Nursing 305 presentation

Mobile applications for emerging adults transitioning to independent diabetes monitoring Jennifer Schindler-Ruwisch and Abby Peters

Egan School of Nursing and Health Studies, Public Health, Fairfield University, Fairfield, CT, USA

ABSTRACT Access to high-quality mhealth tools for diabetes management is critical. The purpose was to systematically review mobile apps for features relevant to helping emerging adults manage their diabetes as they transition to inde- pendent diabetes monitoring. Mobile apps were reviewed for relevance to emerging adults, aged 18–25, living with diabetes. The GooglePlay store was systematically searched to identify diabetes management mobile tools. Of the 29 apps, only one app had any features relevant to emerging adults. In total, 20 apps had a feature to share a copy of diet or blood sugar logs with a family member or provider. Only 9 apps had any interactivity other than tracking. While most apps had graphics, only 5 were deemed high quality. Just one app met all three included Mobile Application Rating Scale (MARS) criteria. This review serves as a starting point to guide educators and patients, especially to aid continuity of care when in-person support is not feasible. Ongoing review of new apps with improved functionality and effectiveness studies of the apps’ impact on emerging adults’ diabetes management is imperative.

KEYWORDS mhealth; diabetes management; emerging adults; mobile apps; diabetes technology

Introduction

The transition of emerging adults to more independent diabetes management, with less active parental supervision and support, can be challenging. This transition can lead to emotional distress, decreased blood glucose monitoring, and ultimately poorer health outcomes.1 To enhance a sense of indepen- dence, Babler and Strickland recommend more effective communication strategies that allow for improved self-monitoring.1 Mobile applications (apps), are a potential avenue to improve commu- nication and effective diabetes management as emerging adults are transitioning to independent monitoring.

In the past decade, there has been tremendous growth in the field of mobile health (mhealth), particularly for diabetes self-management. Mobile phone applications (apps) designed for diabetes self-management have a broad range of features, which can include options for logging blood glucose (sometimes directly from a glucose monitor), logging diet and exercise, assisting with insulin dosing and medication adherence, and sharing the data with others, including one’s provider.2 Additionally, evaluations of these mhealth tools for diabetes management have demon- strated efficacy in several contexts and trials.2 However, few reviews of diabetes apps have high- lighted the specific need and usefulness of these apps among emerging adults, many of whom are millennials, and represent some of the highest frequency users of mobile apps.3 An estimated 95% of teens have smartphone access, and this is consistent across socio-economic groups, genders and racial/ethnic groups in the U.S (see Figure 1 for details on internet usage among this demographic).4

Further, in a nationally representative survey of 1,337 young people aged 14–22, 64% reported using

CONTACT Jennifer Schindler-Ruwisch jschindler-ruwisch@fairfield.edu Marion Peckham Egan School of Nursing and Health Studies, Fairfield University, Fairfield, CT 06824-5195, USA

INFORMATICS FOR HEALTH AND SOCIAL CARE 2021, VOL. 46, NO. 1, 56–67 https://doi.org/10.1080/17538157.2020.1837839

© 2020 Taylor & Francis Group, LLC

a health-related mobile app.5 Smartphone usage has increased from 73% of teens in 2014–2015 to 95% of teens in 2018.4

Literature review

In a study of 1,682 social media users living with diabetes, 1,179 (70%) utilized diabetes self- management apps.6 Among app users specifically, there were significant increases in self-reported blood glucose, diet, and physical activity monitoring, as well as cumulative self-care compared to non- app users.6 While the mean age of respondents in this survey was 39 years, and the majority of the sample was under age 40, there was no specific breakdown to highlight the utility of these applications for diabetes self-management among emerging adults.

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Figure 1. (a) Internet Usage by U.S. Teens (%); adapted from data from Pew Research Center.4, 1b. Smartphone Usage by U.S. Teen Demographic Groups (%); adapted from data from Pew Research Center.4

INFORMATICS FOR HEALTH AND SOCIAL CARE 57

Despite the potential utility of mobile apps for diabetes management, an international study of usability, found that many app users felt these mobile tools often were not user-friendly and lacked needed engagement-related features.7 Adult respondents surveyed (N = 217) indicated that younger adults were significantly more likely to utilize apps for diabetes management and that the most utilized features included trackers for blood glucose, blood sugar and calories; with the most useful features being blood glucose and calorie monitoring. Participants did note that they wished apps had improved functionalities including actionable reminders, and consolidated, customized options, reliable and current information, and simplicity of use.

