthcare providers are often frustrated with the lack of contact between office visits. However, recent advances in “mobile health” or “mHealth” – the use of mobile technology such as smartphones in healthcare – have opened up exciting new ways to keep track and stay connected.

Mobile computing technology has become mainstream and is advancing at a swift pace. Today over one billion people worldwide own a smartphone, and there are over 30,000 health care apps for mobile devices. The American Association of Retired Persons (AARP) reports 53 percent of those over the age of 50 are using or want to use some kind of health information technology in their mobile device. And about 20 percent of smartphone users have at least one health app on their mobile device.

Some of these types of apps were reviewed in the Spring 2013 issue of EmPower Magazine.* Many go beyond simply presenting information you can find on the internet. They are designed to engage the user more personally. We will focus on how these powerful apps, when working together with various wireless devices, can change diabetes self-management and care.

Recent advances in three areas make mobile health possible:

1. Today’s hardware gadgets are powerful. Inside these devices are tiny computers that process, analyze and store large amount of data. Smart phones are really computers with a cellphone feature.

2. New sensors measure body function for brief periods of time without active recording efforts by the user. These include continuous glucose monitors (CGM) and physical activity monitors.

3. The wireless features embedded in the devices mean all-around 24/7 connectivity.

The use of mobile health technology in medicine is not new. Intensive care physicians have long been able to track patient’s vital signs far away from a patient’s bed. For example, radiologists have been able to look at a patient’s x-ray transmitted via the internet. This type of technology is finally coming to patients with diabetes.

Here are a few areas where there are some exciting new developments.

Physical Activity Monitors

Physical activity monitors is a fast-growing area. Wearable devices like Fitbit® track the number of steps you walk, distance, calories burned and even sleep cycle with little effort. The device wirelessly connects to a smartphone, tablet or personal computer via Bluetooth. Other users as well as family and friends can track the user’s progress from any mobile device. Some are using this feature to set up friendly competitions to motivate changes. Others simply use it for social support.

Most people shy away from wearing bulky, medical looking devices. If you think most of the activity monitors look too much like a medical device or too sporty to wear at work, you may find Misfit Shine more suitable for you. It is a small and powerful activity monitor that is made of lightweight aluminum and can be worn discreetly as a necklace, wristband or a clip. It was designed to help people wear the monitor anytime anywhere so activity level can be accurately recorded. So far, it is the only activity monitor that tracks activities under water, like swimming. Placing Shine on the screen of your smartphone to synchronize its data with the phone app is all that is needed to make it work.

Like previous examples, Motorola MotoActv™ serves as an accelerometer -- an instrument for measuring acceleration or for detecting and measuring vibrations -- and much more. It also has a GPS receiver for tracking outdoor activity, Wi-Fi radio, MP3 player and Bluetooth hardware. Bundling these features cuts down on the need for carrying multiple devices during everyday activities and especially during exercise.

Nutrition

There are many great nutrition apps available that are beyond the scope of this review. Some have been covered in EmPower Magazine. However, in the area of nutrition, there has not yet been a lot of progress merging powerful apps with hardware devices. One new app that is being developed uses a camera phone to photograph food. The picture is then sent wirelessly for analysis of nutrient content. Such a tool will be especially helpful when patients are eating meals prepared by others.

Glucose monitoring

Glucose monitoring is another field that has attracted a lot of attention. Gone are the days when patients needed to check their blood sugar, write down the result on a piece of paper and fax it to their health care providers. iBGStar® blood glucose meter is about the size of a USB memory stick. It is compatible with the iPhone 3G/3GS/4/4S and iPod touch versions 2/3/4. iBGStar also is compatible with the iPhone 5 or iPod touch 5 using an Apple Lightning™ to 30-pin adapter (sold separately). The small size enables it to be more discreet and seamless with daily life. The data is displayed on the iPhone it is attached to, but it also has a small screen so that it can be used as a stand-alone device. The iBGStar automatically synchronizes data with the iBGStar Diabetes Manager on the iPhone to track carbs, glucose and insulin. There is an option to tag meals and exercise, graph data and share data via email with friends, family and health care providers.

If you are like many patients who use more than one meter, companies like SweetSpot are working to combine all your glucose information in one place. SweetSpot is an advanced, cloud-based platform (a network of remote servers hosted on the Internet to store, manage and process data, rather than a local server) that uploads and processes your blood glucose data from multiple devices. The software synchronizes with all your meters and provides a time stamp on the glucose values which are sent to your health care provider(s). SweetSpot can store data online and even integrate the data into your electronic medical records. The software organizes glucose values in a way that is easy for your healthcare providers to evaluate. This service is now ready for glucose meters. In the future, more information will be included in these reports, with data from other devices like continuous glucose monitors.

The Macaw™ Mobile Manager for Diabetes is a smartphone app for diabetes self-care. It includes fitness apps and nutrition trackers. It can also wirelessly connect with various glucose monitors, GPS-enabled activity trackers, blood pressure monitors and weight scales, connecting data from many different devices and apps into one central hub to offer the healthcare team a complete picture of a patient’s current health status.

The WellDoc® DiabetesManager® system is one of the more complete mobile device programs that incorporates online education, diabetes self-care and connection to healthcare providers. The goal is to extend care beyond a doctor’s office, linking patients and doctors through mobile devices. The software analyzes glucose data and provides feedback along with virtual diabetes coaching and education. The system is designed to help patients make smarter lifestyle choices. A recent study showed that people who used this program lowered their average blood glucose more than those getting the usual care.

Summary

Mobile devices like smartphones have been hailed by some as one of the most impactful inventions of our time. Combined with the ability to share data wirelessly, mobile health technology holds the promise for a new way of managing diabetes and other chronic illnesses.

Ultimately, the goal of using mobile health technology is to help change health behavior, improve health outcomes and lower healthcare costs. Despite its value, technology will never replace the doctor-patient relationship because there is so much more to the medical visit than just making a diagnosis or recommending a certain treatment. In the future, we envision mobile health technology as a tool to effortlessly gather patient data so that healthcare providers can better use their time and energy focusing on what humans do best, resulting in better care by being a good “friend” and knowledgeable health coach.

*Editor’s Note: Previous EmPower Magazine issues and articles can be viewed online at: http://www.empoweryourhealth.org/magazine

Greeshma K. Shetty, MD, is a board certified endocrinologist at Joslin Diabetes Center and Beth Israel Deaconess Medical Center and an Instructor of Medicine at Harvard Medical School. She attended medical school at Albany Medical College. She completed her residency in Internal Medicine at Beth Isreal Deaconess Medical Center. She also completed her fellowship training in Endocrinology and Metabolism at Harvard Medical School - Beth Israel Deaconess Medical Center and Joslin Diabetes Center. Her interests include diabetes technology, insulin pump therapy, and culturally competent diabetes prevention and treatment in the South Asian population.

Dr. William Hsu is a senior endocrinologist, Director of Asian Clinic and Senior Director of International Programs at Joslin Diabetes Center. He is an Assistant Professor at Harvard Medical School. Dr. Hsu graduated from Cornell University and received his medical degree from Mount Sinai School of Medicine. He completed his residency at Yale School of Medicine and completed his fellowship training in Endocrinology and Metabolism at Harvard Medical School. His research and clinical interests include developing novel mobile health solutions and culturally tailored treatments for individuals with diabetes.