The second Moroccan mobile application for type 1 diabetes self-care : towards a new pedagogical dynamism in T1DM self-management

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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Ready or not? Greater readiness for independent self‐care predicts better self‐management but not HbA1c in teens with type 1 diabetes

Diabetic Medicine ◽

10.1111/dme.14507 ◽

2020 ◽

Author(s):

Eveline R. Goethals ◽

Lisa K. Volkening ◽

Liane Tinsley ◽

Lori M. Laffel

Keyword(s):

Type 1 Diabetes ◽

Self Care ◽

Self Management

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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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Use of a Self-Management Mobile Application by Adolescents with Type 1 Diabetes

Canadian Journal of Diabetes ◽

10.1016/j.jcjd.2016.08.186 ◽

2016 ◽

Vol 40 (5) ◽

pp. S65-S66

Author(s):

Caitlin Nunn ◽

Michael Rotondi ◽

Shivani Goyal ◽

Sally Reiser ◽

Angelo Simone ◽

...

Keyword(s):

Type 1 Diabetes ◽

Mobile Application ◽

Self Management

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Effect of Diabetes Self-Management Education (DSME) with and without Motivational Interviewing (MI) on Glycemic Control among Children and Adolescents with Type 1 Diabetes Mellitus: A Randomized Controlled Trial

Siriraj Medical Journal ◽

10.33192/smj.2021.82 ◽

2021 ◽

Vol 73 (10) ◽

Author(s):

Ornsuda Lertbannaphong ◽

Pimonsri Hantanasiriskul ◽

Pornpimol Kiattisakthavee ◽

Sunsanee Ruangson ◽

Nantawat Sitdhiraksa ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Management Education ◽

Self Care ◽

Self Management ◽

Diabetes Knowledge ◽

Hba1c Levels

Background: Type 1 diabetes mellitus (T1DM) is a chronic disease that is difficult to control. Motivational interviewing (MI) is a collaborative style of communication that was designed to strengthen a person’s motivation and commitment to change and improve. We hypothesized that applying MI to diabetes care would lead to improved glycemic control and improved diabetes self-care behavior. Methods: Subjects were T1DM patients aged 10-18 years with HbA1C ≥8% that were recruited from the Outpatient Diabetes Clinic during October 2016 - March 2017. Subjects were randomized into the diabetes self-management education (DSME) or DSME plus MI groups. HbA1C levels, diabetes knowledge test, and diabetes self-care behavioral questionnaire were performed. Results: Thirty-five patients (17 DSME, 18 DSME + MI) completed the study. Baseline HbA1C was not significantly different between groups. At the end of the study, HbA1C levels were not significantly different within or between groups. From pre-intervention to post-intervention, diabetes knowledge scores were significantly increased, and self-care behavioral scores were significantly increased for dietary control and medical taking. Transition to the stages of change action stage was increased from 0 to 12 persons. Conclusions: The effectiveness of MI on glycemic control was not found to be statistically significant at 6 months. However, continuation of DSME in T1DM patients is necessary for improving diabetes knowledge and care. Further study in a larger sample size with longer duration of MI and follow-up is needed to conclusively establish the value of MI on glycemic control in pediatric T1DM.

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Diabetes Self-Care in Older Adults With Type 1 Diabetes Mellitus: How Does Cognition Influence Self-Management

Frontiers in Clinical Diabetes and Healthcare ◽

10.3389/fcdhc.2021.727029 ◽

2021 ◽

Vol 2 ◽

Author(s):

Ana Lúcia Taboada Gjorup ◽

Frank J. Snoek ◽

Eelco van Duinkerken

Keyword(s):

Diabetes Mellitus ◽

Older Adults ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Cognitive Functions ◽

Self Care ◽

Self Management ◽

Future Research

With increasing knowledge and improvements in options for glycemic control, the life-expectancy of patients with type 1 diabetes mellitus (T1DM) has increased considerably over the past decades. Whereas this is undeniably positive for patients, aging is related to natural decline in cognitive functions. As patients with T1DM across the life-span are susceptible to cognitive deterioration, an interaction with aging may be expected and the risk of development of dementia might be increased. As achieving glycemic control depends on a set of diabetes self-management behaviors, it is imperative to understand how cognitive functions are involved in the upkeep of these behaviors and how cognitive impairment may affect them. In this narrative review, we set out to understand the relationship between cognition and T1DM self-care by first reviewing the glycemic targets in older adults, what treatment options are available, and what cognitive functions they draw upon. We will then review the cognitive literature in older adults that is available and then link both together. Lastly, we finish with clinical recommendations and suggestions for future research.

