An app to reduce the harm of sedentary behaviour

An app to reduce the harm of sedentary behaviourr7r

Whilst the advent and adoption of technology in all aspects of our lives brings with it many benefits, it has also brought new issues. Specifically, we are now moving less and sitting more, often in front of computer monitors, TV screens and smart devices. This change in our habits over time has led to a vast majority of office workers on average spending over 9 hours per day being sedentary[1].

The relationship between physical activity and all-cause mortality has been known for several decades based on results from population-based cohort studies. More recent systematic reviews and meta-analyses have confirmed that physical activity is inversely associated with all-cause mortality, after adjustment for other demographic and behavioural risk factors[2][3][4].

A recently published longitudinal study over 45 years following 792 men found that low aerobic capacity was linked to increased risk of death second only to smoking[5]. Many other studies have linked lack of activity to obesity, cancer, hypertension, diabetes, depression and metabolic syndrome[6][7][8].

The converse is also true.  The Diabetes Prevention Program and the Finnish Diabetes Prevention Study showed that lifestyle intervention, which included diet and an intense lifestyle program, resulted in a 58% reduction in the incidence of diabetes in individuals with impaired glucose tolerance[9][10] Furthermore the 23 year follow-up of the Da Qing Diabetes Prevention Study revealed that subjects with impaired glucose tolerance who were assigned to the lifestyle intervention group had a 41% and 29% reduction in cardiovascular and all-cause death respectively and 45% reduction in diabetes incidence[11].

From the above discussion, it is absolutely clear that inactivity has significant deleterious implications on many areas of our health, yet despite this, the average Australian is not moving nearly enough to reduce their risks of a multitude of chronic diseases. Furthermore, people tend to underestimate how long they spend sitting during the day and research has found that regular exercise does not completely offset all of the effects of sitting for long periods of time[1] [2].

The good news is that there is evidence that breaking up sedentary time with movement is valuable in reducing the impacts of sitting for long periods[3].

So what can we do to mitigate the risks for what is for most, a necessary part of our work life?

In seeking opportunities to overcome these issues, the Baker IDI has developed an app that attempts to change how long people sit for. Rise & Recharge is a gamification app that encourages people to stand, stretch or walk every 30 minutes. The app can be set to remind you to stand from your chair every 20-30 and if you take more than 15 steps you get a rewarded.  The more times you take a break and move the more rewards with the ultimate being 5 stars for the day.

The app is designed to identify movement through the accelerometer that is built into most smart phones and with an increasing number of Australians carrying a smartphone, the app is highly accessible to much of the population. Movement can also be tracked by the app through data sharing with other wearable tracking devices (such as Fitbit) or information can be manually entered.

The target audience for Rise & Recharge is the average Australian who may or may not be active outside work but is sitting at a desk most of the work day.

In summary, evidence clearly demonstrates the health risks of long periods of sitting. Breaking sedentary periods every 20-30 minutes has been demonstrated to reduce blood glucose levels in patients with type 2 diabetes and be effective in reducing the risk of developing chronic diseases and cancer.

The Rise and Recharge app fills a gap in the market providing a simple, easy to use tool for reminding people to find a healthier way to do their day job.


App name:  Rise & Recharge

Cost: Free


  • Google play
  • iTunes


[1] Canning KL, Brown RE, Jamnik VK, Salmon A, Ardern CI, Kuk JL (2014) Individuals Underestimate Moderate and Vigorous Intensity Physical Activity. PLoS ONE 9(5): e97927. doi:10.1371/journal.pone.0097927

[2] Owen, Neville et al. “Too Much Sitting: The Population-Health Science of Sedentary Behavior.” Exercise and Sport Sciences Reviews 38.3 (2010): 105–113. PMC. Web. 6 Aug. 2016.

[3] Breaks in Sedentary Time

Genevieve N. Healy, David W. Dunstan, Jo Salmon, Ester Cerin, Jonathan E. Shaw, Paul Z. Zimmet,Neville Owen

Diabetes Care Apr 2008, 31 (4) 661-666; DOI: 10.2337/dc07-2046


[3] Powell KE, Paluch AE, Blair SN. Physical activity for health: What kind? How much? How intense? On top of what? Annu Rev Public Health. 2011; 32: 349-365.

[4] US Department of Health and Human Services. Physical Activity Guidelines for Americans Resources. At-a-Glance: A Fact Sheet for Professionals.  Washington, USA, 2008.  Accessed June 2012.

[5] Ladenvall et al Low aerobic capacity in middle-aged men associated with increased mortality rates during 45 years of follow-up European Journal of Preventive Cardiology  2047487316655466, first published on July 26, 2016doi:10.

