A customer looks at an iPhone 4 at the Apple Store 5th Avenue in New York June 24, 2010.Eric Thayer/Reuters
"All the kids have them." "I need it for my music." "My phone sucks." Kids are full of reasons why they must have the latest smart phone. But teens suffering from diabetes may soon have a rock solid case for an upgrade.
Starting next month, Toronto's SickKids hospital is hosting a medical pilot of a new iPhone application designed to help 20 children aged 12 to 15 with Type 1 diabetes manage their condition over the course of three months. The hope is that the app will help them better adhere to good health habits and manage their sugar levels more carefully.
Teen years mark "the difficult transition [from]childhood, where parents are mostly responsible for taking the readings and managing the insulin," says Joseph Cafazzo, one of the developers of the app. "They're starting to go out more often. They're also exerting their independence."
It's also when their blood sugar measures can skyrocket, says Prof. Cafazzo, who teaches at the University of Toronto medical school and is lead researcher at the Centre for Global eHealth Innovation at Toronto's University Health Network.
Unlike most diabetes apps, this one connects wirelessly to the patient's blood sugar monitor. After they prick their finger and use their glucometer, they send the info directly to their iPhone, which stores the data and tracks it over time. The app also allows users to enter other data, such as foods eaten, using the drag and click method. And it connects users to other young people with diabetes.
The app's interactive features are designed with teen behaviour in mind. For instance, the developers took a page from gaming and added in rewards. Kids in the Bant pilot project (named after insulin discoverer Frederick Banting, and an update of an adult app that does not connect wirelessly to a glucometer) will receive iTunes redemption codes every few days for taking their readings regularly.
Future models might include Farmville-style "gifts" - especially for challenging tasks, such as taking a blood sugar reading during school lunch hour, something some kids are loathe to do.
It's the latest in a booming area of health-related phone and PDA apps, many of them developed by programmers who suffer from the diseases. Popular programs offer help with diabetes, kidney disease, Crohn's and colitis - conditions that can require detailed daily logging. Although the cost of the hardware is still prohibitive to many, the apps themselves are mostly free or about $1.
Kimberly Brown, who lives in Markdale, Ont., has had Type 2 diabetes for about a decade. She's been using two diabetes programs, Livestrong, which focuses on nutrition, and Diabetes Diary on her iPhone for about two years.
She struggles to control her carbohydrate intake and has found the most benefit from the apps' calorie- and carb-counting features. As a result, she says, her blood sugar readings have come down over the past two years from a height of 24 mmol/L (millimols per litre) to the recommended range of 4-6 mmol/L.
"I really attribute that to some of these apps," she says. "If you're entering this information every day, you're more likely to control yourself. It's right in front of you."
She admits that playing with her iPhone is a pleasant distraction. "That's what we need. The whole diabetes thing is really depressing," she says.
Ian Roth, a colitis sufferer who lives in Toronto, feels the same way about an app he downloaded three months ago to help him manage his chronic digestive disease.
The GI Monitor tracks his eating habits and symptoms - and helps him plot his progress during flare-ups, which can last for months. In 12 years of trying to keep paper journals, Mr. Roth figures he's written in them a total of four times.
"Having it on an iPhone makes it - I hate to use the word - but almost fun," he says. "I don't think that I'm healthier because of it. I do think that I'm a bit more aware of what is having an impact on my systems."
For instance, Mr. Roth says that during a flare-up he often thinks he's starting to improve and takes risks, such as eating the spicy or greasy foods he knows trigger his symptoms. "The app allows me to see on a graph if I am actually making progress or if I've taken a step back."
Mr. Roth says he doesn't expect his physician to make much of it, though. "I won't be shy about showing it to him, but I'm not sure he's going to jump for joy to know that I've got it."
Indeed, some doctors are upfront about their distrust of hand-held helpers. Ian Blumer, a Toronto diabetes specialist who is active with the Canadian Diabetes Association, tells almost all of his patients to use old-fashioned pen and paper.
Diabetes apps might be convenient, says the author of Diabetes for Canadians for Dummies, "But most people don't use their blood glucose results to their advantage anyhow. So, whether you record your readings in a book or in an app or not at all won't make a difference unless you do something with the data. That's the biggest single shortcoming."
Dr. Blumer says he'd love to see an app screen pop-up that tells a patient: "Joe, this is the eighth day your blood sugar has been high before breakfast. Here are eight possible causes; make sure you do something about it!"
That's the hope of the new Bant pilot project. Prof. Cafazzo hopes the app will prompt children with questions such as "Why do you think your sugars are up? Did you eat something?"
The project is a collaboration between the UHN and SickKids with funding from the Saint Elizabeth Health Care foundation and technical support from Telus. If the pilot is successful, the group will conduct a wider trial while waiting for Health Canada approval - necessary because the app turns the iPhone into an actual medical device.