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NUTRITION411: THE PODCAST, EP. 33

Useful Mobile Apps for People With Diabetes

Lisa Jones, MA, RDN, LDN, FAND

In this podcast episode, Lisa Jones, MA, RDN, LDN, FAND, interviews Rachel Stahl Salzman, MS, RDN, CDN, CDCES, and Livleen Gill, MBA, RDN, LDN, FAND, on useful mobile applications for people with diabetes, including ways to individualize the selection of apps for different populations, configure the apps to optimize health outcomes, and collaborate between clinicians and people with diabetes.

Additional Resources:

 

TRANSCRIPTION:

Jessica Bard: Hello and welcome to Nutrition411: The Podcast, a special podcast series led by registered dietician and nutritionist, Lisa Jones. The views of the speakers are their own and do not reflect the views of their respective institutions or Consultant360.

Lisa Jones: Hello and welcome to Nutrition411: The Podcast where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of a series of episodes on diabetes technology featuring a Q&A with Livleen Gill and Rachel Stahl Salzman. Welcome Livleen, and Rachel.

Rachel Stahl Salzman: Thanks so much for having us.

Lisa Jones: I'm excited about this episode. I want to take a moment to introduce each of you first. So I will start with Livleen Gill. Livleen is the President and CEO of Apostle Group, LLC, a consulting company that provides innovative solutions to clients in healthcare, food, and nutrition. She's also the CEO of Wholesome Village Company in Rockville, Maryland. Previously she was a private practice nutrition consultant for more than 20 years and a food and nutrition services director and outpatient dietician at Healthcare Centers in Maryland. She will serve as the Academy of Nutrition and Dietetics President in the 2024 to 2025 year.

Next, I want to introduce Rachel. Rachel is a registered dietician and diabetes care and education specialist in the Division of Endocrinology, Diabetes, and Metabolism at Weill Cornell Medicine in New York City. Rachel is passionate about empowering individuals to make sustainable lifestyle changes and leverage diabetes technology and digital health to improve their health and quality of life.

So again, welcome Livleen and Rachel.

Livleen Gill: Thank you.

Lisa Jones: Alright. Well, our next topic of discussion is apps. So let's get appy. For my first question, I want to know what are your favorite diabetes apps. Let's start with Rachel.

Rachel Stahl Salzman: That's always such a difficult question to answer and I do get that question quite a lot. So, I'm going to give it to you how I say is that I don't have one favorite app. Okay?

My reason is that it depends on the person’s understanding, their individual needs, what their individual preferences and treatment goals might be. When I think about different apps, I think about the categories. There are ones that are more nutrient-tracking apps, so if that's what the person's interested in and that could be helpful for them, there are a couple of apps and I'm sure Livleen will talk through some of them. Maybe there are some more aspects of glucose monitoring apps. Ones that are helping to take their glucose meter readings and putting it onto an app or CGM apps which are connected to the device, which can give people in real-time their glucose values. So, it really depends, and there's no one size fits all.

Lisa Jones: Yes, excellent answer. Because there really isn't. And that is a hard question, I realized after I asked it, to answer. I would have to specifically say if you have this patient and this is the case study, what app would you recommend? So, your last patient, last success story, what would you say was the app that their app of choice? Is that a better-phrased question?

Rachel Stahl Salzman: Or maybe I could just give an example of one app?

Lisa Jones: That would be great.

Rachel Stahl Salzman: Okay, so let's take for example a person who has pre-diabetes and they're really trying to monitor their meal plan and evaluate their nutrition, especially around carbohydrates and fiber. And they seem like someone who's really interested in number crunching and data. So, in that case, I'm thinking it sounds like they might be interested in tracking their meals, and they were. So, in that case, I think about some apps that have that meal-tracking component. And some examples that I think about are MyFitnessPal, Lose It, Cron-O-Meter, and LifeSum. There are a lot of different apps within that nutrient-tracking category, and a lot of them, for the basic version, are free. So, I often encourage the patient to try one or two and see which ones they like. Some have different interfaces or personalization options, so that could be an option for that particular example.
 

Lisa Jones: Alright, thank you. I do want to ask Livleen, what are your thoughts on this? Do you have a patient example that you would like to share with us?

Livleen Gill: I can say that the two main apps that we found our patients using and the dieticians who are supporting them using. One is MyFitnessPal. By far, most of our patients who are using an app, it's MyFitnessPal, and I think it's partly because they're familiar with it. They can track their exercise and nutrition, and their family members are probably also using it, so they feel comfortable with it.

The other app that I've seen lately that they're asking about is My Sugar. I know that tracks blood glucose and our healthcare professionals like it because there is a healthcare professional side of the report.

So, those are the two that I've seen in our practice being used. And it's again, as Rachel said, it depends on where the individual falls, what their preference is, what they want to use. And for us, they're the ones who are suggesting it and bringing what they're comfortable with.
 

Lisa Jones: And then I'm kind of thinking, as I'm listening to you talk about the different apps, I've heard of MyFitnessPal. But My Sugar… is that one a little bit newer of an app that is not as well known?

