Most Diabetes Apps Do Not Provide Real Time Decision Support (yet) Interview with:
Prof. Car Associate Professor Josip Car
MD, PhD, DIC, MSc, FFPH, FRCP (Edin)​
Associate Professor of Health Services Outcomes Research,​
Director, Health Services Outcomes Research Programme and Director
Centre for Population Health Sciences
Principal Investigator, Population Health & Living Laboratory What is the background for this study?

Response: In 2018, almost 8% of people with diabetes who owned a smartphone used a diabetes app to support self-management. Currently, most apps are not regulated by the US Food and Drug Administration (FDA). We downloaded and assessed 371 diabetes self-management apps, to see if they provided evidence-based decision support and patient education. What are the main findings?

Response: We found that the majority of diabetes apps did not provide real-time decision support or situation-specific education on blood glucose self-management. Only about 20% of apps that displayed explicit alert messages for low blood glucose (hypoglycaemia) also prompted an action to address it; this was 15.3% for hyperglycemia. Blood glucose related education was included in only 10.6% of apps.

Although disappointing, the results were not surprising given our previous work assessing health apps for asthma and apps that provided insulin calculators — most apps do not provide evidence-based self-management (references below).

Huckvale K, Morrison C, Ouyang J, Ghaghda A, Car J. The evolution of mobile apps for asthma: an updated systematic assessment of content and tools. BMC Med. 2015;13:58.

Huckvale K, Adomaviciute S, Prieto JT, Leow MK, Car J. Smartphone apps for calculating insulin dose: a systematic assessment. BMC Med. 2015;13:106. What should readers take away from your report?

Response: Diabetes apps still have some way to go in terms of being able to provide evidence-based support for self-management in a timely fashion. These apps have not reached their full potential yet — most are missing opportunities to improve care and health outcomes for individuals with diabetes.

Clinicians as well as users of diabetes apps should be aware of both the potential benefits as well as the shortcomings of these apps. If you have diabetes (or looking after someone who does) and are using or thinking of using an app for self-management, discuss this with your doctor/healthcare provider; figure out the areas in which you need support (e.g. perhaps you need a reminder to measure your blood glucose), see whether the app can provide it appropriately/safely (e.g. does the app’s reminder feature work offline, if your phone is on silent mode, etc.) and be clear on when you need to consult your doctor/health provider. What recommendations do you have for future research as a result of this work?

Response: Future research in the personalisation of diabetes apps for the individual (in terms of progression of illness); and governance processes for app development and release. We encourage app developers to invite clinicians (as well as people with diabetes) to provide input when designing and developing diabetes apps. Is there anything else you would like to add?

Response: This study demonstrates the immaturity of diabetes apps and missed opportunities to improve care and health outcomes. Quality assurance mechanisms such as certification of apps are needed to help achieve their potential of supporting diabetes and other long-term conditions.

No conflicts of interest to declare


Lum E, Jimenez G, Huang Z, et al. Decision Support and Alerts of Apps for Self-management of Blood Glucose for Type 2 Diabetes. JAMA. 2019;321(15):1530–1532. doi:10.1001/jama.2019.1644

Apr 18, 2019 @ 1:58 pm

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