Bellfield Edward J, Sharp Lisa K, Xia Yinglin, Gerber Ben S
Department of Pediatrics, University of Illinois at Chicago, Chicago, IL, United States.
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States.
JMIR Diabetes. 2018 Feb 7;3(1):e3. doi: 10.2196/diabetes.8357.
Cloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D).
The purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency.
We used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0%-10.7%, self-monitoring behavior of ≤5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate.
For mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=-.47, P<.001). Although all participants had positive opinions about the app, its utilization was highly variable.
We demonstrated modest feasibility of adolescents with uncontrolled T1D utilizing a glucose monitoring mobile app. Further study is needed to better determine its effects on BG level and monitoring frequency. Psychosocial factors and motivational barriers likely influence adoption and continuous use of technology for diabetes management.
基于云的血糖监测程序允许糖尿病患者将血糖仪与手机进行无线同步。它们还通过其移动应用程序提供数据的可视化和远程访问。很少有研究评估其在1型糖尿病（T1D）青少年中管理糖尿病的有效性。
本研究的目的是评估使用移动应用程序改善每日平均血糖（BG）水平并增加BG监测频率的可行性。
我们采用ABA单受试者前瞻性研究设计。我们招募了5名年龄在13至17岁之间、T1D控制不佳、糖化血红蛋白A1c为9.0%-10.7%、自我监测行为≤每天5次检查且每天多次注射胰岛素的参与者。该研究包括三个阶段，每个阶段为期4周：（1）A阶段：常规血糖监测日志（传真）；（2）B阶段：移动应用程序；（3）A'阶段：第二阶段A。一名认证的糖尿病教育者和内分泌学家每周审查日志并提供建议。使用准泊松模型分析数据以调整个体参与者之间的过度离散，并使用广义估计方程模型分析总体干预效果。
对于每日平均BG（mg/dL）水平，参与者1在移动应用程序上的值有所下降（从298降至281，P=0.03），并在A'阶段保持。参与者4在A'阶段的每日平均BG有所增加（从175升至185，P=0.01），而参与者5在A'阶段每日平均BG有所下降（从314降至211，P=0.04）。对于每日监测（检查次数/天），参与者3在B阶段增加（从4.6增至8.3，P=0.01），并在A'阶段保持。参与者5在每个阶段的每日监测也有所增加（从2.1增至2.4，P=0.01；从2.4增至3.4，P=0.02）。对于5名参与者的综合情况，A阶段的总体平均BG和每日BG检查次数分别为平均254.8（标准差99.2）和平均3.6（标准差2.0），B阶段为平均223.1（标准差95.7）和平均4.5（标准差3.0），A'阶段为平均197.5（标准差81.3）和平均3.7（标准差2.1）。与A阶段相比，B阶段的平均血糖水平下降，且在A'阶段保持较低水平（P=0.002）。各阶段的BG检查次数没有总体变化（P=0.25）。然而，平均BG水平与每日BG检查次数呈负相关（r=-0.47，P<0.001）。尽管所有参与者对该应用程序都有积极的看法，但其利用率差异很大。
我们证明了T1D控制不佳的青少年使用血糖监测移动应用程序具有一定的可行性。需要进一步研究以更好地确定其对BG水平和监测频率的影响。心理社会因素和动机障碍可能会影响糖尿病管理技术的采用和持续使用。
