test drive July/August, 2009

This issue, we thought we’d have a Test Drive “in the making” to try to sort out what technology readers enjoy using to help manage their diabetes. Please write us at feedback@diaTribe.us if you can tell us about an application you like! Just now there’s a great deal happening with technological development in the diabetes field, which is good to see for all whom have been watching the integration of multimedia and personal medicine. Recently, we asked all of you which technology and apps you like and don’t like and this is what we’ve heard so far… to be continued as we update this over time!

As we started to navigate this topic, we thank many in the community who weighed in on this topic, especially Manny Hernandez of tuDiabetes. His site was very helpful on iPhone and iPod Touch apps and we recommend visiting that here for an ongoing discussion - thanks so much for providing a place for so much interesting input Manny! In connection with that, here is a place on tuDiabetes to read more about online blood glucose monitoring tools.

The Good…

• iFitness ($1.99): We at Close Concerns are already big Mac fans, so it’s comes as no surprise that we’re fond of this great new application for iPhone and iPod Touch users. This popular application has a clear, simple display that we heard was top-rate – from one of the keenest doctors on our advisory board! He tells us it features an extensive list of exercises by muscle type (wow, pretty specific…) and a custom workout creator (I need this!), in addition to set workout routines. For anyone who doesn’t feel like employing a personal trainer or looking up new exercise techniques before hitting the gym, this application may just be your new best friend – after hearing so much on this one, I’m excited to check it out, especially since I need a lot of help in the discipline department. I look forward across the board to seeing more apps on the exercise front that can get and keep me more motivated. (And yes, I personally love pedometers, speaking of fitness and basic information, but I keep either breaking or losing the ones that I’ve purchased. Kaku got me into walking more after his Test Drive in issue #7 – if you have a pedometer that you love, let me know!)
• WaveSense (FREE): This application received quite a bit of attention on the web of late and in the exhibition hall at AADE 2009. Amy Tenderich of Diabetes Mine provided an excellent recent review here, pointing out that WaveSense was ahead of the curve by creating mobile apps for easy data management and connectivity – this is definitely still an “unsolved problem” in diabetes management. This app also received some excellent reviews from various bloggers at the Roche Summit – and some recommendations on how others who don’t have an iPhone or iPod Touch could use it. From our view, although it has features similar to other applications, its real stand-out quality is the user interface. As others wrote, unlike some of the other diabetes loggers for the iPhone/iPod Touch, this app has a very intuitive system of navigation and data entry as well as an attractive visual theme (which can be changed to suit your taste). Each entry of your blood glucose can be associated with the number of carbohydrates you have eaten, the amount and type of insulin administered, and typed notes – and what we really liked about the digital logbook was that it also gives you the option of noting things like whether you’ve missed exercise, skipped a meal or eaten fattier food, or miscalculated your carbs—things we all do, but might not get to record on more basic applications (see below). As with others we’ve liked, WaveSense’s iPhone application is easy to use and has a simple, uncluttered display. You can also view graphs that display your readings over any given amount of time. One particularly handy feature is that you can see your average readings (with standard deviation for those who know their statistics) over different periods of time, divided into the time of day (i.e., pre-breakfast, post-breakfast, post-dinner). This is handy to check for patterns in the deviation of your blood sugar over the course of the day. Also included is a feature to send your readings to somebody, such as your healthcare team (though really, with all these apps – we’re not sure how many healthcare teams will want all the information so we liked best the ones where it was easy for us to use the information). Overall, this was the easiest and most enjoyable to use, and we think it is great that the company is still working to improve it – send them your input at http://www.wavesense.info/iphone. WaveSense has said that future versions will have the capability of synchronizing with their meters, which would be MUCH more convenient than entering them manually. And, many thanks to WaveSense for making this free - overall, big kudos to WaveSense for really thinking this through and thanks for so many bloggers for great updates on this one. See Bennett’s—the blogger behind Your Diabetes May Vary—view here.
• Diabetes Pilot ($11.99): This tool for the iPhone and iPod Touch is the most advanced of the applications we tried, but this also comes at the expense of a slick user interface and, well, $11.99. For the extra money, you get the ability to track (in addition to the parameters mentioned above) blood pressure, weight, any medicine, and your nutritional intake using a very sophisticated food-entry system. In addition to standard carbohydrate counting, Diabetes Pilot can assemble the nutrition facts of a meal based on its components. You need to enter what the meal contained (for example: one teaspoon of oil, one pepper, and 100g chicken) and the program will estimate the total carbohydrates, fiber, sugars, fat, saturated fat, protein, calories, calories from fat, sodium, and cholesterol from an internal database of nutrition information. Wow! This can be a huge advantage for people counting not just carbs, but calories and fat as well. Unfortunately, this adds quite a bit of time to each entry, so only those willing to spend a few minutes after every meal would find the program useful for tracking. However, we believe that this feature is also very handy for meal planning, so some people may also find this tool an advantage when deciding on recipes.
• PocketAid – This provides a place to put medications, doctors’ phone numbers, contact numbers, etc – not specifically for diabetes, but won praise from tuDiabetes members.
• Restaurant Nutrition – This is good for decoding the nutrition facts of restaurant chains.
• And, exciting! One member of TuDiabetes said that he had been in touch with Calorie King to see if they could make an iPhone or iTouch application and he says they are working on it. That would be great.
• Diabetes Daily Tools (FREE – for now!): David and Elizabeth Edelman, of the Diabetes Daily blog, recently unveiled the beta version of Diabetes Daily Tools. These are management tools that you can use to add or import your glucose information (they’re compatible with over 20 different glucose meters), track glucose and insulin levels or your medications, and chart your glucose and insulin information over time. Right now these tools are free and are available in BlackBerry, Palm, and iPhone format – since they just came out, I haven’t been able to try this yet on my BlackBerry, but I’m certainly looking forward to it and I’ve heard positive early remarks! These tools are co-hosted by HealthEngage, meaning that you can check out what others in the online diabetes community are doing with their diabetes and get snapshots of community health around the world – this should be most interesting to see. In short, anything that makes logging more interesting and easy seems to receive positive votes, so we look forward to learning more… check these out at DiabetesDaily.com/tools/.

