Ray Mary Katherine, McMichael Alana, Rivera-Santana Maria, Noel Jacob, Hershey Tamara
Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States.
Department of Psychiatry, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States.
JMIR Diabetes. 2021 Jun 3;6(2):e27027. doi: 10.2196/27027.
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.
1型糖尿病（T1D）是儿童期最常见的慢性疾病之一，其患病率正在迅速上升。T1D患者的血糖管理具有挑战性，因为青少年在做出糖尿病护理决策时必须考虑众多因素。这项任务常常导致一整天出现显著的高血糖、低血糖以及血糖波动，这些都与短期和长期的医疗并发症相关。目前，关于这些并发症以及可能导致并发症的健康行为的大多数认知，都是在临床环境或基于实验室的研究中发现的。然而，这些环境中常用的工具在捕捉与T1D相关的动态行为、感受和生理变化方面能力有限，这些变化在一天中时刻波动。更好地了解日常生活中的T1D可能有助于开发干预措施，以改善糖尿病护理并减轻与之相关的负面医疗后果。因此，有必要在青少年中测量这种疾病反复出现的、实时的和现实世界中的特征。这种方法被称为生态瞬时评估（EMA），它相对于实验室研究具有相当大的优势。因此，本观点旨在描述已用于收集T1D青少年日常生活数据的EMA工具，并讨论使用这些方法探索T1D在日常生活中细微差别的研究。本观点聚焦于以下EMA方法：持续葡萄糖监测、活动记录仪、动态血压监测、个人数字助理、智能手机和基于电话的系统。该观点还讨论了使用EMA方法收集在实验室可能无法收集到的重要数据的好处、每种工具的局限性、该领域的未来方向以及其使用可能产生的临床意义。
