JMIR Publications

ABSTRACT

Background:

Though multiple self-monitoring technologies for Type-2 Diabetes Mellitus (T2DM) show promise for improving T2DM self-care behaviors and clinical outcomes, they have been understudied in Hispanic adult populations who suffer disproportionately from T2DM.

Objective:

The objective of this study was to evaluate the acceptability, feasibility, and potential integration of wearable sensors for diabetes self-monitoring among Hispanic adults with T2DM.

Methods:

We conducted a pilot study of T2DM self-monitoring technologies with Hispanic adults with T2DM. Participants (n=21) received a real-time continuous glucose monitor (RT-CGM), a wrist-worn physical activity (PA) tracker, and a tablet-based digital food diary to self-monitor blood glucose, PA, and dietary intake, respectively, for one week. The RT-CGM captured viewable blood glucose concentration (mg/dL) in five minute intervals, and the PA trackers collected accelerometer-based data, viewable on the device or on an associated tablet application. After one week of use, we conducted a semi-structured interview with each participant to understand experiences and thoughts on integration of the devices and their data into a technology-facilitated T2DM self-management intervention. Feasibility was measured by device utilization and objective RT-CGM, PA tracker, and diet logging data. Acceptability and potential integration were evaluated through thematic analysis of verbatim interview transcripts.

Results:

Participants (n=21, 76% female, 50.4±11 years) had a mean self-reported Hemoglobin A1c of 7.4 ± 1.8 mg/dL and had been diagnosed with T2DM for 7.4±5.2 years (range:1-16 years). Most (89%) were treated with oral medications (i.e., Metformin), while the others self-managed through diet and exercise. Nearly all (n=20) used both the RT-CGM and the PA tracker, and 52% (n=11) logged at least one meal, with 33% (n=7) logging meals for four or more days. Of the 8 possible days, PA data was recorded for 7.1±1.8 days (range: 2-8), and participants averaged 7822±3984 steps per day. Interview transcripts revealed that participants felt most positive about the RT-CGM, as it unveiled previously unknown relationships between lifestyle and health and contributed to changes in T2DM-related thoughts and behaviors. Participants felt generally positive about incorporating the wearable sensors and mobile applications into a future intervention given support were provided by a health coach and/or health care provider, device training were provided, applications were tailored to their language and culture, and content were both actionable and accessible and delivered on a single platform.

Conclusions:

Sensor-based tools for facilitating T2DM self-monitoring appear to be a feasible and acceptable technology among low-income, Hispanic adults. We identified barriers to acceptability and highlighted preferences for wearable sensor integration in a community-based intervention. These findings have implications for the design of T2DM interventions targeting racial and ethnic minorities.