[6] Grontved A and Hu FB. (2011) Television viewing and risk of type 2 diabetes, cardiovascular disease, and all-cause mortality: a meta-analysis. JAMA, Volume 305, No.23, pp.2448–2455.

[7] Dunstan D.W., Barr E.L.M., Healy G.N., Salmon J., Shaw J.E., Balkau B., Magliano D.J., Cameron A.J., Zimmet P.Z. and Owen N. (2010) Television viewing time and mortality: the Australian Diabetes, Obesity and Lifestyle Study (AusDiab). (2010) Circulation, Volume 121, Issue 3, pp.384—391.

[8] de Rezende L.F., Rodrigues Lopes M., Rey-López J.P., Matsudo V.K.R. and Luiz O.C. (2014) Sedentary behavior and health outcomes: an overview of systematic reviews. PLoS One, 9(8):e105620.

[9] Knowler WC, Barrett-Connor E, Fowler SE, Hamman RF, Lachin JM, Walker EA, Nathan DM. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England Journal of Medicine 2002;346(6):393-403.

[10] Tuomilehto J, Lindstrom J, Eriksson JG, Valle TT, Hamalainen H, Ilanne-Parikka P, Keinanen-Kiukaanniemi S, Laakso M, Louheranta A, Rastas M, Salminen V, Uusitupa M, for the Finnish Diabetes Prevention Study Group. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001;344:1343-1350.

[11] Pan X, Li g, Hu Y, Wang J, Yang W, An Z. Effects of diet and exercise in preventing NIDMM in people with impaired glucose tolerance. The Da Qing IGT and Diabetes Study. Diabetes Care 1997; 20: 537-544

A link to the published article in the Diabetes Management Journal





An app a day keeping the doctor away?


Natalie Wischer RN, BN, RM, CDE, Grad Dip Mgt

Executive Director, Australian Diabetes Online Services

Chief Executive Officer, National Association of Diabetes Centres


Trends are not just uniquely the domain of the fashion industry, and my dad’s wardrobe containing an orange skivvy, from possibly the 70’s, indicates that some trends are misguided and perhaps even harmful, as was the case when I found the skivvy and spent a good 10 minutes laughing at him.

The health care industry is another area that attracts an abundance of trends and fads that often come with much hype and die a quiet death when the outlandish statements of their health benefits are found to be unsubstantiated by the masses who purchase what they believe will be the answer to all their problems. Think back…., not that long ago when we were told that only seven minutes a day on the ‘ab circle pro’ would give us an up to 10 kg weight loss and a six pack set of abs in only a few weeks. Then remember those sneakers that have a uniquely shaped sole that would give us the pert buttocks we had always wanted? I could go on and on, but the industry is littered with examples, and many have little or no scientific rigor to prove their claims. So where does technology in health care and diabetes fit into this? Is it a fad that will die a quiet death, or is it genuinely evidence based?

Like most things, it depends. It depends on the type of technology, who it is designed for, how it works, and what type of person is using it. Nevertheless, if you have been following my articles, you would know that multifunctional technology aids designed for people with diabetes can decrease HbA1c of up to 1.9%[1]. The latest health trend utilising fitness trackers has been the source of emerging research, but note that most devices are worn on average for less than 12 months. Where they have improved or motivated people are in those that were generally active and fit already and had a propensity to measure, track and analyse everything anyway, and thus the benefits have been less than remarkable on the whole. However, this is by no means a reason to ditch fitness trackers or other similar technologies, because what they do offer is a window of education, an opportunity for people to become a little more self-aware of how many steps they are taking, how well they are sleeping or how much they are eating. The magic lies in translating this knowledge into opportunities for behaviour change that can be sustained long term. This is where an app like Lark is focusing its effects.

Lark is an app that is trying to be a personal fitness, sleep, and food coach in your pocket. Named by Apple as one of the top 10 Apps of 2015, it has made a big splash in the e-health market. The app, even its free version, tracks exercise time, sleep quality, and diet, and with a mix of artificial intelligence and the texting interface, will provide personalised responses and education support 24/7. The feedback it gives is in an encouraging and educational format that is optimised toward your goals and focus. In the apps settings, you can customise the coach to support you in your goals such as weight loss, asking about meal types and even allows you to set your diet preferences such as vegetarian, vegan, paleo, low to no carb diets, lactose/dairy free or gluten free. You can also set up notifications and frequency which will, if switched on, provide reminders on the need to increase your activity during the day.

One of the most beneficial and useful elements of Lark is that it provides feedback on your activity levels and compares your status to previous days and weeks and can even tell you, on average, which days you are most active and at what times of day. Push notifications can also give positive reinforcement to healthy habits by sending messages that say “nice job on that walk you just did”.

