A Mobile App for the Self-management of Type 1 Diabetes as Tool for Preventing of Exercise-Associated Glycemic Imbalances

BACKGROUND Adults with type 1 diabetes (PWDs) face challenging self-management regimens including monitoring their glucose values multiple times a day to assist with achieving glycemic targets and reduce the risk of long-term diabetes complications. Recent advances in diabetes technology have reportedly improved glycemia, but little is known about how PWDs utilize mobile technology to make positive changes in their diabetes self-management. OBJECTIVE The aim of this qualitative study was to explore PWDs’ experiences using Sugar Sleuth, a glucose sensor–based mobile app and Web-based reporting system, integrated with the FreeStyle Libre glucose monitor that provides feedback about glycemic variability. METHODS We used a qualitative descriptive research design and conducted semistructured interviews with 10 PWDs (baseline mean glycated hemoglobin, HbA1c) 8.0%, (SD 0.45); 6 males and 4 females, aged 52 years (SD 15), type 1 diabetes (T1D) duration 31 years (SD 13), 40% (4/10, insulin pump) following a 14-week intervention during which they received clinical support and used Sugar Sleuth to evaluate and understand their glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11 (QSR International Pty Ltd). RESULTS A total of 4 main themes emerged from the data. Participants perceived Sugar Sleuth as an Empowering Tool that served to inform lifestyle choices and diabetes self-management tasks, promoted preemptive self-care actions, and improved discussions with clinicians. They also described Sugar Sleuth as providing a Source of Psychosocial Support and offering relief from worry, reducing glycemic uncertainty, and supporting positive feelings about everyday life with diabetes. Participants varied in their Approaches to Glycemic Data: 40% (4/10) described using Sugar Sleuth to review data, understand glycemic cause and effect, and plan for future self-care. On the contrary, 60% (6/10) were reluctant to review past data; they described receiving benefits from the immediate numbers and trend arrows, but the app still prompted them to enter in the suspected causes of glucose excursions within hours of their occurrence. Finally, only 2 participants voiced Concerns About Use of Sugar Sleuth; they perceived the app as sometimes too demanding of information or as not attuned to the socioeconomic backgrounds of PWDs from diverse populations. CONCLUSIONS Results suggest that Sugar Sleuth can be an effective educational tool to enhance both patient-clinician collaboration and diabetes self-management. Findings also highlight the importance of exploring psychosocial and socioeconomic factors that may advance the understanding of PWDs’ individual differences when using glycemic technology and may promote the development of customized mobile tools to improve diabetes self-management.

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A HIDDEN EDUCATION: THE FORMATIVE IMPACTS OF TECHNOLOGIES FOR THE SELF-MANAGEMENT OF TYPE 1 DIABETES

INTED2020 Proceedings ◽

10.21125/inted.2020.0892 ◽

2020 ◽

Author(s):

Guendalina Cucuzza

Keyword(s):

Type 1 Diabetes ◽

The Self ◽

Self Management

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Using an mHealth App to Transition Care of Type 1 Diabetes from Parents to Teens: Protocol for a Pilot Study (Preprint)

10.2196/preprints.10803 ◽

2018 ◽

Author(s):

Bree E Holtz ◽

Katharine M Mitchell ◽

Denise D Hershey ◽

Shelia R Cotten ◽

Amanda J Holmstrom ◽

...

Keyword(s):

Type 1 Diabetes ◽

The United States ◽

Mobile App ◽

Self Management ◽

Pilot Test ◽

Pilot Testing ◽

App Development ◽

Difficult Time ◽

Two Phases

BACKGROUND Type 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association–recommended glycated hemoglobin (HbA1c) targets. This lack of adherence can lead to negative health outcomes. OBJECTIVE The goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app. METHODS This study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management. RESULTS The pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming. CONCLUSIONS Adolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use. CLINICALTRIAL ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z) INTERNATIONAL REGISTERED REPOR RR1-10.2196/10803

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Promoting Self-Management Behaviors In Adolescents With Type 1 Diabetes, Using Digital Storytelling: A Randomized Controlled Trial