The Mixed:

• DiabetesLog (Free), Diamedic ($5.99), and GlucoseCharter ($0.99): These iPhone applications are more directed toward diabetes, but we’ve heard mixed reviews for all three. The main complaint for these applications is that they’re all manual entry, which (as we’re sure you know) can become tedious. DiabetesLog is a very basic (free) application that gives you the option of logging your meals, glucose, and insulin; Diamedic is more extensive, and you can record exercise and medication in addition to charting your stats. GlucoseCharter delivers the same features as DiabetesLog in addition to giving out diet advice for diabetics. As a whole, we think these could be useful but that there are definitely better applications out there.
• Islet ($2.99): “Islet” shares many of the features of WaveSense, but in a somewhat less glamorous package. You can record your glucose, insulin and carbohydrates easily, and you can chart the results. This program additionally allows you to record your levels of physicial activity, specifying the duration and level of exercise. This is a handy feature for athletes with diabetes who need to keep track of how exercise affects their blood glucose levels and plan accordingly. A unique feature of this program is its simple local backup system. By downloading a small application to your Mac or PC, you can easily synchronize your data from Islet to your computer and restore it as necessary. So if you lose your iPod or need to erase it for any reason, you can quickly restore your collected data.

And the Bad:

• Most of all, what we learned a lot from the blogs and social networks out there (especially tuDiabetes!) about what people do not want. Manual entry is a negative – many do not want to have to put numbers that automatically go into their meter into another device – though some see the benefit of doing so, many noted a lot of fatigue. We encourage more work on mobile applications and on all technology that makes diabetes management easier. More on Bluetooth please!
• Calling a spade a spade: Boy could I relate to this. Said star blogger Scott K. Johnson “I've tried so many different things, and I go strong for a while, then just get burned out. I think I've come to the decision that there are no systems that are awesome, because logging diabetes SUCKS! It's nothing to do with the applications or programs - but rather the daunting task of tracking everything we need to track!  It is such a difficult thing to do …” Continued Scott in a note a couple of days later: “The biggest challenge for me is accurately quantifying food.  I hate that it is so much work to measure and count everything! How do you track something like "ate some chips", much less bonus for them!” Scott, I definitely hear you. I’m hoping that since there are so many new mobile devices out that are connecting us far and wide, that a diabetes application really will emerge but I know it might be wishful thinking.
  
  Scott wrote me a couple of days later to say that what he had used most recently is an excel spreadsheet application that was written by Kevin.  It was (is) beautiful, he says: “I think what I liked the most about it was I could mold it to fit my diabetes lifestyle, versus trying to put my diabetes lifestyle into a box.  This system was also much easier to keep up with when I had a desk job.  I could just open it in the morning and keep it around on my desktop for updates through the day.  I would count on my pump memory to help me fill in the evening data sometime the next morning.”
  
  Continues Scott: “What I was going to say next is that I am on the move so much now that I just don't go in to update.  But that's a bunch of crap.  Logging my diabetes burned me out, and I haven't been back since.  It's a real catch-22 because I manage my diabetes so much better when I'm logging.  It seems that just the simple act of logging helps me make better decisions.  But it is so hard to keep up on.  Maybe I try to log too much information.  I mean, what good is a single blood sugar if I don't know the surrounding circumstances and variables?  So with that, I try to capture almost everything.  No wonder it burns me out!”
• LogbookFX Beta: This BlackBerry application seems, unfortunately, to be pretty clunky and inefficient! But if you’d like to try it out, download instructions are available here! Lee Ann Thill, of The Butter Compartment blog (check it out if you haven’t already right here) test drove this app on her BlackBerry and noted that it’s difficult to log even basics like the number of carbs in a meal without first entering other information; we’re going to try it and hope better apps will continue emerging on the BlackBerry side of things.