Evaluation of Glucose Buddy app as diabetes monitoring tool for patients and clinicians

Patient Centric App Review Series

App Reviewed: Glucose Buddy 3.6.5

Goals of app review:

  • To determine whether Glucose Buddy has the applicability to be utilized by diabetic patients for recording their glucose levels (eg. SMBG’s), meals, and medication usage.
  • To evaluate the possible integration of Glucose Buddy into diabetes management for patients

Introduction:
Diabetes is a chronic disease that requires close management by healthcare professionals in conjunction with patients. One key step for managing diabetes is measuring patients self-monitored blood glucose (SMBG) levels at home.

Currently only one app/device exists that can measure and record SMBGs. As such, most apps rely on patients entering the data into mobile applications manually.

Glucose Buddy is a diabetes monitoring tool developed by Tom Xu, a graduate from University of California Berkeley with a B.S. in Electrical Engineering and Computer Science. He is responsible for overseeing all interface usability and technical aspects of Glucose Buddy’s development.

Glucose Buddy is supported by SkyHealth LLC, which also supports other lifestyle modulation apps. These include Fitness Buddy and BP Buddy.

App Specifics:

Last Updated: May 7, 2011
Compatibility: iPhone, iPad, iPod Touch
Requires: iOS 3.0 or later
Reviewed on:  iPhone 4G

The app opens onto a simple user interface screen that displays several options. These include areas to add logs for SMBG, medications, diet, reminders, and user’s info.

The ‘My Info’ option allows the user to input their personal information. Included are options to record what type of BP cuff they are using and what SMBG monitoring device (eg. Bayer Breeze). There is also a display for the total average blood glucose per total data recorded.

Data can be input into the ‘Add Log’ option. Here, the user may input their SMBG and include the date and time of recording. In addition, there is a menu for the user to record SMBGs related to activities during the day (e.g. before breakfast, after lunch). Users may also include what they have eaten, medications utilized, and any exercise undertaken at the time of the recording.

 

After a user inputs their data, they can review the results on the ‘Logs’ and ‘Graph’ options. These screens allow the user to view all data entered (e.g. BG levels, calorie intake). The graph displays the trends over the course of data entered, allowing the user and caregiver to visualize BG levels. This data can then be emailed via the app to the patient’s provider for up-to-date BG control.

The graph only displays the trends of High, Average, and Low BG levels. It does not display the time of BG levels and when low or high levels were noted. This data is only available in the log option, which cannot be emailed or sent to providers.  In order to graph BP, HR, and weight, an in-app purchase must be made.

Lastly, the app has the ability to display reminders with push notifications on when to retest SMBG after previous recordings.

Healthcare Goals:
Glucose Buddy seeks to address the information gap between patients’ home monitoring of their diabetes and communication with their healthcare provider. It allows for the visual understanding of trends in a diabetic patient’s BG levels throughout the day, along with a diary of diet, medication, and exercise habits.

Evidence to Support Goals:
The measurement of SMBG is a common practice of evaluating patients’ BG control at home, especially when on insulin. This helps a provider to determine opportunities to adjust insulin and reduce adverse drug events (i.e. hypoglycemia); however, a common issue is communication of SMBG between patient and caregiver.

The Mobile Diabetes Intervention Study evaluated the utilization of a mobile diabetes management tool’s effect on diabetic patients’ glycated hemoglobin levels (A1c) over a 1-year period [1]. Results demonstrated that patients enrolled in the intervention group had a reduction in A1c by 1.9%, compared with 0.7% for the control group, a difference of 1.2% (P < 0.001) over 12 months [1].

Additional studies have evaluated the integration of mobile devices into direct diabetes management and care [2-4]. A review by Russell-Minda E, et al. noted that electronic SMBGs allow for easier communication between patients and prescribers about diabetes management [2]. A pattern analysis conducted by Parkin CG, et al. demonstrated that the utilization of SMBGs allows healthcare providers to identify issues in diabetes management and make rational therapeutic adjustments based on objective data [3].

