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      Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis

      research-article
      , MA 1 , , , PhD 1 , 2 , 3 , , MD, PhD 1 , 4
      (Reviewer), (Reviewer)
      JMIR mHealth and uHealth
      JMIR Publications
      chronic diseases, diabetes, Google, health apps, mobile phone

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          Abstract

          Background

          The availability of smartphone health apps empowers people to manage their own health. Currently, there are over 300,000 health apps available in the market targeting a variety of user needs from weight loss to management of chronic conditions, with diabetes being the most commonly targeted condition. To date, health apps largely fall outside government regulation, and there are no official guidelines to help clinicians and patients in app selection. Patients commonly resort to the internet for suggestions on which diabetes app to use.

          Objective

          The objective of this study was to investigate apps identified through a Google search and characterize these apps in terms of features that support diabetes management.

          Methods

          We performed a Google search for the “best diabetes apps 2017” and explored the first 4 search results. We identified and compiled a list of the apps recommended in the returned search results, which were Web articles. Information about each app was extracted from the papers and corresponding app store descriptions. We examined the apps for the following diabetes management features: medication management, blood glucose self-management, physical activity, diet and nutrition, and weight management.

          Results

          Overall, 26 apps were recommended in 4 papers. One app was listed in all 4 papers, and 3 apps appeared on 3 of the 4 lists. Apart from one paper, there were no explicit criteria to justify or explain the selection of apps. We found a wide variation in the type and the number of diabetes management features in the recommended apps. Five apps required payment to be used. Two-thirds of the apps had blood glucose management features, and less than half had medication management features. The most prevalent app features were nutrition or diet-related (19/24, 79%) and physical activity tracking (14/24, 58%).

          Conclusions

          The ambiguity of app selection and the wide variability in key features of the apps recommended for diabetes management may pose difficulties for patients when selecting the most appropriate app. It is critical to involve patients, clinicians, relevant professional bodies, and policy makers to define the key features an app should have for it to be classified as a “diabetes management” app. The lessons learned here may be extrapolated for the development and recommendation of apps for the management of other chronic conditions.

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          Most cited references7

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          Do Mobile Phone Applications Improve Glycemic Control (HbA1c) in the Self-management of Diabetes? A Systematic Review, Meta-analysis, and GRADE of 14 Randomized Trials.

          To investigate the effect of mobile phone applications (apps) on glycemic control (HbA1c) in the self-management of diabetes.
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            The promise and peril of mobile health applications for diabetes and endocrinology.

            We are in the midst of what some have called a "mobile health revolution". Medical applications ("apps") for mobile phones are proliferating in the marketplace and clinicians are likely encountering patients with questions about the medical value of these apps. We conducted a review of medical apps focused on endocrine disease. We found a higher percentage of relevant apps in our searches of the iPhone app store compared with the Android marketplace. For our diabetes search in the iPhone store, the majority of apps (33%) focused on health tracking (blood sugars, insulin doses, carbohydrates), requiring manual entry of health data. Only two apps directly inputted blood sugars from glucometers attached to the mobile phone. The remainder of diabetes apps were teaching/training apps (22%), food reference databases (8%), social blogs/forums (5%), and physician directed apps (8%). We found a number of insulin dose calculator apps which technically meet criteria for being a medically regulated mobile application, but did not find evidence for FDA-approval despite their availability to consumers. Far fewer apps were focused on other endocrine disease and included medical reference for the field of endocrinology, access to endocrine journals, height predictors, medication trackers, and fertility apps. Although mobile health apps have great potential for improving chronic disease care, they face a number of challenges including lack of evidence of clinical effectiveness, lack of integration with the health care delivery system, the need for formal evaluation and review and organized searching for health apps, and potential threats to safety and privacy. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
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              Smartphone apps for calculating insulin dose: a systematic assessment

              Background Medical apps are widely available, increasingly used by patients and clinicians, and are being actively promoted for use in routine care. However, there is little systematic evidence exploring possible risks associated with apps intended for patient use. Because self-medication errors are a recognized source of avoidable harm, apps that affect medication use, such as dose calculators, deserve particular scrutiny. We explored the accuracy and clinical suitability of apps for calculating medication doses, focusing on insulin calculators for patients with diabetes as a representative use for a prevalent long-term condition. Methods We performed a systematic assessment of all English-language rapid/short-acting insulin dose calculators available for iOS and Android. Results Searches identified 46 calculators that performed simple mathematical operations using planned carbohydrate intake and measured blood glucose. While 59% (n = 27/46) of apps included a clinical disclaimer, only 30% (n = 14/46) documented the calculation formula. 91% (n = 42/46) lacked numeric input validation, 59% (n = 27/46) allowed calculation when one or more values were missing, 48% (n = 22/46) used ambiguous terminology, 9% (n = 4/46) did not use adequate numeric precision and 4% (n = 2/46) did not store parameters faithfully. 67% (n = 31/46) of apps carried a risk of inappropriate output dose recommendation that either violated basic clinical assumptions (48%, n = 22/46) or did not match a stated formula (14%, n = 3/21) or correctly update in response to changing user inputs (37%, n = 17/46). Only one app, for iOS, was issue-free according to our criteria. No significant differences were observed in issue prevalence by payment model or platform. Conclusions The majority of insulin dose calculator apps provide no protection against, and may actively contribute to, incorrect or inappropriate dose recommendations that put current users at risk of both catastrophic overdose and more subtle harms resulting from suboptimal glucose control. Healthcare professionals should exercise substantial caution in recommending unregulated dose calculators to patients and address app safety as part of self-management education. The prevalence of errors attributable to incorrect interpretation of medical principles underlines the importance of clinical input during app design. Systemic issues affecting the safety and suitability of higher-risk apps may require coordinated surveillance and action at national and international levels involving regulators, health agencies and app stores. Electronic supplementary material The online version of this article (doi:10.1186/s12916-015-0314-7) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                JMIR Mhealth Uhealth
                JMIR Mhealth Uhealth
                JMU
                JMIR mHealth and uHealth
                JMIR Publications (Toronto, Canada )
                2291-5222
                January 2019
                16 January 2019
                : 7
                : 1
                : e11848
                Affiliations
                [1 ] Centre for Population Health Sciences Lee Kong Chian School of Medicine Nanyang Technological University Singapore Singapore
                [2 ] Institute of Health and Biomedical Innovation Queensland University of Technology Brisbane Australia
                [3 ] School of Clinical Sciences Faculty of Health Queensland University of Technology Brisbane Australia
                [4 ] Global eHealth Unit, Department of Primary Care and Public Health School of Public Health Imperial College London London United Kingdom
                Author notes
                Corresponding Author: Geronimo Jimenez geronimo.jimenez@ 123456ntu.edu.sg
                Author information
                http://orcid.org/0000-0002-1304-426X
                http://orcid.org/0000-0002-0853-3018
                http://orcid.org/0000-0001-8969-371X
                Article
                v7i1e11848
                10.2196/11848
                6352016
                30303485
                16625357-b6bb-4c8e-9f3b-45dce91a844b
                ©Geronimo Jimenez, Elaine Lum, Josip Car. Originally published in JMIR Mhealth and Uhealth (http://mhealth.jmir.org), 16.01.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR mhealth and uhealth, is properly cited. The complete bibliographic information, a link to the original publication on http://mhealth.jmir.org/.as well as this copyright and license information must be included.

                History
                : 7 August 2018
                : 13 September 2018
                : 20 September 2018
                : 29 September 2018
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                chronic diseases,diabetes,google,health apps,mobile phone
                chronic diseases, diabetes, google, health apps, mobile phone

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