Rachel Stahl Salzman: That one has been out for a while from my knowledge, and like Livleen, I've had patients on it. It's evolved over time. And this one is a more diabetes-specific one. So, just a couple of days ago, I had a patient using it. She has the Freestyle Lite glucose meter, and it integrates with My Sugar. So, My Sugar integrates with different glucose meters, and I think recently, one of the CGMs offer that, not only the diabetes logging aspect but also food.

So again, I would say it's like taking it one level up from a MyFitnessPal, again, for a person with diabetes who also then wants to evaluate their glucose data and other factors alongside it. Right, Livleen? Have you found that helpful?

Livleen Gill: Yes, absolutely. And I know that's why I said my healthcare professionals are more partial towards that because the reports that are generated, those reports are specifically for them so that they can follow.

But those are the two that I've seen in our practice that are being used.

Rachel Stahl Salzman: And Lisa, I would add what Livleen is saying is that if the data can also get to us, that makes it like a slam dunk, right? Because the patient is getting the benefit of using the app that we might be recommending. But if that app could then provide clinician-specific reports or a way to share the data, even just being able to see what they're putting in it to help offer insights to help our medical-nutrition therapy and diabetes management, that really helps to elevate it. In addition to some of the food tracking apps, I've also found, and Livleen might also have experienced, are some apps that are more photo-based. And this has been helpful for the patients who aren't into nutrient tracking or necessarily need to track every single nutrient they're putting in. Apps that I love would be Under My Fork, in which users would take pictures of their meals, and it's connected for those using Dexcom CGM, so people could see the pictures in conjunction with their glucose values to really be able to see how did that meal affect their glucose values? Did it keep them in range? Did they have some hyperglycemia? What were the factors? And then from the provider perspective to be able to see the pictures of what they're actually eating really helps me so much in being more efficient and personalized with counseling.

Lisa Jones: And that's incredibly helpful too, listening to what you're saying about when it's connected, for the patient and the clinician because you have the data there. So, I think that's really helpful.

And then the other question that popped up in my mind was do you have a list for patients? Because that can be overwhelming. Which app did they choose? Do you have a list of apps and then you're constantly updating that list? Or do you just go on a case-by-case basis when you're working with patients?

Rachel Stahl Salzman: That's such a great question, Lisa. It's something that I've written articles with the ADCES in the practice group, and I feel like that's the next step–putting together a whole chart of the different apps and features. So stay tuned, it'll help hold me accountable. But at Weill Cornell, we just developed and updated a diabetes self-care booklet that's going to be accessible for all patients, inpatient and outpatient, across multiple sites in our hospital system. And we've added, as part of our big rehaul and update, we've added a section on apps because these should be considered as part of diabetes management. So we are actively building that.

Lisa Jones: Yeah, and you mentioned your article, Rachel, which leads me nicely to the fact that you've published an article in ADCES. It's called “Embracing Diabetes Apps in the Digital Age.” In this article, you discuss innovative approaches to empower people with diabetes to achieve positive clinical outcomes and improve their quality of life. I would love it if you would share with our audience the key learnings from your article for those who haven't had the opportunity to read it yet.

Rachel Stahl Salzman: Sure. Yeah, I'd be happy to give a quick snapshot of the article. So, the article is really geared toward the healthcare professional, the dietitian, the diabetes care and education specialists, and others about how we can support patients to use diabetes apps in a way that's going to best optimize their care. So, in the article, I talk about some different types of apps, different features around nutrition or diabetes-specific management, and how to really individualize the selection of apps to support them with some sample questions that you can even ask to help gauge their interest. Has the person ever tracked their health data on their smartphone? Have they used apps before? What's worked? What hasn't? That ultimately helps you to help to identify. So, really that's the first category.

The second category with the summary is really configuring it. So, once you've identified which app or which apps that person might want to try, I walk you through my process, mine and Dawn's, I did co-author the article with my colleague Dawn Noe. And we walk through a six-step process on how to individualize and rather configure the app to meet their goals and treatment plan.

And then lastly is thinking about collaboration. So, think of it again, identify, configure, and collaborate, and the collaboration we like to say is where that magic happens. How do we work with that person who's been doing great jobs and entering data or connecting devices and having those discussions to support shared decision-making to come up with goals and help really, again, I think it's individualizing, it's helping us to personalize goals and these apps can be great tools to help with that accountability between appointments where we might not have the capabilities and bandwidth to be checking in with them so frequently.

Lisa Jones: Yes, exactly. And that's wonderful to hear, and I really like the breakdown. We identify, configure, and collaborate. And I just want to hear Livleen’s thoughts from her perspective on identifying, configuring, and collaborating.

Livleen Gill: Lisa, I have to say I really enjoyed Rachel's article and the way it was all laid out. In fact, I shared it with my team to be able to come together and put a resource together for the clinic and so that they could follow those steps, because the way she's laid it out in the article and her co-authors, it's really great, and it's helped us considerably. So Rachel, thank you for writing that and sharing.

