Morwenna J Kirwan*, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Australia Corneel Vandelanotte, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Australia Mitch J Duncan, Institute for Health and Social Science Research, Central Queensland University, Rockhampton, Australia Track: Research Presentation Topic: Mobile & Tablet Health Applications Presentation Type: Oral presentation Submission Type: Single Presentation Building: Joseph B. Martin Conference Center at Harvard Medical School Room: Auditorium Date: 2012-09-16 02:00 PM – 02:45 PM Last modified: 2012-09-12

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Background: Currently there are over 17,000 health-related smartphone apps available for consumers. Increasing numbers of people are using these apps to self-manage chronic diseases, such as diabetes. Despite the health care services available, many Type 1 Diabetes patients have poor glycemic control. These poor results may be attributed to the continued burden and complexity of the disease, such as applying the calculation of insulin doses, keeping a logbook and having regular consultations with their health care provider. Furthermore, health care providers often face a lack of information on which to base their advice regarding the patient’s insulin dose adjustments during consultations.
Objective: To examine the effectiveness of a freely available diabetes-related smartphone app combined with support from a Credentialed Diabetes Educator to improve self-management, glycemic control and quality of life in poorly controlled patients with Type 1 diabetes.
Methods: In a six-month intervention, followed by a three-month follow up, adult patients (n = 72) with type 1 diabetes (>6 months), and poor glycemic control (HbA1c ≥7.5%), were randomized to usual care - quarterly visits to health care provider (control group) or usual care added with the use of a smartphone app (Glucose Buddy) with weekly text-message feedback from a Credentialed Diabetes Educator (intervention group). The primary outcome measure was the improvement in glycemic control assessed glycosylated haemoglobin levels (HbA1c). Diabetes-related self-efficacy, self-care activities and quality of life were also measured. All measures were collected at baseline and every 3-months over the 9-month study for both groups. The engagement of patients in the intervention group was measured in terms of usage of the smartphone app, and text-message communication with the Credentialed Diabetes Educator.
Results: Linear mixed modelling analysis employing intention-to-treat principles showed a significant time by group interaction with glycemic control (HbA1c), F(1, 246.00) = 20.07, p <.001. The intervention group significantly decreased HbA1c from baseline (M = 9.08 ± 1.18) to nine month follow-up (7.80 ± 0.75), compared to the control group (baseline M = 8.47 ± 0.86, follow-up M = 8.58 ± 1.16). No significant change over time was found in either group in relation to self-efficacy, self-care activities and quality of life. Over the 6-month study period, intervention participants received 1714 text messages (M = 2 per week) and sent 559 text messages (M = 0.6 per week) to the Credentialed Diabetes Educator. Intervention participants logged 24,720 (M = 28.6 per week) measures (blood glucose, insulin, diet and physical activity) on the Glucose Buddy app over the 6-month intervention period. Linear regression analysis revealed that engagement of intervention participants as measured by number of logs on the smartphone app and text-messages sent to Credentialed Diabetes Educator was not significantly related to HbA1c change scores.
Conclusion: In adjunct with usual care, the use of a diabetes-related smartphone app combined with weekly text-message support from a health care provider can significantly improve glycemic control in adults with Type 1 Diabetes.