Developing a mobile app to help manage type 2 diabetes

Diabetes is the fastest growing health threat of our times and an urgent public health issue as it can lead to a whole host of medical conditions which increases the burden on healthcare systems. Type 2 diabetes is often linked to being overweight and it’s well known that lifestyle changes can drastically improve health outcomes. But encouraging patients to make and then maintain those changes can be a tough job for medical staff working in general practice. Advances in digital and mobile technology have enabled life science companies to create new digital tools to help healthcare professionals support patients.

In 2018 a small UK-based medtech company called Healum accessed support from the NIHR to trial a mobile app which enables GPs to support patients with type 2 diabetes. In 2023 Healum published positive findings from the trial.

Healum, a medtech SME (Small and Medium Enterprise) based in the UK, creates digital solutions that enable healthcare professionals to empower, support and motivate their patients to make healthier choices to tackle chronic diseases.Healum's product is a digital solution formed of two parts: an online software for use by GPs which is linked to a mobile app for use by patients on their phone, tablet or laptop.

To pilot the product, it was customised to help manage type 2 diabetes (it can be adapted to manage other conditions). The software was made available to GPs (and other primary care team members) who accessed it online and then issued the app to patients with diabetes. Once the patient and GP were connected, the two tools became a platform for the patient and GP to work together to manage the patient’s condition and hopefully improve their health outcomes.

The product can automatically pull in information from a variety of sources including the GP’s database, wearable technology and the internet. It can use that data to enable the healthcare professional and patient to co-create a customised healthcare plan that contains a variety of informational content.

The product has the ability to track key health indicators such as cholesterol, weight, blood pressure, blood glucose, sleep and exercise (if linked to a wearable). It also has the ability to set goals and track metrics to measure progress.

In addition, the product can gather relevant local resources from the internet such as recipes and timetables for local exercise classes for the GP to recommend to the patient via the app. Once a recommendation is received, the patient can choose to save the resources or add them to their care plan, or dismiss the recommendation. The app uses AI (Artificial Intelligence) algorithms to learn what the healthcare professional recommends, what the patient likes and dislikes, and used this information to tailor future recommendations appropriately. The result is a convenient, personalised, interactive healthcare plan and, by continually suggesting new ideas and resources, the product helps to keep the patient engaged.

In 2018 the NIHR provided a range of support to help Healum design and deliver a clinical trial to demonstrate the product's potential to improve health.

Without that support, I don’t believe that we would have been so far in our journey and be a this stage; ready for the study to go live in the next couple of months. And I also don’t think that, as a company, we would really understand how we would develop our evidence strategy at this stage in our life cycle. 
Jonathan Abraham, CEO and Co-founder, Healum

NIHR support: Clinical expert feedback

We acquired feedback from our NHS clinical experts to confirm that the study protocol was compatible with the chosen healthcare setting - GP practices and the community.

NIHR support: Identifying suitable sites

Healum was initially seeking 20 sites to work with. Our site identification service returned 117 expressions of interest. Sites responding were also able to demonstrate that they had the relevant expertise and met the specific capacity and capability criteria set out by the company.

“The response was huge, more than we expected. Some of the expressions of interest were from clusters of practices and even one CCG, which meant the total number of practices interested in piloting our app was over 130. This was great because immediately we knew there was an appetite out there and a clinical need to be met... We now have a strong list of sites we intend to work with.”
Cassandra Baiano, Research Lead and Partnerships Manager for Healum

“We worked really hard to put the protocol together based on NIHR advice, and then the moment they sent it round to the list of research-active primary care sites was a huge ‘aha’ moment for us. Within two days 117 research-ready practices had responded and signed an expression of interest. We were high-fiving in the office because we were going from a place of not knowing how we were going to run this research project, and wondering how we were going to identify who to work with from thousands of GP practices - to a place where, not only did we have some great sites, but we also had really in-depth information about who those sites were, and how we could work with them.”
Jonathan Abraham, CEO and Co-founder, Healum

NIHR support: Costing tool supports accurate budgeting and site selection

We introduced Healum to the Primary Care Costing tool. As a result of using this tool the company reduced the number of sites to ensure they did not exceed their planned budget.

“The Network team in Manchester helped us to complete the costing template which was invaluable. We quickly realised we needed to reduce the number of sites to stay within planned budget.”
Cassandra Baiano, Research Lead and Partnerships Manager for Healum

NIHR support: Added Value 

The Network also helped Healum to engage two essential delivery partners (an academic chief investigator and a CCG (Clinical Commissioning Group) or primary care federation) to take the pilot trial forward.

“Having received the expressions of interest, we were also able to engage our delivery partners and academic chief investigator, again the Network helped to pull this collaboration together. We were extremely pleased to enlist an academic investigator from Manchester University who will conduct an independent analysis and write up the findings of the pilot.”
Cassandra Baiano, Research Lead and Partnerships Manager for Healum

The study results published in April 2023 revealed that patients who received a digital plan of care had better outcomes than those who didn’t. On average, patients who used the digital care plans through their app were able to lower their blood glucose levels (Hb1Ac) by an average of 7.37%, compared with an increase of 2.05% for the control group who received standard care over the same six months.

In addition, patients that used the Healum app saw an improvement in quality of life measured by changes in their pre and post-trial questionnaires. 

Alongside these results, the study has also revealed that using the Healum app had a positive impact on patients engaging in the management of their diabetes. Patients in the study made 6,797
measurable healthy choices, completed 343 goals, read over 2,200 health education resources and tracked their health 2,430 times.

The results of the study have been published in the Diabetes Therapies journal.

Dr Adrian Heald, consultant physician in diabetes and endocrinology at Salford Royal Hospital presented the findings as a poster at Diabetes UK Professional Conference in May 2023 (DUKPC) and a follow up article is available on the Medscape UK website.

Further detail is also available on the Healum website.

Healum is now inviting GP practices across the North of England to be involved in a follow-on real-world study.