Study: Diabetes Management Apps May Not Be The Panacea to Glucose Management

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By : Suvarna Sheth

You may be a little overwhelmed by all the new diabetes management apps out there. Well, you’re not alone.

Now, a new study from Singapore suggests that apps may not provide the most accurate or timely blood glucose management “advice” when blood sugars are too high or low, leading to dangerous conditions.

How was the Study Conducted?

While other studies have examined features, privacy, security, and usability, the current study, carried out by authors at the Centre for Population Health Sciences, and Lee Kong Chian School of Medicine at Nanyang Technological University in Singapore, analyzed key management features, namely decision support and alerts for self-management of blood glucose in Type 2 diabetes.

Researchers looked at apps that could be used on both Apple and Android devices. They did not include apps that were part of continuous glucose monitoring devices.

In their study, researchers cited an industry estimate that 7.8% of people with diabetes who owned a smartphone used a diabetes app to support self-management.

Out of all the diabetes apps found in the English language, 371 met the study’s inclusion criteria to be evaluated further regarding the provision of decision support.

They found that about 58 percent of the apps gave users an alert when they had out-of-range high or low blood sugar levels.

However, only a small fraction of the alerts offered suggestions or guidance about what to do in the present situation.

When people did get advice on how to handle out-of-range low blood sugar, the apps suggested that people consume food, juice or sugar just about 14 percent of the time.

With out-of-range high blood sugar, the apps that gave advice told people to seek medical help about 13 percent of the time.

“Clinicians, as well as users of diabetes apps, should be aware of both the potential benefits as well as the shortcomings of these apps,” Dr. Josip Car, chair of the health services and outcomes research program at Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore told dLife.

Car advises 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 or healthcare provider first.

“Figure out the areas in which you need support, perhaps you need guidance on what to do when blood glucose is very low, see whether the app can provide it appropriately and safely,” he adds.

Other considerations, the authors point out, are to make sure you know whether the app’s reminder feature will work offline if your phone is on silent mode, etc. and be clear on when you need to consult your doctor/health provider.

The authors of the study point out their findings don’t prove whether or how apps might directly impact health outcomes for people with diabetes.

As far as whether the authors think the apps have the potential to make changes in some key areas, the authors say diabetes is a long-term illness that requires self-management over a lifetime.

“In other words, people with diabetes will need to make many decisions relating not only to diet and lifestyle but also which medication to take and what dose depending on their blood sugar levels,” Car says. “Apps could potentially support some aspects of self-management – if well-designed.”

However, Car tells dLife the 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,” Car adds.

The authors say the take-home message for patients is to ask your doctor, diabetes nurse, and other health professionals to advise you which diabetes app to use.

“Ask them if that app has been approved/certified and by whom,” Car says. “We need patients and carers to encourage health professionals to embrace these technology solutions which could be convenient, affordable and offered to all.”

The study was funded by the Centre for Population Health Sciences, Lee Kong Chian School of Medicine, and Ageing Research Institute for Society and Education, Nanyang Technological University.

The authors have disclosed no relevant financial relationships.

The research letter has been published in JAMA.


  1. JAMA. Decision Support and Alerts of Apps for Self-management of Blood Glucose for Type 2 Diabetes.
    (2019, April 16). Retrieved: