By Melinda Young

New research suggests older patients with diabetes and depression are less likely to use a smartphone app to help with diabetes self-management.1 Self-care apps are an important tool, and use likely will increase as people become more comfortable using them.

“I see apps as being the future [of disease self-management],” says Diane Orr Chlebowy, PhD, RN, MSN, MA, MSN program director and association professor in the University of Louisville (KY) School of Nursing. “There are a lot of considerations in the app development and in the implications for when those apps are ready for use among those with chronic illnesses and those with diabetes. Diabetes management is very complex with comorbid conditions. Taking all of that into consideration is really important.”

The study was developed around the question of whether adults with diabetes would be interested in using a mobile app for self-management. “We did survey research and asked 35 adults to tell us a little bit more about whether they have smartphones and if they use mobile apps,” she explains.

Researchers also asked:

  • Do you use any apps specific to diabetes?
  • Do you use any health-related apps, such as apps that help with physical activity or diet management?

Most adults surveyed did not use a health app or diabetes-specific app. “We did not necessarily ask them as part of the survey why or why not, but we were interested in looking at whether they had any visual problems that could be affecting their use of apps,” Chlebowy says. “Nearly half of participants had visual problems.” Visual problems can affect whether a person is comfortable using mobile apps.

Participants also reported numbness, pain, and/or tingling in their hands. This could contribute to a person’s decision to not use mobile apps. “We did not ask whether that impacted their use of apps, but we felt those were important findings,” Chlebowy says.

In additional, unpublished research, Chlebowy and co-investigators worked with participants with diabetes on a mock-up mobile app and found the participants were interested in the technology. “They felt like anything like an app that could help them with management would be very beneficial,” she says.

Respondents were interested in participating in the study and receiving help to manage their diabetes. “Some said the apps could help them and remind them of self-care behaviors and what they should be doing on a daily basis in an effort to manage diabetes. One takeaway from this study and what we learned is that those who had more education were more likely to use apps. If we think about the general population as people get older and are trying to manage not just their diabetes, but other comorbid conditions, we realize they will, in many cases, need some additional education.”

Case managers should remember patients could benefit from mobile apps for self-care, but they likely will need education on how to download and use them — particularly if the patients are older.

“They were not always as comfortable using apps as young adults, but they were not resistant to using apps,” Chlebowy says. “As future apps are developed, or if we suggest diabetes patients use apps on their phones, we should think about how they may have visual problems related to diabetes, which can definitely impact their comfort and ability to use these apps.”

Case managers and other healthcare professionals who seek ways to improve patients’ adherence to self-care and to promote behavior changes should remember that technological tools can be challenging for some patients.

“It’s challenging for them to manage and to make some of the necessary behavior changes,” Chlebowy says.


  1. Chlebowy DO, Coty MB, Lauf A, et al. Mobile app use in adults with comorbid type 2 diabetes and depression. West J Nurs Res 2021:193945920988791. doi: 10.1177/0193945920988791. [Online ahead of print].