JMIR Publications

ABSTRACT

Background:

Hypoglycemia or low blood sugar for people with diabetes can be a serious life-threatening condition and serious outcomes can be avoided if low levels are proactively detected. While technologies exist to detect the onset of hypoglycemia, they are invasive, costly, or suffer from high false alarms. Tremors are a commonly reported symptom of hypoglycemia and may be used to detect hypoglycemic events, yet their onset is not well researched or understood.

Objective:

This study seeks to understand diabetic patients’ perceptions of hypoglycemic tremors as well as their user experiences with technology to manage diabetes, and expectations from a self-management tool, ultimately to inform the design of a non-invasive and cost-effective technology that detects tremors associated with hypoglycemia

Methods:

A cross-sectional, internet panel survey was administered to adult type 1 diabetes patients using the Qualtrics platform in May 2019. Questions focused on three main constructs: (1) perceived hypoglycemia experiences, (2) experiences and expectations about a diabetes management device and mobile application, and (3) beliefs and attitudes regarding intention to use a diabetes management device. The analysis in this manuscript focuses on the first two constructs. Non-parametric tests were used to analyze Likert scale data, with Mann-Whitney U test, Kruskal-Wallis test, and Games-Howell post hoc test as applicable, for subgroup comparisons to highlight differences in perceived frequency, severity, and noticeability of hypoglycemic tremors across age, gender, years living with diabetes, and physical activity.

Results:

Data from 212 respondents (60.9% female) revealed statistically significant differences in perceived noticeability of tremors by gender; whereby males noticed their tremors more; and age with the older population reporting lower noticeability than the young and middle age groups. Differences in noticeability were marginally significant, while severity was significant for with those living with diabetes ≤1 year reporting higher than other groups. Severity of tremors were higher in those physically active, leading a marginally significant difference compared to those who were insufficiently active. Other subgroup comparisons in perceived frequency, severity, and noticeability were not found to be statistically significant. The majority (n=150) have used diabetes monitoring devices; descriptive results for technology use and feature preferences are also reported.

Conclusions:

Our findings suggest that men notice their tremors significantly more than women and older adults confirmed that they notice their tremors less compared to younger patients, due to the inhibition of symptoms over time. While hypoglycemic tremors were perceived to occur frequently, such tremors were not found to be as severe compared to other symptoms reported in the literature, such as sweating. Using a combination of tremor and perspiration sensors may show promise in detecting the onset of hypoglycemic events.