DiaDigital: making sense of diabetes apps

While they are very useful, health apps have one major drawback: anyone can release and distribute them unchecked. Only some apps require medical device certification. So how can users spot a great, safe and useful app? When it comes to diabetes apps, the "DiaDigital" seal of distinction is the answer.

In this MEDICA-tradefair.com interview, Diana Droßel talks about "DiaDigital", describes its advantages for app development companies and the evaluation process behind it, and explains privacy, usability and other criteria for app evaluation.

Ms. Droßel, what prompted the creation of the "DiaDigital" official seal?

Diana Droßel: At the 2015 DiaTec Conference – the abbreviation stands for "diabetes and technology" – we realized that while patients with diabetes want to learn more and more about diabetes apps, doctors and diabetes educators often lack the relevant in-depth knowledge to coach them.

To increase and foster their skills and knowledge, we have formed a working group that includes patients and focuses on diabetes apps, while tackling issues like usability and data protection. That said, our conversations about diabetes apps soon revealed that while we have the medical expert knowledge, we are not authorities in technical matters. By collaborating with the ZTG Center for Telematics and Telemedicine, we have found a partner who helps us in this area.

At one of our workshops, we created a set of criteria for evaluating diabetes apps. It is based on the CHARISMHA study (Chances and Risks of Mobile Health Apps). We also collaborated with experts like Prof. Peter Schwarz from the University Hospital Dresden. Our app testers are currently using this set of criteria checklist, which was presented at the 2017 Diabetes Congress of the German Diabetes Association.

Are physicians, diabetes educators, and patients embracing the diabetes apps?

Droßel: Yes, they increasingly take advantage of these apps. Admittedly, this is a very slow process, causing the apps to not be in widespread use just yet. The trend gradually changes from simple tracker apps like bread unit calculators and calorie management to blood glucose diaries and finally apps that can be connected to blood glucose meters, continuous glucose monitoring systems or pumps.

How does your app evaluation process work?

Droßel: The app development companies initiate the process by filling out a self-report questionnaire. We use this initial report to conduct a preliminary check via an abbreviated assessment procedure. If the app passes the test, the ZTG Center performs the technical check. Our registered testers subsequently use the app for four weeks and check off our set of criteria using a questionnaire. Anyone who is interested in working with diabetes apps can register to become a tester. We review and discuss the results of the questionnaires during a final conference call. Lastly, the apps that receive our seal are published on our website along with the self-report and technical evaluation.

We also contact the development company and make recommendations on how to improve the app if it does not pass our evaluation process on the first try.

What criteria do you use for evaluating the apps?

Droßel: Usability is one very important criterion. It is actually the criterion we put the highest value on because it determines whether the app is relevant for daily use in the first place. Quite often, apps are great in theory, yet very cumbersome to use. Needless to say, all the information the development company has provided related to function must also be valid and accurate. Users must be able to rely on the app functioning properly, thus allowing them to manage their diabetes well. Things always take some time and effort but it should only be as much effort as needed and as little struggle as possible. Data protection is also a very key criterion of course. Having said that, these are just a few aspects from our extensive set of criteria.

Personally, I think it is also very important that the apps are closely tied with programming standards that ensure accessibility for people with disabilities. Google and Apple devices come standard with built-in accessibility features in their respective operating systems, thereby facilitating the programming of accessible apps. I am certain that someone who adheres to these standards has obviously given some thought to creating a great app.

Please tell us in your own words why app development companies should get their apps certified by "DiaDigital".

Droßel: To make sure that those who use and need these apps – this also includes physicians and educators aside from patients – truly know which apps are good ones and worth the download. App stores offer a confusing array of apps in this setting. You can find countless apps for diabetes management, but you never really know which ones are worth downloading. And even though our evaluation process is very elaborate and time-consuming, you may rest assured that the apps that receive our seal have been thoroughly tested and can be used with confidence.