JMIR Publications

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:

This qualitative study explored 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 semi-structured interviews with 10 PWDs (baseline A1c 8.0% ± 0.4; 60% male, 52±16 years old, T1D duration 31±14 years, 40% insulin pump) following a 14-week intervention during which they received clinical support and used “Sugar Sleuth” to review glucose data. Audio-recorded interviews were transcribed, coded, and analyzed using thematic analysis and NVivo 11.

Results:

Four 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 pre-emptive 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% described using “Sugar Sleuth” to review data, understand glycemic cause and effect, and plan for future self-care. On the other hand, 60% described focusing only on the feedback from immediate numbers and trend arrows, receiving benefit from this information but feeling reluctant to review past data. Finally, only two participants voiced Concerns about Use of “Sugar Sleuth”; they perceived the app as sometimes too demanding of information or as not attuned to the socio-economic 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 socio-economic 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.