Lark did not just haphazardly stumble on a well-designed holistic app; it was specifically designed to be evidenced based in its behavioural coaching focus. The advisory committee for the app included world leading experts in health and behaviour change from Stanford, Harvard and beyond with expertise in sleep, diabetes, psychology, nutrition, exercise physiology and cognitive behaviour therapy to name just a few.

As with all apps and technology, the key is not only in how well it engages the person using it over the long term, but how well it can lead to sustained behaviour change. This app is one of the best I have personally used and even in its free version it has potential to be a fabulous resource for all those trying to eat well, sleep better and be more active, and let’s face it, there are not many of us, or our patients, that can’t do with a bit of personal coaching in all these areas.

Even if this app is a download fad, it should be one that inspires more apps to be personalised, synchronised, motivating and evidence based. Now all it needs is some scientific research to analyse its effect on the long term health changes made by its users. This is a research study begging to be done.



  • Free
  • Or $30.99 a month for the personalised 16-week weight loss program

Available on:

  • iOS 8.0 or later (compatible with iPhone, iWatch and iPod touch)
  • Android


4.2 (2610 ratings for all versions)


  • Lark will synchronise data with many common fitness and activity trackers on the market but will also use the phones in built tracking devices available or most newer models.


[1] Quinn CC, Shardell MD, Terrin ML, Barr EA, Ballew SH, Gruber-Baldini AL. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934-42


Gourmet diabetes meals for less than $10


We are delighted to see a great selection of new and delicious meals from our friends at Diabetes Meals Online http://diabetesmealsonline.com.au/

As their website states, managing diabetes doesn’t mean skimping on flavour. Their range is fabulous and they also are now offering a large range of smoothies now too.

The convenience of having these meals delivered to your or your loved one’s door each week is very re-assuring as you can be assured they are suitable, tasty and nutritious meals.

All the meals are clearly marked with carbohydrate and sugar content so no nasty surprises on the blood glucose meter or the waistline.

There is a team of health care professionals (including myself) that are apart of Diabetes Meals Online so you can be assured that each of their meals meet the strict nutritional and quality criteria you should expect from an organisation that really cares about people living with or caring for people with diabetes.

I encourage you to have a look at their website and sample some meals – you will be really happy you did. Also consider what you could save in time and money by avoiding driving to the shops, finding a carpark, doing the shopping, cooking at home (especially if its for one) and then waste from leftovers – all this can be avoid for less than $10 per meal.





Remote Monitoring of Diabetes not so Remote

telstra-health-my-care-manager-160415Each morning Mavis knows the routine, she weighs herself, checks her blood pressure, pulse, oxygen saturation then blood glucose levels.  All of this data is seamlessly uploaded to the screen in front of her and securely transmitted to a central location and checked by one of the nurses shortly after it is entered. Mavis has diabetes, chronic obstructive pulmonary disease, hypertension with early signs of dementia but is trying to stay in her home as long as possible.

Mavis may receive a phone call if one of her levels is out of her target range set by her GP. Sometimes when Mavis has had low blood glucose for example, they have called her via the video conferencing facility on the unit to have a chat about her treatment of the hypoglycaemic episode as well as check that she is ok. This telehealth consultation also provides opportunistic education, reinforcing self management practices when they matter most.

Mavis with all of her information uploaded, swipes across the screen to see the list of her morning medications. She takes these from her cabinet, swallows them with a glass of water and then self administers her insulin, she then taps the screen again acknowledging that her mane medication regimen has been followed. She noticed however whilst taking her tablets that her Metformin was running low. Again on the screen, she touches the appropriate box and selects Metformin from the list and the script is automatically filled and ready for her to pick up at her selected pharmacy later that day. With an estimated 50% of medications not taken as prescribe[i]; it is evident that this reminder system could have a significant impact on medication adherence and disease management.

Just before Mavis begins her Google search for a gift she wants to purchase for her granddaughter using her home monitoring tablet, an alert comes up reminding her of her appointment during the week with the podiatrist. She checks her calendar. She is grateful for the reminder as she has a tendency to forget some of her appointments as there seems to be so many she needs to keep track of, but this system has helped her to attend these.

downloadHow does it work?

The remote monitoring solutions on the market in Australia, such as those from Tunstall[ii] and Telstra[iii], provide the client with an internet enabled large screen tablet that is pre loaded with the monitoring platform. The device at the consumer end also come with blood glucose meters, thermometers, BP monitors, pulse oximeters and scales that are Bluetooth enabled to allow the information to be automatically upload to both the patients and caregivers portals. These tablets also support video conferencing and some allow the use of the patients own devices such as personal trackers to be uploaded as well as manual data entry where devices are not Bluetooth enabled. Most units on the market provide access to internet and email servers making them more than simply a health monitoring device, but connecting their owners to the online world.