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Caregiver’s Opinions on the Design of the Screens of a Future Gamified Mobile Application for Self-Management of Type 1 Diabetes in Children in Saudi Arabia

International Journal of Telemedicine and Applications ◽

10.1155/2021/8822676 ◽

2021 ◽

Vol 2021 ◽

pp. 1-13

Author(s):

Demah M. Alsalman ◽

Zahra Bu Ali ◽

Zainab Alnosaier ◽

Norah Alotaibi ◽

Turki M. Alanzi

Keyword(s):

Type 1 Diabetes ◽

Saudi Arabia ◽

Blood Glucose ◽

Mobile Application ◽

Eating Habits ◽

Stable State ◽

Insulin Injection ◽

Self Management ◽

Practical Implementation

The objective of this study was to design the screens of a future gamified mobile application for self-management of type 1 diabetes in children based on the opinion of caregivers at the King Fahad Hospital Diabetes Center, Saudi Arabia. To achieve this objective, a questionnaire was designed and distributed among 100 caregivers through face-to-face communication and social media using a Google Forms link. 65% of the participants met the inclusion criteria. The main result of this study was the design of 13 screens of a gamified application for self-management of type 1 diabetes in children from Saudi Arabia. The key features of the screens were caring for a character; using a challenging friend; inclusion of points, level, and leaderboard as rewarding principles; use of reminders and notifications for doctor’s appointments, insulin injection times, blood glucose readings; and tips for improving medication adherence, increasing blood glucose readings, supporting physical activities, and adopting healthy eating habits. It can be concluded that the practical implementation of the screens in a future mobile application can motivate children with type 1 diabetes to improve eating habits, physical exercise, and cognitive, emotional, and social behaviors to maintain a stable state of health. Also, the content of the designed screens can help to monitor blood glucose readings and comply with medication treatment. The designed screens are adapted to the Arab culture.

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Human Factors and Data Logging Processes With the Use of Advanced Technology for Adults With Type 1 Diabetes: Systematic Integrative Review (Preprint)

10.2196/preprints.9049 ◽

2017 ◽

Author(s):

Marion Waite ◽

Clare Martin ◽

Rachel Franklin ◽

David Duce ◽

Rachel Harrison

Keyword(s):

Type 1 Diabetes ◽

Human Factors ◽

Technology Use ◽

Self Care ◽

Advanced Technology ◽

Self Management ◽

Data Logging ◽

The Relationship ◽

The Way

BACKGROUND People with type 1 diabetes (T1D) undertake self-management to prevent short and long-term complications. Advanced technology potentially supports such activities but requires consideration of psychological and behavioral constructs and usability issues. Economic factors and health care provider capacity influence access and uptake of advanced technology. Previous reviews have focused upon clinical outcomes or were descriptive or have synthesized studies on adults with those on children and young people where human factors are different. OBJECTIVE This review described and examined the relationship between human factors and adherence with technology for data logging processes in adults with T1D. METHODS A systematic literature search was undertaken by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Quality appraisal was undertaken and data were abstracted and categorized into the themes that underpinned the human factor constructs that were examined. RESULTS A total of 18 studies were included. A total of 6 constructs emerged from the data analysis: the relationship between adherence to data logging and measurable outcomes; satisfaction with the transition to advanced technology for self-management; use of advanced technology and time spent on diabetes-related activities; strategies to mediate the complexities of diabetes and the use of advanced technology; cognition in the wild; and meanings, views, and perspectives from the users of technology. CONCLUSIONS Increased treatment satisfaction was found on transition from traditional to advanced technology use—insulin pump and continuous glucose monitoring (CGM); the most significant factor was when blood glucose levels were consistently <7.00 mmol/L (P ≤.01). Participants spent considerable time on their diabetes self-care. Logging of data was positively correlated with increasing age when using an app that provided meaningful feedback (regression coefficient=55.8 recordings/year; P ≤.01). There were benefits of CGM for older people in mediating complexities and fears of hypoglycemia with significant differences in well-being (P ≤.001). Qualitative studies explored the contextual use and uptake of technology. The results suggested frustrations with CGM, continuous subcutaneous insulin infusion, calibration of devices, and alarms. Furthermore implications for “body image” and the way in which “significant others” impacted on the behavior and attitude of the individual toward technology use. There were wide variations in the normal use of and interaction with technology across a continuum of sociocultural contexts, which has implications for the way in which future technologies should be designed. Quantitative studies were limited by small sample sizes, making it difficult to generalize findings to other contexts. This was further limited by a sample that was predominantly white, well-controlled, and engaged with self-care. The use of critical appraisal frameworks demonstrated where research into human factors and data logging processes of individuals could be improved. This included engaging people in the design of the technology, especially hard-to-reach or marginalized groups.

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