Abstract
BackgroundHypoglycemia, or low blood sugar levels, in people with diabetes can be a serious life-threatening condition, and serious outcomes can be avoided if low levels of blood sugar are proactively detected. Although technologies exist to detect the onset of hypoglycemia, they are invasive or costly or exhibit a high incidence of false alarms. Tremors are commonly reported symptoms of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood.ObjectiveThis study aimed to understand diabetic patients’ perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to ultimately inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia.MethodsA cross-sectional internet panel survey was administered to adult patients with type 1 diabetes using the Qualtrics platform in May 2019. The questions focused on 3 main constructs: (1) perceived experiences of hypoglycemia, (2) experiences and expectations about a diabetes management device and mobile app, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this paper focuses on the first two constructs. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity.ResultsData from 212 respondents (129 [60.8%] females) revealed statistically significant differences in perceived noticeability of tremors by gender, whereby males noticed their tremors more (P<.001), and age, with the older population reporting lower noticeability than the young and middle age groups (P<.001). Individuals living longer with diabetes noticed their tremors significantly less than those with diabetes for ≤1 year but not in terms of frequency or severity. Additionally, the majority of our participants (150/212, 70.7%) reported experience with diabetes-monitoring devices.ConclusionsOur findings support the need for cost-efficient and noninvasive continuous monitoring technologies. Although hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be severe compared with other symptoms such as sweating, which was the highest rated symptom in our study. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events.
Highlights
BackgroundDiabetes is a chronic disease affecting more than 9.4% of the world’s population [1], with an estimated US $327 billion in economic costs each year [2]
The majority of the population living with diabetes has type 2 diabetes mellitus (T2DM), while about 10% have type 1 diabetes mellitus (T1DM)
Hypoglycemia or low blood glucose (BG) is a dangerous condition that affects people with diabetes when the blood glucose level falls below 70 mg/dL [5]
Summary
BackgroundDiabetes is a chronic disease affecting more than 9.4% of the world’s population [1], with an estimated US $327 billion in economic costs each year [2]. When the body is unable to secrete epinephrine that generates hypoglycemic symptoms [8], the risk of death could increase by more than 3-fold [9] This is risky during sleep where nocturnal hypoglycemia leads to cases of “dead in bed” [10]. Objective: This study aimed to understand diabetic patients’ perceptions of hypoglycemic tremors, as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool to inform the design of a noninvasive and cost-effective technology that detects tremors associated with hypoglycemia. Nonparametric tests were used to analyze the Likert scale data, with a Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity. Using a combination of tremor and galvanic skin response sensors may show promise in detecting the onset of hypoglycemic events
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