Blood Glucose Tracking Research Articles

Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study.

Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted "think-aloud" interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs.

Technology and Continuous Glucose Monitoring Access, Literacy, and Use Among Patients at the Diabetes Center of an Inner-City Safety-Net Hospital: Mixed Methods Study.

Despite the existence of an increasing array of digital technologies and tools for diabetes management, there are disparities in access to and uptake and use of continuous glucose monitoring (CGM) devices, particularly for those most at risk of poor diabetes outcomes. This study aims to assess communication technology and CGM access, literacy, and use among patients receiving treatment for diabetes at an inner-city safety-net hospital. A survey on digital technology ownership and use was self-administered by 75 adults with type 1 and type 2 diabetes at the diabetes clinic of Grady Memorial Hospital in Atlanta, Georgia. In-depth interviews were conducted with 16% (12/75) of these patient participants and 6 health care providers (HCPs) to obtain additional insights into the use of communication technology and CGM to support diabetes self-management. Most participants were African American (66/75, 88%), over half (39/75, 52%) were unemployed or working part time, and 29% (22/75) had no health insurance coverage, while 61% (46/75) had federal coverage. Smartphone ownership and use were near universal; texting and email use were common (63/75, 84% in both cases). Ownership and use of tablets and computers and use and daily use of various forms of media were more prevalent among younger participants and those with type 1 diabetes, who also rated them as easier to use. Technology use specifically for diabetes and health management was low. Participants were supportive of a potential smartphone app for diabetes management, with a high interest in such an app helping them track blood sugar levels and communicate with their care teams. Younger participants showed higher levels of interest, perceived value, and self-efficacy for using an app with these capabilities. History of CGM use was reported by 56% (42/75) of the participants, although half (20/42, 48%) had discontinued use, above all due to the cost of the device and issues with its adhesive. Nonuse was primarily due to not being offered CGM by their HCP. Reasons given for continued use included convenience, improved blood glucose control, and better tracking of blood glucose. The in-depth interviews (n=18) revealed high levels of satisfaction with CGM by users and supported the survey findings regarding reasons for continued use. They also highlighted the value of CGM data to enhance communication between patients and HCPs. Smartphone ownership was near universal among patients receiving care at an inner-city hospital. Alongside the need to address barriers to CGM access and continued use, there is an opportunity to leverage increased access to communication technology in combination with CGM to improve diabetes outcomes among underresourced populations.

Reversal of diabetes by an oral Salmonella-based vaccine in acute and progressive diabetes in NOD mice.

Type 1 diabetes (T1D)-associated hyperglycemia develops, in part, from loss of insulin-secreting beta cells. The degree of glycemic dysregulation and the age at onset of disease can serve as indicators of the aggressiveness of the disease. Tracking blood glucose levels in prediabetic mice may demonstrate the onset of diabetes and, along with animal age, also presage disease severity. In this study, an analysis of blood glucose levels obtained from female NOD mice starting at 4 weeks until diabetes onset was undertaken. New onset diabetic mice were orally vaccinated with a Salmonella-based vaccine towards T1D-associated preproinsulin combined with TGFβ and IL10 along with anti-CD3 antibody. Blood glucose levels were obtained before and after development of disease and vaccination. Animals were classified as acute disease if hyperglycemia was confirmed at a young age, while other animals were classified as progressive disease. The effectiveness of the oral T1D vaccine was greater in mice with progressive disease that had less glucose excursion compared to acute disease mice. Overall, the Salmonella-based vaccine reversed disease in 60% of the diabetic mice due, in part, to lessening of islet inflammation, improving residual beta cell health, and promoting tolerance. In summary, the age of disease onset and severity of glucose dysregulation in NOD mice predicted response to vaccine therapy. This suggests a similar disease categorization in the clinic may predict therapeutic response.

