Background  
The Apollo Sugar App is a unique interface that allows patients to requisition services and seek support and also interact with human diabetes coaches through a built in messenger. We had previously demonstrated the capabilities of this system (1). Subsequently we have enhanced the ability of this system through a process called ERV(Experience Relationship Value). Using the app as a primary interface and backed up by telephone and video services we were able to respond to large Apollo sugar patient base during the pandemic. The Apollo sugar system has served more than 400,000 patients nation-wide.

Aim  
To review the utility of a unique “human digital support interface” in the management of diabetes during the second wave of the COVID 19 pandemic.

Method  
We retrieved information of patient interactions with the app between September 2020 and August 2021 from the Apollo sugar database and also reached out proactively to 19,000 registered users, who had enrolled for Long Term &amp; Short Term Programs with Apollo Sugar Clinics.

Results  
Of the 400,000 number of registered patients with Apollo Sugar Clinics; 55,102 used the app at least once. More than 1039 users used the app at least once a month during the period of study. 19,000 were enrolled in a short term or long term program with Apollo Sugar out of total registered patients.  
A total of 47,159 interactions with the app &amp; call center (ERV) were recorded, though team had made an attempt of 131,401 connect. Of these 832 registered users requested Health Coaches for one or other support or services. 60.9 % (n = 507) were interactions for consultation with physicians (Endocrinologists or Diabetologists). 18.9% (n=157) of the interactions were used to request a laboratory test. 7 interactions were to re-order medications. 12.6% (n = 105) of the interactions were to order glucometer strips (SBMG) and 6.7% (n=56) interactions for renewal of long &amp; short term programs.   


Discussion  
We describe the ability of a human digital interface to support patients through a difficult pandemic. The repeated use of the interface by patients also demonstrates the value of technology in chronic care under restrictive conditions such as lockdowns. The security and familiarity of an app allows patients to seek “human support” securely and efficiently. The app also demonstrates the ability of short or long term programs to keep patients engaged even while they are in remote locations or are with restricted mobility. The app as a means of requisitioning lab services or medications demonstrates the adaptability of patients in India to use technology to achieve these tasks when mobility is restricted. Health Coaches proactively calling 19,000 enrolled users (Long &amp; Short Term Programs at Apollo Sugar Clinics) &amp; offering support - was added advantage to these Diabetic patients in restricted environment.

References  
(1) ADA - Diabetes 2018 Jul; 67(Supplement 1): https://doi.org/10.2337/db18-949-P 



A human digital interface uniquely supports diabetes patient care during COVID 19