Diabetes apps assuming mHealth bellwether role

From the mHealthNews archive
By Ephraim Schwartz

Unlike mobile phones and flat panel displays, the market for mobile healthcare systems is nowhere near saturation, and that is perhaps most true in the case of diabetes apps. But the emerging market segment, ripe with opportunity, is where the attention and products are headed.

With more than 11 percent of the U.S. population currently classified as diabetic, commercial solutions for managing the condition are pure green fields. And judging from the positive response to mobile developer Tandem Diabetes Care’s initial public offering this month, which raised more than expected, that market is ready for more.

Looked at more closely, diabetes care is a leading indicator for the entire mobile healthcare industry. The lessons learned in managing diabetes through mHealth will translate to better mobile products across the board, whether for patient engagement, population health or EHRs with clinical decision support. 

There is at least one caveat, however. With so many solutions to choose from, the challenge for providers and patients alike is going to be separating the good solutions from the bad.

Agile Health went live earlier this month with its solution to support diabetes patients. The company is following up on its first mobile application, Kick Buts, a smoking cessation program, with My AgileLife, basically a text messaging application that reminds and cajoles diabetics to take better care of themselves. And there is more.

Agile offers multiple levels of service, starting with boilerplate reminders to test their glucose level all the way up to responding on an individual basis to patients who need personalized coaching to deal with their condition.

Built-in business rules are used to monitor such events as a patient’s response to a text question about inappropriate food cravings. This can, in turn, set off an ad hoc text that says, ‘We see you are struggling. We can help either by text or by phone.’

Most patients prefer texting rather than phone contact, said Agile CEO Gary Slagle. He said all data collected by Agile is available to other systems through Web Services or APIs.

[Infographic: E-empowered patients. How far we've come.]

The University of Southern California Department of Emergency Medicine used My AgileLife as the basis for a three-week study of diabetes patients to understand whether engaging them via text messaging had any effect on the management of their illness. The results were encouraging, although a bit mixed.

Results of the study, published in the Annals of Internal Medicine, found a slight statistical improvement in HbA1c hemoglobin levels, a 1.5 reduction in HbA1c for the test group and a .65 HbA1c reduction in the control group. What's more, in a six-month follow-up, emergency room visits were reduced significantly – 35.9 percent of the group that received text messages returned to an emergency room, versus 51.6 percent of the control group.

Clinicians also saw an improvement in the patients’ health habits, such as a 30 percent improvement in eating more fruits and vegetables, as well as patients reporting that they exercised more and performed more foot checks following the text messages.

The company is now getting ready to launch a mini trial with USC to measure the efficacy of expanding MyLife to include social support by caregivers selected by the patient.

What’s next for Agile Health? Just follow the stats and you’ll find diabetes prevention on the road map. Talk about green fields – there are an estimated 79 million pre-diabetic Americans, and that number is growing, said Slagle. This will be followed with services for metabolic syndrome related to weight loss and fitness and a heart health solution.

Ginger.io, developed by MIT’s Media Lab, also sees a market opportunity. Its current solution taps sensors already in most smartphones to evaluate a diabetic’s ongoing health status. Through the smartphone, it can monitor how often a patient travels, how far he or she travels and even at what speed – all to get a sense, according to Ginger.io, of their “activity radius.” In other words, are they a homebody or a busy body?

By evaluating how people typically interact with the world around them and how they interact with other people, Ginger.io maps out a predictable pattern. When that pattern is broken, it signals something is wrong and an outbound call to the patient can be made.

Novant Health, a large healthcare provider based in Winston-Salem, N.C., comprised of 13 facilities, 2,700 licensed beds and 24,000 employees, is using Ginger.io in a year-long trial. Matthew Gymer, corporate director of innovation, told mHealthnews.com that the system is already reducing the number of emergency room visits, though he wouldn't give specifics until the trial is completed.

Ginger.io is also planning on expanding the program to include people in the patient’s social network who are willing to offer support.

[See also: Mobile interventions for sexual risk-reduction show promise.]

Glooko, on the other hand, offers a more traditional solution. The company's app comes with a cable compatible with 26 FDA-approved glucose meters on one end connecting to either Android devices or an Apple iPhone on the other end. The software includes a logbook to record and display results. Users can also record carb intake, insulin doses and lifestyle events.

According to Holly McGarraugh, vice president of business development at Glooko, all of this data can be reviewed by a patient's diabetes management team remotely on the Glooko Web dashboard or during the next patient visit. For a medical team reviewing the data, the application would certainly offer some benefits to the patient. For example, by monitoring a consistent pattern of hypoglycemia in the afternoon and hyperglycemia at night, it would indicate the need for changes in an insulin regimen. Future improvements are in the works, including a device with Bluetooth compatibility.

iHealth already offers Bluetooth compatibility with its Wireless Smart Gluco-Monitoring System, which measures glucose levels and sends the results directly to its smart phone or tablet application in the cloud.

The fact that iHealth’s product is sold nationwide through Best Buy for $79.95 (with 50 test strips) speaks volumes for the interest manufacturers have on both mobile health products and the growing number of diabetics in the population.

It's clear that these solutions offer different benefits to a patient. Something as simple as text messaging requires a greater degree of participation by people in their own well-being – one of the major healthcare goals for the near-term.

Such mobile solutions, however, also raise a thorny matter: Applications that offer advice based on behavior and a history of, say, glucose readings straddle a thin line between coaching to improve a patient’s health and actually delivering treatment.

With the U.S. Food and Drug Administration’s final guidance on which types of mobile medical apps it intends to regulate and the “Sensible Oversight for Technology which Advances Regulatory Efficiency Act of 2013’’ (SOFTWARE ACT), recently introduced in Congress, which seeks to limit FDA regulatory power in the area of mobile healthcare, it's clear that the federal government is taking notice of the industry as well.

Ephraim Schwartz is a freelance writer based in Burlington, Vt. He is a recognized mobile expert and columnist, having spent 15 years as Editor-at-Large for InfoWorld, half of them covering the mobile space. Prior to that, he was Editor-in-Chief of Laptop Magazine.

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