JMIR Publications

ABSTRACT

Background:

Gestational diabetes (GDM) is an increasing health risk for pregnant women as well as their child. Telehealth interventions targeted to management of GDM have been shown to be effective, but they still have required work from health care professionals for providing guidance and feedback. Feedback from wearable sensors has been suggested to support self-management of GDM, but it is unknown how the self-tracking beyond capillary glucose meters used in clinical care should be designed.

Objective:

Our aim was to investigate how to support self-management of GDM with self-tracking of continuous blood glucose and lifestyle factors without the help by health care personnel. We examined comprehensive self-tracking from self-discovery (i.e. learning associations between glucose levels and lifestyle) and user experience perspectives.

Methods:

We conducted a mixed-methods study where women with GDM (N =10) used a continuous glucose monitor (Medtronic Guardian) and three physical activity sensors: activity bracelet (Garmin Vivosmart 3), hip-worn sensor (UKK Exsed), and electrocardiography sensor (Firstbeat 2) for a week. We collected the data from the sensors, and after the usage participants took part in semi-structured interviews about the wearable sensors. Acceptability of wearable sensors was evaluated with Unified theory acceptance and use of technology (UTAUT) questionnaire. In addition, maternal nutrition data was collected by 3-day food diary, and self-reported physical activity was collected with a logbook.

Results:

We found that a continuous glucose monitor was the most useful sensor for the self-discovery process, especially when learning associations between blood glucose and nutrition. We identified new challenges of using data from continuous glucose monitor and physical activity sensors in supporting self-discovery in GDM. These challenges included (1) missing important trackable features, like amount of light physical activity and other types of physical activity than walking, (2) discrepancy in the data between different wearable physical activity sensors and between continuous glucose meter and capillary glucose meters, and (3) discrepancy in perceived and measured quantification of physical activity (women with GDM perceived the intensity of physical activity higher than measured with wearable sensors). We found that body placement of sensors as a key factor in the quality of measurements, preference, and ultimately a challenge for collecting data. For example, we found that a wrist-worn sensor was worn more than a hip-worn sensor. In general, the study showed overall a high acceptance for wearable sensors.

Conclusions:

The results guide the design of a mobile health technology supporting the self-management of GDM. Clinical Trial: clinicaltrials.gov (clinical trial reg. no. NCT03941652)