《JAMA》:血糖管理app,真的有助于管理血糖吗?

数据显示,2018年,全球拥有智能手机的糖尿病患者中,约有7.8%的人会使用手机APP帮助自己记录、管理血糖数值。这一比例在2013年大约是1.2%。快速增长的使用人群与可穿戴医疗设备与智能手机的进步有关。那么,手机APP真的可以有效帮助糖尿病患者,提高血糖控制水平吗?来自新加坡的科学家们对此进行了分析,研究结果近日发表于《JAMA》杂志。

研究者以“diabetes”(糖尿病)、“blood glucose”(血糖)及“blood sugar”(血糖)为关键词在安卓及苹果应用市场中进行搜索,选取用于患者自主记录管理血糖值功能的,且近几个月有至少一次更新(说明仍在维护)的APP,无论其是否为免费软件。


共有371个APP符合纳入标准,其中,安卓应用198个,iOS应用173个。所有APP均可手动输入、记录血糖测定值,支持血糖仪的数据链接的不足10%。只有大约1/3可设定血糖目标值,大约1/4可提醒患者定时测血糖。大约58%的APP可对低血糖(≤3.9 mmol/L)或高血糖(>10 mmol/L)状态做出提醒,然而,近90%的提示未对单次异常值和持续24h以上的异常值作出区分。有不到15%的APP提供疾病管理建议(改变饮食、使用胰岛素、进一步监测或就医)。


值得注意的是,这些APP信息的来源并未得到FDA的认证,且在监测、警报、提示采取行动和疾病管理建议方面功能差异很大。因此,研究者认为,目前多数血糖管理APP更多的是提供数据记录而非所谓疾病管理,无法对患者的实时情况做出有价值的建议。未来,此类APP应在规范性、专业性上有所提高,同时对血糖仪的数据共享有更好的支持。


如果你也在寻找一个给力的血糖管理软件,不妨借鉴本研究的分析角度:基本的血糖值和糖化血红蛋白值的记录,目标值设定,异常值的警报及行动提示,还有健康生活习惯的小贴士。当然最重要的是,诚实的告诉你的医生,你是如何利用这些功能来改善自己的行动的。参考文献:


Lum E et al. Decision support and alerts of apps for self-management of blood glucose for type 2 diabetes. JAMA 2019 Apr 16; 321:1530. (https://doi.org/10.1001/jama.2019.1644)



Background

In 2018, an estimated 7.8% of individuals with diabetes who owned a smartphone used a diabetes app to support self-management. This study analyzed key management features, namely decision support and alerts for self-management of blood glucose in type 2 diabetes.


Methods

The apps database 42 Matters (https://42matters.com/) was searched using the terms diabetes, blood glucose, and blood sugar on December 7, 2018. Evidence-based app assessment criteria derived from guidelines for diabetes management included data capture (recording blood glucose levels); decision support (goal setting for blood glucose levels andHbA1c, reminders, alerts, and action prompts); and patient education (management of hypoglycemia and hyperglycemia).


Results

Of 5184 potential apps, 371 (198 Android; 173 iOS) met inclusion criteria (Figure) and were downloaded. Blood glucose levels could be recorded in all apps. Goal setting was available in 37.0%. Additional features accompanying blood glucose recording were available in 98.4%. Consecutive out-of-range values within a 24-hour period triggered the same alert as for a single out-of-range value in 86.6% of apps for hypoglycemia and 88.9% for hyperglycemia.


Discussion

The majority of diabetes apps did not provide real-time decision support or situation-specific education on blood glucose self-management.


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