Mark Casselman*, Centre for Global eHealth Innovation, Toronto, Canada Nathaniel Hamming, Centre for Global eHealth Innovation, Toronto, Canada Kevin Tallevi, Centre for Global eHealth Innovation, Toronto, Canada Joseph Cafazzo*, Centre for Global eHealth Innovation, Toronto, Canada Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: DEMO Interactive Session Submission Type: Single Presentation Last modified: 2011-10-31

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Background

More than 80% of primary care visits and two thirds of medical admissions into hospital emergency departments are related to chronic diseases. Effective chronic disease management can result in improved health outcomes and increased quality of life. One of the most common chronic diseases affecting children, adolescents, and adults is type 1 diabetes mellitus (T1DM).

World-wide data have repeatedly demonstrated that therapeutic targets are not met among adolescents with T1DM. Moreover, data have failed to demonstrate a correlation between insulin regimen and glycemic control, suggesting that factors such as self-care behaviors and educational models likely have substantial impact on outcomes. Increased attention to these factors may lead to improved blood glucose control.

Given their propensity for new technology, eHealth may provide important opportunities to engage adolescents and to help them improve self-management skills and behaviors.

Objective

The goal of this project is to evaluate whether technology can be used to assist adolescents with self-care behaviours and improve glycemic control.

With patient, family, and multidisciplinary professional input, we have developed a novel iPhone diabetes application (“bant”) that differs from current technology in that it uses prompts to aid adolescents in families with analysis of data and with decision making regarding needed changes in treatment plans. Additional features include wireless transfer of readings from glucose meter to the iPhone, and trending tools and alerts to support proactive decision-making. “bant” also utilizes social networking and a rewards algorithm to incent healthy self-care behaviors.

Methods

Pre-pilot research involved qualitative, ethnographic interviews with patients and family caregivers (parents) to inform the design and development of the application. The major themes that emerged were used to inform the design and development of the self-management system.

The pilot trial consists of 20 adolescent participants (aged 12-16 years old) with T1DM who will be using "bant" to assist with self-management for a period of 3 months.

The primary outcome is improved glycemic control (A1C); secondary outcomes include measures of quality of life, self-care behaviors, self-efficacy, adherence to self-care recommendations, and effectiveness of different components of bant.

Each participant will receive an Apple iPhone or iPod Touch device pre-loaded with a diabetes self-management application ("bant") and a blood glucose meter that is linked wirelessly to the device. Participants will use this system for 3 months to track and manage BG and inform daily decision-making related to their diabetes management between quarterly clinic visits (standard care).

Results

We are in the midst of completing the 3-month pilot study to test the system with adolescents as they self-manage their diabetes on a daily basis between quarterly visits with their healthcare team. The pilot trial will be completed in June 2011.

Conclusions

If successful, bant may lead to long-lasting improvements in care of patients with T1DM and to the development of other technology-based self-management systems.