Similarly, survey data from 746 adults across China living with diabetes utilizing the Unified Theory of Acceptance and Use of Technology found that intentions to use diabetes management mobile apps were most related to performance expectancy (perceived usefulness of the app) and social influence of providers, family members, or important others (subjective norms).8 These results suggest that if diabetes self-management apps are perceived to be useful and recommended by key people, that their uptake and intended use may improve. While there exists a myriad of diabetes self-management apps available for download by interested patients, many are not meant to be stand-alone tools, but rather a complement to in-person clinical interactions.9 Health practitioners can act as key players in helping refer patients to relevant and credible mobile apps to allow for increased engagement and monitoring in a variety of settings.9

When looking at adolescents specifically, apps designed for efficiency, and with relevant social outreach were most appreciated among a small focus group and highlight the importance of apps specific to the targeted needs of the younger population living with diabetes.10 Understanding features most relevant to a younger population, including use of color and ease of navigation, easy data entry (not manual), and capability to share with parents, may be unique to this population, but highly relevant in encouraging app use and self-monitoring. A related qualitative study of young people (aged 15–23) living with diabetes in Denmark looked at their utilization of a mobile app (Young with Diabetes) designed by and for young people.11 Again, youth highlighted the importance of sharing features, that allowed communication with peers, parents, and health care providers to assist with diabetes self-monitoring. Youth appreciated having chat rooms within the mobile app, having all of their self-management data in one location, and simple (informal) ways to connect with health providers in between appointments, which added to collective support.11

Features that may be relevant to diabetes self-management are not necessarily helpful to emerging adults transitioning to more independent diabetes management (i.e., students leaving home, going to school etc.). For example, in one analysis, not specific to emerging adults, the authors reviewed 201 diabetes self-management apps and found that of 15 desired functions, none covered all the necessary features.12 While about half of the reviewed apps had functions surrounding medication, self- management, and diabetes education, only 25% had the ability to share data with one’s provider or provide notifications, and only 14% had the option to work with a local device. The authors concluded that the diabetes apps were largely informational and served basic tracking functions rather than providing the comprehensive tools and features needed for self-management. Further, they posited that a standard baseline set of criteria should be used to develop apps to prevent repetitive apps that lack core features.

A summary of systematic reviews on diabetes app efficacy (n = 6 for Type 1 diabetes; n = 5 for Type 2 diabetes) found that several apps, supplemented by provider support, may help improve HbA1C levels for both of these types of diabetes but, usability (i.e., navigation by users) was mixed among adults.13 A meta-analysis of efficacy studies (randomized controlled trials, specifically) on diabetes mobile apps included 18 studies that covered Type 1 (n = 5), Type 2 (n = 11) and pre-diabetes (n = 2). The results of the meta-analysis14 on a key diabetes outcome (HbA1c) found statistically significant improvement for those with Type 2 diabetes (both in the long and short term). Outcomes for the other diabetes types were inconclusive and not specific to any particular age group.14

Another systematic review of literature focused on mobile applications with integrated (patient- provider) communication features for diabetes management found that few methodologically rigorous

58 J. SCHINDLER-RUWISCH AND A. PETERS

studies are available on this topic and likewise that few studies highlight apps with integrated features to communicate directly with health providers,15 which is of special utility to younger users. Of the available and relevant studies, three highlighted the significant impact of integrated app-based provider communication. However, in most apps uncovered, if health provider feedback was provided within the app, it was typically an automated reply, which has limited utility.

