Advancement level of mobile applications intended for type 1 diabetes therapy supporting

Diabetes mellitus is a group of metabolic diseases characterized by hyperglycaemia due to defective secretion and/or action of insulin. Chronic hyperglycaemia is associated with damage, dysfunction, and failure of various organs, in particular eyes, kidneys, nerves, heart, and blood vessels. It is estimated that the number of patients with type 1 diabetes accounts for about 10% of all diabetics, even more children and young adults i.e. under 30 constitute between 85 – 90 % of morbidities. The fundamental part of type 1 diabetes therapy is providing patient with an external insulin therapy. The objective of this research was to


INTRODUCTION
According to the definition formulated by the Polish Diabetic Association "diabetes mellitus is a group of metabolic diseases characterized by hyperglycaemia due to defective secretion and/or action of insulin. Chronic hyperglycaemia is associated with damage, dysfunction, and failure of various organs, in particular eyes, kidneys, nerves, heart, and blood vessels" [1].
The definition emphases that diabetes mellitus is not a single disease but a group of them with a common characteristic that is hyperglycaemia. The definition explains also two main causes regarding the increase in serum glucose [2].
The fundamental part of type 1 diabetes therapy is supplying a patient's body externally with an analog insulin analog [3]. There are plenty of insulin analogs available on the market that are able to imitate human insulin secretion with increasing precision [4]. The aim of the insulin therapy is to maintain life, preventing complications of diabetes and providing patient with a good quality live. The success is possible only by mimicking healthy pancreas action with proper injections of insulin analogs [5].
Nowadays there is a possibility to conduct a therapy of diabetes mellitus using computer programs that are available as mobile applications intended for smartphones. Due to this it is feasible to use such programs almost at any time and any place. At present computer programs at the service of diabetes constitute a leading group of modern tele-medicine. The diabetes epidemic is visibly reflected in a big number of applications intended for diabetics.
These programs offer different functionality most important of which are helping with blood glucose level self-control, reporting of carbohydrate intake, physical activity, body weight, blood pressure, logging drugs taken orally and injected insulin, calculating of insulin doses and so on. In 2013, approximately 390 applications for iOS platform and 380 for Android operating system were available for diabetic patients [7].

OBJECTIVE
The objective of this research has been to formulate a list of requirements concerning mobile applications regarding diabetes 1 therapy as well as an overview and classification of such applications that are available on the market.

MATERIALS AND METHODS
The research has been narrowed down to mobile applications for Android operating system only. However, most of the presented applications are also available for iOS operating system.
All of the information has been sourced from the web pages of the developers. The criteria for including an application for the analysis have been: (1) the application is available at play.google.com, (2) the application is useful in diabetes treatment, (3)

The scale of expectation for mobile applications
Referring to a mobile application supporting the therapy of type 1 diabetes we mean a computer program that is an extension of the medical equipment that patient has already acquired and been using. Whereby, the equipment may be successfully utilized without the application. Such application only supports creating and managing a database of the therapy, making decisions and planning events. The patient is still responsible for conducting his or her therapy. The Table 1 lists and describes requirements for such applications. These requirements have been ranked from the simplest to the most advanced ones. This list is the authors' original proposal developed based on their own experience in the treatment of type 1 diabetes. All these requirements are derived from the therapeutic point of view (Tab. 1). Table 1. Expectations for mobile applications supporting the therapy of type 1 diabetes.

Function name
Description of the function

Database
Archiving all the events important for the therapy such as: glucose levels, eaten meals, physical and mental efforts, past sickness.
This function facilitates studding history of the therapy. All the records stored here is referred farther as data.

Data presentation
Delivering the data in a readable form of tables, charts etc.

Data analysis
Statistical processing of the data: indicating trends, searching for periodicity, localizing problems etc.

Data acquisition
Automatic collecting of the data.

Data backup
Archiving the data in an external storage in case of loss of a mobile device.

Remote information
Sending real time data to another person, e.g. a parent.
This function let the person monitor the patient's condition and take an action by other methods, e.g. telephone call.

Android interface
The application mimics a being with a personality. The contact with application uses phone calls, short message service, multimedia messaging service. The application can interact with other persons in order to make appointments or ask for help.