However, the limitations facing the utilization of diabetes monitoring apps are the reliance on patients inputting data manually, which may reduce adherence, as noted by Ciemins E, et al [4].  It must be noted that further studies are needed to determine the use of applications to reduce microvascular and macrovascular complications of diabetes [2, 4].

Lastly, a recent review conducted via iMedicalApps evaluated the use of Diabetes Buddy in managing patients with Adult Type 1 Diabetes. The study investigated the utilization of the application as an adjunctive tool to help manage diabetes. Results demonstrated that there was a significant decrease in A1c in the intervention group over the control group who did not use the app [5].

Price:

  • Free – Displays ads intermittently amongst the screen
  • $3.99 – BP and Weight Add-On
  • $3.99 – Remove Ads Add-On
  • $12.99 – Multi-device Cross Connectivity

Likes:

  • On-line support to help monitor diabetes with multiple device-sync option
  • Data can be displayed visually and sent to provider
  • Free version has bare necessities to function as a diabetes monitoring tool

Dislikes:

  • Data input cannot be edited after saving and requires deletion and re-entering
  • Ads can be annoying and limit screen view
  • Display of data could be refined to show transition of BG throughout the day by time (e.g. before breakfast, before lunch), in order to visualize trends, and not by high-average-low display, which does not help to understand BG trends
  • Does not display BG averages by time of day, only overall BG averages
  • Data must be emailed separately with no direct in-app support

What type of provider would benefit from this app?

  • Endocrinologist
  • Primary Care Physician
  • Diabetes Clinic

What type of patient would benefit from this app?

  • Patients that require close monitoring of BG
  • Patients with type 1 or 2 diabetes
  • Patients on insulin with high incidences of hypoglycemia
  • Patients that can enter their personal data manually on a daily basis

Conclusions:

  • Glucose Buddy is an application that seeks to address the issue of communication between patients’ daily maintenance of their diabetes and their healthcare providers
  • Pros – Glucose Buddy is a good tool with a basic free option that is available to address the need to record SMBGs and display them for providers
  • Cons – current form of data visualization does not demonstrate an easy ability to understand patients’ SMBG trends based upon time of monitoring and can only visualize patients’ range of values on a set day

Bottom Line:

Integration of this app with patients’ BG monitoring may be beneficial for patients who are tech savvy, can record their data on a daily basis, and are facing difficult BG control that needs to be monitored carefully. However, the app does not support a direct means of communicating patient results with their providers and may hinder provider-patient communication.

iTunes Link

References:
1.       Quinn CC, Shardell MD, Terrin ML, Barr EA, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011 Sep;34(9):1934-42.
2.       Russell-Minda E, Jutai J, SPeechley M, Bradley K, et al. Health Technologies for Monitoring and Managing Diabetes: A Systematic Review. J Diabetes Sci Technol. 2009 Nov 1;3(6):1460-71
3.       Parkin CG, Davidson JA. Value of Self-Monitoring Blood Glucose Pattern Analysis in Improving Diabetes Outcomes. J Diabetes Sci Technol. 2009 May 1;3(3):500-8.
4.      Ciemins E, Coon P, Sorli C. An Analysis of Data Management Tools for Diabetes Self-Management: Can Smart Phone Technology Keep Up? J Diabetes Sci Technol. 2010 Jul 1;4(4):958-60.
5.    iMedicalApps Team. Randomized controlled study shows mobile app includes glucose control in type 1 diabetes. imedicalapps. http://www.imedicalapps.com/2012/06/randomized-controlled-study-shows-mobile-app-improves-glucose-control-type-1-diabetics/. Published June 26, 2012. Accessed July 7, 2012.

Disclaimer:
This post does not establish, nor is it intended to establish, a patient physician relationship with anyone. It does not substitute for professional advice, and does not substitute for an in-person evaluation with your health care provider. It does not provide the definitive statement on the subject addressed. Before using these apps please consult with your own physician or health care provider as to the apps validity and accuracy as this post is not intended to affirm the validity or accuracy of the apps in question. The app(s) mentioned in this post should not be used without discussing the app first with your health care provider.

