Experiences of Adults With Type 1 Diabetes Using Glucose Sensor-Based Mobile Technology for Glycemic Variability: Qualitative Study

Marilyn D Ritholz; Owen Henn; Astrid Atakov Castillo; Howard Wolpert; Stephanie Edwards; Lawrence Fisher; Elena Toschi

doi:10.2196/14032

Experiences of Adults With Type 1 Diabetes Using Glucose Sensor-Based Mobile Technology for Glycemic Variability: Qualitative Study

JMIR Diabetes. 2019 Jul 8;4(3):e14032. doi: 10.2196/14032.

Authors

Marilyn D Ritholz^{1

2}, Owen Henn¹, Astrid Atakov Castillo¹, Howard Wolpert^{1

3}, Stephanie Edwards¹, Lawrence Fisher⁴, Elena Toschi^{1

3}

Affiliations

¹ Joslin Diabetes Center, Boston, MA, United States.
² Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
³ Department of Medicine, Harvard Medical School, Boston, MA, United States.
⁴ University of California, San Francisco, San Francisco, CA, United States.

PMID: 31287065
PMCID: PMC6643769
DOI: 10.2196/14032

Abstract

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, HbA_1c) 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.

Keywords: blood glucose self-monitoring; diabetes mellitus, type 1; educational technology; qualitative research.

©Marilyn D Ritholz, Owen Henn, Astrid Atakov Castillo, Howard Wolpert, Stephanie Edwards, Lawrence Fisher, Elena Toschi. Originally published in JMIR Diabetes (http://diabetes.jmir.org), 08.07.2019.