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When a child gets diagnosed with type 1 diabetes these days, one of the first things parents do is go looking for useful smartphone apps to help manage the disease. Surprisingly, despite the huge number of diabetes apps available, those focused on the needs of children, parents and caregivers are scarce.

We’ve discovered three new apps that are helping to fill that void, by the names of Happy Bob, Emmett, and Invincible. Here are the details on each:

Happy Bob is an app designed to help young people (or anyone) with diabetes stay healthier and more motivated in their own care, using gamification and machine learning.

The app is connected to Apple HealthKit and streams CGM (continuous glucose monitor) data, but instead of showing a stream of dots representing glucose values, the readings are shown as stars that the user can “collect.” This makes the data look more fun, and offers a sense of accomplishment.

When you download Happy Bob, you need to connect the app with your CGM, so you can see your glucose value in stars. Tapping a star tells what your sugar value has been at a given time. You can select your own daily star target. Every morning you get a notification that tells you if your target was met and how many stars you collected the previous day. If you want, you can share your star score with other users.

Meanwhile, a simple smiley face of “Bob” guides you in diabetes care. For example, if your sugar is too low, Bob turns purple and notifies you to take action to make sure you stay safe. If your sugar is too high, Bob turns yellow and prompts with suggestions on how to bring your reading down, but in a fun way.

With Happy Bob’s personalized machine learning model, your past glucose data is used to predict future blood sugar levels two hours ahead. Recently the creators also added activity tracking in the app.

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The Happy Bob mobile app for iOS

The D-Mom behind “Happy Bob”

Happy Bob was created by Jutta Haaramo in Finland, which happens to have the highest incidence of T1D in the world. Her son was diagnosed with type 1 a little more than five years ago at 6 years old. She says that once they started him on an insulin pump and CGM, “diabetes diagnosis seemed to come with a presumption of some Excel, data management and engineering skills.” This is a lot to ask of many parents, she thought.

Also, the thought of looming diabetes complications was haunting, and Haaramo says her family was constantly on the hunt for new solutions, phone apps, and other help to make their lives easier. But all the available solutions were too complex or very technical, she explains, and that motivated her to create a “simple and intuitive” mobile app that might “take at least some of the mental load away from our lives.”

They designed the app and approach through a combination of their own experiences, as well as many discussions with people with T1D, diabetes nurse educators, doctors, designers, developers and pharma companies.

She says they chose the name Happy Bob because “we wanted to have a character the user can interact with.” She proudly notes that Happy Bob’s color and expression on your watch quickly inform you if your sugar is within range or if you need to take an action, and you can also check your sugar prediction and trend on the watch.

The app was recently nominated as one of the finalists in the Digital Diabetes Congress Mobile app contest.

Not just for kids

Happy Bob app on Apple Watch

“Even though we designed the app with kids in mind, a lot of our users are adults who like the motivating and fun approach we have to daily diabetes,” Haaramo says.

She says most users are currently from the US, but they also have European users. You need to have a CGM to use Happy Bob, and you can connect it via Apple Health, login with Dexcom or connect Nightscout.

“Our users tell us they use Happy Bob as it makes their daily life with diabetes a bit less stressful while helping them to stay in range,” she says, citing a quote from a user: “My favorite thing about the app is the comments that Happy Bob makes. When my blood sugars are in range, Bob is there to give me a compliment and make me feel accomplished. Meanwhile, when I’m out of range, Happy Bob gives me a comment that I can laugh at and remind me that my blood sugars will go back in range.”

One young user decided that Bob should be a little bit snarky as well as happy. Check out her video that led to some more realistic messaging in the app, here.

Where can you get Happy Bob?

The current version of the Happy Bob app, launched in August 2019, is available on iOS, iPhone and Apple Watch.

It is free for now on the Apple store, but eventually it will be available with a subscription model.

The still in-development app known as Emmett is designed and owned by Chicago D-Dad Dan Korelitz. It is named after his son Emmett, diagnosed with T1D at 11 months old in 2016.

Designed for both iOS and Android, the Emmett app connects to data from CGMs, insulin pumps, and other wearable sensors, and allows users to log food via voice/chat interface. It captures all that info to provide tips on carb counting, insulin dosing, and other actions a person with T1D might need to take.

“We not only connect the necessary devices, but the essential people in the patient’s life,” Korelitz says, explaining that users can chat and exchange information with members of your care team (doctor, teacher, school nurse, grandparents, etc.).

On-boarding is easy by just answering a few questions, and the UI users simple buttons and swipe. Eventually, it will work with Alexa, allowing users to have a voice-command function as well.

“We view Emmett as our AI and just another member of the care team,” Korelitz says. “The user will be able to ask Emmett a question and receive information back in the chat.”

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Image: Emmett app by Human Capital Works

Based on a family’s need

The Korelitz family struggled managing Emmett’s blood sugars early on, waking up every morning thinking “today would be different” and “it would get better.” But it didn’t. They also realized that, despite all the technology and apps they already used, there was no easy way to share their learnings about caring for a child with T1D with other people. Therefore, they opted to create an app uniquely designed for caregivers of loved ones with T1D.

