Feuerstein-Simon Carly, Bzdick Suzan, Padmanabhuni Amitha, Bains Puneetpal, Roe Cheryl, Weinstock Ruth S
1 SUNY Upstate Medical University, Syracuse, NY, USA.
J Diabetes Sci Technol. 2018 Nov;12(6):1192-1199. doi: 10.1177/1932296817749859. Epub 2018 Jan 1.
Hypoglycemia and hypoglycemia unawareness are common in long-standing type 1 diabetes (T1D). This pilot study examined the real-world use of a smartphone application (app), which receives meter readings and logs hypoglycemic symptoms, causes, and treatments to reduce hypoglycemia.
Adults with T1D and recent hypoglycemia synchronized their glucose meter to their smartphone and used the Joslin HypoMap™ app powered by Glooko to track hypoglycemic events. At baseline, and after 6 and 12 weeks of using the app, a blinded continuous glucose monitor (CGM; Dexcom G4) was used for 2 weeks and surveys administered.
Participants (n = 22) at baseline had mean (SD) age 43 (14) years, duration of diabetes 26 (13) years, A1c 8.0% (0.87) and 21/22 had reduced hypoglycemia awareness per Clarke Hypoglycemia Unawareness survey scores; 13 (59%) were "CGM completers" (CGM data available at baseline and follow-up). Most noncompletion related to time required/difficulties using the mobile app. After 6 weeks, 8/13 completers (62% of CGM completers, 36% of total participants) had reduced daytime minutes with glucose <54 mg/dL (mean ↓331 minutes) and 10/13 (77% of CGM completers; 45% of total participants) had reduced time ≤ 70 mg/dL (mean ↓449 minutes). This was not sustained at 12 weeks, at which time half of the completers had less time ("improved"). Five participants reported improved hypoglycemia awareness; 9 stated the app helped them better recognize hypoglycemia.
Use of this phone app has the potential to help reduce daytime hypoglycemia in a subset of T1D adults with reduce hypoglycemia awareness; larger studies are needed.
低血糖和低血糖无意识现象在长期1型糖尿病（T1D）患者中很常见。这项初步研究考察了一款智能手机应用程序（应用）在现实中的使用情况，该应用接收血糖仪读数并记录低血糖症状、病因及治疗方法，以减少低血糖的发生。
患有T1D且近期发生过低血糖的成年人将血糖仪与智能手机同步，并使用由Glooko提供支持的Joslin HypoMap™应用来追踪低血糖事件。在基线时，以及使用该应用6周和12周后，使用盲法连续血糖监测仪（CGM；德康G4）进行为期2周的监测，并进行问卷调查。
基线时的参与者（n = 22）平均（标准差）年龄为43（14）岁，糖尿病病程为26（13）年，糖化血红蛋白（A1c）为8.0%（0.87），根据克拉克低血糖无意识调查问卷得分，21/22的参与者低血糖意识降低；13名（59%）为“CGM完成者”（基线和随访时有CGM数据）。大多数未完成与使用移动应用所需时间/困难有关。6周后，8/13的完成者（占CGM完成者的62%，占总参与者的36%）血糖<54 mg/dL的日间分钟数减少（平均减少331分钟），10/13（占CGM完成者的77%；占总参与者的45%）血糖≤70 mg/dL的时间减少（平均减少449分钟）。在12周时这一情况未持续，此时一半的完成者时间减少（“改善”）。5名参与者报告低血糖意识有所改善；9名表示该应用帮助他们更好地识别低血糖。
使用这款手机应用有可能帮助减少一部分低血糖意识降低的T1D成年患者的日间低血糖；需要开展更大规模的研究。
