App Features for Type 1 Diabetes Support and Patient Empowerment: Systematic Literature Review and Benchmark Comparison (Preprint)

BACKGROUND Research in type 1 diabetes management has increased exponentially since the irruption of mobile health apps for its remote and self-management. Despite this fact, the features affect in the disease management and patient empowerment are adopted by app makers and provided to the general population remain unexplored. OBJECTIVE To study the gap between literature and available apps for type 1 diabetes self-management and patient empowerment and to discover the features that an ideal app should provide to people with diabetes. METHODS The methodology comprises systematic reviews in the scientific literature and app marketplaces. We included articles describing interventions that demonstrated an effect on diabetes management with particular clinical endpoints through the use of mobile technologies. The features of these apps were gathered in a taxonomy of what an ideal app should look like to then assess which of these features are available in the market. RESULTS The literature search resulted in 231 matches. Of these, 55 met the inclusion criteria. A taxonomy featuring 3 levels of characteristics was designed based on 5 papers which were selected for the synthesis. Level 1 includes 10 general features (Personalization, Family support, Agenda, Data record, Insulin bolus calculator, Data management, Interaction, Tips and support, Reminders, and Rewards) Level 2 and Level 3 included features providing a descriptive detail of Level 1 features. Eighty apps matching the inclusion criteria were analyzed. None of the assessed apps fulfilled the features of the taxonomy of an ideal app. Personalization (70/80, 87.5%) and Data record (64/80, 80.0%) were the 2 top prevalent features, whereas Agenda (5/80, 6.3%) and Rewards (3/80, 3.8%) where the less predominant. The operating system was not associated with the number of features (P=.42, F=.81) nor the type of feature (P=.20, χ2=11.7). Apps were classified according to the number of level 1 features and sorted into quartiles. First quartile apps had a regular distribution of the ten features in the taxonomy whereas the other 3 quartiles had an irregular distribution. CONCLUSIONS There are significant gaps between research and the market in mobile health for type 1 diabetes management. While the literature focuses on aspects related to gamification, rewarding, and social communities, the available apps are focused on disease management aspects such as data record and appointments. Personalized and tailored empowerment features should be included in commercial apps for large-scale assessment of potential in the self-management of the disease.

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Experiences and perspectives of the parents of emerging adults living with type 1 diabetes

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2019-001125 ◽

2020 ◽

Vol 8 (1) ◽

pp. e001125

Author(s):

Cheryl Pritlove ◽

Benjamin Markowitz ◽

Geetha Mukerji ◽

Andrew Advani ◽

Janet A Parsons

Keyword(s):

Type 1 Diabetes ◽

Emerging Adulthood ◽

Emerging Adults ◽

Diabetes Management ◽

Self Management ◽

Comparative Approach ◽

Transition To Adult Care ◽

Adult Care ◽

Difficult Time

IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child’s diabetes ‘self’-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.Research design and methodsSemi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.ResultsAnalysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; negotiating parent–child roles, responsibilities and relationships; and new and evolving fears. Parents spoke in detail about the time surrounding their child’s diagnosis of type 1 diabetes to emphasize the complexity of diabetes care and the need to establish a ‘new normal’ for the family. In turn, adolescence and emerging adulthood required a renegotiation of roles and responsibilities, with many parents continuing to play a role in high-level diabetes management. Several parents of emerging adults with type 1 diabetes (particularly those of young men) vocalized worries about their child’s readiness to assume responsibility for their self-care, and some expressed frustration with the apparent dichotomy in the role expectations of parents between the pediatric and adult care settings.ConclusionsAdult healthcare providers should recognize both the ongoing involvement of parents in the ‘self’-management of emerging adults with type 1 diabetes and the unique aspects of the caregiver burden that they experience.

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Working Toward an mHealth Platform for Adolescents with Type 1 Diabetes: Focus Groups With Teens, Parents, and Providers

The Diabetes Educator ◽

10.1177/0145721720943123 ◽

2020 ◽

Vol 46 (5) ◽

pp. 444-454

Author(s):

Manuela Sinisterra ◽

Katherine Patterson Kelly ◽

Caitlin Shneider ◽

Ashley El-Zein ◽

Ellen Swartwout ◽

...

Keyword(s):

Health Care ◽

Type 1 Diabetes ◽

Focus Groups ◽

Health Care Providers ◽

Diabetes Management ◽

Self Management ◽

Care Providers ◽

Open Communication ◽

Management Behaviors

Purpose The purpose of the study was to explore facilitators and barriers to self-management behaviors in adolescents with type 1 diabetes (T1D) to inform the development of an mHealth platform. Methods Eight adolescents with T1D, 9 parents, and 13 health care providers participated in separate focus groups that explored teen self-management behaviors. Results Adolescents and their parents have distinct preferences for handling diabetes management and use of mHealth technologies. Health care providers support the use of new technologies yet acknowledge concern meeting the potential increased volume of communication requests from teens and families. Conclusion Stakeholders agreed that an ideal mHealth platform would facilitate open communication between teens and their care network and easily integrate with other diabetes technologies. Future directions include incorporating additional feedback from stakeholders to build and modify the mHealth platform. The use of mHealth platforms could be integrated into clinical practice to optimize self-management and support communication between educators, providers, and families in between clinic visits.

