Will we be managing diabetes with smart watches ?

Smart watch

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.

Author:

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

Executive Director: Australian Diabetes Online Services

www.onlinediabetes.com.au

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/

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