Several diabetes apps have been evaluated systematically. For example, the SocialDiabetes App was analyzed to see if the frequency of app usage affected patient outcomes among a group of adults (over 18) who had diabetes for at least 1 year.16 While results were slightly better for users with Type 1 versus Type 2 diabetes, there were significant improvements in blood glucose across all of the groups studied, regardless of app usage frequency.16 The SocialDiabetes platform includes remote monitoring, insulin dosing, HbA1c estimation tools, diet tracking, and carbohydrate calculators, reminders, and the ability to connect with one’s provider.16 The authors suggest that while app use can be continuous and consistent, the usage of such tools may promote diabetes self-management beyond the frequency of use of the app itself.16

A content analysis of “best diabetes apps” in 2017 used Google to come up with 4 papers in which the author discussed 26 apps.17 The identified apps (of which only half were completely free) were then reviewed for medication, blood glucose and weight management functions, and exercise/diet features. In total, most had blood glucose monitoring features (67%) and diet tracking features (79%), but fewer had the remaining features. The authors ask, as noted above, whether apps with just a few diabetes features truly offer sufficient diabetes self-management support. Further, none of these apps specifi- cally consider the population of emerging adults, who may require additional familial monitoring and data-sharing capabilities.

The Association of Diabetes Care and Education Specialists (ADCES) also helps promote quality app selection through their program Danatech. Danatech provides a library of enhanced consumer reviews including the Association of Diabetes Care and Education Specialists’ customized reviews highlighting information such as literacy level, interactivity, and information sharing.18 While a very useful repository of vetted mobile resources, this subscription platform does not explicitly highlight specific functionalities or app features that may further assist emerging adults and their families in selecting the most appropriate app for those transitioning to independent diabetes monitoring, including shared data monitoring.

The results of this literature review are summarized in Table 1, and demonstrate very few studies on diabetes apps relevant to emerging adults. The purpose of this paper was to systematically review mobile apps that may have features relevant to helping emerging adults, individuals aged 18–25, manage their diabetes as they transition to independent diabetes monitoring. An independent review of apps from the GooglePlay store was undertaken to better elucidate key features that may have particular relevance to this population, such as sharing and dual-monitoring capabilities with parents and caregivers. In addition, criteria for the evaluation of, and reporting on, mobile apps were reviewed and adapted from a variety of sources.19–22 In particular, several elements of the Mobile App Rating Scale (MARS), which was recently devised to help better assess mhealth app quality,23 were employed to enhance application evaluation.

Materials and methods

The Google Play store was systematically searched (from a location in the U.S.) for apps with the following search criteria, “diabetes AND management OR log OR tracker,” with at least 4-stars and free to download to capture high-quality and accessible diabetes management apps. Next, app landing pages were reviewed to ensure they met the following inclusion criteria: 1) English language, 2) specific to diabetes (any type), 3) includes a tracking mechanism or log for blood sugar, and 4) and a way to track diet (for insulin dosing). Whether each app met the inclusion criteria was determined based on the app store landing page, which included a description and screenshots of the application.

INFORMATICS FOR HEALTH AND SOCIAL CARE 59

Two independent reviewers, using a common codebook, reviewed all application landing pages and associated screenshots, between June–September 2019 to ensure there were none erroneously excluded. Any errors or questionable apps were marked, discussed, and reconciled based on codebook definitions. Of the final included applications, each independent reviewer cataloged the following information for half of the apps and then systematically and thoroughly checked the others work for confirmation: app category (i.e., Medical, Health & Fitness), author/creator, country of origin/lan- guages offered (other than English), version, year created/updated, GooglePlay rating (stars and by how many people), download/install frequency, group target/diabetes type (if specified), and several additional features adapted from the Mobile Application Rating Scale (MARS).23 Since the apps were not individually downloaded, not all the MARS questions were applicable, but generally, the main content areas were reviewed for engagement (interactivity, customization), esthetics/graphics (and level of quality), and information/credibility/accuracy (sourcing). For example, if the app had any interactivity (games, responses, customization) other than basic tracking and reminders, the app was given credit for interactivity. Esthetics and graphics quality were rated as low/moderate/high quality depending on the type of imaging (clip art versus photographs) and the use of icons/symbols and color contrast. Finally, the source was noted for each app (if any) and categorized by credibility (i.e., government organization or nonprofit versus independent developer). All MARS items relevant to these categories are summarized in Table 2. If the app was in any way specific to emerging adults, this was noted, and if the app had sharing ability to link data to family, friends, providers or a device, this was also cataloged, as this is relevant for communication and transitioning to independent monitor- ing. Finally, the type of blood sugar and diet tracker were noted (i.e., graphically, manual entry, database of foods/bar code) as well as any referrals to additional support or resources. In August 2020, all included apps were re-reviewed for currency and any notable updates are highlighted in Appendix 1.

