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Do Mobile Applications Lower A1C in People with Diabetes?
Jarred Rosenberg, WNEU COPHS PharmD candidate 2020
Tiffany Truong, WNEU COPHS PharmD candidate 2020

When it comes to managing multiple disease states and complex medication regimens, diabetes is one that poses many hardships for patients. One reason for this is medication nonadherence, which is a major public health issue within the United States and contributes to an estimated 125,000 annual deaths¹ There are many ways to improve adherence, such as conventional pill boxes, cook timers, and sticky notes; however, with the advancement of technology, mobile applications are now a tangible and convenient option for many patients. Research regarding the benefits of such applications highlights the many advantages of using this new technology. These applications contain various integration tools that allow for easy use by patients, caregivers, and health care providers that contribute to improving patient health status and outcomes, in this case A1C lowering.

Diabetes is a condition that often requires patients to take several medications with complicated regimens. As a result, this patient population is especially at risk for medication nonadherence, which can greatly affect their overall health. Glucose Buddy Diabetes Tracker™ and One Drop™ are just a few of the hundreds of applications aimed at improving health outcomes, such as A1C.  These two applications were chosen mainly due to reported A1C data, app ratings, customer reviews, and most importantly its accessibility to the end user for tracking medication usage.

Glucose Buddy Diabetes Tracker™ is geared towards people with diabetes who would like to record and track their blood glucose levels, activity, and nutrition.²

Glucose Buddy Diabetes Tracker™ features:²

• Allows for easy logging of blood glucose, medications, and meals using an extensive food database in one entry
• Tracks trends in blood glucose, insulin usage, weight, blood pressure, A1C, and more
• Provides a comprehensive 12-week diabetes education plan featuring 5-minute lessons
• Meal IQ to help users make better food choices and better understand how food impacts blood glucose
• Allows users to add notes to entries for future references
• Shows changes in blood glucose and carb intake on an hourly basis
• Automatically tracks steps, walks, and other cardio activities
• Exports data into printable PDF reports and CSV files for personal or healthcare provider use

This application is available on the Google Play Store™ for Android™ users as well as the App Store™ for Apple IOS™ users. The basic version is free and includes the aforementioned features. On the App Store, it has a 4.8/5 rating based on ~17,000 users. “Simple and well worth it,” “super easy,” and “a great way to record my intake” are just some of the positive reviews left by different users.

If you aren’t convinced by reviews, there is data to support its use as well. Glucose Buddy Diabetes Tracker™ was studied in a randomized control trial aiming to improve glycemic control and other diabetes-related outcomes in adults with type 1 diabetes. In a 6-month intervention with a three-month follow-up period, 72 patients were randomized to usual care or usual care and the use of a smartphone application (Glucose Buddy Diabetes Tracker™) with weekly text-message feedback from a Certified Diabetes Educator. All outcome measures were collected at baseline and every three months over the study period. A1C was measured and diabetes-related self-efficacy, self-care activities, and quality of life were measured with online questionnaires. Of the initial 72 patients, 53 completed the study. Despite there being no significant difference in either group with regards to self-efficacy, self-care activities and quality of life, the intervention group’s A1C were significantly improved from baseline (mean 9.08%, SD 1.18) to 9-month follow-up (mean 7.80%, SD 0.75) compared to the control group (baseline: mean 8.47%, SD 0.86, 9-month follow-up: mean 8.58%, SD 1.16, p<0.001). The study concluded that as adjunct to usual care, the use of Glucose Buddy Diabetes Tracker™, combined with weekly text-message support from a healthcare professional can significantly improve glycemic management in adults with type 1 diabetes.³  This is a great option for those with diabetes who are looking for aid with staying adherent, managing all facets of the disease state and overall want to try something new to assist with improving diabetes management.


 

In addition to the A1C benefits seen with the Glucose Buddy Diabetes Tracker™, there are many other advantageous applications to aid with adherence and improving diabetes management. Another application that demonstrated a reduction in A1C is One Drop™.⁴

One Drop™ features:⁴

• Medication management via input data, providing a comprehensive list of all medications, dosages, refill information and prescriber information for each prescription
• Integrated tracker that records input health information and patterns, such as vital signs and progression over time (e.g., blood glucose)
• A meal planning function is available to search the built-in food and nutrition database, scan barcodes, and have automated carbohydrate calculations performed
• Track physical activity utilizing the pedometer built into the users smartphone, this allows the users to sync data from other apps via the Apple Health™ or GoogleFit™ applications, and has the ability to connect directly to the user’s FitBit and/or Apple Watch
• Automated decision support is an advanced system which provides users with food and activity suggestions based on projected highs and/or lows from entering a single blood glucose reading into the application
• Sharing capabilities allow information accessibility not only to the user, but caregivers and healthcare providers that are granted permission to view the collected data

The One Drop™ application is available within the United States, on the Google Play Store™ for Android™ users and the App Store™ for Apple IOS™ users. Like Glucose Buddy Diabetes Tracker™, the application is free to download and utilize for all users, and has several paid subscription options when using One Drop™ glucose meters and test strips. This is a widely used application with over 20,000 reviews, averaging 4.2 and 4.5 stars out of five for the Google Play Store™ and Apple Store™, respectively.

Similar to Glucose Buddy Diabetes Tracker™, One Drop™ also has data to support its use. A 2017 study assessed A1C change in users of the One Drop™ application and associations of application engagement. This study included people with type 1 diabetes (n=367) and type 2 diabetes (n=921). The participants were mostly men (65%) who had been diagnosed with diabetes for a mean of 9.4 (SD 9.9) years. On average people using the application experienced a decrease in A1C between their first (mean 8.14%, SD 2.06) and second A1C entry (mean 6.98%, SD 1.1). During a median 4-month follow-up period, there was an absolute reduction in A1C in people with type 1 diabetes (1.07%, p<0.001) and type 2 diabetes (1.27%, p<0.001).

These applications, Glucose Buddy Diabetes Tracker™ and One Drop™, have shown a clear benefit in reducing A1C for people with diabetes. More information on both of these mobile applications can also be found in Danatech on the Association of Diabetes Care and Education Specialist website.


References

1. Dayer L, Heldenbrand S, Anderson P, et al. Smartphone Medication adherence apps: Potential benefits to patients and providers. J Am Pharm Assoc. 2013; 53(2): 172-181
2. Glucose Buddy app [Internet]. 2020 [cited 2020 Apr 24]. Available from: https://www.healthnavigator.org.nz/apps/g/glucose-buddy-app/
3. Kirwan M, Vandelanotte C, Fenning A, et al. Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial. J Med Internet Res. 2013 Nov 13;15(11): e235
4. One Drop app [Internet]. 2015 [cited 2020 Apr 24]. Available from: https://onedrop.today/
5. Osborn C, Ginkel J, Rodbard D, et al. One Drop | Mobile: An Evaluation of Hemoglobin A1c Improvement Linked to App Engagement. JMIR Diabetes. 2017 Aug 24; 2(2): e21