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Children and young people’s experiences and perceptions of self-management of type 1 diabetes: A qualitative meta-synthesis

Health Psychology Open ◽

10.1177/2055102919877105 ◽

2019 ◽

Vol 6 (2) ◽

pp. 205510291987710 ◽

Cited By ~ 2

Author(s):

Ella Tuohy ◽

Caroline Rawdon ◽

Pamela Gallagher ◽

Michele Glacken ◽

Nuala Murphy ◽

...

Keyword(s):

Type 1 Diabetes ◽

Young People ◽

Contextual Factors ◽

Self Management ◽

Inclusion Criteria ◽

Children And Young People ◽

Thematic Synthesis ◽

Synthesis Approach

The aim of this review was to conduct a meta-synthesis of the experiences and perceptions of self-management of type 1 diabetes of children and young people living with type 1 diabetes (CYPDs). Six databases were systematically searched for studies with qualitative findings relevant to CYPDs’ (aged 8–18 years) experiences of self-management. A thematic synthesis approach was used to combine articles and identify analytical themes. Forty articles met the inclusion criteria. Two analytical themes important to CYPDs’ experiences and perceptions of self-management were identified: (1) negotiating independence and (2) feeling in control. The synthesis contributes to knowledge on contextual factors underpinning self-management and what facilitates or impedes transition towards autonomous self-management for CYPDs.

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Habits and Routines during Transitions among Emerging Adults with Type 1 Diabetes

Western Journal of Nursing Research ◽

10.1177/0193945919882725 ◽

2019 ◽

Vol 42 (6) ◽

pp. 446-453

Author(s):

Kathleen M. Hanna ◽

Jed R. Hansen

Keyword(s):

Type 1 Diabetes ◽

Blood Glucose ◽

Emerging Adults ◽

Diabetes Management ◽

Insulin Dose ◽

A Priori ◽

Self Management ◽

Typical Day ◽

Insight Into

To provide insight into poorly understood diabetes self-management among emerging adults with type 1 diabetes (TID) experiencing transitions, this study described their diabetes self-management-related habits, routines, and disruptions as well as explored relationships among habits and routines. A qualitative study, guided by critical incidence technique, was conducted. Participants were asked to describe situations when they did and did not check blood glucose, administer insulin, eat meals, and exercise as planned. They were also asked to describe activities in a typical day and in association with diabetes self-management. Content analysis with a priori definitions of habits and routines was performed. Participants described diabetes self-management-related transitional disruption as forgetting and disorder. They described habits associated with checking a blood glucose, giving an insulin dose, eating a meal, and initiating exercise. They described routines in association with meals, exercise, and overall diabetes management. These findings provide information on variables to target in intervention research.

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Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users

Journal of Health Psychology ◽

10.1177/1359105317718615 ◽

2017 ◽

Vol 25 (4) ◽

pp. 429-438 ◽

Cited By ~ 10

Author(s):

Molly L Tanenbaum ◽

Esti Iturralde ◽

Sarah J Hanes ◽

Sakinah C Suttiratana ◽

Jodie M Ambrosino ◽

...

Keyword(s):

Type 1 Diabetes ◽

Qualitative Study ◽

Closed Loop ◽

Diabetes Management ◽

New Technology ◽

Self Management ◽

Closed Loop Systems ◽

Trial Participants ◽

User Trust

Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.

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Customizing the Types of Technologies Used by Patients With Type 1 Diabetes Mellitus for Diabetes Treatment: Case Series on Patient Experience (Preprint)

10.2196/preprints.11527 ◽

2018 ◽

Author(s):