Checking the patient information at the other end are usually community care provider organisations such as the RDNS and Silver Chain that have developed a clinical care team to respond according to their clients individually set parameters. Intervention may be set to occur if medications are not taken by a set time or if monitoring parameters are out of the individuals set target range. The targets and trigger points for intervention are individualised. Some monitoring systems allow the information (where appropriate permissions have been sought) to also be shared live with other health care professionals and integrate into their existing and varied software programs.

What is the evidence this technology helps?

Remote monitoring is not new to Australia with some of the early trials being run in Queensland in areas where the NBN has been made available. The trials of this technology have been, for the most part, successful with improvements seen in HbA1c and overall satisfaction with the management of their condition. A recent Parliamentary inquiry into telehealth demonstrates improved patient satisfaction and quality of care in many of the programs introduced in Queensland.[iv]

A system similar to those utilised in Australia was researched and published by the US team at WellDoc, demonstrating that through remote monitoring and timely clinical interventions, reductions of HbA1c of 1.9% over 12 months could be achieved[v].


Achieving optimal and personalised outcomes is enhanced by regular and timely education interventions and engagement at opportunistic moments in the person’s health care journey. Remote monitoring with telehealth intervention appears to be a perfect fit for people with chronic disease such as diabetes, to not only live safely at home but to improve self management of their condition as it is easy to use and provides timely support as required.

The use of remote monitoring with telehealth will undoubtedly continue to grow if connectivity across all areas of Australia is supported and if costs of the service are contained. If this happens, people living with diabetes and other chronic diseases could be provided with another tool to assist with putting them in control to improve their health outcomes no matter where they live in our vast continent.


[i] https://www.monash.edu/pharm/current/step-up/clinical-roles/med-adherence

[ii] http://www.tunstallhealthcare.com.au/solutions/chronicdiseasemanagement

[iv] http://www.parliament.qld.gov.au/documents/tableOffice/TabledPapers/2014/5414T5969.pdf

[v] Quinn, C et al, Cluster and Randomized Trial of Mobile Phone Personalised Behavioural Intervention for Blood Glucose Control.  Diabetes Care September 2011 34:9 1934-1942


sanofi diabetes titrartion app

Diabetes Decision Support Technology Making a Difference

Decision Support Technology Making a Difference

Would you believe it if I told you that there is a program that can decrease mean HbA1c by 1.9% over 12 months from a baseline HbA1c of 9.4%? Well it’s true and the exciting news is that it utilises technology to do this. Most interestingly, the study was done in 2011, yet sadly it has taken some time to adopt these learning’s and translate them into ‘usual’ care.

Published in Diabetes Care, Quinn and associates from the University of Maryland in Baltimore, published these exciting results[1]. The cluster-randomized controlled trial (RCT) included 163 patients across 26 primary care practices assigned to treatment or control groups (usual care) for one year. Maximal treatment was a mobile and web based self-management patient coaching system, which included provider decision support software. Patients received automated, real-time educational and behavioural messaging in response to individually analysed blood glucose values, diabetes medications, and lifestyle behaviours that was communicated by mobile phone. Those in the maximal treatment arm also had their care providers receive quarterly reports summarising their glycaemic control, diabetes medication management, lifestyle behaviours and evidence-based treatment options and treatment suggestions that were provided through the WellDoc Clinical Decision Support software.

A primary outcome to the success of this program was that these physicians nearly doubled the number of medication changes they made for their patients versus those who provided usual care alone. This one year RCT found that the virtual patient coach portion of the WellDoc solution reduced HbA1c on average by 1.5 % and that when physicians utilised the clinical decision support the A1c was further reduced by approximately 30 percent, or a total of 1.9%. These results were significant in comparison to the 0.7 percent A1c reduction in the control group.

Dr. Quinn stated that “The WellDoc intervention provided a patient-centric care solution that impacted medication therapy management at the provider level, while simultaneously supporting other key aspects of diabetes self-management, such as glucose testing, diet, and exercise.”

This study provides clear evidence that decision support tools are highly valuable in the management of, not only diabetes, but potentially many other chronic conditions. The WellDoc team have gone on to develop another decision support tool for the management of diabetes that is provided on script in the US. This new version, called BlueStar, is an automated expert analytics system that provides real-time motivational, behavioural and educational coaching. In addition, it offers “smart” blood glucose testing, healthy diet and exercise recommendations, medication adherence tools, and information about compliance with quality standards of care for diabetes such as A1c tests, foot exams, and blood pressure and lipid levels.

