Army Veteran William Baker, who has type 2 diabetes, discusses his health with LaCresha Mitchum, a registered nurse, certified diabetes educator and diabetic coordination at the William Jennings Bryan Dorn VAMC in Columbia, SC. Photo by Jennifer Scales, Dorn VAMC
TAMPA, FL — Like Americans everywhere, veterans have integrated smartphones and wearable devices into many aspects of their lives. For veterans with diabetes, those devices, healthcare and wellness apps are increasingly transforming care and improving outcomes.
“VA’s Office of Connected Care has made significant strides in telehealth and mobile health technologies and the future looks even more promising as we continue to lead from the cutting edge by expanding our capabilities through these efforts and others,” said Kathleen Frisbee, executive director, Connected Health at the VA in a recent editorial. “Most importantly, our use of patient-generated data to influence major improvements in our veterans’ health care cannot be overemphasized.”
Mobile health technologies address many common issues for veterans with diabetes. At the James A. Haley Veterans’ Hospital in Tampa, Fla., the VA has launched a program that combines telehealth technology with health data from Apple Watches to monitor heart health, a common concern for diabetic patients. Veterans use the VA-provided watches to perform an electrocardiogram (EKG) and then upload the results to the Health app on their iOS device. The data can be shared with their care team during a VA Video Connect appointment or through the VA’s online patient portal, My HealtheVet.
The VA has also developed a mobile app, Sync-My-Health-Data (SMHD), that transfers data from Fitbits or glucometers via a paired device to the VA’s Patient Generated Database for analysis. The Office of Connected Care is currently analyzing this data plus data from the VA’s electronic health record and socioeconomic data for patients with diabetes.
At the South Texas Veterans Health Care System in San Antonio, Texas, researchers have used Fitbit to support behavioral lifestyle interventions in overweight or obese type 2 diabetics during the pandemic. The study used the Look AHEAD and Diabetes Prevention Program Group Lifestyle Balance, delivered over 10 sessions. Participants received a Fitbit and the accompanying Fitbit app to record their food and activity. Only two veterans left the study before its conclusion at six months.1
“[A}lthough one might expect reduced interest in the program due to disruptive stressors related to the pandemic, participant responses reflected a high degree of acceptability for the behavioral intervention while dealing with new challenges,” the authors wrote. “Overall program acceptability was observed in the participant descriptions of mindfully tracking their diet and physical activity through the Fitbit application, as well as enthusiasm in their plans to continue to track behavior using program strategies.”
Notably, the study showed that older adults (average age of participants was 72) could successfully use mobile health technology to support behavioral modification, with many commenting that they enjoyed using the Fitbits for self-monitoring and to gain greater confidence in their decisions around self-care and diabetes management.
More Diabetes Apps
The Annie app helps veterans take care of themselves through text messages. Annie is named for Lt. Annie G. Fox, Army Nurse Corps, the chief nurse at Hickam Field during the attack on Pearl Harbor on Dec. 7, 1941, and the first woman to receive the Purple Heart for combat. The app can be programmed to reflect the needs of each veteran. For diabetics, Annie could text a reminder to a patient to take their medications, check their blood glucose levels, have a snack, or move, and reinforce the importance of taking the nudged step as part of reaching the veteran’s health goals.
Annie also provides COVID-19 specific information on staying healthy, identifying symptoms, managing stress, and receiving vaccinations, and more.
“VA providers should be wholeheartedly enthusiastic about using Annie. It allows us to reach our patients in ways we couldn’t previously and ultimately improve health outcomes,” said Lynn Kataria, MD, chief of Neurology Education at the Washington, D.C. VAMC.
Another app, MobileKidney, helps diabetic veterans with kidney disease track their personal information, such as blood pressure, weight, and blood glucose levels. The app reminds users to log their health information and allows veterans to share that data with their healthcare provider. It also sends reminders from the care team and provides information about kidney health.
The MOVE! Coach app helps veterans manage their weight with a 16-week program that builds awareness of the components of a healthy diet while encouraging regular physical activity. The app provides a daily weight, activity, and diet diary and tools to measure exercise intensity, calories burned and activity-to-step conversions.
Apps also simplify scheduling VA appointments online, requesting medication refills, and using Video Connect for medical visits with the care team.
Beyond Apps
In addition to a wide range of apps, the VA delivers other tools via technology for veterans with diabetes to better manage their health. At least two groups provide live online yoga sessions. At the Coatesville VAMC in Pennsylvania, Ompractice offers 16 weeks of free access to their online classes to veterans participating in self-management programs for diabetes, weight loss, and some other conditions. The Coatesville classes are led by a veteran who attributes his own recovery from combat injuries that resulted in double amputations to yoga. The small classes allow the instructor to connect with and encourage new students. The Veterans Yoga Project offers three hours of free, live practices on Zoom and Facebook.
The West Texas VA Healthcare System engages veterans with diabetes through a fun and easy cooking class, which will be available in a monthly video series as of 2021. The program promotes healthy eating and a positive approach to making lifestyle changes to prevent or manage diabetes. “We want everyone participating to ask questions, to find ways to improve their situation,” said Marcia Merrell, chief of Nutrition and Food Services at the West Texas VA. “For me, cooking classes are all about inspiration. It’s really about inspiring you to do more research and inspiring you to ask questions.”
- Jiwani R, Dennis B, Bess C, Monk S, Meyer K, Wang J, Espinoza S. Assessing acceptability and patient experience of a behavioral lifestyle intervention using Fitbit technology in older adults to manage type 2 diabetes amid COVID-19 pandemic: A focus group study. Geriatr Nurs. 2020 Nov 19;42(1):57-64. doi: 10.1016/j.gerinurse.2020.11.007. Epub ahead of print. PMID: 33248357.