Rachel Stahl Salzman: Oh, so happy to hear. Thank you. It really is just kind of how as all of us, right, as we're practicing and in clinical care, how could we help to organize these workflows to really help support people?

Lisa Jones: Livleen, I love that you shared it with your team. That's fantastic to hear. And then Rachel, your article that you wrote is being shared, so that’s amazing as well.

Rachel Stahl Salzman: That's so nice. And I would add this ICC framework was actually created from ADCES. It was a framework created just in the past few years for integrating technology. So really, I took that framework that existed, that's been encouraged, and I applied it to the use of apps in a really systematic process. So, that was really a helpful, guiding force and thinking about technology integration.

Lisa Jones: And, dieticians love processed, s0, the fact that you did that is also another great thing.

Rachel Stahl Salzman: Thank you.

Lisa Jones: I do have another question too because all this talk about apps, I'm thinking about there's so much diversity with apps. Could you speak a little bit about apps that are geared for specific populations?

 

Rachel Stahl Salzman: Absolutely. So, there are now apps that are more fine-tuned within diabetes management. For example, there are some pediatric-focused apps. There's one that I was just reading about. It was in Startup Health Type One Diabetes Moon Shoot, which is an organization, a healthcare startup organization that is focused specifically on type one diabetes. And this app that's called E-D-E-D-I-I, and it's for pediatrics for people living with type one diabetes, so that really intrigued me. I don't work in the pediatric space, but I love that there are apps that are really honing in on specific populations. And in this example, really working on gamification and conversational tools embedded with the app to make, to kind of brighten the mood. You can only imagine how hard it might be for the patient, the family, and the pediatric world. So, I was excited to hear about that.

 

Lisa Jones: Oh, I love hearing that. And especially, too, the magic word that you said there was the gamification because especially in that population, that's really too for something that they had so motivating, especially if there are stars that they get or point-based or however they work it. But yeah, thank you for sharing that one. How about you Livleen? Anything that you want to share about an app that's for a specific population?

Livleen Gill: We don't have to recreate things. For somebody like Rachel who wrote that article on embracing diabetes apps, we took it and it's like we don't have to recreate things. So, for our population, the only thing that I would say that I haven't, at least in my practice or learning from my team, we haven't come across something that is a perfect app for our older adults. Now I'm talking about older adults who are now in their seventies and eighties in order to be able to embrace them and use it because they are not as technologically advanced or savvy or had to use it when they were younger. And I would like to see something in that age group come through, which is easy for them. Just like we have a Jitter Bug phone that is easy to do, and easy for them to use. Something like that, that would be easy for that population to use.

Lisa Jones: I love that. So, what I'm hearing Livleen is you're putting a call to action for someone that's listening to this to develop an app for that age population.

Rachel Stahl Salzman: And I think too, I've seen apps evolving to help meet those needs. They could be, that people can customize it maybe for someone who has trouble reading, it's too small on their phone, but has audible alerts or voice recognition to be able to log your food by just pressing a button and talking to it. So, those could transcend different ages and other factors too. So, it's been exciting to see how that's evolved. I also want to share one other exciting thing that I'm following in the app world, if that's okay.

Lisa Jones: Yes, please do.

Rachel Stahl Salzman: So, one area that I've been following in the app space is being able to take a picture of the food. So, we talk about older adults, and as just one example, how much easier it could be to take a picture of the food and can that app analyze the nutrition composition in an accurate way. This has traditionally been something that has been very challenging for app developers and apps to be able to do. I'm sure all of us, as dieticians, could imagine. How would an app be able to take into account if you put two tablespoons of sugar and coffee and you took a picture, how would it know that there's sugar in it? Really exciting to follow this app, Snap Calorie which uses innovative lidar technology, which is able to measure the depth and dimension of food along with AI algorithms and human reviewers for that added layer of confirmation. So, I'm excited to kind of see how this evolves and how logging food from our traditional entering every ingredient into an app and the portion to be able to simply take a picture to get an accurate amount of information. So, we'll see where that goes.

Lisa Jones: Yeah, that one sounds like an exciting development. I can't wait to find out more about it. I'm sure the next time we talk, Rachel, you'll have an update on that one.

Rachel Stahl Salzman: Probably.

Lisa Jones: Oh, well thank you both for sharing all about apps with me today. And I want to close out with what is your one biggest takeaway from our app discussion that somebody can do?

Rachel Stahl Salzman: My takeaway would be just to try an app out, download a few on your phone, try it out because the best way for you to feel comfortable to potentially recommend it or offer it as part of your dietician toolkit is to try it out yourself. So, that's my takeaway.

Lisa Jones: Oh, perfect. Thank you. Thank you, Rachel. How about you, Livleen?

Livleen Gill: I think there are lots of apps out there and there is one for everyone. They're evolving. They're not perfect. They're evolving, and I think they're going to provide us much better information and guidance in managing our nutritional needs, diabetes, and whatever we are looking to do.

Lisa Jones: Yes, that was well-rounded, and there's an app for everyone. So, everyone should just get “appy” then. Right. Thank you so much. Thank you.

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