Application of Biosensors in Non-invasive Blood Glucose Monitoring

Blood glucose monitoring is essential for managing conditions like diabetes and liver dysfunction, with a growing need among various population groups, including the elderly, pregnant, and individuals engaging in specific dietary and exercise regimes. The technology for glucose monitoring is divided into invasive and non-invasive methods. Invasive techniques, while accurate, involve bodily fluid extraction, posing risks of infection and inconvenience for frequent monitoring. Conversely, non-invasive methods, which include biosensors that analyze internal signals, offer a safer and more user-friendly alternative, providing instant feedback on glucose levels. Recent advancements in biosensor technology have focused on enhancing accuracy, biocompatibility, and ease of use, with significant progress in areas like optical and electrochemical sensors. These developments aim to offer more reliable, convenient, and comprehensive glucose monitoring solutions, leveraging innovations in sensor technology and data analysis to cater to the diverse needs of individuals requiring blood glucose tracking.

ISM Band 2.4 GHz Wearable Textile Antenna for Glucose Level Monitoring

Wearable technology has recently attracted much interest for various uses. An essential component of the wearable system is the wearable antenna. Textile and non-textile materials have both been used to create wearable antennas. Textile antennas are very useful and widely used nowadays, particularly in body-worn applications monitoring health parameters. Fabricated using microstrip technology, textile antennas have various benefits, including small size, lightweight, simple fabrication, and ease of wear. In this study, a microstrip antenna is created utilizing a substrate made of jeans. It works between 2.4 to 2.5 GHz in the ISM (industrial, scientific, and medical) band. High-frequency structure simulator (HFSS) software was used to simulate two antennas, one with an incomplete and the other with a complete ground plane. Wearable antennas can protect the body from the impacts of RF radiation by utilizing the entire ground plane principle. Results from a vector network analyzer were obtained for the fabricated antenna (VNA). This antenna's main function is to track blood glucose levels. Blood's dielectric characteristics change when blood sugar levels fluctuate, affecting the antenna’s output frequency. There are two ways to monitor glucose levels. One method requires placing a finger on an antenna patch, while the other involves fixing an antenna to a person's arm and detecting the output frequency fluctuation. The antenna's resonant frequency raises in reaction to increased blood glucose levels. Therefore, these textile antennas are a great choice for non-blood sample monitoring of blood glucose levels.

Development of Smartphone-Controlled and Microneedle-Based Wearable Continuous Glucose Monitoring System for Home-Care Diabetes Management.

Continuous glucose monitoring (CGM) can mini-invasively track blood glucose fluctuation and reduce the risk of hyperglycemia and hypoglycemia, and this is is in great demand for diabetes management. However, cost-effective manufacture of CGM systems with continuously improved convenience and performance is still the persistent goal. Herein, we developed a smartphone-controlled and microneedle (MN)-based wearable CGM system for long-term glucose monitoring. The CGM system modified with a sandwich-type enzyme immobilization strategy can satisfy the clinical requirement of interstitial fluid (ISF) glucose monitoring for 14 days with a mean absolute relative difference of 10.2% and a cost of less than $15, which correlated well with the commercial glucometer and FDA-approved CGM system FreeStyle Libre (Abbott Inc., Illinois, USA). The self-developed CGM system is demonstrated to accurately monitor glucose fluctuations and provide abundant clinical information. It is better to find the cause of individual blood glucose changes and beneficial for the guide of precise glucose control. On the whole, the intelligently wearable CGM system may provide an alternative solution for home-care diabetes management.