Results

In total, 189 unique apps were found in the GooglePlay store using the search criteria. Three apps were excluded as they were no longer available 2 months after initial data collection, nine apps were excluded because they were not in English, 12 included apps did offer translations or international versions), 94 apps were excluded because they had no blood sugar tracker, 127 apps were excluded because they had no diet tracker, and three apps were not specific to diabetes (not mutually exclusive). A total of 86 apps were excluded for multiple reasons (most frequently, missing both a diet and blood sugar tracking function). Further, nine apps were excluded because they had a “freemium” or paid version of the app that was necessary to access all the inclusion criteria. In total, 157 apps were excluded (see Figure 2), and 29 apps (see Appendix 1 for a complete list of apps) were included for further review. The two independent coders had 95% agreement in codes after dual-review.

Table 3 includes descriptive characteristics of the apps with their categorization in the app store, the year the app was last downloaded, rating (out of 5 stars) and download frequency. As indicated, most included apps (n = 20) fell into the “Medical” GooglePlay category, but several were categorized as “Health & Fitness.” The majority of apps (n = 17) were last updated in 2019, but several were updated years earlier (2013–2018). Most apps received a 4-star rating (n = 24). Two apps received a perfect 5-star rating, but the rating is based on number of reviews and these two apps had only 9 and 13 reviews, respectively. Other included apps had anywhere between 12 and 29,205 reviewers rating the app. While only apps above a 4-star rating were originally searched, three apps dropped below the 4-star rating during the review period (two apps to 3.9 stars and one to 3.6 stars). Finally, the GooglePlay store categorizes the install frequency to estimate user number in categories as depicted in Table 1. As shown, 6 apps were downloaded 1000 times or less, 10 apps 5,000–50,000 times, and 13 apps were downloaded over 100,000 times. One app was even downloaded over 1,000,000 times (mySugr).

60 J. SCHINDLER-RUWISCH AND A. PETERS

Most the apps were relevant for individuals with any type of diabetes (pre-diabetes, Type 1, Type 2, or gestational diabetes), although some apps specified they were targeted to Type 1 and Type 2 diabetics only (N = 2). One app was targeted specifically for Type 2 or prediabetes only, and one app was designed specifically for Type 1 diabetes. Of the 29 apps, only one app had any features that were specifically relevant to emerging adults. This one app, Dario, had a “hypo alert” feature, which was specifically designed for parents and caregivers with diabetic children, to automatically send a GPS location via text-message to four emergency contacts when a low blood sugar level is recorded. Additionally, 20 of the 29 apps had some type of sharing feature that a user could download or directly share a copy of their logs (diet, blood sugar, etc) with a family member, provider, or friend. Several apps had options to directly e-mail a provider, while others required a user to download a PDF or CSV file that they could share. Only 12 of the included apps linked directly with an accompanying glucose, insulin, or related medical device to track and automatically populate data. Of these 12 apps, several connected via Bluetooth, and others were only compatible with certain device systems.

The type of diet and blood sugar logs available were varied in terms of features and capabilities. For example, 23 apps had some type of blood sugar graphing function, whether the graph came directly from device data or was based on manually entered blood sugar levels. For the diet trackers, many required manual entry (N = 20), several had the option of selecting foods from a pre-populated food database (N = 7), and a few had barcode scanning capabilities to detect and log food items (N = 2). Additionally, a few apps had the ability to upload your own images of the food, in addition to a manual entry (N = 3). Several devices had additional features such as linking with fitness trackers, syncing over multiple devices, personal coaching, analysis of data trends, bolus calculators, and reminders to take/ record readings.