10.21203/rs.3.rs-587938/v1 ◽

2021 ◽

Author(s):

Nahid Zarifsanaiey ◽

Masoomeh Otrodi Shirazi ◽

Manoosh Mehrabi ◽

Zahra Bagheri

Keyword(s):

Type 1 Diabetes ◽

Digital Storytelling ◽

The Self ◽

Self Management ◽

Control Group ◽

Controlled Clinical Trial ◽

Management Behavior ◽

Randomized Controlled ◽

Management Behaviors

Abstract Background: This study aimed to assess the effects of digital storytelling on the self-management behavior of adolescents with type 1 diabetes (TID). Methods: In this randomized controlled clinical trial, 60 adolescents with TID were randomly allocated into two parallel groups: intervention (training with digital storytelling method, n=33) or control (training with a conventional method, n=33). The primary outcome was the assessment of the Self-Management behavior of adolescents with TID (SMOD-A), at baseline and three months after the intervention.Results: The results revealed that digital storytelling can lead to significant improvement in self-management behaviors amongst the adolescents with TID (P=0.005), while in the control group no significant changes were observed (P>0.05). The results also showed that the level of collaboration with parent’s dimension scores had a significant reverse relationship with the adolescent age after digital storytelling (p = 0.048). With respect to HbA1c levels, significant changes were not observed in any of the groups (P>0.05).Conclusions: Digital storytelling is practicable and a potentially beneficial training modality for adolescents with TID.Trial registration: This trial was respectively registered.ClinicalTrials.gov Identifier: IRCT20191220045828N1. Date of registration: Oct 29. 2020(https://clinicaltrials.gov/ct2/show/NCT04608058?term=zarifsanaiey&draw=2&rank=1)

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Evaluating a Glucose-Sensor-Based Tool to Help Clinicians and Adults With Type 1 Diabetes Improve Self-Management Skills

Journal of Diabetes Science and Technology ◽

10.1177/1932296818791534 ◽

2018 ◽

Vol 12 (6) ◽

pp. 1143-1151 ◽

Cited By ~ 4

Author(s):

Elena Toschi ◽

Lawrence Fisher ◽

Howard Wolpert ◽

Michael Love ◽

Timothy Dunn ◽

...

Keyword(s):

Type 1 Diabetes ◽

Rating Scales ◽

Glucose Sensor ◽

Self Care ◽

Mobile App ◽

Self Management ◽

Management Skills ◽

Motivation To Change ◽

Freestyle Libre

Background: The goal of this uncontrolled pilot study was to assess the feasibility of a self-care management mobile app, called Sugar Sleuth, which incorporates the FreeStyle Libre™ glucose sensor, to help clinicians and people with type 1 diabetes (PWD) identify and mitigate self-care behaviors that contribute to glucose variability. Methods: PWDs with a baseline A1c between 7.5 and 9.0% used the mobile app for 14 weeks. The app prompted the PWD to enter the suspected cause of detected glycemic excursions, and to record food and insulin information. PWDs met with clinicians to collaboratively review data, identify challenges, and devise a specific self-care plan. Outcome measures included a single glycemic outcome score (SGOS) and attitude rating scales to better understand how participant attitudes could affect glycemic outcome. Results: Thirty enrolled PWDs had a mean age of 55 ± 2.6 years, and a mean diabetes duration of 32 ± 2.9 years. A significant average reduction in A1c of 0.5 ± 0.07% ( P < .01) and in mean daily carbohydrate intake of 43 ± 21 grams ( P = .05) was found. No statistically significant change in glycemic metrics, body weight, or total daily insulin dose was found. A significant negative association occurred between SGOS and “hypoglycemia tolerance” ( P = .04), and a positive correlation occurred that approached significance with “motivation to change behavior” ( P = .06). Conclusions: These findings suggest that this mobile app system, in conjunction with CGM, provides a useful platform for helping clinicians and adults with T1D improve self-management skills to improve glycemic control.

