JMIR Publications

ABSTRACT

Type 1 diabetes (T1D) is one of the most common chronic childhood diseases and its prevalence is rising rapidly. Management of glucose in T1D is challenging as youth must consider a myriad of factors when making diabetes care decisions. This often leads to significant glucose variability throughout the day, with poorly controlled glucose being 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, has 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 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 often associated with it. Therefore, there is a need to measure repeated, real-time, real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA) and it has considerable advantages to in-laboratory research. Thus, the aim of the current review is 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 review focuses on the following EMA methods: continuous glucose monitoring (CGM), actigraphy, ambulatory blood pressure monitoring (ABPM), personal digital assistants (PDA), smartphones, and phone-based systems. The review also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory, limitations of each tool, future directions of the field, and possible clinical implications for their use.