Appropriateness of action prompts for hypoglycaemia and hyperglycaemia in type 2 diabetes self‐management apps

Abstract

Background:Control of blood glucose levels is needed not only to alleviate symptoms of hypoglycaemia and hyperglycaemia, but also to prevent or delay diabetesrelated complications. Advice for glucose control is usually provided to patients by members of the health care team. However, many diabetes apps claim to enhance self-management of blood glucose by providing decision support to patients when an out-of-range blood glucose level is recorded. In this study, we investigated the appropriateness of action prompts provided by diabetes apps for hypoglycaemia and hyperglycaemia against evidence-based guidelines. Methods:We used methods previously reported to identify and select diabetes apps, which were downloaded and assessed against the American Diabetes Association (ADA) guidelines. Screenshots of action prompts corresponding to low or high outof-range blood glucose values were subjected to content analysis. Results:Of 371 diabetes self-management apps evaluated, only 217 and 216 apps alerted patients about hypoglycaemia and hyperglycaemia, respectively. Of these, 20.7% (45/217) and 15.3% (33/216) also provided action prompts. We found 5.1% of apps (hypoglycaemia: 11/217; hyperglycaemia: 11/216) provided prompts that were either too general to be helpful or not aligned with ADA guidelines. Overall, only 17.9% (39/217) and 14.8% (32/216) provided appropriate action prompts for hypoglycaemia and hyperglycaemia, respectively. Conclusion:Less than one fifth of apps provided evidence-based steps to guide patients through hypoglycaemia and hyperglycaemia. The majority of apps failed to provide just-in-time diabetes self-management education to prevent frequent or severe episodes of hypoglycaemia and hyperglycaemia. Our findings emphasize the need for better design and quality assurance of diabetes apps. K E Y W O R D Sapps, decision support, diabetes, hyperglycaemia, hypoglycaemia | INTRODUCTIONThe detrimental effects of hypoglycaemia and hyperglycaemia are well known. Frequent episodes of hypoglycaemia can lead to development of hypoglycaemia unawareness, an increased risk of cerebrovascular and cardiovascular morbidity, neurocognitive dysfunction, and vision impairment. 1 A history of hypoglycaemia predicts future episodes of hypoglycaemia in people with type 2 diabetes including severe hypoglycaemic events requiring medical assistance (eg, hospitalization, emergency department visit, and treatment by emergency medical personnel either at home or in a clinical setting), 2 which in turn is associated with an increased risk of mortality for this

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“…For example, diabetic self-management applications alert patients on hypo-and hyperglycaemia as well as provide information on what they need to do if they encounter those complications. 12 Diabetes selfmanagement apps also offer medication management support, such as medication reminders, medication adherence reviews, medication-taking records, instruction on taking medication, information about medicine, and motivational support to encourage medication adherence. 13 The usage of diabetes self-management mobile application has been shown to be positively associated with lifestyle changes and better glucose monitoring among type 1 and type 2 diabetes patients.…”