Korelitz created the first iteration for his family in 2018, and it won the first-ever Novo Nordisk Innovation Challenge in 2019. He’s been working since then to connect the Alexa voice solution to this mobile app, and they have just released the first version for testing in mid-February. They were showing it off during the big international Advanced Technologies and Treatments for Diabetes (ATTD) conference on Feb. 18-21 in Madrid, Spain.

When will the app be available?

Korelitz’s small company, Human Capital Works, expects to have the Emmett app completed and released in by mid-2020. It will be offered free of charge.

Their vision for the future is for all information to be exchanged via messaging with Emmett, so users don’t have look through multiple apps/screens for answers. They plan to add more device integrations through partnerships, and they’d welcome the idea of partnering with a device manufacturer to connect to an insulin pump and/or CGM.

Created by Bob Weishar, who worked for a time at diabetes startup Bigfoot Biomedical, the Invincible app is designed to help families communicate with school about daily diabetes care.

School staff can log diabetes care for each child, including blood sugar readings, insulin dosing, food, exercise and other important notes. The app automatically notifies families about the care provided, storing a history of everything all in one place. If the school or family needs more info, the app allows for a real-time chat function to facilitate that communication.

“Over time, we help connect the dots about all the care happening in and around school to provide a more holistic view,” Weishar says.

“The core of our app is communication: we make it really easy to communicate about care that’s happening at school. In addition, we are integrating fun, engaging training that helps everyone learn the skills to support a child with diabetes.”

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Image: Invincible app

The app is still under development, so specific details of the interface are still a work in progress.

But Weishar has big plans to apply the technology to support families who have kids with any type of health issue — including autism, asthma, and epilepsy. They also want to expand beyond schools to help families wherever kids go: grandparents’ house, after school activities, sports practice, etc. “Our mission is to inspire kids with health issues throughout their journey, and we feel lucky we get to wake up every day and prove that truly great things can come from life with a health issue,” he says.

About the creator

Bob Weishar

Diagnosed with T1D as an 18-year-old freshman at the University of Michigan, Weishar says he knew from the beginning that he wanted to make something of this “new normal” and turn it into a life purpose. That led him to California where he worked at Bigfoot Biomedical, on the customer care side for their future automated insulin delivery (AID) system.

“I had an itch to start something that could have an immediate impact,” he tells DiabetesMine. Conversations with D-parents led to a common pain-point in diabetes care: schools. He spent the first months of 2019 talking to 60+ school nurses across California and learned they see up to 1 in 4 kids with a chronic health condition, and a whopping 2,500 students per school nurse!

Eager to provide peace of mind to families and simplify diabetes care for schools, his vision for the Invincible app began to take shape.

When will the app be available?

They’re currently running multiple pilot studies in various school districts, and expect to expand our that network in the next 1-2 months. “We’re taking our time to get the product right before opening it up to all families, but we’re aiming for a broader launch in time for the 2020 school year,” Weishar says.

Once launched, Invincible will be available for iOS, Android and eventually a web-view version, too.

Invincible will be avialble at no cost at first, to schools and families participating in an Early Access Pilot Program. Eventually, it will be available through a “Freemium” monthly subscription of $10, meaning it will be free for schools and the charge to families will be used to add new team members and device integrations. Those interested in joining the waitlist for this pilot program can signup here.

This is a controversial question, that continues to be actively evaluated and debated.

Research from 2017 indicates that over 45,000 diabetes apps were “languishing in mobile app stores” and not being used. But at the same time the authors state that there’s a need for more apps that are better integrated into patients’ holistic care.

Another study from August 2019 shows that D-apps aren’t effective because most users stop using them almost immediately. And yet, this clinical study from March 2019 concludes that certain diabetes apps do help some individuals better manage their own diabetes.

The Agency on Healthcare Research and Quality (AHRQ) commissioned research and issued a 73-page report in May 2018, saying that data is inconclusive on the overall effectiveness of mhealth apps in diabetes care and that, really, it’s anyone’s guess on how they might impact health outcomes.

“Although there is limited evidence that commercially available mobile apps improve diabetes-related outcomes, patients are downloading and using them anyway,” the report notes. “Strong evidence can help people make informed choices, but when evidence is limited, patients who use these apps are essentially experimenting on themselves.”

“Considering this, clinicians should consider asking their patients if they use apps in their self-management, and determine if the information provided by these apps adheres to current guidance for diabetes self-management,” researchers concluded. “Patients should be… wary of claims that these apps will improve their outcomes if not supported by evidence.”

The AHRQ study focused on 280 selected apps currently available to those with diabetes, and examined how they promised to reduce A1C results, stabilize and control blood sugar levels, reduce triglyceride levels and improve the user’s quality of life.

When searching for additional clinical evidence, researchers found only 15 studies evaluating 11 apps, six for patients with type 1 diabetes and five for those with type 2 diabetes. The found that eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, but of those eight apps, only two were scored “acceptable” in quality testing, while three were rated as “marginal” and the other three were rated “not acceptable.”

“Our results highlight that relatively few apps available through app stores have evidence of efficacy,” they reported.

At the end of the day, the efficacy of any given diabetes app may be in the eye of the beholder; if the user feels more motivated, empowered or educated — or can keep better tabs on their T1D child’s safety — that’s a win in our book.