BACKGROUND: Ehealth apps have 3.7 billion downloads yearly. The accessibility of diabetes mobile applications allows for patient self-management of diabetes. Renal and cardiovascular complications,1 which play a role in diabetic patient outcomes, are newly highlighted by the 2019 American Diabetes Association’s Standards of Medical Care in Diabetes.2 Purpose: To evaluate free Android mobile apps using the Diabetes Self-Management Education and Support (DSMES) and the 2019 American Diabetes Association (ADA) guidelines for renal and cardiovascular complications. Methods: Using the search term “diabetes,” Google Play store was accessed. Inclusion criteria: 1) Apps with downloads 1M-100,000; 2) free; 3) DSMES criteria; and 4) medication adherence. Exclusion criteria: 1) Purely educational factual apps on diabetes; 2) no ranking or download information. Google displayed a list of 10 free apps in 2019. The 2019 apps were analyzed for DSMES criteria, renal and cardiovascular complications (ADA 2019), and medication adherence via push notification. Results: The top 10 mobile apps in descending order were: 1) mySugr, 2) Onetouch Reveal, 3) OneDrop Diabetes Management, 4) Diabetes: M, 5) Diabetes, 6) Ontrack Diabetes, 7) Health2Sync, 8) Diabetes Connect, 9) Glucose Buddy Diabetes Tracker, 10) Blood Glucose Tracker. All of the mobile apps had the functionality of tracking blood glucose levels. 8/10 had the ability of tracking HbA1C levels. The percent of DSMES incorporation within the apps ranged from 18.2%-81.8%. None of the apps used all the DSMES guidelines or 2019 ADA. Only 1/10 of the mobile apps had the ability to track the presence of heart palpitation and retina/eye issues recommendations. None of the apps had the ability to track cardiovascular and renal complications. 7/10 of the apps had medication reminders (sound notification) and 4/10 of the apps had push notifications. Conclusion: eHealth mobile apps could be a powerful tool for patient self-management of diabetes. Currently, none of the apps incorporate all of the DSMES or ADA guidelines regarding comorbidities and complications of diabetes. Despite these shortcomings, these apps provide an introduction to the concept of patient-centered tracking of health data. We look for future improvements as more physicians use the apps and provide feedback to the app developers and eHealth commerce space. References 1. Davies MJ, D’Alessio DA, Fradkin J, et al. Management of hyperglycemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetes Care 2018;41:2669-2701 2. American Diabetes Association. 4. Comprehensive medical evaluation and assessment of comorbidities: Standards of Medical Care in Diabetes—2019. Diabetes Care 2019;42(Suppl. 1):S34-S45

Purpose: To evaluate if COVID-19 apps address risk factors such as diabetes, hypertension, race, gender, sexual orientation, language. Background: In 2019, there were 204 Billion app downloads and 3.7 billion downloads of ehealth apps. COVID-19 affects ethnic minority patients with diabetes, hypertension, and other risk factors. Spanish is the second most commonly used language after English in the U.S.. African Americans, Hispanic Americans, and Asian Americans are at an increased risk of COVID-19. LGBTQ+ communities are also at higher risk for COVID due to historically poor access to healthcare. Methods: The search term, “COVID,” in Google Play store and Apple App store was used to find the most popular COVID-19 apps. App inclusion criteria: 1) Contains COVID-19 information and/or COVID symptom tracker, 2) Marketed and designed for the general public, 3) Free, 4) Android (DROID): 100,000+ Downloads; Apple (iOS): highest star ratings. Apple does not provide a number of downloads. App features: COVID-19 information, COVID-19 symptom questionnaire (QN), Diabetes, Hypertension, Cardiovascular disease, Languages (Spanish, Chinese), Race, Gender, and Sexual Orientation. Results: The top 10 DROID apps in descending order are: 1) GuideSafe, 2) CO Exposure Notifications, 3) Care19 Diary, 4) Care19 Alert, 5) Crush COVID RI, 6) MI COVID Alert, 7) DC CAN, 8) CombatCOVID MDC, 9) CombatCOVID PBC, 10) Stronger than C19. The top 10 iOS apps in descending order are: 1) SlowCOVIDNC, 2) COVIDWISE, 3) COVID Alert Pennsylvania, 4) COVID Alert DE, 5) COVID Alert NY, 6) Covid Watch Arizona, 7) Apple COVID-19, 8) COVID Alert NJ, 9) COVID Trace Nevada, 10) CDC. Of the 20 apps: COVID 19 information: 20/20; COVID-19 symptom QN: 8/20; DM: 2/20; HTN: 1/20; CardioVasc: 2/20; Spanish: 11/20 (2/11 of the Spanish apps have Chinese as well). Race: 5/20. Gender: 8/20; Sexual Orientation: 3/20; Age: 10/20. Conclusion: 1) Most apps do not ask about important risk factors such as DM, HTN, and Race. 2) Smartphone apps are not uniform in their health education features. 3) Healthcare providers should continue to play an important role in public education despite the ubiquity of mobile apps.

