Researchers from ORCHA have found that blood glucose levels amongst those with Type 2 Diabetes can be reduced by up to 1.1% when patients use digital health tools alongside their standard medication.

Patients with Type 1 Diabetes can reduce their blood sugar (HbA1c), on average, by 0.5%.

This reduction is significant because every 0.1% increase in HbA1c increases the risk of retinal damage, blindness, kidney failure, ulceration and limb amputation.

The cost of healthcare for ulceration and amputation in diabetes has been estimated at almost one billion pounds per year.* Twenty per cent of people with diabetes will need treatment for kidney disease.**

ORCHA and its research team, headed by Doctor Simon Leigh, analysed 25 independent randomised controlled trials where those with diabetes had used health apps. Across the trials, 3,360 patients were involved. The study was published in Frontiers in Clinical Diabetes and Healthcare in October 2022.

Dr Leigh, who is himself a Type 1 Diabetic, said: “This is a commanding result which we hope clinicians will take note of. By the end of this decade this country will have over 5.5 million citizens living with diabetes. Adequate management is vital as some of the consequences of diabetes take time to evolve and are difficult to remedy. This study shows that health apps can be an effective part of this process, complementing other forms of care.”

The study is the first systematic review of these clinical trials. Its aim was to establish whether health apps could assist with Hba1c levels. It found that:

In 21 out of the 25 trials, patients using digital health tools to supplement their care achieved better HbA1c results.

In 20 out of the 25 trials, there were additional reported reductions in cholesterol levels, blood pressure and Body Mass Index.

Amongst those with Type 2 Diabetes, the improvements in blood sugar levels were similar to the benefits patients receive when using Metformin, a commonly used medicine to lower blood sugar levels which is often the first line of treatment for the condition.

Although researchers expect a drop-out rate of 40% when patients trial digital tools, there were lower drop-out rates when the people with diabetes used them, at 20%.

In the trials, the average duration of diabetes for those using digital health was 12.49 years and the average age was 52.  The researchers were surprised that this group, seemingly well entrenched in their self-management habits, were so open to trying new approaches, showing there is a role for digital health in those with well-established diabetes. They commented that it suggests the introduction of digital health to younger or newly diagnosed patients could lead to even greater results, if they had grown up as digital natives.

Dietician and clinical lead for diabetes at ORCHA, Susan Gallagher, said: “The improvement demonstrated in the research paper is clinically valuable and a comparison could be made to the impact of diabetes medication. It is important that digital solutions are evidence based, proving they can add value to a person’s care. This paper has shown the improvements that can be realised. “Many apps exist but not all have the same standards or ability to show a positive impact. Individuals and clinicians should consider a trusted app when selecting one to support their care needs”.

Digital solutions can range from those that help patients manage their own day-to-day health, solutions that help patients and doctors share information and those that are integrated with wearable technology, of which some are available as prescribed products on the NHS.

Patients living with diabetes need to balance multiple health commitments – such as eye screening, feet checks and annual reviews of blood pressure and weight. Health apps can range from tracking food, activity and medication to offering peer support and information and also sharing and monitoring information between patient and clinician; these help the person with diabetes self-manage and can reduce the burden during clinical appointments.  Health apps can help them track activity, food intake and medication, whilst giving peer support and remotely monitoring their data which reduces the burden of data collection during clinical appointments.

Susan Gallagher added: “This is not to take away from the benefit and need for in person consultations; however, digital health tools can help us use technology in a manner that suits the person and their needs, supporting patients and healthcare professionals in doing so.”

Three of ORCHA’s top-rated diabetes apps:

MyWay Diabetes: This educational app allows users to learn about diabetes at their own pace, offering access to over 200 multimedia resources including e-learning courses. Eighty-eight per cent of users say it helps them manage their condition better. The developers note that for every £1 the NHS spend on this app, £5 is saved because diabetes is being managed better.