Anna Holubová ◽

Martina Vlasáková ◽

Jan Mužík ◽

Jan Brož

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Diabetes Management ◽

Case Series ◽

Diabetes Control ◽

Self Management ◽

Telemedicine System ◽

Specific Patient

BACKGROUND Despite the fact there are many wearable and mobile medical devices that enable patients to better self-manage their diabetes, not many patients are aware of all the options they have. In addition, there are those who are not fully satisfied with the devices they use, and those who often do not use them effectively. OBJECTIVE The study aimed to propose possible changes to the combination of devices used by 6 specific patients for diabetes self-management. We assessed the suitability of selected technical devices for diabetes control. METHODS Data of 6 patients (3 men and 3 women) with type 1 diabetes mellitus, who had been using the Diani telemedicine system for at least 3 months, were analyzed. The suitability of selected technical devices for diabetes control was ascertained using the data obtained via the Diani telemedicine system, as well as the patients’ subjective feelings and statements, their everyday life habits, and self-management of diabetes. Informed consent was signed and obtained from each of the patients included. RESULTS Each of the presented case studies describes how a given patient handled the system and its specific components based on his or her lifestyle, level of education, habits related to diabetes management, personality type, and other factors. At the conclusion of each case study, the best composition of devices for patients with similar personal descriptions was suggested. CONCLUSIONS We believe this study can provide relevant guidance on how to help particular patients choose the technology that is best suited for their needs, based on the specific patient information we are able to obtain from them. Furthermore, clinicians or educators should be aware of available technologies a given patient can choose from. In addition, there is a substantial need for proper patient education in order for them to effectively use devices for diabetes self-management.

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Self-Management Behaviors of Patients with Type 1 Diabetes: Comparing Two Sources of Patient-Generated Data

Applied Clinical Informatics ◽

10.1055/s-0039-1701002 ◽

2020 ◽

Vol 11 (01) ◽

pp. 070-078

Author(s):

George Karway ◽

Maria Adela Grando ◽

Kevin Grimm ◽

Danielle Groat ◽

Curtiss Cook ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Insulin Pump ◽

Assessment Tools ◽

Insulin Pump Therapy ◽

Self Management ◽

Pump Therapy ◽

Mixed Effect ◽

Management Behaviors

Abstract Objectives This article aims to evaluate adult type 1 diabetes mellitus (T1DM) self-management behaviors (SMBs) related to exercise and alcohol on a survey versus a smartphone app to compare self-reported and self-tracked SMBs, and examine inter- and intrapatient variability. Methods Adults with T1DM on insulin pump therapy were surveyed about their alcohol, meal, and exercise SMBs. For 4 weeks, participants self-tracked their alcohol, meal, and exercise events, and their SMBs corresponding with these events via an investigator-developed app. Descriptive statistics and generalized linear mixed-effect models were used to analyze the data Results Thirty-five participants self-tracked over 5,000 interactions using the app. Variability in how participants perceived the effects of exercise and alcohol on their blood glucose was observed. The congruity between SMBs self-reported on the survey and those self-tracked with the app was measured as mean (SD). The lowest congruity was for alcohol and exercise with 61.9% (22.7) and 66.4% (20.2), respectively. Congruity was higher for meals with 80.9% (21.0). There was significant daily intra- and interpatient variability in SMBs related to preprandial bolusing: recommended bolus, p < 0.05; own bolus choice, p < 0.01; and recommended basal adjustment, p < 0.01. Conclusion This study highlights the variability in intra- and interpatient SMBs obtained through the use of a survey and app. The outcomes of this study indicate that clinicians could use both one-time and every-day assessment tools to assess SMBs related to meals. For alcohol and exercise, further research is needed to understand the best assessment method for SMBs. Given this degree of patient variability, there is a need for an educational intervention that goes beyond the traditional “one-size-fits-all” approach of diabetes management to target individualized treatment barriers.

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Diabetes and play therapy

Journal of Social Health and Diabetes ◽

10.4103/2321-0656.120274 ◽

2014 ◽

Vol 02 (01) ◽

pp. 040-044 ◽

Cited By ~ 2

Author(s):

Sanjay Kalra ◽

Shuchy Chugh ◽

P. Dinakaran

Keyword(s):

Type 1 Diabetes ◽

Play Therapy ◽

Diabetes Management ◽

Interpersonal Relationship ◽

Medical Community ◽

Self Management ◽

Regimen Adherence ◽

Context Type ◽

Medical Regimens

Abstract Context: Type 1 diabetes is a lifelong disorder needing 24 × 7 × 365 care and attention. In these children, adherence to prescribed medical regimens and monitoring on a continuous basis is one of the most challenging problems faced by the medical community. Self-management becomes very essential for ensuring good outcomes, since psychosocial factors also play a crucial role in regimen adherence and glycemic control. Aim: This article aims to describe the utility of play therapy in diabetes management. Play therapy is a useful approach that can help in establishing a dynamic interpersonal relationship between the child and the therapist in a playful unconventional manner, supporting in their learning process for self-management. Materials and methods: This communication reviews available literature on play therapy, and describes examples of play therapy used in a mulitnational programme. The changing diabetes in children program focused at reaching out to the economically underprivileged children with type 1 diabetes, has implemented two useful play therapy tools to help the type 1 child learn to take insulin injections and understand the basic do′s and don′ts for proper diabetes management. Conclusion: Play-therapy is useful in making the difficult task of managing diabetes interesting and easy.

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