REVIEW
SA JOURNAL OF DIABETES & VASCULAR DISEASE
124
VOLUME 10 NUMBER 4 • NOVEMBER 2013
counting) and Fooducate, which allows users to scan products in
shops and learn more about their nutritional value.
In addition, new plug in smart phone ‘widgets’ such the iBG
star, can allow a iPhone to essentially function as a home glucose
monitor.
Devices and software
Diabetes has benefited hugely from the development of electronic
devices ranging form simple home blood glucose monitors through
to insulin pumps and continuous glucose monitoring systems
(CGMS), the later two providing a major breakthrough in the
management of type 1 diabetes. The success of a fully effective
‘artificial pancreas’ will depend on the development of sophisticated
algorithms to predict blood glucose readings, and allow alteration
of insulin administration appropriately.
Even for those patients not using pumps, predictive glucose
software is now available to allow more accurate insulin dose
calculation. ManageBGL
37
for example claims to be able to able
to offer “a simulated or virtual insulin pump” for type 1 diabetes
through use of an online software programme. Current and
previous blood glucose results, carb intake, exercise, insulin doses
and longer term glucose trends are used to predict future glucose
readings and aid auto-calculation of bolus doses of insulin. These
systems do require intensive user input to achieve their goals and
have not been validated in widespread trials.
Communication systems
Increased contact between healthcare professionals and patients has
been shown to improve glucose control and reduce complications.
The average person with diabetes patients will spend on average
around 3 hours with healthcare professions in the year, and self
manages their condition 8 757 hours of the year.
38
Provision of
additional face-to-face care is costly, but a more efficient solution
could be provided by digital technology through the use of virtual
clinics and messaging systems to provide on-going ‘needs driven’
support throughout the year.
Whilst free communication software is widely available (such as
Skype, WebEx, message boards and social networks), integration into
existing healthcare systems with the required security, governance
and confidentially is more difficult. Patients Know Best
39
is an example
of a social enterprise that has developed electronic communication
strategies and patient driven clinical record ownership. This has been
successfully integrated with some healthcare systems, suggesting
these barriers are not insurmountable.
The evidence base for the use of on-line communication/
telemedicine in diabetes care is limited, however a small US
study suggests potential benefits.
40
It demonstrating a dramatic
improvement in HbA
1C
(9.5 versus 8.2%) and a 4% mean weight
reduction compared with conventional care using a telemedicine
(virtual clinic) approach. Simple one way SMS (text) messaging
has also been shown to be beneficial in diabetes care in small
studies,
41–45
increasing adherence and health related behaviours.
Tang
et al.
46
trialled a multi-approach online diabetes management
system in over 400 patients, reporting significant improvements
in HbA
1C
at 6 months, although it was unclear whether these
benefits were sustained. The true impact of wide spread adoption
of online communication tools across diabetes services is still to
be proven.
Online learning
Withthecontinuedgrowthoftheworld-wideweb,onlineknowledge
support for disease management is vast. This mainly comes
from websites provided by government and non-governmental
organisations, pharmaceutical companies, or increasingly from
independent sources. Online blogs, diabetes specific encyclopaedias
(Diapetadia)
47
and search engines (Diaboogle)
48
contribute to the
information mix. In addition, interactive eLearning courses for
patients are emerging in key areas such as carbohydrate counting,
which is traditionally taught through intensive group education
over several days.
49
Online support tools such as mood-gym can
additionally provide patient with self help modules to deal with
psychological problems.
50
Mainstream education providers including
the Open-University, also provide free online courses about diabetes
and its complications which may be useful for both patients and
health care workers.
51
Social networks/blogging
Social networking platforms such as Facebook, Bebo and
LinkedIn
52–54
have seen an explosion in use in recent years, for both
social and business use. The healthcare sector has only begun to
realise the potential of these tools. Rather than providing didactic
knowledge transfer, social networks can encourage learning and
development through community sharing and peer support. They
can also provide a sense of community and have the potential to
problem-solve on a large scale (using techniques such as crowd
sourcing).
Many healthcare trusts, and patient support charities (e.g.
Diabetes UK) have Facebook pages. PatientsLikeMe
8
is an example
of a chronic disease social network with over 170 000 users that
allows users to ‘meet’ other patients with similar problems, enter
into group discussions and share data online. The data generated
from users has resulted in a number of significant publications.
7
DLife,
55
Diabetes.co.uk,
56
Diabetic Connect
57
and Sugar Stats,
58
are other examples of diabetes focused online communities.
Nutrition:
Fooducate
Carbs and Cals
Carb Master Free
Carb counting with Lenny (kids)
Calorie Counter
Calorie Tracker
Daily Burn
Lose it! Sparkpeople Food and fitness
Tracker
GoMeals
Weight Watchers Mobile
Exercise:
Fitness/ Exercise
My Fitness Pal
Workout Trainer
Run Tracker
Diabetes News:
Diabetes Headline News
Glucose:
• Bant
• Blood Glucose Tracker
• On Trak
• Diabetes App
• Diabetes Companion (dLife)
• Diabets Buddy Lite
• Diabetes Log
• GluCoMo
• Glucose Buddy
• WaveSense Diabetes Manager
• Glucool
• Glooko
• Handylogs sugar
• Islet- diabetes assistant
• Diabetes Reference
• Dbees.com
• dLife
• Glucose Meter
• Diabetes Log Book
• GlucaTrend Diabetes
• Diabetes Tracker Life
• SiDiary
• vRee for Diabetes
• On Track
Figure 3.
Examples of mobile phone applications available currently (Dec 2012)
to help people with diabetes self managed their condition.