BA FOR DEPRESSION AND DIABETES MANAGEMENT: EXAMINED VIA SINGLE-CASE DESIGN

Abstract Type 2 Diabetes Mellitus (T2DM) is a pervasive, chronic disease whose prevalence increases with age. The most common treatment options for T2DM include medication, dietary changes, and engagement in physical activity, which require considerable lifestyle changes. Further, individuals with T2DM are highly likely to develop physical and mental health comorbidities that can complicate effective T2DM management. In fact, individuals with T2DM and other comorbidities are frequently excluded from behavioral and other interventions in randomized controlled trials due to their comorbidities. Individualized treatment is necessary to address these comorbid diseases and to effectively navigate lifestyle changes. As part of a larger study evaluating an at-home diabetes management program with patients at a Federally Qualified Health Care Facility, the current study utilized a single-case experimental design approach using changing criterion design to evaluate behavioral activation to treat depression and diabetes in a 68 year-old Hispanic woman with cognitive impairment. Across her intake, five treatment sessions, and two follow-up appointments, we collaborated with her to set and achieve behavioral goals while effectively managing her diabetes. By end of treatment, she reported significant improvements in depression and overall well-being, increased engagement in exercises, increased blood glucose tracking, and rated improvement in her overall efficacy in life that maintained through follow-up. Results revealed the effectiveness of behavioral activation in treating comorbidities in a low-income, diverse individual. Attendees will learn about a promising treatment avenue for older individuals with complex medical and psychiatric conditions and the utility of single case design.

Technical Difficulties in the Implementation of the Continuous Glucose Monitoring System

The continuous glucose monitoring system (CGMS) has been clinically applied to monitor the dynamic change of the subcutaneous interstitial glucose concentration which is a function of the blood glucose level by glucose sensors. It can track blood glucose levels all day along, and thus provide comprehensive and reliable information about blood glucose dynamics. The clinical application of CGMS enables monitoring of blood glucose fluctuations and the discovery of hidden hyperglycemia and hypoglycemia that are difficult to be detected by traditional methods. As a CGMS needs to work subcutaneously for a long time, a series of factors such as biocompatibility, enzyme inactivation, oxygen deficiency, foreign body reaction, implant size, electrode flexibility, error correction, comfort, device toxicity, electrical safety, et al. should be considered beforehand. The study focused on the difficulties in the technology, and compared the products of Abbott, Medtronic and DexCom, then summarized their cutting-edge. Finally, this study expounded some key technologies in dynamic blood glucose monitoring and therefore can be utilized as a reference for the development of CGMS.

Electronic blood glucose monitoring impacts on provider and patient behavior.

ObjectiveRecent technological development along with the constraints imposed by the coronavirus disease 2019 (COVID-19) pandemic have led to increased availability of patient-generated health data. However, it is not well understood how to effectively integrate this new technology into large health systems. This article seeks to identify interventions to increase utilization of electronic blood glucose monitoring for patients with diabetes.Materials and MethodsA large randomized controlled trial tested the impact of multiple interventions to promote use of electronic blood glucose tracking. The total study sample consisted of 7052 patients with diabetes across 68 providers at 20 selected primary care offices. The design included 2 stages: First, primary care practices were randomly assigned to have their providers receive education regarding blood glucose flowsheet orders. Then, patients in the treated practices were assigned to 1 of 4 reminder interventions.ResultsProvider education successfully increased provider take-up of an online blood glucose monitoring tool by 64 percentage points, while a comparison of reminder interventions revealed that emphasizing accountability to the provider encouraged patients to track their blood glucose online. An assessment of downstream outcomes revealed impacts of the interventions on prescribing behavior and A1c testing frequency.DiscussionIt is important to understand how health systems can practically promote take-up and awareness of emerging digital health alternatives or those with persistently low utilization in clinical settings.ConclusionThese results indicate that provider training and support are critical first steps to promote utilization of patient-generated health data, and that patient communications can provide further motivation.

Mobile health as a primary mode of intervention for women at risk of or diagnosed with gestational diabetes mellitus: a scoping review.

