What do adults with type 2 diabetes want from the ‘perfect’ app? Results from the second Diabetes MILES—Australia (MILES-2) study

Our recently published study shows that adults with type 2 diabetes want both practical and psychological support from diabetes self-management apps

By Shaira Baptista


Diabetes self-management is difficult, especially because people living with diabetes must do it on their own for much of the time. Diabetes self-management apps can help provide ongoing support, but very few people with diabetes use them. We wondered if this was perhaps because current apps do not meet their needs. So, in the Diabetes MILES-2 study, we asked a single open-ended question: ‘If you were describing the perfect app to help you manage your diabetes, what would it do?’

A total of 339 people provided responses, which we organized into meaningful themes. We recently published the results in Diabetes Technology and Therapeutics

First, people with diabetes want support with the practical aspects of managing diabetes. This includes comprehensive, continuous tracking and being able to easily visualize multiple sources of data on one screen and make notes about anything unusual. They indicated that it is important for data to be collected with as little effort as possible, for example by linking devices with each other and automating data uploads wherever possible. 

Some people want an app to go even further and provide them with automated coaching, that is, to recommend specific actions based on their data. They say it is important for the recommendations to be personalised to each individual and not just general suggestions, such as “exercise more”. 

We noticed that the type of coaching that participants asked for varied. Some express a strong preference for being able to set their own goals and being in charge of their own management. For these people, an app would simply provide the means to achieve their chosen goals. On the other hand, there are others who want an app to coach them by telling them exactly what they need to do. A self-management app for these people may need to provide much more ‘hands-on’ support. 

People also want reminders of all the things that they need to do, like taking medication or blood glucose readings. Some want alarms that alert them when their blood glucose is out of their target range. 

In addition to wanting assistance with the practical aspects of managing diabetes, people also describe wanting an app that provides psychological support. For example, they describe how an app could provide ongoing encouragement to help them reach their self-management goals by motivating them and providing positive reinforcement. They say it is important that the app empowers them by making them feel more in charge of their self-management and increase their feelings of efficacy and confidence. 

Finally, in addition to motivation and encouragement, participants describe wanting an app to help them cope with the emotional aspects living with diabetes. For example, it is important for an app to put self-management into perspective and accept that there would be times when things would not be ‘perfect’ and helping them deal with feelings of guilt and helping them manage stress in their daily lives.

There are several implications of our findings. 

First, although many diabetes apps offer some level of tracking, they may be inadequate when the reasons for tracking are considered. People with diabetes want to track multiple sources of data in order to make sense of it and recognise the bigger picture of management, perhaps over time. It is important to consider these needs when designing an app to support self-management. 

Second, many participants asked for real-time blood glucose monitoring and alarms, suggesting that what they want is a CGM, rather than an app, but they may not have access to it or even realise that such technology exists. 

Third, not all people with diabetes have the same management style. This suggests that the type of support and the way in which support is presented within an app needs to be designed carefully to fit in with these different styles in order to be effective. 

Data sharing with HPs is a desired feature, but this is often difficult to achieve in practice. For example, large volumes of data, as well as data quality, accuracy, security and privacy are just some of the issues that need to be overcome before this unmet need can be fulfilled. 

Last, but not least, a clear unmet need of people with diabetes is for psychological support. Unfortunately, there are only a handful of apps that offer this type of support, and fewer that integrate both practical and psychological support in a single app.

In conclusion, although it is important for diabetes-self management apps, first and foremost, to be safe and effective, it is just as important for people designing and recommending apps to listen to the needs of people living with the condition, and to provide features, support and benefits that they value most. Our findings suggest that different features will appeal to different users, but overall, the clear desire is for the ‘perfect app’ is to reduce the practical, cognitive and emotional burden of living with type 2 diabetes.

 

Baptista S, Trawley S, Pouwer F, Oldenburg B, Wadley G, Speight J. What do adults with type 2 diabetes want from the ‘perfect’ app? Results from the second Diabetes MILES—Australia (MILES-2) study. Diabetes Technology and Therapeutics, 2019; 21(7): 393-399.