Qualitative assessment of user experiences of a novel smart phone application designed to support flexible intensive insulin therapy in type 1 diabetes.

Brigid A. Knight,Marina Noud,Ingrid J. Hickman,H. David McIntyre

doi:10.1186/s12911-016-0356-6

Abstract

BackgroundModern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis. Automated bolus calculators assist with these calculations, add additional functionality to protect against hypoglycaemia and enhance the record keeping process, however uptake and use depends on the devices meeting the needs of the user. We aimed to obtain user feedback on the usability of a mobile phone bolus calculator application in adults with T1DM to inform future development of mobile phone diabetes support applications.MethodsAdults with T1DM who had previously received education in flexible MDI therapy were invited to participate. Eligible respondents attended app education and one month later participated in a focus group to provide feedback on the features of the app in relation to usability for patient-based flexible MDI and future app development.ResultsSeven adults participated in the app training and follow up interview. App features that support dose adjustment to reduce hypoglycaemia risk and features that enable greater efficiency in dose calculation, record keeping and report generation were highly valued.ConclusionsAdults who are self managing flexible MDI found the Rapidcalc mobile phone app to be a useful self-management tool and additional features to further improve usability, such as connectivity with BG meter and food databases, shortcut options to economise data entry and web based storage of data, were identified. Further work is needed to ascertain specific features and benefit for those with lower health literacy.

Highlights

Modern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis
Self management is the cornerstone of type 1 diabetes (T1DM) management and patient-based flexible multiple daily injection (MDI) therapy requires the individual to perform a number of mathematical calculations [1]
Automated bolus calculators (ABCs) integrated with blood glucose (BG) meters and insulin pumps have enabled safe and effective bolus determination as demonstrated by improvements in 1) glycaemic control [5,6,7], 2) treatment satisfaction [7, 8], and 3) confidence in dose determination [4, 9] and reduction in 1) frequency [10] and fear of hypoglycaemia [9], 2) dose calculation errors [4] and 3) treatment burden associated with mathematical calculations and record keeping [11]

Summary

Introduction

Modern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis. In addition to managing the prandial dose calculation, effective ongoing management of patient-based flexible MDI therapy requires the person with diabetes to undertake additional self management tasks which add to the daily burden of diabetes management These tasks include counting carbohydrates (which involves measuring foods, interpreting food labels, researching unfamiliar foods, performing an estimate of carbohydrate count when eating out), monitoring blood glucose levels (which involves washing hands prior to testing, taking care with meter and test strip handling, remembering to monitor prior to eating, pre bed, prior to driving and when feeling symptomatic with hypoglycaemia), learn the impact of physical activity and alcohol on blood glucose and make anticipatory adjustments, record BG and additional pertinent diabetes management information (such as carbohydrate, alcohol, activity, stress, illness) in a diabetes diary, and effectively collaborate with health professionals.

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