ORCHA score 92%                          Available as a web app                               Cost: entirely free

My Diabetes from My mHealth: This NICE-aligned platform provides expert advice, structured education, nutritional guidance, and exercise programs. With blood glucose monitors, linked via Bluetooth, and the ability to build a personalised set of targets, myDiabetes helps people control their condition. Clinicians have access to remote care, patient management, reports and monitoring tools that makes caring for patients easier and more cost-effective.

ORCHA score 88%                          Available via IoS and Android                    Cost: in app purchases

Hedia – Personal Diabetes App: Hedia tracks exercise and carb intake, makes insulin dosage recommendations, and monitors when users need to regulate their blood sugar. It’s especially recommended to people having insulin-dependent diabetes – such as type 1 diabetes – and its software supports several blood glucose meters.

ORCHA score 86%                          Available via IoS and Android                    Cost: entirely free

Notes:

The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review:  Authors: Simon Leigh, Sebastien Stevens, Susan Gallagher, Tim Andrews, Liz Ashall-Payne, Lloyd Humphreys.

*Major amputation is one of the most destructive complications of diabetes and the number of major lower limb amputations in diabetes continues to rise. Seven-thousand nine-hundred and fifty-seven (7957) major diabetic lower limb amputations were reported in England between 2017 to 2020. Furthermore, the cost of health care for ulceration and amputation in diabetes has been estimated at almost one billion pounds per year. https://resolution.nhs.uk/wp-content/uploads/2022/06/Diabetes_and_Lower_Limb_Complications.pdf

** https://www.diabetes.org.uk/guide-to-diabetes/complications/kidneys_nephropathy

User Experience (UX) is key to the success of a digital health product. It doesn’t matter how beneficial a product has the potential to be, if the user isn’t using it as intended due to a poor user experience, they won’t be getting the most out of it.

The System Usability Scale (SUS) is a widely used scale that is typically used to assess how usable software and hardware products are. The scale was not specifically designed to be used for mobile apps, or digital health products, but it has been used by some to do so.

To understand how useful and accurate it is, and to guide digital health suppliers, the ORCHA research team collaborated with Ulster University on a piece of research to discover whether the SUS can be used to reliably assess the usability of digital health products.

PhD researcher, Maciej Hyzy led the investigation, with support from authors including Sophie Hunt, Senior Digital Health Assessor, and Dr Simon Leigh, Director of Research at ORCHA. The team analysed previously published research to find digital health products which had published SUS scores. They then analysed the distribution of these SUS scores for digital health products in different condition areas, to evaluate whether the existing benchmark of a mean SUS score of 68 (widely accepted for software and hardware products) is relevant when evaluating the usability of digital health products. They found that overall, the SUS is a good starting point for measuring usability in digital health products. However, given that the findings are highly subjective, and demonstrated to be variable by condition area, more work needs to be done in this space, perhaps with reference to more objective and evidence-based approaches to assessing UX.

It was clear from the analysis that future work should aim to supplement the subjective user experience assessments provided by the SUS with questions that can be answered more objectively. This will enable us to understand exactly why some digital health products provide a better user experience than others. We can then learn exactly what makes a digital health product with good user experience.

The report has been published in JMIR Publications mHealth and uHealth, and is available to read on Ulster University’s website.

PhD researcher, Maciej, said:

“The System Usability Scale (SUS) is a widely used scale that has been used to quantify the usability of many software and hardware products. However, the SUS scale was not specifically designed to evaluate mobile apps, or indeed digital health products. The objective of this study was to examine whether the widely used SUS distribution for benchmarking (mean of 68 and standard deviation of 12.5) can be used to reliably assess the usability of digital health products.”

If you have any questions about this research, or about how ORCHA assesses user experience, please get in touch with us at hello@orcha.co.uk.

Published in: BMJ Open

The traditional model of healthcare delivery is based on providing medical services through systems of hospitals, primary care facilities and outpatient clinics. However, the COVID-19 pandemic has profoundly disrupted the routine delivery of physical healthcare, resulting in the widespread deferral of elective, preventive and outpatient appointments by health authorities. Estimates suggest that as many as 40% of appointments have been cancelled or postponed by patients, as part of efforts to avoid public spaces as much as possible. In the USA, ambulatory care visits fell by 60% in the early phase of the pandemic, while in the UK alone, an estimated 1.5 million elective admissions and 2.6 million outpatient attendances were forgone as a result of COVID-19.