The objective of this review was to map the knowledge related to the use of mobile health (mHealth) as a primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications among women at risk of or diagnosed with gestational diabetes mellitus. We also sought to understand if mHealth for women at risk of or diagnosed with gestational diabetes mellitus incorporated relevant behavior change theory and techniques. Prevention and management of gestational diabetes mellitus and its associated adverse outcomes are important to maternal and infant health. Women with gestational diabetes mellitus report high burden of disease management and barriers to lifestyle change post-delivery, which mHealth interventions may help to overcome. Evidence suggests apps could help gestational diabetes mellitus prevention and management; however, less is known about broader applications of mHealth from preconception to interconception, and whether relevant behavior change techniques are incorporated. Studies that focused on mHealth use as the primary mode of intervention for the prevention and management of gestational diabetes mellitus and its long-term implications were considered for inclusion. Telehealth or telemedicine were excluded as these have been reviewed elsewhere. Six databases were searched: MEDLINE, CINAHL, Embase, Cochrane Library, Scopus, and TRIP. No limits were applied to database exploration periods to ensure retrieval of all relevant studies. Gray literature sources searched were OpenGrey, ISRCTN Registry, ClinicalTrials.gov, EU Clinical Trials Register, and ANZCTR. Two reviewers independently screened abstracts and assessed full texts against the inclusion criteria. Data were extracted using an adapted version of the JBI data extraction instrument. Data are presented in narrative form accompanied by tables and figures. This review identified 2166 sources, of which 96 full texts were screened. Thirty eligible reports were included, covering 25 different mHealth interventions. Over half (n = 14) of the interventions were for self-managing blood glucose during pregnancy. Common features included tracking blood glucose levels, real-time feedback, communication with professionals, and educational information. Few (n = 6) mHealth interventions were designed for postpartum use and none for interconception use. Five for postpartum use supported behavior change to reduce the risk oftype 2 diabetes and included additional features such as social support functions and integrated rewards. Early development and feasibility studies used mixed methods to assess usability and acceptability. Later stage evaluations of effectiveness typically used randomized controlled trial designs to measure clinical outcomes such as glycemic control and reduced body weight. Three mHealth interventions were developed using behavior change theory. Most mHealth interventions incorporated two behavior change techniques shown to be optimal when combined, and those delivering behavior change interventions included a wider range. Nevertheless, only half of the 26 techniques listed in a published behavior change taxonomy were tried. mHealth for gestational diabetes mellitus focuses on apps to improve clinical outcomes. This focus could be broadened by incorporating existing resources that women value, such as social media, to address needs, such as peer support. Although nearly all mHealth interventions incorporated behavior change techniques, findings suggest future development should consider selecting techniques that target women's needs and barriers to engagement. Lack of mHealth interventions for prevention of gestational diabetes mellitus recurrence and type 2 diabetes mellitus suggests further development and evaluation are required.

Health Internet Technology for Chronic Conditions: Review of Diabetes Management Apps.

BackgroundMobile health (mHealth) smartphone apps have shown promise in the self-management of chronic disease. In today’s oversaturated health app market, selection criteria that consumers are employing to choose mHealth apps for disease self-management are of paramount importance. App quality is critical in monitoring disease controls but is often linked to consumer popularity rather than clinical recommendations of effectiveness in disease management. Management of key disease variances can be performed through these apps to increase patient engagement in disease self-management. This paper provides a comprehensive review of features found in mHealth apps frequently used in the self- management of diabetes.ObjectiveThe purpose of this study was to review features of frequently used and high consumer-rated mHealth apps used in the self-management of diabetes. This study aimed to highlight key features of consumer-favored mHealth apps used in the self-management of diabetes.MethodsA 2-fold approach was adopted involving the Apple iOS store and the Google search engine. The primary search was conducted on the Apple iOS store using the term “diabetes apps” (device used: Apple iPad). The top 5 most frequently used mHealth apps were identified and rated by the number of consumer reviews, app ratings, and the presence of key diabetes management features, such as dietary blood glucose, A1C, insulin, physical activity, and prescription medication. A subsequent Google search was conducted using the search term “best Apple diabetes apps.” The top 3 search results—“Healthline,” “Everyday Health,” and “Diabetes Apps–American Diabetes Association”—were explored.ResultsIn total, 12 mHealth apps were reviewed due to their appearing across 4 evaluated sources. Only 1 health app—Glucose Buddy Diabetes Tracker—appeared as the most frequently used within the Apple iOS store and across the other 3 sources. The OneTouch Reveal app ranked first on the list in the iOS store with 39,000 consumer reviews and a rating of 4.7 out of 5.0 stars but only appeared in 1 of the other 3 sources. Blood glucose tracking was present across all apps, but other disease management features varied in type with at least 3 of the 5 key features being present across the 12 reviewed apps. Subscription cost and integration needs were present in the apps which could impact consumers’ decision to select apps. Although mobile app preference was assessed and defined by the number of consumer reviews and star ratings, there were no scientific standards used in the selection and ranking of the health apps within this study.ConclusionsmHealth apps have shown promise in chronic disease management, but a surge in development of these nonregulated health solutions points to a need for regulation, standardization, and quality control. A governing body of health IT professionals, clinicians, policymakers, payors, and patients could be beneficial in defining health app standards for effective chronic disease management. Variabilities in features, cost, and other aspects of management could be reduced by regulatory uniformity, which would increase patient engagement and improve disease outcomes.

