How m-Health application on nutrition informatics can be useful for diabetic care at home?

With the advancement of information technologies, mobile health technologies can be leveraged for patient self-management, patient diagnosis and determining the probability of being affected by some disease. Diabetes mellitus is a chronic and lifestyle disease and millions of people from all over the world fall victim to it. Although there are some mobile apps keeping track of calories, sugar taken, medicine doses, lifestyle, exercises to prevent or control diabetes, no application has been found that was explicitly developed to analyze the risk of being a diabetic patient. Therefore, the objective of the research paper attached below is to develop an intelligent mHealth application based on machine learning to assess his/her possibility of being diabetic, prediabetic or nondiabetic without the assistance of any doctor or medical tests.

Read more: Diabetes Predicting mHealth Application Using Machine Learning

According to me - Blood Glucose monitoring, storing, tracking & analyzing previous blood glucose levels is the basic prerequisite for developing a health application for diabetic care. Additional features like simple recipes, general tips for improving glycemic control can be mentioned. Database can be created to track nutrients for various recipes, like automatic carbohydrate counting (which is particularly very important dietary aspect in diabetes management), total calories, protein, fat, fibre, etc. for any mentioned recipe which will help the user to modify their diet accordingly. Additional features like daily/ weekly customized goal setting and reminders for physical activity, water intake, weight management can be included which will help and motivate the user in maintaining a healthy and active daily routine. Simple lifestyle and dietary modifications can yield great results in controlling diabetes hence inbuilt healthy reminders can help the user stay motivated and improve the quality of health.

The M-Health application on nutrition informatics to manage diabetic care at home is a wonderful idea. I believe that the digital intervention for managing diabetes should integrate data from glucometers and insulin pumps and CGMs. Moreover, the mobile app should be interactive and user friendly. Alerts and reminders to follow instructions and follow a specific dietary plan can be added.  It is interesting to note that during the COVID 19 pandemic the search volumes have tripled for self-monitoring and management of diabetes, so definitely there is a big scope for self-care mobile app for diabetic care. 

The “Fitbit app”, a famous mobile app among fitness freaks, has come up with the idea to incorporate blood glucose-monitoring to give insights to the user about glucose levels fall within a target range. The app has already the provision to monitor heart health, stress, and blood oxygen levels.

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//gizmodo.com/soon-youll-be-able-to-track-your-blood-glucose-levels-i-1846224559

This paper demonstrates the study conducted to test whether mHealth interventions can improve patients’ experiences with care, improve population health, and reduce the per capita cost of health care or not. The program was a theory-driven behavioral intervention designed to improve self-care through multiple mediators, including cuing, education, self-efficacy, social support, and health beliefs. The participants included the adult population diagnosed with Type1 or Type 2 diabetes. The intervention involved self-management support and team-based care management through automated text messages. Along with that, the intervention involved Education modules focusing on diabetes self-management topics (such as medications, nutrition, glucose monitoring, foot care, and exercise) and topics related to living with chronic illness (such as navigating the health care system and managing stress). Respondents also received text messages about diabetes self-care, some prompts to engage in a particular action (for example, “Time to check your blood sugar”), and some questions (such as, “Do you need refills of any of your medications?”) to which the patient responded by texting. The research article throws light on how it leverages mobile technology to enable existing health system resources to support chronic disease care for better health outcomes.

//www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2013.0589

I think M-Health application on nutrition informatics is a brilliant way to bring awareness in diabetics. Most diabetics tend to ignore their blood sugar levels and do not keep a track of what they are consuming throughout the day. With built in features of this app, the diabetic would become aware about their consumption and understand the importance of monitoring their blood glucose levels. In times of Covid-19, where everything has become virtual, an app like this is the need of the hour.