An abbreviated version of the MARS scale was used to look at the app features related to engagement, esthetics/graphics, and information/credibility accuracy. For engagement, only nine apps had any interactivity (i.e., games, responses, customization) other than tracking (trends and reminders are not included here). Further, while most apps had graphics of some kind, only five were deemed high quality with clear modern images and color-coded icons. Six had basic icons or clip art, nine had basic icons and some color contrast, three had color contrast, and six had no/limited color contrast. Finally, most of the app creators were individuals or private companies and the included

189 unique apps in Google Play 3 no longer available

186 apps total

Excluded apps: 9 apps non-English 94 no blood sugar tracker 127 no diet tracker 3 not specific to diabetes 9 diabetes features not free

86 apps excluded for multiple reasons:

72 no blood sugar or diet tracker

2 non-English/no diet tracker

7 non-English/no diet tracker/ no blood sugar tracker

157 apps in total excluded

29 included apps

1 no blood sugar/diet tracker/freemium 4 no diet tracker/freemium

Figure 2. Exclusion Criteria for GooglePlay apps.

INFORMATICS FOR HEALTH AND SOCIAL CARE 61

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62 J. SCHINDLER-RUWISCH AND A. PETERS

information and related accuracy of app content are largely unknown. Of the remaining, one app creator stated they partnered with the American Diabetes Association (ADA) and one claimed to follow ADA guidelines. Another creator stated that their app was designed based on the Diabetes Prevention Program (DPP) study. One app was developed by people living with diabetes and three were designed or led by a diabetes/health group or hospital system. Several apps carried other endorsements that may improve their public credibility, such as being featured in ADA’s Forecast magazine or being highlighted on Healthline’s Best app list. Otherwise, few apps had real evidence- based backing, sourcing, or other visible credibility.

Based on the overview of included characteristics and features, apps that met at least one of the MARS criteria and have either, a way to share data with caregivers/providers, or link directly to a device are depicted in Figure 3 with additional and relevant features. Four apps met two of three

Table 3. Descriptive Characteristics of Included Mobile Apps (n = 29).

App Feature Frequency n(%)

Category Medical Health & Fitness

20 (69.0) 9 (31.0)

Last Updated Year 2013 2016 2017 2018 2019

1 (3.4) 1 (3.4)

5 (17.2) 5 (17.2)

17 (58.6) Rating (out of 5)

5 stars 4 stars 3 stars

2 (6.9) 24 (82.8) 3 (10.3)

Download Frequency/Installs 50+ 100+ 500+ 1000+ 5000+ 10,000+ 50,000+ 100,000+ 500,000+ 1,000,000+

1 (3.4) 2 (6.9) 1 (3.4) 2 (6.9) 1 (3.4)

5 (17.2) 4 (13.8) 9 (31.0) 3 (10.3) 1 (3.4)

Table 2. MARS Criteria Utilized for Included Mobile Apps.

MARS Category MARS Questions Utilized Original MARS Questions23

Engagement/Interactivity Does the app have any interactivity (games, responses, customization?) other than basic tracking functionality (trends and reminders not included)?

Interactivity: Does it allow user input, provide feedback, contain prompts (reminders, sharing options, notifications, etc.)? Note: these functions need to be customizable and not overwhelming in order to be perfect.a

Esthetics/Graphics Are there graphics in the app? Quality low or high (icons, color contrast, clip art versus photograph or quality stock image, busy or clear, graphing features)?

Graphics: How high is the quality/resolution of graphics used for buttons/icons/

menus/content?b

Information/Credibility/ Accuracy

Is there a source for the content? Is it credible/ accurate?

Credibility: Does the app come from a legitimate source (specified in app store description or within the app itself)?c

aPart of 5-item engagement scale bPart of 3-item esthetics scale cPart of a 7-item information scale

INFORMATICS FOR HEALTH AND SOCIAL CARE 63

measured MARS criteria (mySugr, One Drop – Diabetes Management, Glucocare, and Habits Diabetes Coach) and one app (Glucocare) met all three MARS criteria. As illustrated, only half of the top ten apps highlighted have a known, credible source for the content within (Dario, Glucocare, Habits Diabetes Coach, Diabetes Plus and DIABNEXT). All but three of the top 10 apps link directly with a device for insulin monitoring (Sugar Sense, BG Monitor Diabetes, Habits Diabetes Coach). While several apps engage users through a mixture of challenges, tips, discussion boards, community blogs, media, and coaching, three of the top 10 apps are only offer one-way interactivity (Dario, BG Monitor Diabetes, Diabetes Plus). All of the top 10 apps have the ability to share data with a caregiver or provider, an important feature for emerging adults, but as noted, only one app has any additional functionality (GPS locator) relevant to the emerging adult population, specifically (Dario). As shown in Figure 3, visually, not one app scored positively on all relevant features.