A Fully Integrated Closed-Loop System Based on Mesoporous Microneedles-Iontophoresis for Diabetes Treatment.

A closed‐loop system that can mini‐invasively track blood glucose and intelligently treat diabetes is in great demand for modern medicine, yet it remains challenging to realize. Microneedles technologies have recently emerged as powerful tools for transdermal applications with inherent painlessness and biosafety. In this work, for the first time to the authors' knowledge, a fully integrated wearable closed‐loop system (IWCS) based on mini‐invasive microneedle platform is developed for in situ diabetic sensing and treatment. The IWCS consists of three connected modules: 1) a mesoporous microneedle‐reverse iontophoretic glucose sensor; 2) a flexible printed circuit board as integrated and control; and 3) a microneedle‐iontophoretic insulin delivery component. As the key component, mesoporous microneedles enable the painless penetration of stratum corneum, implementing subcutaneous substance exchange. The coupling with iontophoresis significantly enhances glucose extraction and insulin delivery and enables electrical control. This IWCS is demonstrated to accurately monitor glucose fluctuations, and responsively deliver insulin to regulate hyperglycemia in diabetic rat model. The painless microneedles and wearable design endows this IWCS as a highly promising platform to improve the therapies of diabetic patients.

THE INFLUENCE OF FAMILY SUPPORT AMONG UNCONTROLLED TYPE II DIABETES MELLITUS PATIENTS

Across the Worldwide, the prevalence of type 2 diabetes mellitus (T2D) is rising significantly. Continuing diabetes mellitus (DM) treatment allows both patients and family members to undergo appropriate self-management instruction and support. This study aimed to review and describe the effect of self-management education for diabetes mellitus (DSME) involving close relatives on patient outcomes associated with patient health habits and perceived self-efficacy on self-management, such as medication adherence, tracking blood glucose, improvements in diet and exercise, health outcomes including psychological well-being and self-efficacy, and physiological indicators like body mass index. Three databases, PubMed, CINAHL, and Scopus, have been reviewed for relevant articles.
 Keywords: close relatives, self-management; family support; uncontrolled glycaemia; type 2 DM.

The Effect of Care Provided at Home by Public Health Nurse on Control of Type II Diabetes Mellitus.

AIMThe aim of the study was to examine the effect of home care provided for patients with type II diabetes by public health nurse on HbA1c, and to investigate the opinions of these patients regarding diabetes.METHODThe quantitative aspect of the study consisted of a pre and posttest with the control group; the qualitative aspect consisted of a semi-structured interviewing technique. The sample size was 48 patients receiving treatment within the clinic of hospital during 11th–30th April 2016. Because some patients were excluded from the study, the research was completed with a sample size of 20 for the experiment and 20 for the control group. The following forms were used during data: Pre and post measurement and qualitative interview forms. A total of seven home visits were conducted for the experiment group and two home visits for the control group, during 2nd May to 27th October, 2016.RESULTSHbA1c decreased by 0.75% in the experiment group (p<0.05). It was found that faulty usage of insulin was treated; all patients developed the habit of tracking blood glucose. Blood glucose of three patients continued to remain at high levels, and most of the patients failed to develop healthy eating habits and regular exercising.CONCLUSIONAccording to these results, it is advised that long-term interventions be planned with the contributions of other experts.

User Retention and Engagement With a Mobile App Intervention to Support Self-Management in Australians With Type 1 or Type 2 Diabetes (My Care Hub): Mixed Methods Study.

