In 2021 Ingeus, the company which delivers the National Diabetes Prevention Programme on behalf of the NHS, began using Lancashire and South Cumbria Health and Care Partnership’s ORCHA Health App Library. The educators for the programme recognised that health apps could play a key role in supporting people with managing their weight, nutrition and exercise in a way that could help reduce their risk of diabetes. By building the recommendation of health apps into their care pathway, they were able to augment the support they gave to patients. They felt this gave participants positive reinforcement whilst helping professionals stay better informed about patient progress.
The service tested its usage of health apps with participants and found that:
Commenting on the work, Linda Vernon, Acting Digital Culture and Transformation Clinical Lead, Lancashire and South Cumbria Health and Care Partnership, said: “Using apps is a really easy way to support our citizens. ORCHA is a big part of our digital health literacy work, enabling people to have access to safe and reliable apps and digital technologies that do what it says on the tin.”
One of its participants, Susan, said: “I wouldn’t have thought to download a health app, but I put my weight loss and healthier lifestyle down to my health app.”
Researchers from ORCHA have found that blood glucose levels amongst those with Type 2 Diabetes can be reduced by up to 1.1% when patients use digital health tools alongside their standard medication.
Patients with Type 1 Diabetes can reduce their blood sugar (HbA1c), on average, by 0.5%.
This reduction is significant because every 0.1% increase in HbA1c increases the risk of retinal damage, blindness, kidney failure, ulceration and limb amputation.
The cost of healthcare for ulceration and amputation in diabetes has been estimated at almost one billion pounds per year.* Twenty per cent of people with diabetes will need treatment for kidney disease.**
ORCHA and its research team, headed by Doctor Simon Leigh, analysed 25 independent randomised controlled trials where those with diabetes had used health apps. Across the trials, 3,360 patients were involved. The study was published in Frontiers in Clinical Diabetes and Healthcare in October 2022.
Dr Leigh, who is himself a Type 1 Diabetic, said:
“This is a commanding result which we hope clinicians will take note of. By the end of this decade this country will have over 5.5 million citizens living with diabetes. Adequate management is vital as some of the consequences of diabetes take time to evolve and are difficult to remedy. This study shows that health apps can be an effective part of this process, complementing other forms of care.”
The study is the first systematic review of these clinical trials. Its aim was to establish whether health apps could assist with Hba1c levels. It found that:
In 21 out of the 25 trials, patients using digital health tools to supplement their care achieved better HbA1c results.
In 20 out of the 25 trials, there were additional reported reductions in cholesterol levels, blood pressure and Body Mass Index.
Amongst those with Type 2 Diabetes, the improvements in blood sugar levels were similar to the benefits patients receive when using Metformin, a commonly used medicine to lower blood sugar levels which is often the first line of treatment for the condition.
Although researchers expect a drop-out rate of 40% when patients trial digital tools, there were lower drop-out rates when the people with diabetes used them, at 20%.
In the trials, the average duration of diabetes for those using digital health was 12.49 years and the average age was 52. The researchers were surprised that this group, seemingly well entrenched in their self-management habits, were so open to trying new approaches, showing there is a role for digital health in those with well-established diabetes. They commented that it suggests the introduction of digital health to younger or newly diagnosed patients could lead to even greater results, if they had grown up as digital natives.
Dietician and clinical lead for diabetes at ORCHA, Susan Gallagher, said:
“The improvement demonstrated in the research paper is clinically valuable and a comparison could be made to the impact of diabetes medication. It is important that digital solutions are evidence based, proving they can add value to a person’s care. This paper has shown the improvements that can be realised. “Many apps exist but not all have the same standards or ability to show a positive impact. Individuals and clinicians should consider a trusted app when selecting one to support their care needs”.
Digital solutions can range from those that help patients manage their own day-to-day health, solutions that help patients and doctors share information and those that are integrated with wearable technology, of which some are available as prescribed products on the NHS.
Patients living with diabetes need to balance multiple health commitments – such as eye screening, feet checks and annual reviews of blood pressure and weight. Health apps can range from tracking food, activity and medication to offering peer support and information and also sharing and monitoring information between patient and clinician; these help the person with diabetes self-manage and can reduce the burden during clinical appointments. Health apps can help them track activity, food intake and medication, whilst giving peer support and remotely monitoring their data which reduces the burden of data collection during clinical appointments.
Susan Gallagher added:
“This is not to take away from the benefit and need for in person consultations; however, digital health tools can help us use technology in a manner that suits the person and their needs, supporting patients and healthcare professionals in doing so.”
MyWay Diabetes: This educational app allows users to learn about diabetes at their own pace, offering access to over 200 multimedia resources including e-learning courses. Eighty-eight per cent of users say it helps them manage their condition better. The developers note that for every £1 the NHS spend on this app, £5 is saved because diabetes is being managed better.