Although we don’t have WellDoc or BlueStar available in Australia, we do have various decision support tools. Some insulin pumps, blood glucose meters and now some apps offer a level of decision support. As noted in the WellDoc study, treatment to target decision support tools can lead to tangible improvements in patient outcomes.

In review this article we look at an app that provides insulin decision support to health care professionals (HCP’s).

Assisting patients to adjust their own insulin doses can be time consuming, yet the rewards can be great. Self titration can lead to patient empowerment and improved glucose control as a result of timely adjustments and responses to not only trends over time, but the daily variations in readings. However to acquire the level of knowledge and understanding to do this safely and effectively, can be resource intensive, but there is help. Credentialled Diabetes Educators (CDE’S) often play a crucial role in supporting people with diabetes to achieve the required skills, but now there is another resource for all HCP’s toolbox to assist the person with diabetes.

The Sanofi Diabetes Titration App for Smartphones is available for free through the iTunes App Store and Google play. The app requires a code to be entered by the health care professional which is provided by Sanofi representatives.

The app guides the user through:

 Dose optimisation – these guides assist the HCP with starting a person with type 2 diabetes (T2D) on Lantus, starting or optimising Apidra administration for a person with T2D  or the use of premix Lantus that guides the clinician through assisting someone switching from once or twice daily 70/30 premix to Lantus. It is important to note that all the titration charts are for guidance of people with T2D only.

Injection technique – this video guides the patient through appropriate areas and techniques for injection of insulin. This is only available in English

Insulin Pen patient guides – these are step by step guides on how to use the ClikSTAR device for injection of Lantus or Apidra. The guides come in 6 languages and include Arabic, Greek, Italian, Vietnamese and Chinese.

Product information is also available, including PBS information for both Lantus and Apidra.

We have seen other similar apps on the market in Australia designed specifically for the person with diabetes. However Government regulation complexities have viewed these apps as being “devices”, similar to a blood glucose meter, and hence require rigorous testing and surrounded by legal red tape, making these unappealing for companies to offer their consumers. We hope to see the red tape change in the future.

There is growing evidence that technology, and specifically decision support tools, play a valuable role in improving the outcomes in many chronic diseases including diabetes. As health care providers, we should embrace these tools as they offer the opportunity to significantly enhance the clinical contribution we can make to our patients lives.

1 Quinn, C et al, Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control Diabetes Care September 2011 34:9 1934-1942;

Social media and conferences

5 Ways to Use Social Media At Conferences

5 Ways to Use Social Media At Conferences

Before you attend your next conference, be sure you know how to use social media to get the most out of the conversation and connections.

Adapted from an article written by: Eric V. Holtzclaw

I attend and speak at professional events at least twice a month and typically return home energized with the latest industry trends and knowledge. Lately I also come back with many new and renewed relationships, simply by networking using social media. Social media tools empower me to accelerate networking, make higher-quality connections, and feel less awkward in the process. Not bad for an introvert!

Here are five tips to get the most from your conference time and dollars:

  1. Join the pre-party

As social media is more widely embraced, online conversation starts well before a conference convenes. If the event you’re attending has a Twitter hashtag (#), LinkedIn group, or other interactive discussion, join it. Follow the conversation beforehand to see who else will be there, set up pre-conference meetings, find out which topics are hot, and judge the overall traction the conference is gaining (or not) among influencers. When I used Twitter before a conference for the first time I “met” half a dozen people in advance.

  1. Vote with your feet

Most of us study a conference agenda and select sessions ahead of time that pique our interest. But what happens when a panel kicks off and you quickly realize the topic or viewpoint is pretty dull? Use social media to eavesdrop on digital conversations happening elsewhere. You might discover an energetic exchange that’s more relevant to your business and switch.

3 – Make better friends, faster

Through social media you can research the interests and backgrounds of contacts you feel will be most valuable to meet. When you schedule a time to grab a meal or talk between sessions, your time spent together will be more meaningful and productive because you will already understand your common interests and experiences.

At one recent conference there was an unofficial “Meetup” for those of us who had been “talking” over social media. It was one of the most satisfying, fun, and productive networking events I had ever attended. In the past, I would walk away with a few business cards and then only keep up with one or two people. Today, I connect with dozens of people and easily stay in touch (on social media) long after the event, which in turn nurtures more meaningful deals, partnerships, and friendships.

  1. Have fun

Think of social media as taking notes, with the advantage of having dozens or even hundreds of others also taking notes and sharing them with you. You pick up tidbits from sessions you could not otherwise attend, which can in turn spark discussions and connections. I have seen attendees use social media to interact directly with speakers. You can chime in with your point of view, agree or disagree, and have a robust discussion.