BackgroundMobile health apps are commonly used to support diabetes self-management (DSM). However, there is limited research assessing whether such apps are able to meet the basic requirements of retaining and engaging users.ObjectiveThis study aimed to evaluate participants’ retention and engagement with My Care Hub, a mobile app for DSM.MethodsThe study employed an explanatory mixed methods design. Participants were people with type 1 or type 2 diabetes who used the health app intervention for 3 weeks. Retention was measured by completion of the postintervention survey. Engagement was measured using system log indices and interviews. Retention and system log indices were presented using descriptive statistics. Transcripts were analyzed using content analysis to develop themes interpreted according to the behavioral intervention technology theory.ResultsOf the 50 individuals enrolled, 42 (84%) adhered to the study protocol. System usage data showed multiple and frequent interactions with the app by most of the enrolled participants (42/50, 84%). Two-thirds of participants who inputted data during the first week returned to use the app after week 1 (36/42, 85%) and week 2 (30/42, 71%) of installation. Most daily used features were tracking of blood glucose (BG; 28/42, 68%) and accessing educational information (6/42, 13%). The interview results revealed the app’s potential as a behavior change intervention tool, particularly because it eased participants’ self-care efforts and improved their engagement with DSM activities such as BG monitoring, physical exercise, and healthy eating. Participants suggested additional functionalities such as extended access to historical analytic data, automated data transmission from the BG meter, and periodic update of meals and corresponding nutrients to further enhance engagement with the app.ConclusionsThe findings of this short-term intervention study suggested acceptable levels of participant retention and engagement with My Care Hub, indicating that it may be a promising tool for extending DSM support and education beyond the confines of a physical clinic.

202-OR: Basal Insulin Digital Titration App vs. Enhanced Paper Titration Tool: A Randomized Control Study

Self-adjusting insulin is challenging for people with type 2 diabetes (PWT2D). Mobile health technologies (mHealth) can help PWT2D track blood glucose more easily, but it remains unclear whether an mHealth-enabled digital therapeutic tool can effectively support basal insulin (BI) titration in a large multispecialty health care setting. We randomized 242 PWT2D on BI (baseline HbA1c 7.5% - 12.5%) to use either an app-based self-titration tool [Mobile Insulin Dosing System (MIDS)] or an enhanced paper titration tool based on a stepped algorithm with diabetes educator support (control) for 16 weeks. Cohort characteristics for the intent to treat sample (MIDS n = 117; control n = 120) were: median age 61 years [IQR: 53 - 69], 41.7% female, 75.9% non-Hispanic White, 11.4% new to insulin, median duration of diabetes 11 years [IQR: 7 - 18], and median baseline HbA1c of 8.7% [IQR: 8.0 - 9.6]. Improvements in HbA1c (-1.3% [IQR: -2.2 - -.5] and -1.2% [IQR: -1.9 - -.5]; both Ps &amp;lt; .05) with increased median insulin dose (+8 IU [IQR: 2 - 22] and +10 IU [IQR: 2 - 25.5]; both Ps &amp;lt; .05) and no change in hypoglycemia were observed at 16 weeks in both the MIDS and control groups, respectively. No differences in HbA1c (P = .48) or insulin dose change (P = .34) were observed between the groups. Among SMBG readings recorded during the study, the mean proportion of readings between 70-180 mg/dL (76.8% ± 22.0; 70.0% ± 26.7; p&amp;lt;0.05) and &amp;gt;250 mg/dL (4.9% ± 9.2; 9.2% ± 18.4; p&amp;lt;0.05) both favored the MIDS group. The use of MIDS and the enhanced paper-based tool for BI self-titration both resulted in higher insulin dose and significantly improved glycemic control among PWT2D who were relatively uncontrolled despite most already being treated with insulin. An mHealth-enabled digital therapeutic tool such as MIDS may offer an effective alternative option for PWT2D and their HCPs for titrating BI to non-mHealth approaches; future RCTs will more clearly elucidate the efficacy of MIDS compared to usual care. Disclosure A. Philis-Tsimikas: Advisory Panel; Self; Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. Employee; Spouse/Partner; Ionis Pharmaceuticals, Inc. Research Support; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Lilly Diabetes, Medtronic, Novo Nordisk A/S, Sanofi. A.L. Fortmann: None. A. Bastian: None. A. Kanchi: Employee; Self; Glooko, Inc. Stock/Shareholder; Self; Glooko, Inc. R. Abad: Employee; Self; Glooko, Inc. T. Sheng: Employee; Self; Glooko, Inc. L. Parks: Employee; Self; Glooko, Inc. M. Greenfield: Consultant; Self; Glooko, Inc. M.A. Clements: Consultant; Self; Glooko, Inc. Other Relationship; Self; Glooko, Inc.