Discussion

Mobile apps for diabetes self-management are a promising tool for people living with diabetes and diabetes educators. Apps can supplement in-person care and help bridge gaps between routine provider visits and medical care. Navigating the landscape of available diabetes apps can be over- whelming based on the sheer quantity and variable quality of the apps. The final list of suggested apps described herein differs from apps listed in common searches like “Healthline’s Best Diabetes Apps of 2019.”24 While many of the apps included in such lists were reviewed in this content analysis (not all were freely available), only three of Healthline’s 13 made our top ten list (MySugr, BG Monitor Diabetes, Sugar Sense). These three apps had great variability in available sourcing, credibility, engagement, quality graphics, and the ability to link with a medical device. One app (mySugr) was also reviewed in previous

Figure 3. Key Features of Selected Apps (n = 10).

64 J. SCHINDLER-RUWISCH AND A. PETERS

research, and found to be most popular among a large sample of people living with both Type 1 and Type 2 diabetes who indicating that tracking blood sugar and diet were the most useful features of an app.6

This study also found many other apps that overlapped with the apps discovered in this review, highlighting that these apps are not just available, but commonly used by individuals living with diabetes. This review serves as a starting point to guide educators and people living with diabetes to higher quality apps and to understand the limitations inherent to the apps available.

There are limitations to the methodology described herein, mainly that apps were not individually downloaded due to device constraints. However, the review of app content using the landing page is consistent with the strategy used in similar content analyses12,17 and representative of the information a user would have at their disposal prior to downloading an app. Further, only free apps were reviewed to understand which apps would be accessible to all users, but it is possible that apps with paid features or upfront costs may have additional features and functionality. Including only free apps can be useful for widespread distribution to various populations who are looking for no-cost supplemental options for diabetes self-monitoring. Likewise, the app store search was limited to highly-rated apps to help ensure the top user rated results were included in this review, indicating that there are likely many additional apps with even fewer features and functions. The GooglePlay store was chosen for this content analysis because Google has the majority of the market share worldwide in this mobile arena,25 and because the iTunes app store cannot be searched with multiple Boolean operators as is typically necessary in a content analysis.20 Additional apps may be available in the iTunes store that were not included here. Users with varying mobile technology (i.e., Apple versus Android devices) may not be able to access all of the apps included in this review. It should also be noted that the GooglePlay store does not check the quality of apps in advance of posting them,20 this burden falls on the user to evaluate. Further, research indicates the need for constant review and re-assessment of mobile apps and features due to the constantly evolving mobile landscape, updating of features, and changing mobile offerings.20 While the mobile apps included herein were first vetted in 2019, the authors re-vetted the included apps in 2020. While most apps remain current, the authors suggest another formal app analysis is undertaken in two to three years to highlight any additional changes in the app marketplace and improved technologies that may be available. The authors would also like to note that health literacy of the included apps was not assessed as part of this review, and this is something important to consider when disseminating mobile apps to a variety of audiences, so could also be part of a future review.

Conclusions

Few apps exist specifically for the emerging adult population, with features that enable family and caregivers to help support independent diabetes monitoring in a variety of settings. In total, only one app was found with any features that were specifically relevant to emerging adults. Further, almost 70% of included apps has some type of data-sharing feature, which has potential utility for emerging adults, but which could benefit from more integrated communication with parents or providers directly rather than limited options to download data files or send an e-mail. Manual entry was a common way to update app information, but as noted in the literature,10 younger people prefer more automated entry and technol- ogy exists to allow blood glucose data directly from a device, Bluetooth functionality for merging device data, and scanning of foods or databases for relevant caloric or meal content. Only one app met all three MARS criteria for usability, including features of particular relevance to emerging adults such as engagement and esthetic features.7,10,11 Further, few apps had credible backing or evidence-based documentation, highlighted a critical concern for ensuring emerging adults have access to the most reputable and dependable diabetes management software and further documenting a need from the literature for more evidence-based review of mobile applications.15

