Abstract
BackgroundSelf-monitoring and self-management, crucial for optimal glucose control in type 1 diabetes, requires many disease-related decisions per day and imposes a substantial disease burden on people with diabetes. Innovative technologies that integrate relevant measurements may offer solutions that support self-management, decrease disease burden, and benefit diabetes control.ObjectiveThe objective of our study was to evaluate a prototype integrated mobile phone diabetes app in people with type 1 diabetes.MethodsIn this exploratory study, we developed an app that contained cloud-stored log functions for glucose, carbohydrates (including a library), insulin, planned exercise, and mood, combined with a bolus calculator and communication functions. Adults with diabetes tested the app for 6 weeks. We assessed the feasibility of app use, user experiences, perceived disease burden (through questionnaires), insulin dose and basal to bolus ratio, mean glucose level, hemoglobin A1c, and number of hypoglycemic events.ResultsA total of 19 participants completed the study, resulting in 5782 data entries. The most frequently used feature was logging blood glucose, insulin, and carbohydrates. Mean diabetes-related emotional problems (measured with the Problem Areas in Diabetes scale) scores decreased from 14.4 (SD 10.0) to 12.2 (SD 10.3; P=.04), and glucose control improved, with hemoglobin A1c decreasing from 7.9% (mean 62.3, SD 8 mmol/mol) to 7.6% (mean 59.8, SD 7 mmol/mol; P=.047). The incidence of hypoglycemic events did not change. Participants were generally positive about the app, rating it as “refreshing,” and as providing structure by reinforcing insulin-dosing principles. The app revealed substantial knowledge gaps. Logged data enabled additional detailed analyses.ConclusionsAn integrated mobile diabetes app has the potential to improve diabetes self-management and provide tailored educational support, which may decrease disease burden and benefit diabetes control.
Highlights
Optimizing Self-Management of Type 1 DiabetesType 1 diabetes is an autoimmune disease that occurs in genetically susceptible individuals and leads to the complete absence of insulin production by pancreatic beta cells [1]
To reduce the risk of long-term complications, people with diabetes aim for optimal blood glucose control, which requires self-monitoring of blood glucose levels at least four times daily, injection of rapid-acting insulin before every meal and of long-acting insulin before night, and adjustment of insulin dose based on food intake, actual glucose levels, intended physical activity, and experience [2]
The study population was heterogeneous with respect to age, diabetes duration and glucose control, frequency of hypoglycemic events, and treatment: 12 people were on basal bolus, 7 on pump therapy, 3 used continuous glucose measurement, and 4 used a bolus calculator
Summary
Type 1 diabetes is an autoimmune disease that occurs in genetically susceptible individuals and leads to the complete absence of insulin production by pancreatic beta cells [1]. It often debuts in childhood or early adolescence and requires insulin replacement therapy. Optimal self-monitoring and self-management requires extensive education and substantial efforts from people with diabetes. Self-monitoring and self-management, crucial for optimal glucose control in type 1 diabetes, requires many disease-related decisions per day and imposes a substantial disease burden on people with diabetes. Innovative technologies that integrate relevant measurements may offer solutions that support self-management, decrease disease burden, and benefit diabetes control
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