ORCHA score 92% Available as a web app Cost: entirely free
My Diabetes from My mHealth: This NICE-aligned platform provides expert advice, structured education, nutritional guidance, and exercise programs. With blood glucose monitors, linked via Bluetooth, and the ability to build a personalised set of targets, myDiabetes helps people control their condition. Clinicians have access to remote care, patient management, reports and monitoring tools that makes caring for patients easier and more cost-effective.
ORCHA score 88% Available via IoS and Android Cost: in app purchases
Hedia – Personal Diabetes App: Hedia tracks exercise and carb intake, makes insulin dosage recommendations, and monitors when users need to regulate their blood sugar. It’s especially recommended to people having insulin-dependent diabetes – such as type 1 diabetes – and its software supports several blood glucose meters.
ORCHA score 86% Available via IoS and Android Cost: entirely free
The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review: Authors: Simon Leigh, Sebastien Stevens, Susan Gallagher, Tim Andrews, Liz Ashall-Payne, Lloyd Humphreys.
*Major amputation is one of the most destructive complications of diabetes and the number of major lower limb amputations in diabetes continues to rise. Seven-thousand nine-hundred and fifty-seven (7957) major diabetic lower limb amputations were reported in England between 2017 to 2020. Furthermore, the cost of health care for ulceration and amputation in diabetes has been estimated at almost one billion pounds per year. https://resolution.nhs.uk/wp-content/uploads/2022/06/Diabetes_and_Lower_Limb_Complications.pdf
** https://www.diabetes.org.uk/guide-to-diabetes/complications/kidneys_nephropathy
On Wednesday 16 November, ORCHA’s founding CEO, Liz Ashall-Payne, will attend a reception at Buckingham Palace. The event, initiated by King Charles, will recognise and celebrate the contribution of small businesses to the UK economy.
Liz said: “It’s not every day a Royal invitation lands on my desk and it’s an honour and a privilege to be able to meet His Majesty.
“My message will be that ORCHA is one of the many specialised small businesses in the digital health ecosystem – an industry set to be worth more than £320 billion by 2024,1 as it brings a major shift in how healthcare is delivered, making services sustainable for now and our future.
“I will also highlight how the UK is leading in the field, home to the largest number of digital health developers,2 and how nearly half of the UK public have used a digital health product as part of our day-to-day self-care.
“But most importantly, I will thank and highlight our NHS, social care and charity clients across the UK, who everyday use our assessment and activation products, helping us achieve our mission, of putting the power of digital health, safely into the hands of everyone who needs it.”
ORCHA has doubled its turnover every year since launch, and this year is set to treble its annual revenue. This fast growth has required an ongoing recruitment programme and staff numbers are now in excess of 120.
Liz concluded: “I feel so lucky to be attending, but ORCHA’s success wouldn’t be possible without the creativity and dedication across the digital health ecosystem, NHS and ORCHA colleagues, so I’m there to represent this amazing team.”
Sources:
Two thirds of healthcare professionals involved in a new research project believe that digital health interventions can help patient care management, but over half had never recommended them to patients.
That’s the finding of a new study of Spanish physicians by Spanish academics in partnership with public health researchers at ORCHA (Organisation for the Review of Care and Health Apps). The team used non-alcoholic fatty liver disease (NAFLD) as a test case for examining this issue.
NAFLD was chosen because of its growing prevalence in Spain and because it often remains undiagnosed. It’s a condition which can be avoided by simple lifestyle changes such as better diet and exercise – and there’s growing evidence that these changes can be supported by digital health interventions.
The presence of some fat in the liver is normal but having too much can prevent normal liver function. In the most advanced stages, liver function can break down and a transplant may be needed.
The study was carried out in early 2022 amongst almost 300 gastroenterologists and hepatologists. Most of the physicians recognised the potential of digital health interventions: 60% felt these tools would help with improve the efficiency of care delivery and 52% felt they would improve patient engagement and self-management of their health.
Only 25% of these physicians had received training in how to use digital health interventions although 94% of them thought it would be useful to receive training.
In addition to training, two key factors influencing whether these tools would be used were time and evidence. Fifty-nine per cent of the physicians said they would recommend these tools if there was time within the consult and 51% said they would need evidence that the tool would work well before recommending it.
Dr Simon Leigh, head of research at ORCHA, said:
“There’s a shift in how care is being provided but it’s not occurring uniformly and that’s why it’s so important for us to examine distinct areas of care in such detail. Lessons learned in one area can be shared more broadly.
“We were very pleased with the positive feedback from the physicians, but they raised practical considerations regarding training, time within consultations, and trust in these products. All of these are areas we can work on. For example, in the UK all frontline healthcare workers now have access to free and professionally accredited digital health training via the ORCHA Digital Health Academy.”
High quality digital health interventions can support patients with their liver health by encouraging better lifestyle choices. Apps can log exercise, help with smoking cessation, assist with healthier food choices, and encourage lower alcohol intake.
The full results of the study are available at the Liver Meeting 2022, in Washington DC until 8 November.