Ongoing review of new and emerging apps with improved functionality, evidence-based content, and app usability, specifically for emerging adults, are needed. Further, additional effectiveness studies that review the impact that these tools can have on diabetes management and outcomes are also

INFORMATICS FOR HEALTH AND SOCIAL CARE 65

warranted. Additional app development or supplemental functionality specific to the emerging adult population should be considered by developers and health professionals.

Acknowledgments

The authors would like to acknowledge Sally Gerard and Christa Esposito for their review and support.

Declaration of conflicting interests

The Authors declare that there is no conflict of interest.

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Appendix 1.

List of Included/Reviewed Apps

mySugr- https://play.google.com/store/apps/details?id=com.mysugr.android.companion Diabetes:M- https://play.google.com/store/apps/details?id = com.mydiabetes Dario: Diabetes Management Simplified- https://play.google.com/store/apps/details?id = com.labstyle.darioandroid ForDiabietes: diabetes self-management app- https://play.google.com/store/apps/details?id = gr.tessera.

fordiabetesapp Glucose buddy diabetes tracker- https://play.google.com/store/apps/details?id = com.skyhealth.glucosebuddyfree Diabetes, blood pressure, health tracker app1- https://www.amazon.com/Justin-Taylor-Diabetes-Health-Tracker/dp/

B00WKU1D2W One Drop- Diabetes Management- https://play.google.com/store/apps/details?id = today.onedrop.android Sugar sense- Diabetes app2- https://diabetespedia.com/mobile-apps/sugar-sense/ A1C Blood sugar calculator tracker diabetes app- https://play.google.com/store/apps/details?id = com.procyoncon

sult.a1cconvert Glooko- Track Diabetes Data- https://play.google.com/store/apps/details?id = com.glooko.logbook OnTrack diabetes- https://play.google.com/store/apps/details?id = com.gexperts.ontrack Diabetes Connect- https://play.google.com/store/apps/details?id = com.squaremed.diabetesconnect.android Cornerstones4care diabetes app- https://play.google.com/store/apps/details?id = com.glooko.novo BG monitor diabetes- https://play.google.com/store/apps/details?id = com.wonggordon.bgmonitor Glucocare- A diabetes management app- https://play.google.com/store/apps/details?id = com.ihealth.iglucopro Habits Diabetes coach- https://play.google.com/store/apps/details?id = com.janacare.habits Diaguard: Diabetes Diary- https://play.google.com/store/apps/details?id = com.faltenreich.diaguard GLog: Glucose logbook for diabetics- https://play.google.com/store/apps/details?id = com.stelladomus.glog Gluci-chek- https://play.google.com/store/apps/details?id = com.roche.glucichek Diabetic’s logbook- https://play.google.com/store/apps/details?id = com.doctorkalina Diabetes plus- https://play.google.com/store/apps/details?id = com.squaremed.diabetesplus.typ1 DSM Diabetes self management- https://play.google.com/store/apps/details?id = com.ionicframework.dms689197 Glimp- https://play.google.com/store/apps/details?id = it.ct.glicemia Dottli: Diabetes made simple- https://play.google.com/store/apps/details?id = com.modz.app ManageAm App- https://play.google.com/store/apps/details?id = com.app.shei.manageam Betes- your diabetes diary- https://play.google.com/store/apps/details?id = com.dev.matte.sugarlog GluQUO: Control your Diabetes3- https://apps.apple.com/app/gluquo/id1187195552 Kyorr- https://play.google.com/store/apps/details?id = com.istrategyweb.kyorr DIABNEXT make your Diabetes management easy- https://play.google.com/store/apps/details?id = com.diabnext.

diabnext 1As of August 2020, available for download on Amazon.com for Android devices under the name “Diabetes Health

Tracker” 2As of August 2020, not available in U.S. store, but still available internationally 3As of August 2020, only available on iTunes store

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