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A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocz147 ◽

2019 ◽

Vol 26 (12) ◽

pp. 1627-1631 ◽

Cited By ~ 2

Author(s):

Shelagh A Mulvaney ◽

Sarah E Vaala ◽

Rachel B Carroll ◽

Laura K Williams ◽

Cindy K Lybarger ◽

...

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Problem Solving ◽

Ecological Momentary Assessment ◽

Mobile App ◽

Self Management ◽

Within Subjects ◽

Ecological Momentary ◽

Momentary Assessment

Abstract Effective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood glucose. Stress, energy, mood, and fatigue were associated with missed insulin. Within-subjects analyses indicated that all factors were associated with both self-management tasks. Intraclass correlations showed within-subjects accounted for the majority of variance. The ecological momentary assessment method provided specific targets for improving self-management problem solving, phenotyping, or integration within just-in-time adaptive interventions.

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The application of mobile APP for diabetic self-management in adolescent with Type 1 diabetes

Diabetes Research and Clinical Practice ◽

10.1016/s0168-8227(16)31170-6 ◽

2016 ◽

Vol 120 ◽

pp. S102

Author(s):

Ting Ju Cahn ◽

Li-Chi Huang ◽

Ching-Chu Chen ◽

Chung-Hsing Wang ◽

Kuei-Mei Yeh

Keyword(s):

Type 1 Diabetes ◽

Mobile App ◽

Self Management

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A Digital Health Intervention (SweetGoals) for Young Adults With Type 1 Diabetes: Protocol for a Factorial Randomized Trial

JMIR Research Protocols ◽

10.2196/27109 ◽

2021 ◽

Vol 10 (2) ◽

pp. e27109

Author(s):

Catherine Stanger ◽

Tobias Kowatsch ◽

Haiyi Xie ◽

Inbal Nahum-Shani ◽

Frances Lim-Liberty ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Glycemic Control ◽

Randomized Trial ◽

Health Coaching ◽

Mobile App ◽

Self Management ◽

Target Range ◽

Secondary Outcomes

Background Many young adults with type 1 diabetes (T1D) struggle with the complex daily demands of adherence to their medical regimen and fail to achieve target range glycemic control. Few interventions, however, have been developed specifically for this age group. Objective In this randomized trial, we will provide a mobile app (SweetGoals) to all participants as a “core” intervention. The app prompts participants to upload data from their diabetes devices weekly to a device-agnostic uploader (Glooko), automatically retrieves uploaded data, assesses daily and weekly self-management goals, and generates feedback messages about goal attainment. Further, the trial will test two unique intervention components: (1) incentives to promote consistent daily adherence to goals, and (2) web health coaching to teach effective problem solving focused on personalized barriers to self-management. We will use a novel digital direct-to-patient recruitment method and intervention delivery model that transcends the clinic. Methods A 2x2 factorial randomized trial will be conducted with 300 young adults ages 19-25 with type 1 diabetes and (Hb)A1c ≥ 8.0%. All participants will receive the SweetGoals app that tracks and provides feedback about two adherence targets: (a) daily glucose monitoring; and (b) mealtime behaviors. Participants will be randomized to the factorial combination of incentives and health coaching. The intervention will last 6 months. The primary outcome will be reduction in A1c. Secondary outcomes include self-regulation mechanisms in longitudinal mediation models and engagement metrics as a predictor of outcomes. Participants will complete 6- and 12-month follow-up assessments. We hypothesize greater sustained A1c improvements in participants who receive coaching and who receive incentives compared to those who do not receive those components. Results Data collection is expected to be complete by February 2025. Analyses of primary and secondary outcomes are expected by December 2025. Conclusions Successful completion of these aims will support dissemination and effectiveness studies of this intervention that seeks to improve glycemic control in this high-risk and understudied population of young adults with T1D. Trial Registration ClinicalTrials.gov NCT04646473; https://clinicaltrials.gov/ct2/show/NCT04646473 International Registered Report Identifier (IRRID) PRR1-10.2196/27109

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