  1. Have follow-up “coffee”

You can maintain new connections virtually, without filling up your already busy calendar. Even without “real-world” contact, social media allows you to keep up with what’s going on with the people in your network, and stay on top of trends they’re following. The information they shared will be more valuable because you know where it’s coming from.

Social Media

Can using Social Media help your career?

Can Using Social Media Help your career?

We have read the horror stories, seen the photos and heard the rumours and know that social media used without caution can get you fired, but can it get you hired?

Inappropriate use of social media such as posting photos from the beach on a day you have called in sick, reference to issues or people in your workplace, even compromising information posted on other people’s platforms are recipes for career disaster, but don’t let this deter you from using it.  Social media can increase your profile, show-case your expertise, knowledge and experience in the industry and help you to find perhaps the job of your dreams. Indeed prospective employers and recruitment companies are actively using social media platforms to identify potential candidates, so its in your benefit to be involved.

So where do you start?

Check yourself out! Google your name and review what articles and images come up. This is a good time to untag yourself from any posts or images that portray your image negatively.

Develop your online professional profiles by first considering what you are going to use. Below are the most common and how they are best used.


LinkedIn is an online social networking tool designed specifically for professionals to find a job and build opportunities to connect with others in their industry online (ok – you know this as you are on it now, but have to keep the article inclusive of all).

Once you have registered with LinkedIn and built your professional profile, uploaded your most professional photo (selfie free zone), it’s time to search for vacancies, follow relevant organisations and connect with others in your industry. Once you have developed your network, it is time to venture further afield and even send out posts, comments and “likes” on a topic you are interested in, which helps to increase your profile. Also have previous employers or colleagues to write recommendations for you.


Twitter is an information network where “tweets” are sent via short 140 character messages to registered followers. Once registered with twitter, you can follow industry experts and organisations and participate in discussions relevant to you.

It is often advisable to have a personal and professional twitter account but it is quite acceptable to show your interests and style and build a bigger personality picture of yourself which helps potential employers to get to know you a little better.


Facebook is possibly the most popular social networking site worldwide and allows users to create profiles, share photos, images and messages.

It is very important to note the cautions listed in the following section of this article in regard to Facebook as it tends to be used for a more social rather than work focused communication tool, nonetheless, it can assist in building your professional network and also acts as a useful tool for your employer to research you and you to research your potential employer!

A few words of caution

According to research conducted by Telstra, job screening in undertaken by more than a quarter of all Australian bosses who use social networking sites to do this.

To ensure you remain on the candidate list for a new position, it is recommended you:

  • Review all your social media accounts (such as Facebook, Twitter, LinkedIn) and delete any comments or images that may be perceived offensive. Be over vigilant here and “if in doubt take it out”.
  • If you want to keep your Facebook or other social media profiles uncensored to your friends and family, but think these may not portray your most professional side, head to the security settings. By putting maximum privacy settings on your social media accounts, you can keep them confidential to only those who you have linked with.
  • Ensure that all you claim to have done, worked and been involved with is accurately reflected online. Just as it is vital to keep your CV up to date when job hunting, your social media profiles need to be regularly updated too.
  • Carefully consider all the friend and link requests before accepting. Without careful scrutiny of your privacy settings, private postings can soon become public and if they are reposted by a ‘friend’ not so vigilant with security. Being “tagged” in someone else’s photo can be found by those doing a social media search if your security settings are not in place.

Once you have the job, don’t become complacent. The Telstra research also showed that one in ten employers regularly trawl networking sites to review productivity levels ensuring that staff are demonstrating appropriate social media boundaries that align with the organisations policies and procedures.

Social media, both personally and professionally is a powerful tool and therefore must be used with wisdom to achieve your goals. Being clear about what you want from the outset is imperative, and although it may be new ground for you to try, ask yourself if what you are doing today is getting you closer to where you want to be tomorrow.

Natalie Wischer RN, BN, RM, CDE, Grad Dip Mgt

Executive Director, Australian Diabetes Online Services



Smart watch

Will we be managing diabetes with smart watches ?

With the long awaited release of the Apple Watch onto the Australian market this year, I have been pondering its offerings and the value for the person living with diabetes. However, before we delve into the specifics of this device, we should be reminded that there is increasing evidence that many apps and newer technologies can work well in assisting people with tracking and achieving their health goals.

Adherence to a very popular app called Lose it, was found to work as well or even better than programs that were based on paper or on a website for achieving weight loss[1]. Furthermore, a review of the current literature on the effectiveness of mobile health (mHealth) solutions in lowering glycated hemoglobin by the John Hopkins School of Medicine[2] found that the mobile health solutions demonstrated reductions in HbA1c that were clinically significant ranging from 0.35 to 1.9%. The article concluded that mHealth interventions in diabetes are promising and are likely to lead to reductions in medical costs associated with the condition. With these and other mounting research papers supporting the value of technology in the management of diabetes and other related co-morbidities in mind, we can now turn our focus onto the specifics of the Apple Watch.