Diabetes Diary [9] by mEL Studio, Austrialian Diabetes Monitor [10] written by Huan
Nquyen. It is easy to find plenty of corresponding applications on the Internet all over the world.
One of the most interesting application in this group is Australian Diabetic Calculator [11] ( Fig. 1c), which except the requirements 1 and 2 implements also function no 7 i.e. the meal assistance. This program has been written by an individual programmer for his own use. Diabetes Journal [8], c) Diabetic Calculator [11] There are also simple educational mobile programs for smartphones that meet the  (Fig. 2) developed for a German insulin pump mylifeYpsoPump manufactured by Ypsomed [17]. When using this application, it is easy to keep records of all therapeutic documentation. Data is collected automatically from the insulin pump via a Bluetooth connection. The data can be presented in the legible form of tables and charts. Basic statistical calculations are performed. The data of individuals patient is gathered in the company computational cloud so it is secured in the case of a patient's equipment crush and can be easily shared with others. The application let the user check current and previous settings of their insulin pump. This functionality enables to study effectiveness of the therapy.
The application meets the expectations from no 1 to no 7, as well as no 13 and no 19.
However, the full potential of this applications comes only with the dedicated insulin pump. history of therapy events.

Advanced commercial products
When using the name advanced commercial products, we have in mind multipurpose software systems manufactured by professional enterprises in a scheduled engineering process. Such applications are able to connect to most of popular insulin pumps and glucose meters and offers sophisticated algorithms.
Nowadays the best know application in this group is an Austrian program mySugr [18] (Fig.   3). The project has been started in 2012. It has got many language versions and is used all over the world. It is a commercial product which basic version is free of charge,althoughtheir professional full version requires payment. The application implements the requirements from no 1 to no 5 in a very good way. It means that the application automatizes keeping a diabetes diary. It offers easy and quick presentation module of therapeutic data including statistical calculations. User data is stored in the company's database and thus protected against loss. A meal assistant (requirement no 7) is available in the form of carbohydrate and insulin calculator. It is possible to note events related to the therapy such as efforts, sickness, emotional states, which mean partial implementation of expectations 9, 10 and 11. The application predicts the level of HbA1c glycated hemoglobin based on observation of blood sugar levels. Therefore, it is a fragmentary implementation of point 16. Using the application gives the opportunity to participate in a wide community of people involved in the subject of diabetes so the functionality 14 is fulfilled as well. The second example of a high-class application intended for supporting a diabetes patient is Diabetes: M [19] (Fig. 3c). It has been developed by Bulgarian company Sirma Group. The application has been in offer from 2013. As a professional application it realizes entirely requirements from no1 to no 5. The app includes a meal assistant (7), allowing to compose a meal and a plan with a correct insulin bolus. It is possible to send personal therapeutic data for medical consultation, which fulfils functionality no14. The application included a module for analysis the data that has been gathered. It can suggest the cause of the problems that have appeared. Future events are predicted by an artificial intelligence module. Consequently Diabetes: M fulfils partially expectations no 15 and no 16.

CONCLUSIONS
Keeping a diary and ability of interpreting collected data is an essential part of type 1 diabetes therapy. Nowadays a person suffering from this disease can do this job using an application run on a smartphone. There is a broad offer of such applications. In this paper the applications have been divided in three groups according to their genesis. All of the presented applications can be used free of charge. Small amateur programs are distributed absolutely free. Other include advertisements, which is the only cause of using them for free. Advanced applications are available for free in their basic versions which are still useful from the therapeutic point of view. However, full versions that include additional functions require payment.
This paper has included a set of 20 requirements for mobile applications intended for type 1 diabetes patients. All the expectations are based on the therapeutic point of view and some of them are beyond the possibilities of the modern-day IT industry. Nowadays there is no applications that meets all of criteria. However, the tendency to fulfill all of them can be noticed. It has not been the authors' intention to rank the applications. In this paper they are only enumerated applications when taking into consideration supporting patients. It may turn out that an application with higher functionality is too difficult and the exposure to it may discourage a patient to using any applications. Such situation would have an adverse effect because even the simplest computer program used consequently could benefit the therapy.