SAT-637 Patient-Centered Glycemic Management of Type 2 Diabetes with Mobile Applications

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.

Prosthetics and the Chronically Ill Body: Living with Type 1 Diabetes and an Insulin Pump

Prosthetics and the Chronically Ill Body: Living with Type 1 Diabetes and an Insulin Pump

Determining minimum set of features for diabetes mobile apps.

Interest in mobile health applications (apps) for diabetes self-care is growing. Mobile health is a promising new treatment modality for diabetes, though few smartphone apps have been designed based on a proper study and prioritization. The aim of this study was to determine a minimum set of features for diabetes mobile apps. This study was conducted in three steps: 1.A review of the literature to collect all available features, 2. Assessing the validity of suggested features by Content Validity Index (CVI) and Content Validity Ratio (CVR), 3. Examining the importance of features by Friedman test. We retrieved all features of available mobile apps for type 2 diabetes, which are suggested and discussed in literature and compiled as a single list comprising of 33 features. Then, a survey of expert's opinion produced a set of 23 final minimum features which includes all types of tracking, mealtime tagging, food database, diet management, educational materials, healthy coping, reducing risks, problem solving, Email, color coding, alerts, reminder, target range setting, trend chart view, logbook view, numerical indicators view, customizable theme, preset notes, and custom notes. According to the mean rank which indicates the priority of each feature, the most important one was blood glucose tracking (with 16.71 mean rank) and the least important feature was the numerical indicators like such as standard deviation or average (with 6.50 mean rank). The present study is the first step towards the development of our mobile apps for people with type II diabetes, and highest the essential features that are required for an optimal self-care comprehensively.

Evaluation of Smartphone Diabetes Tracking Applications for Use in Pregnancy Using the APPLICATIONS Scoring System [10K

INTRODUCTION: To systematically evaluate the quality and functionality of smartphone diabetes tracking applications for use in pregnancies complicated by diabetes. METHODS: We adapted the previously described APPLICATIONS scoring system (score 0-16) with the definition of comprehensiveness as the incorporation of: ability to record blood glucose, medication use, carbohydrates, and weight gain; provide reminders for checks and/or medication; identify abnormal glucose levels; and export the collected data in reports. The Apple App Store (iPhone/iPad) and the Google Play Store (Android phones/tablets) were both searched systematically with pertinent key words to identify smartphone applications for review by three independent reviewers. RESULTS: Initial searches revealed 408 smartphone applications. Non-English applications and those without diabetes tracking abilities were excluded as well as applications that were not available on both operating systems, all paid applications, and those requiring institutional affiliation or proprietary equipment--leaving eight pairs of applications for evaluation. No application received a perfect APPLICATIONS score. The mean score for each was 11.3 (SD 2.1). Only one application was found to have all seven functions on both operating systems. The desired functions were available in the following percentages: blood glucose tracking (100%); medication tracking (94%); carbohydrate tracking (81%); weight tracking (75%); data exporting (75%), ability to set reminders (56%); in-app recognition of high and low glucose levels (69%). CONCLUSION: This systematic review using the adapted APPLICATIONS scoring system identified many diabetes tracking smartphone applications most suitable for in pregnancies complicated by diabetes. There are many excellent apps but only one app that contained all desired functions.