The Apple Watch is one of many smart watches on the market, but like all Apple products that arrive on the Australian shores, the hype seems to permeate even those who profess they are technology luddites or Apple opponents. So as the loud thud of the newest smart watch vibrated across our technology thirsty island in April, my first question was; could it monitor blood glucose levels (BGL’S)? The answer is yes…BUT there are a few significant hurdles to be navigated over first.

Dexcom, a manufacture of blood glucose meters and insulin pumps has developed a thin sensor that can be implanted under the skin and can transmit BGL’s to the watch every 5 minutes. These levels can be displayed in graphical form and can be shared with family and health care providers. These data can also be overlaid with that captured in the Apple Healthkit platform. Yet, here is the “BUT”, and it’s a big one – the Dexcom sensors alone are $400 for 5 sensors, each sensor lasting around 2 weeks. To alleviate these costs, in time the Government may look at subsiding these by perhaps placing them on the NDSS consumables list, but these may only be available for those that would benefit from intensive monitoring.

The Dexcom unit will undoubtedly be one of many continuous blood glucose monitoring devices and insulin pumps available on the Australian market that will synchronise with the Apple Watch. This technology including the benefits of convenient access to real time data, will undoubtedly have positive impacts on patient care, however affordability of consumables will be the key to their uptake.

Not withstanding these financial impediments, the Apple Watch has other offerings that will entice the users of this modern and much talked about wrist technology with its many health apps pre loaded that may be of benefit to the person living with diabetes (Table 1).

As a huge advocate of the quantified self, believing the adage “that which is measured can be improved” I am an enormous proponent of health and fitness trackers on the whole. The exciting advancements in this space have been further propelled by the simplicity and ease of access of these devices being a mere touch of a finger away which significantly removes some of the historical barriers of health data tracking.

Collecting, measuring, interpreting and sharing health data has traditionally been time consuming and burdensome and as such, not sustainable in the long term. Now devices like the Apple Watch offer a simple, secure and centralized location for this data to be collected, integrated, stored and shared and could be one of the best personal electronic medical health records we have seen yet.

The Mayo Clinic and Epic Systems in the US collaborated with the development of the HealthKit available on the Apple Watch. In trying to assess how health data is being used and shared, evaluations are underway by the Joslin Diabetes Institute. Dr Wolpert and members of the Joslin team[3] are also investigating how apps such as the Joslin Hypo Map TM (developed in collaboration with Glooko) which serves as a hypoglycaemia tracker, can be synergistically integrated into the multitude of tracking data available.

Personalised information can start from the basic height, weight and age information then simply be expanded to adding exercise duration and intensity, food intake, heart rate, stress, sleep quality, blood pressure and more. Other apps are also available to provide reminders to take medication, have regular exercise and stretch breaks, and even drink some water. However with all these data being captured the value comes from it being reviewed, interpreted and acted upon. We need to ensure our patients have the health literacy to do this. If we spend the time educating and empowering our patients to understand, interpret and appropriately react to the patterns they see in their data, then we will be moving significantly toward achieving true self management and long term health gains.

So although you may be cautious and skeptical about smart watches, the numerous health apps and growing array of fitness trackers, I encourage you to remain open minded and supportive of those who use them as part of their health care toolkit. We are in the midst of a revolution in healthcare and technology and we need to ensure that we don’t discourage our patients, but watch, listen, encourage and learn. This technology journey in health will continue to travel at high speed, with or without us, but inevitably, it will involve each of us, so I encourage you not to be left too far behind and jump on board.

Table 1:

Some of the currently available health apps featured on the Apple Watch

App Function
Nike + running Tracks distance, duration and pace and allows users to share this data and compare with online users.
Lifesum A nutrition tracking app that allows users to monitor food and water intake throughout the day
Hello Heart This app emulates the role of the patient held electronic health record and allows patients to store their laboratory data and other metrics as well as sync heart rate and blood pressure readings. It also states that it will assist clients in making sense of their data.
Medication Alarm This app provides alerts when patients need to take their medication. The patient can then confirm they have taken the medication via a simple tap on the watch.
Wake Alarm Clock A sleep tracker that provides information on the duration and quality of sleep and of course, can be an wake up alarm also.
Strava Not dissimilar to the Nike + app, if users also carry their iPhone during exercise, it provides heart rate, distance, elevation and other tracking data to be displayed on the watch.
Green Kitchen Costing $4.99, the app provides healthy recipes that can be displayed on the iPhone or other Apple device but then integrates any timing required on the Apple Watch allowing the user to tap their watch to start the timer and it also displays messages such as “your quinoa should now have little tails”.
Mayo Clinic Synthesis This is an app for the doctor who needs tools to help manage their time. The app displays the Doctors appointment schedule, alerts them when a patient has arrived and also gives basic patient information prior to the consultation.


