Mobile Health Enables New Approaches for Diabetes Self-Management

By Susan A. Knight

The prevalence of diabetes has been a worldwide concern for decades. While the number of new cases in the United States has been declining in recent years, there are still more than 29 million Americans living with the disease. According to the Centers for Disease Control and Prevention, 14 U.S. adults are newly diagnosed every five minutes.

For people living with diabetes, self-management plays a key role in maintaining good health and reducing the risk of further health complications. In the past, the tools available to support self-management were fairly limited, and patient education revolved around in-person medical visits with a health specialist. This has changed significantly over the past decade, thanks to developments in mobile and wireless technologies. Today, mobile health, also known as mHealth, is giving patients access to a wide range of tools and resources, enabling new approaches for diabetes self-management.

Customized Content Based on User Input

The most widely known delivery format for mHealth is a smartphone with a health-related app downloaded onto it, and there’s certainly no shortage of diabetes-specific apps. According to the University of Florida Diabetes Institute, more than 1,100 such apps are available.

Many of the earlier apps were limited in their functionality, largely focusing on providing generic health information for educational purposes. Today’s apps, however, contain additional features that serve to personalize each user’s experience. This is done by delivering customized content, adapted based on health data entered by the user. This allows more targeted and meaningful information to be provided, as opposed to generic information that may at times seem irrelevant. As the user continues to provide input, the app continues to filter and tailor its content based on the data entered.

These apps can serve as a valuable aid between medical visits, helping patients as they work toward achieving their goals. For instance, someone who struggles with medication adherence might choose to receive medication reminders via pop-up alerts or text messages throughout the day. Someone else might appreciate prompts and feedback pertaining to exercise and physical activity. Another patient might benefit from being able to view a list of healthy snack alternatives when choosing what to have during a work break.

Some apps go a step further, connecting the user to a larger online diabetes network. These apps facilitate communication and information sharing between multiple users through online communities and discussion forums. Participants get to engage with a community of peers to discuss specific experiences, challenges, and coping strategies. These online relationships can be particularly helpful in providing emotional support, due to the ability of group members to empathize with each other. Participants also benefit from seeing examples of their peers engaging in healthy behaviors.

Health Devices Synced to Mobile Apps

Mobile communication devices such as smartphones and tablets, and the apps that run on these devices, are just a small segment of a much larger mHealth arena. There are also a variety of health-monitoring devices that can be synced to an associated mobile app (i.e., the device and app are integrated for automatic data sharing). This includes blood pressure monitors, blood glucose meters, and wearable sensor devices such as fitness or activity trackers.

These devices collect data from the user and transmit them to a smartphone or tablet, where they are displayed through the associated app. The data are stored electronically and the individual can view them at any time, from any location, through the app.

This type of mHealth solution makes it much easier for people to track important vital signs and health information over time. The process is quicker and more convenient, since there’s no need to record anything on paper; nor is there a need to enter everything into the device manually. The automated data transmission process also ensures that data get recorded accurately.

Comprehensive Platforms for Health Data Analysis

In some cases, mobile app and device integration is supported by a more comprehensive, cloud-based system with additional features. This type of solution typically allows users to upload their health data to a secure central platform for analysis. When the related output is presented in the form of a graph, it becomes much easier to spot patterns and trends. This can help an individual to better understand their health status, the practical implications of that status, and steps they can take to improve their health.

For example, if someone has increased their overall activity level, this might be displayed in a graph that illustrates the individual’s activity level over time and the increase. Encouraging feedback can be included about the beneficial impact of physical activity, along with a prompt to keep up the good work. The individual receives confirmation that their efforts are having a positive impact, and healthy behaviors are reinforced.

Or, perhaps someone hasn’t taken notice of how their activity level has been slowly decreasing. Seeing this change displayed visually in a graph alerts the person to the situation and the impact their behavior is having on their health. A related prompt might offer some practical steps the person can take to start increasing their activity level again.

In both of these scenarios, the individual gains greater insight into the relationship between their actions and their health status, along with education and prompts to support healthy choices in future. The information can also be shared with the patient’s doctor, enabling both parties to discuss and understand what’s happening with the patient on a daily basis.

Continuous Glucose Monitoring Devices

Monitoring blood glucose levels is an important part of diabetes self-management. A continuous glucose-monitoring (CGM) device is a small sensor that gets implanted beneath the skin to measure the wearer’s glucose levels. Glucose readings are transmitted to a monitoring and display device for viewing, allowing the patient to track and monitor their glucose levels continually throughout the day. Some CGMs are able to transmit data to a smartphone, eliminating the need for the wearer to carry a separate display device.

This allows the wearer to see precisely when throughout the day their glucose level is or isn’t within the desired range. They can examine what is taking place during those periods in order to identify what is having an impact and what adjustments might need to be made. For instance, it may allow them to see how particular foods are impacting their glucose levels, information they might not be able to glean otherwise.

These devices typically have an alarm feature, which is especially useful for glucose monitoring at night during sleep hours. Day or night, the alarm feature can provide a warning alert if the patient’s glucose levels are getting dangerously high or low.

Research in this space is actively under way, and we can expect to see a wider assortment of CGM devices hitting the market in the near future. This will include more devices that work independent of insulin pumps (currently most CGM devices are designed to work with an insulin pump) along with advanced integration with mobile devices like smartphones and tablets. As the research continues and the associated technologies advance, we can also expect to see future CGM devices that can be inserted for longer periods than the current range of three to seven days.

Breaking Down the Barrier of Poor Health Literacy

The ease and convenience of mHealth solutions make them appealing across the population. However, for those segments of the population most likely to be dealing with poor health literacy as well as diabetes, these solutions have added value.

Poor health literacy impacts health education, which in turn compromises people’s ability to make healthy choices. Individuals who struggle with low health literacy tend to utilize emergency services at a higher rate, and are likely to have higher hospitalization rates. Poor health literacy has also been associated with poor self-care, failure to seek preventive care, and noncompliance with medication and treatment plans, all of which lead to poorer health outcomes. This has major implications for patients with diabetes, where self-management, preventive care, and compliance with medication and treatment plans are essential for preventing serious health complications. With their diversity and adaptability, mHealth solutions are ideal for reaching people wherever they may be in terms of their literacy level.

Carol E. Torgan, PhD, a health strategist and educator with more than 15 years of experience in public health and medicine, identified mHealth’s potential to positively impact health literacy back in 2009, the year the first mHealth summit was held in Washington, DC. In a blog post that year, she stated: “mHealth offers an exciting platform by which to develop new tools and messaging strategies that don’t require a high level of literacy and also to develop programs to increase health literacy in a targeted, nonstigmatizing, nonthreatening manner.”

Torgan’s vision is now a reality. With their incredible reach and accessibility, mHealth tools are helping to improve health literacy and empowering patients. And by equipping patients to better manage their health on a daily basis, the mHealth trajectory promises to contribute to improved health outcomes in the long term.

— Susan A. Knight works with organizations in the social services sector to help them get the most out of their client management software.

Resource
Torgan, C. E. (2009, November 6). The mHealth Summit: Local & global converge [blog post]. Retrieved from http://caroltorgan.com/mhealth-summit/.