Thanks to our correspondent Dan Fleshler in New York, who continues his 'Media Matters' column here at the 'Mine with a different perspective on the many mobile health devices out there...
The diabetes community is deluged with news stories proclaiming that mobile health technology will change our lives. Some news is genuinely exciting, like recent reports that a “smartband” on the Apple Watch could display data from Dexcom continuous glucose monitors (CGMs).
But some breathless headlines about “activity trackers” worn on the wrist focus on a more dubious claim: they will help you lose weight. In fact, steadily accumulating research shows you’re likely to be disappointed if you expect a mobile health device to help you take off pounds.
These devices -- which track steps taken, calories burned, hours of sleep and other health indicators -- have been overhyped when it comes to weight loss, an important goal for many people with both type 1 and type 2 diabetes.
What’s more, when used by themselves, the apps’ impact on diabetes management appears to be very small, although they do show great promise when linked to CGMs (more on that later).
And while they certainly provide some overall health benefits when used properly -- as noted here -- they also might have downsides.
Disappointing News on Wearables and Weight Loss
- Stanford researchers recently showed that while 7 different wearable health devices accurately measured people's heart rates, they didn't effectively measure the calories burned by users.
- Another study, called TRIPPA, showed while the apps increased physical activity, they didn't produce improvements in blood pressure or weight.
- A third study, published last fall in the Journal of the American Medical Association, indicated patients wearing these devices didn’t perform better than patients without them in a weight loss intervention program.
As far as blood glucose management is concerned, evidence of the positive impact of these trackers is underwhelming.
- One study found that while the A1C decreased a bit more in people with diabetes who used these devices when compared to a control group, the difference was “not significant.”
- A survey of relevant studies concluded that there was “a lack of evidence demonstrating the effectiveness of activity monitors in chronic disease,” including type 2 diabetes.
The Good Apps Do
Don’t get me wrong. The apps do help people. I personally don’t need a tracker to motivate me to exercise, but any tool that prompts "couch potatoes" to get their blood moving and their muscles working should be encouraged.
Another benefit: PWDs can use activity trackers to gauge the impact of exercise on their blood glucose levels, as noted in Diabetes Forecast by John Jakicic, director of the Physical Activity and Weight Management Research Center at the University of Pittsburgh.
That’s the goal of very exciting technology developed by Medtronic and Fitbit, which will combine information from continuous glucose monitors and Fitbits to provide insights into glucose trends and insulin needs. See also: D'Mine's take on that news from late 2016.
Still, the trackers can also have drawbacks. The very same John Jakicik writes that Fitbit users can “develop a false sense of achievement. People would say, ‘Oh, I exercised a lot today, now I can eat more.’ And they might eat more than they otherwise would have.”
Johnny Adamic, a Daily Beast columnist, personal trainer and public health expert who served on New York City’s Obesity Task Force, has another concern. He thinks wearable health technology leads to a lack of “self-reflection,” a critical tool in maintaining health.
Adamic told me, “All of these physiological processes are going on within us. Yet we rely on these tracking devices and stop having conversations with our own bodies. I see people just reading data about the number of steps, calories and the intensity of their heartbeats instead of asking, `Why did I have low energy in the morning? What did I do last night and what did I eat?’”
Of course, if you have diabetes and want a fighting chance to be healthy, you need to ask yourself these and many other questions, almost 24-7. If Adamic is right and activity trackers can drown out essential, internal monologues, that’s something PWDs need to be very careful about.
Some very smart people in the Diabetes Online Community swear by these devices. Search for “Fitbit and Google Watches and diabetes” and you will find rave reviews. If the technology works for them, it might work for other PWDs and there is no reason not to give it a shot.
But in my view, the devices are not all they’ve been cracked up to be. PWDs should have reasonable expectations about their value, especially if they are concerned about their weight. Eric Finkelstein, a co-author of the aforementioned JAMA study, says “having a fitness tracker is like having a scale in the bathroom -- it can be a helpful measurement tool, but it’s not a public health intervention in and of itself.”
Thanks for your take on the Pros and Cons here, Dan.
What do you think, Diabetes Community?