Background: Over 70 million Americans are obese and 99 million are overweight. There are over 3.7 billion ehealth mobile app downloads per year. Weight loss apps offer information on exercise and nutrition as well as weight tracking. Obesity is a risk factor for COVID-19 infection, along with diabetes and hypertension. In addition, obesity plays a role in the increased mortality of COVID patients. In March of 2020, the U.S. government, through the Small Business Administration and through the Small Business Innovation Research program, as well as through Facebook and Google, offered individuals and companies money for public education and/or solutions for the COVID-19 epidemic. Thus, are software app developers adding information about COVID-19 for their audience? Specifically, do weight loss apps mention obesity being a risk factor for DM, Hypertension, and COVID-19? Weight loss apps target a young demographic, and for public health purposes, COVID-19 information needs to reach this demographic since obesity can be a risk factor for COVID-19 infection. Purpose: Do weight loss apps provide information about DM, HTN, and COVID-19 during this pandemic era? Methods: Evaluation of the 10 most popular apps in the Apple (iOS) and Google (Android) stores via the search term “weight loss.” Apps were ranked by downloads/star rating respectively for Android and iOS apps. Apple does not provide information about the number of downloads. App inclusion criteria: 1) Free 2) iOS: star ratings greater than 4 (greater than 10K ratings); Android: greater than or equal to 1 Million downloads; App features: DM, HTN, Race, Gender, COVID-19, BMI, Heart Disease, Calorie Count, and Fitness. Results: DM: 0/20, HTN: 0/20, BMI: 19/20, while Race is 0/20; Gender 19/20; COVID-19: 0/20; Calorie Count 11/20; Fitness 13/20. Conclusion: 1) Weight Loss apps have not ventured in the public education realm of risk factors and comorbidities of COVID-19 despite the pandemic in 2020. 2) As physicians, we should continue to educate our patients with weight issues and other risk factors in the era of a worldwide pandemic.

Background: Imaging is an important tool for diagnosis of hypertension and diabetes for all physicians. In the US, 300 million smartphones were purchased in 2019. Purpose: A smartphone-based ophthalmoscope for fundus imaging was compared to an office based retina camera to evaluate the average time spent on each device. Methods: Inclusion criteria: Patients with 20/20-20/50 vision, informed consent was obtained. D-Eye/iphone digital direct ophthalmoscope (Padova, Italy) was used on the dilated and undilated eyes of patients, video recorded to attain an image of the optic nerve and internally timed in the iPhone. Optos (Marlborough, MA) was then used to take retinal images of both dilated and undilated eyes of patients for comparison. The start time and end time was recorded from the timestamp of the 1st and last image taken on Optos, then the difference between both timestamps was calculated to obtain time spent on Optos. Results: For dilated patients (n=12, 24 eyes), the average time taken to obtain a clear video of both eyes using D-Eye was 28.08 seconds. The average time to take images of both eyes using Optos was 1.83 minutes. For undilated patients (n=10, 20 eyes), the average time of a clear video of both eyes using D-Eye was 29.8 seconds. The average time to take clear images of both eyes using Optos was 1.2 minutes. Conclusion: The portable D-Eye attachment may be useful at primary care settings, eye MD offices, bedside, ER, and wheelchair patients for evaluation and diagnosis. The D-Eye attachment for the smartphone is useful for imaging both dilated and undilated eyes. We look forward to future studies of the D-Eye for more complex retinal images.

Background: Annually, there are 3.7 billion downloads of mobile health apps. There are 275.6 million smartphones in the US. Diabetes affects 34.2 million people and 88 million have prediabetes. Diabetes is a risk factor for COVID-19 and affects longterm health of the survivors. Other risk factors for COVID-19, include race and gender. There are also linguistic barriers to care in Diabetes and COVID-19. Both diabetes and COVID-19 have higher risks associated with race and ethnicity. With the pandemic, the US government, Google and Facebook, in March 2020, provided emergency grants for COVID-19 and dissemination of public education. Did the Diabetes apps meet this moment of public health crisis?. Purpose: Do Diabetes Apps provide information about COVID-19 and its risk factors? Methods: Using the search term “diabetes,” the top ten most downloaded android and iOS apps were assessed in the Google Play Store/Apple App Store, respectively. Inclusion criteria: 1) Android: Downloads > 100,000; iOS: Reviews > 300, star rating >4. Apple App store does not provide download information. 2) Free; 3) Ability to track health data: HbA1C, FBS; 4) Language Accessibility via in-app language settings. Results: In the Google Play Store(DROID), the top ten apps in descending order were: 1) mySugr, 2) Onetouch Reveal, 3) OneDrop Diabetes Management, 4) Diabetes: M, 5) Health2Sync - Diabetes Care, 6) Diabetes, 7) Ontrack Diabetes, 8) Blood Glucose Tracker, 9) Glucose Buddy Diabetes Tracker, and 10) Diabetes Connect. In the Apple App Store(iOS), the top ten apps in descending order were: 1) OneTouch Reveal, 2) Glucose Buddy Diabetes, 3) One Drop for Diabetes, 4) Glucose - Blood Sugar Tracker, 5) Blood Sugar Monitor by Dario, 6) mySugr, 7) Sugarmate, 8) DiabetesPal, 9) Diabetes:M, 10) Center Health - The Diabetes App. Of the 10 DROID apps: 0/10 had COVID symptom information in the app; 3/10 had a COVID statement; In-app language settings: 2/10 had Spanish and 1/10 had Chinese. Gender: 7/10 Droid apps. Race/Ethnicity: 0/10. Of the ten iOS apps: 0/10 had COVID symptom information in the app; 4/10 had a COVID statement (Only mySugr has CDC link for COVID information); In-app language settings: 1/10 had Spanish and 0/10 had Chinese settings. Gender: 9/10 Droid apps; 7/10 iOS apps, Race/Ethnicty:1/10. Conclusion: Of the top 20 diabetes apps, none had information about COVID-19 and its symptoms within the app. Also, the overall language accessibility is limited. Despite popularity of ehealth, physicians can continue to play an important role in public education about Diabetes and COVID-19 during this important time of the pandemic.