Keeping diabetes in check with an app? Study says it's possible
Published on 15 October 2021
In her 27 years as a dietitian, Dr Lim Su Lin found herself repeatedly perplexed by a particular category of patients: those who came in too late.
“Most of the time, when patients come to see us in the hospital, they’re already suffering from complications of diabetes,” said Dr Lim, who is chief dietitian at the National University Hospital.
An elevated sugar level doesn’t immediately manifest in symptoms, she explained. “So I have patients who think that because they don’t feel it, they can go on and eat whatever they like. That since the doctor has already given them the medicine, they should be OK,” she said.
Unfortunately, once diabetes gets to the point where it starts to affect the organs – such as the kidneys, the nerves, or the vessels in the eyes – the damage is irreversible, and dialysis, amputations or blindness may become their inevitable fate.
“It’s very sad…when they get into this situation and finally ask for help,” she said. “Sometimes they’ll ask if I can help them to reverse the kidney failure. And I have to explain to them that all I can do is buy some time, maybe an extra year – but the damage has already been done. I can’t reverse it.”
With a mind to help change things, Dr Lim set out to conceptualise an app to help people gain better control over their diet, targeted particularly at people with (or who are at risk of) type 2 diabetes and pre-diabetes.
The app – called Nutritionist Buddy Diabetes, or nBuddy Diabetes for short – has since gotten close to 15,000 downloads, comprising a mix of patients and members of the public.
It has 11 key features, from a steps tracker to a glucose monitoring system, but the app’s most important feature is its meal logging system. Users are first prescribed with individualised calorie and carbohydrate goals, calculated according to their profile. After that, they’re encouraged to log their meals into the system, in order to keep track of them.
Let’s say you’re about to have lunch, and you’re zeroing in on the char kway teow stall. You make that selection in the system (it has a database of about 14,000 food items). If the dish doesn’t fit in with your health goals, the app will tag it with a red ‘thumbs down’ icon, with an explanation as to why: for instance, if the fat content is too high, or if it contains too much sugar.
The app then suggests alternative courses of action: to go for a different food (it provides a list of options), or a smaller portion. It will also alert the user if he or she exceeds their calorie or carbohydrate limits for the meal or day.
Its functions don’t stop at food, though; the app also makes recommendations as to the number of steps the user should take a day, and encourages regular monitoring of weight and, for users with diabetes, blood glucose levels.
“For most people, if they follow the app’s guidance and dietitian’s coaching, their sugar level will come down in as quickly as one to two weeks,” Dr Lim explained.
She shared about a patient, who uses it regularly to decide what to eat when he goes out for lunch with his colleagues. “He actually lost 16kg because of that. His fatty liver reversed, his blood pressure dropped, his liver enzymes all came down…it was so beautiful,” she said.”
Another patient – 70-year-old Mr Yeo Teow Chong, who was diagnosed with diabetes 12 years ago – saw significant improvement after he began to use the app, losing about 14 to 16kg within a year.
“We managed to catch him in the nick of time,” Dr Lim said, adding that his proteinuria – a condition which signifies the beginning of kidney disease – also disappeared, and his medication dosage was reduced. “If he didn’t do anything, I think by now, he would already be doing dialysis.”
In fact, Dr Lim and her team of researchers have recently published a study citing the effectiveness of the app in helping patients with diabetes. Published in medical journal JAMA Network Open in June this year, the study compared two groups of people: participants who received diet and physical activity advice from a dietitian, and participants who were additionally required to use the app to guide them on their food choices and exercise.
The study showed that the use of the app led to significantly greater reductions in body weight and blood sugar levels, with 52% of participants in the app group achieving normal blood glucose levels within three months, as compared to 31% in the control group.
In addition, 23% of patients who used the app with dietitian’s coaching were able to have their diabetes medication reduced, as compared to 5.4% in the control group. This could translate to lower medical costs and fewer side effects for patients as well.
“At first when using the app, people will just say, alamak, I didn’t know my diet is so unhealthy,” Dr Lim quipped. “But day in day out, when they're receiving that same feedback, being reminded all the time, they start to think that maybe they better do something. It helps them to make the change.”
She is currently working on a number of other related studies, including one that illustrates the effects of the app on people with pre-diabetes. But ultimately, Dr Lim just hopes to help as many people as possible take control of their own health.
“My one and primary goal is to help people with their diet control, to manage or to prevent diabetes,” she said. “As a dietitian, sometimes I manage to save one life at a time. But with this app, I can help many people at one go and the effect is amplified. So it’s very rewarding and motivating.”
In consultation with Dr Lim Su Lin, Chief Dietitian & Senior Assistant Director, Department of Dietetics, National University Hospital.