The app can have additional features such as entering their blood glucose levels everyday and evaluating their progress weekly. As diet plays an important role, the app must be able to scan and analyze the nutrient value of each meal and maintain record. If drugs and insulin are a part of their daily regimen, it must take those into consideration as well. Simple diabetic friendly recipes, exercise routine and yoga asanas that are beneficial for diabetics can be updated everyday. A feature that could be taken into consideration is- making friends through the app. In my opinion, this is a fantastic feature that is emotionally and socially very uplifting. It would help them find new people, make friends, share their progress and motivate each other to improve every week. People find solace in knowing they are not alone. Fun activities, such as diabetic friendly lunches or workout sessions can also be conducted. 

Diabetes is generally associated with other comorbities such as obesity, cardiovascular diseases, hypertension etc. Considering this, the app must have features to measure their heart rate, number of steps per day and the calories burnt. Having said that, the application must be user friendly for all age groups such that maximum number of people install and use it. 

Regular updates and reminders from the application will keep the person consistent with their progress. 

Mobile communication technology is the fastest growing sector of the communications industry with a high geographical coverage with many advances in the mobile technologies. The World Health Organization (WHO) considers mHealth as a component of electronic health (eHealth). The definition of eHealth according to the WHO is “the use of information and communication technologies for health” while mHealth is defined as “medical and public health practice supported by mobile devices, such as mobile phones, patient monitoring devices, personal digital assistants (PDAs), and other wireless devices.”

It is important that individual should be able to manage their sugar levels they should be empowered for self management. 

According to me the app should have following components:

a. Need of self management

b. Personalised lifestyle counselling

c. Helpline center where individual can clarify the doubts

d. Reminders for sugar testing/ medicine/ doctors appointment.

e. Group where diabetic people from various regions can discuss their views and condition.

f. Diary to maintain monthly/weekly record of sugar level.

Good read: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5367240/

The global burden of diabetes continues to increase, specifically rapidly in low-middle income countries. Contextually the need to increase patient’s self-management skills is important to reduce the health-related costs and enhance the clinical outcome. Additionally, there is growing evidence which supports the fact that digital interventions such as mobile apps can be used for effective self-management of the disease along with ensuring accessibility and affordability. However, only limited number of apps can be effectively used for self-management of diabetes which highlights the need for comprehensive, efficient, and flexible mobile apps for self-management of diabetes with additional features to increase the number of long-term users for self-management and patient empowerment. This paper talks about identifying the most agreed-upon features for T2DM self-management mobile apps; and the most agreed-upon strategies that prompt users to use these apps.

//mhealth.jmir.org/2020/9/e17083/

Studies have shown that health apps and digital interventions have potential to self-manage diabetes. In this article, “Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review” specific methods and evaluation criteria have been  identified to assess apps and digital interventions for diabetes self-management. It was reported apps were the most commonly used  for  self-management of diabetes and the most evaluated criteria for apps and digital diabetes self-management interventions were cognitive impact, clinical impact, and usability. Most common methods of evaluation were questionnaires, interviews, and user-group meetings.

Read here for more information:

//www.ncbi.nlm.nih.gov/pmc/articles/PMC7381260/

mhealth has revolutionized in every aspect of life especially in today's life, it has a big impact on the way we manage physical and mental health.

People are adopting the use of mobile apps for managing their lifestyle. diabetes and kidney diseases remain undiagnosed in the early stages but if one person starts monitoring this condition he/she may save themself from complications and worse effects of NSDs. 

in my opinion, one diabetes app should have an exercise component for the age group. it should be tailored and personalized. specially for the geriatric population .

Mobile communication technology is the fastest growing sector of the communications industry with a high geographical coverage with many advances in the mobile technologies. The World Health Organization (WHO) considers mHealth as a component of electronic health (eHealth). This article demonstrates a narrative review of the mHealth technologies used for the prevention and management of T2DM. Majority (48%) of the studies used short message service (SMS) technology as their intervention while some studies (29%) incorporated applications for medication reminders and insulin optimization for T2DM management. Few studies (23%) showed that, along with mHealth technology, health-care professionals' support resulted in added positive outcomes for the patients. This review highlights the fact that an mHealth intervention need not be restricted to SMS alone.