Author:

Timothy Aungst, PharmD

Digital Pharmacist seeking to integrate technology and mHealth into pharmacy practice and patient care. Assistant Professor by day, blogger and writer by night.

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11 Responses to Evaluation of Glucose Buddy app as diabetes monitoring tool for patients and clinicians

  1. Darren July 24, 2012 at 10:45 pm #

    As an iPad app developer and Plastic Surgeon with a type I diabetic daughter I see apps such as this as a tiny step forward but am waiting for the big leap. That will be an app that has auto entry of BGL’s from a meter as well as interaction with insulin pumps. Plus the ability to allow remote monitoring or notification of those results and the action taken would be a reassuring option for a parent as well. Hopefully we will see cross platform, cross company standards soon that will allow all of this to happen. Then we might see some spectacular studies and results with HbA1c reductions and better safety profiles as well.

  2. Timothy Aungst, PharmD July 25, 2012 at 7:50 am #

    @Darren – Thank you for taking your time to comment and giving your insight. I greatly agree with your perspective and think that the nature of trying to produce apps that may bridge the lapse of up-to-date communication about SMBGs (and overall all ambulatory measurements) is heading in the right direction with the utilization of mobile technology. I do think it will take some time, and that a developer who will pursue this endeavor will have an issue producing technology capable of being available on multiple OS platforms and supplying information as its available to providers through some means of communication that will allay fears of violations of HIPPA and personal information. As it stands now, these apps rely on the patient taking the effort to communicate through these apps on their own whim, which in itself may be a great limitation. I would personally like to see more studies to investigate the utilization of these apps in practice and whether we can gather outcome data supporting their daily use. This may then help drive developers to then concentrate further on this technology.

  3. sgomez1031 October 6, 2012 at 1:07 am #

    I have had this app for quite some time now. I am on an insulin pump and I’m a nurse. It was, as most new diabetes gadgets, a great new toy. It does the trick for making a quick graph of things to flash in front of a PCM provider when all they want to know is the meat and potatoes of my management. (The nitty gritty is left to the Endocrinologist.) However until we get to the point of the data moving without my interaction with a device I won’t be totally satisfied.

  4. norman April 13, 2013 at 1:20 pm #

    You must have designed this app for geeks only. why not simplify the entry and results so that it can be used by us nongeeks. or at least produce a manual or demo dvd or utube demo that make since to those of us thats not trying to be a geek but just would like to use the program for its intended purposes.

  5. kctexan July 17, 2013 at 1:00 am #

    I don’t know why anyone would have to be a “geek” to use the free version of this app. I found it extremely user intuitive. It took me about 15 seconds per type of entry to figure out how/what to enter. The app is barebones (free version) but I’m the type that keeps my smartphone with me all the time and have developed a pretty good habit of entering data immediately, so it’s working pretty well for me.

  6. Ben February 27, 2014 at 11:13 pm #

    I really appreciate this app. I am a Type-II diabetic. One of the things that would be really helpful would be to be able to sort the food items.

  7. Sharon Hutchins April 27, 2014 at 9:01 pm #

    I am a graduate student who is writing about a technology application used in healthcare. I would like to write my discussion post about Glucose Buddy and use screenshots related to Glucose buddy for my post. I need permission from the author to use these screenshots. Do I have permission?
    Thanks
    Sharon Hutchins

    • Iltifat Husain, MD April 27, 2014 at 11:31 pm #

      please use the contact page, not this public comment section for such inquires. thanks!

  8. ken August 20, 2014 at 12:04 am #

    i like the app as a new diabetic and presently collecting the data for the doctor. i do wish there was a way to record an activity or food intake time without having to add in a bg reading. i also have no luck with the contact us for help icon as i get no reply and have paid the $6.99 to upgrade to glucose pro and they wont email me the upgrade.

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