We explored if consumer interest in digital health products (DHPs) changed following the COVID-19 pandemic and the lockdown measures that ensued. We identified all web-based internet searches for DHPs in the UK using ORCHA app libraries, split over two periods, pre-COVID-19 lockdown (January 2019–23 March 2020) and post-COVID-19 lockdown (24 March 2020–31 December 2020).

There were 126 640 searches for DHPs over the study period. Searches for DHPs increased by 343% from 2446 per month prior to COVID-19 lockdown measures being introduced to 8996 per month in the period following the first COVID-19 lockdown in the UK. In total, 23/25 (92%) of condition areas experienced a significant increase in searches for DHPs, with the greatest increases occurring in the first 2 months following lockdown.

Musculoskeletal conditions (2.036%), allergy (1.253%) and healthy living DHPs (1.051%) experienced the greatest increases in searches compared with pre-lockdown. Increased search volumes for DHPs were sustained in the 9 months following the introduction of lockdown measures, with 21/25 (84%) of condition areas experiencing monthly search volumes at least 50% greater than pre-lockdown levels.

Our findings suggest that the COVID-19 pandemic has profoundly disrupted the routine delivery of healthcare, making face-to-face interaction difficult, and contributing to unmet clinical needs. This study has demonstrated significant increases in internet searches for DHPs by members of the UK population since COVID-19, signifying an increased interest in this potential therapeutic medium. Future research should clarify whether this increased interest has resulted in increased acceptance and utilisation of these technologies also.

Read the full research piece here: https://bmjopen.bmj.com/content/11/10/e053891

Published in: BMJ Open

The traditional model of healthcare delivery is based on providing medical services through systems of hospitals, primary care facilities and outpatient clinics. However, the COVID-19 pandemic has profoundly disrupted the routine delivery of physical healthcare, resulting in the widespread deferral of elective, preventive and outpatient appointments by health authorities. Estimates suggest that as many as 40% of appointments have been cancelled or postponed by patients, as part of efforts to avoid public spaces as much as possible. In the USA, ambulatory care visits fell by 60% in the early phase of the pandemic, while in the UK alone, an estimated 1.5 million elective admissions and 2.6 million outpatient attendances were forgone as a result of COVID-19.

We explored if consumer interest in digital health products (DHPs) changed following the COVID-19 pandemic and the lockdown measures that ensued. We identified all web-based internet searches for DHPs in the UK using ORCHA app libraries, split over two periods, pre-COVID-19 lockdown (January 2019–23 March 2020) and post-COVID-19 lockdown (24 March 2020–31 December 2020).

There were 126 640 searches for DHPs over the study period. Searches for DHPs increased by 343% from 2446 per month prior to COVID-19 lockdown measures being introduced to 8996 per month in the period following the first COVID-19 lockdown in the UK. In total, 23/25 (92%) of condition areas experienced a significant increase in searches for DHPs, with the greatest increases occurring in the first 2 months following lockdown.

Musculoskeletal conditions (2.036%), allergy (1.253%) and healthy living DHPs (1.051%) experienced the greatest increases in searches compared with pre-lockdown. Increased search volumes for DHPs were sustained in the 9 months following the introduction of lockdown measures, with 21/25 (84%) of condition areas experiencing monthly search volumes at least 50% greater than pre-lockdown levels.

Our findings suggest that the COVID-19 pandemic has profoundly disrupted the routine delivery of healthcare, making face-to-face interaction difficult, and contributing to unmet clinical needs. This study has demonstrated significant increases in internet searches for DHPs by members of the UK population since COVID-19, signifying an increased interest in this potential therapeutic medium. Future research should clarify whether this increased interest has resulted in increased acceptance and utilisation of these technologies also.

Read the full research piece here: https://bmjopen.bmj.com/content/11/10/e053891