Read more: //www.ncbi.nlm.nih.gov/pmc/articles/PMC5367240/

I think, India being the capital of diabetes to world, management and prevention play an effective role in curbing chronic symptoms of diabetes. Although mhealth wouldn't replace a health professional care but can definitely play a supporting role in diabetes prevention and management. Diabetes in most of the individuals is due life style factors. Using technology can be a great intervention to create awareness on preventing not just diabetes but several other chronic illnesses. Further more, mobile phones, bring wireless technology providing capacity to provide instant access to internet which sets an advantage for health care industry to use in prevention and management of diabetes.

Read more- //www.ncbi.nlm.nih.gov/pmc/articles/PMC5367240/#!po=25.0000

@m-mounika-gupta

I completely agree with you on the role m-Health can play in diabetes management. A very interesting paper “Empowering Diabetes Patient with Mobile Health Technologies” delves into the concept of diabetic patient empowerment by introducing current and future possibilities of m-Health technology. When a patient is actively involved in controlling and managing the health, then there is a paradigm of transferring the health care responsibility in the hands of the patient. This can be attained by knowledge enhancement, self-management strategies, shared decision-making, and most importantly by educating the patients with patient-centered care that is tailored-fit to their priorities, culture, and socioeconomic background. Challenges like nutrition management, glycaemic control, medication adherence, and psychosocial care can be addressed by m-Health. Utilizing mobile health technologies is an emerging way to assist patients in making decisions in real-time. But, intensive research is still required to evaluate the quality, usability, and acceptability of the various apps on the available platforms.

Diabetes is a serious problem. And by the above projected statistics, it looks like it’s about to get bigger. Although there is no absolute way to cure diabetes, there is always scope to improve living with diabetes. Self-care and monitoring is the key strategy to manage diabetes. A visit to a medical facility is not always possible and affordable to everyone in cases of minor fluctuations in the glycaemia levels. Hence it is essential for a person suffering from such a chronic condition to be equipped with knowledge and skills on how to recognize, understand and manage any case of abnormality experienced.

By the advancement of the 21st century, most of the population avail the services of a smartphone. Adults and youth all alike seem to rely on their mobile devices for day to day activities. Using this technological advancement, many healthcare applications and tools can be invented and utilized to improve the prognosis of a condition. M health applications for diabetes can easily be designed and various components such as tracking glucose levels, estimation of glycemic load of food consumed, carbohydrate counting for meals, various levels of physical activity along with their recommended durations, yoga and other holistic methods of management can be included. Diabetic friendly recipes and food exchange list, lists of food to be avoided and included and other guidelines can also be incorporated. I also feel a section on diabetes education- explaining what actually diabetes is and a little of its pathophysiology- what it does to the body can be added. A section on types, risk factors and complications can also be included to increase awareness and improve the mindset of people and clear any misconceptions. We can also add a section that talks about signs and symptoms of hypoglycemia and how to tackle the situation. Also we can include the service of contacting a qualified health professional through the application at the comfort of their homes. This also generates new employment opportunities.

In conclusion, usage of well-designed M health application can improve quality of life, reduce risk of morbidity and makes the patient self-reliant. It makes the work of both the patient and the health care provider easier and more convenient.

Diabetes self-management and care process via smart mobile phone apps allows better education and awareness of disease condition for diabetes patients. For the purpose of monitoring, smart devices such as continuous glucose monitors (CGM) and continuous subcutaneous insulin infusion pumps used by people with type 1 diabetes(T1D), can be communicated wirelessly to patients’ smart phone. Both technical and clinical areas of m-health care technology include major challenges. For example; regulatory and efficacy challenges, long terms patient compliance and usage, behavioural change, security and privacy issues among others. These and other challenges constitute major barriers in this area which facilitates the need of further research and work for the development of next generation m-health systems.

Read more- //www.ncbi.nlm.nih.gov/pmc/articles/PMC5847844/