Natalie Wischer (RN, BN, RM, CDE, Grad Dip Mgmt, Grad Cert Diab Ed)

Executive Director: Australian Diabetes Online Services


Nil conflicts of interest.

[1] Carter MC, Burley VJ, Nykjaer C, Cade JE. Adherence to a smartphone application for weight loss compared to website and paper diary: pilot randomized controlled trial. J Med Internet Res 2013:173:105-11

[2] Javitt, JC. Effectiveness of Mobile Health Solutions in Lowering Glycated Hemoglobin and Resulting Economic Effects – A Review of the Current Literature. US Endocrinology 2014: 10(2):98-102

[3] Speaking of Diabetes – Joslin Diabetes Centre Blog: http://blog.joslin.org/2014/12/will-the-iwatch-transform-diabetes-management/


Fitness Trackers – Do they work?

Fitness Trackers – Do they work?

Natalie Wischer (RN, BN, RM, CDE, Grad Dip Mgt)
Executive Director, Australian Diabetes Online Services

It was in the not so distant past that the term “fitness tracker” did not even exist. Fast forward to today and walk into a gym or even a business meeting and you would be hard pressed to find someone not adorned with one of these somewhere on their body. Nike’s Fuelband, FitBit, Jawbone Up and apps that track everything from breathing, sleep and diet have rapidly progressed past just simply the ideas in the heads of fitness and health scientists. The most sought after features often being the counting of calories and monitoring the number of daily steps taken. Yet, this is without a doubt, just the tip of the iceberg when it comes to what this technology can do.

Do Fitness Trackers Work?
The old adage of “you can’t manage what you don’t measure” rings loudly when asking if these devices can help with achieving fitness goals. Research has shown that if you want to stick to a new habit, monitoring is one of the best ways to make a change (Duhigg, 2014). If tracking something is burdensome, then it will be difficult to sustain. These devices, however, have significantly reduced the effort of having to manually monitor everything yourself. And yes they work: a recent study presented at the annual meeting of the American College of Sports Medicine showed that people who wore pedometers lost more weight, spent more time being active and less time sitting than those not wearing them (Dallas, 2014).

Tracking simply gives you feedback on the realities of your life. Because, honestly, even if it feels like you have conquered the goal of 10,000 steps after a day of spring cleaning, the sad reality is that you probably didn’t. Research shows that people commonly overestimate activity by 3-4 fold (Willbond, 2010) and underestimate food intake, but by having more objective information we can clearly identify the problem areas and where changes need to be made.

Is there a downside?
As with most things in life, even healthy habits, sometimes moderation can become lost if you come to rely on a gadget.  There are certainly distinct personality types that are more likely to fall into this trap and these can lead to secondary issues such as stress as a result of not meeting the set goals. Some individuals can lose sight of their overall aims, such as improved strength and wellbeing in favour of meeting for example, a steps-per-day goal, and while, making 10,000 steps a day is terrific, if it’s keeping people from doing resistance training in favour of walking or running each day, then one could argue that tracking can lead to a mismatch of the ultimate goals.

Tracking every small thing day in day out can take a toll emotionally too because as we all know, conditions change daily. Despite best intentions, sometimes for no known reason you can feel tired, sore or just feeling not quite right and you’re not able to hit your goal, and if you are a slave to a device, you can unfairly beat yourself up over not meeting an arbitrary figure or worse still pushing yourself to meet this goal only to end up with an injury.


Making Trackers Work for You
Instead of monitoring for monitoring sake, it is important that you are clear about your goals. Write them down and decide on which metrics are most important to track and meet your goals. Finding devices with the most features you can get within your budget is usually a good start. Don’t get caught up in simply tracking steps and calories and neglect to look at all of other useful information such as sleep length and quality as this can be an enormous window into understanding why sometimes your expected progress is not tracking as it should.

For many people, wearable technology offers a subtle but successful motivational tool assisting in the achievement of health, weight and fitness goals and sustaining these over the long term. With Christmas coming up, consider suggesting the addition of a fitness tracker on your Santa wish list.

Rapid Calc

Rapid Calc App Review – Diabetes Management Journal

In this edition of the Diabetes Management Journal I have written an article and review on the Rapid Calc app developed by an Australian with type 1 diabetes, Ian Gillespie.

Please let me know if you have used the app, what your thoughts are and if you have found it gives you improved control and information to help you manage your diabetes.