Hundreds of smartphone apps promise to make managing diabetes easier, but very few offer real-time guidance on what to do for dangerously high or low blood sugar, a US study suggests.

Researchers looked at 5,185 apps for phones running Google’s Android software or Apple’s iOS system. 

Out of this total, they found 371 apps that claimed to provide several key components for diabetes management: Recording blood sugar data; reminding patients when they need to do specific things to manage the illness; and educating patients on how to handle conditions like dangerously low or high blood sugar.

“People with diabetes will need to make many decisions relating not only to diet and lifestyle but also which medication to take and what dose depending on their blood sugar levels,” said senior study author Dr Josip Car of the Center for Population Health Sciences at Nanyang Technological University in Singapore.

“Apps could potentially support some aspects of self-management – if well-designed,” Car said by email. 

“But our study demonstrates the immaturity of diabetes apps and missed opportunities to improve care and health outcomes.”

The study focused only on patients with type 2 diabetes, the most common form, which is associated with obesity and aging and happens when the body can’t properly use or make enough of the hormone insulin to convert blood sugar into energy. Left untreated, diabetes can lead to nerve damage, amputations, blindness, heart disease and strokes.

Roughly one in 13 people with diabetes who own smartphones use an app to help them manage their condition, researchers note in JAMA.

Earlier studies suggested that using an app that supports blood sugar management may help people achieve lower blood sugar than they can on their own, the study team writes.

Every app in the current analysis allowed people to record blood sugar levels.

But just 37 per cent let people set goals like a target blood sugar level, and only 28 percent gave patients reminders to check their blood sugar.

Roughly 58 per cent of the apps alerted users when they had dangerously high or low blood sugar levels. But only 21 per cent of the prompts warning about low blood sugar offered suggestions for what to do about it, and just 15 per cent of warnings about high blood sugar gave this kind of guidance.

When people did get advice on how to handle dangerously low blood sugar, the apps suggested that people consume food, juice or sugar just about 14 per cent of the time – about as often as the apps advised patients to seek medical help.

With dangerously high blood sugar, the apps that gave advice told people to seek medical help about 13 per cent of the time, and proposed insulin about three percent of the time.

The study can’t prove whether or how apps might directly impact health outcomes for people with diabetes. Another limitation is that the apps were reviewed in December, 2018, and features might have changed since then.

“Smartphone apps can be a great way to track health data, but there are many inconsistencies, flaws, and shortcomings that need to be worked out,” said Dr Kevin Platt of the University of Michigan in Ann Arbor.

“There is tremendous variability in available apps, and there is minimal regulatory control to ensure content is accurate or efficacious,” Platt, who wasn’t involved in the study, said by email.

As the study shows, patients who rely on the apps for medical advice may not get what they need when they need it, said Sheri Colberg of Old Dominion University in Norfolk, Virginia.

“Many of these apps did have alerts for blood glucose out of range, but little usable advice to follow the alerts,” Colberg, who wasn’t involved in the study, said by email.

“For example, the message ‘seek medical help’ is not useful to most if they lack easy access to medical care or the financial means to do so,” Colberg added. “Self-management has been shown to work better but requires diabetes education not provided by most of these apps.”