Qualitative assessment of user experiences of a novel smart phone application designed to support flexible intensive insulin therapy in type 1 diabetes

BackgroundModern flexible multiple daily injection (MDI) therapy requires people with diabetes to manage complex mathematical calculations to determine insulin doses on a day to day basis. Automated bolus calculators assist with these calculations, add additional functionality to protect against hypoglycaemia and enhance the record keeping process, however uptake and use depends on the devices meeting the needs of the user. We aimed to obtain user feedback on the usability of a mobile phone bolus calculator application in adults with T1DM to inform future development of mobile phone diabetes support applications.MethodsAdults with T1DM who had previously received education in flexible MDI therapy were invited to participate. Eligible respondents attended app education and one month later participated in a focus group to provide feedback on the features of the app in relation to usability for patient-based flexible MDI and future app development.ResultsSeven adults participated in the app training and follow up interview. App features that support dose adjustment to reduce hypoglycaemia risk and features that enable greater efficiency in dose calculation, record keeping and report generation were highly valued.ConclusionsAdults who are self managing flexible MDI found the Rapidcalc mobile phone app to be a useful self-management tool and additional features to further improve usability, such as connectivity with BG meter and food databases, shortcut options to economise data entry and web based storage of data, were identified. Further work is needed to ascertain specific features and benefit for those with lower health literacy.

[1]  A. Gessler,et al.  Training in flexible intensive insulin therapy improves quality of life, decreases the risk of hypoglycaemia and ameliorates poor metabolic control in patients with type 1 diabetes. , 2009, Diabetes research and clinical practice.

[2]  I. Colin,et al.  Glucose Meters with Built-In Automated Bolus Calculator: Gadget or Real Value for Insulin-Treated Diabetic Patients? , 2012, Diabetes Therapy.

[3]  M. O'Kane,et al.  Comparing patient‐generated blood glucose diary records with meter memory in diabetes: a systematic review , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[4]  B Shashaj,et al.  Benefits of a bolus calculator in pre‐ and postprandial glycaemic control and meal flexibility of paediatric patients using continuous subcutaneous insulin infusion (CSII) , 2008, Diabetic medicine : a journal of the British Diabetic Association.

[5]  Gunnar Hartvigsen,et al.  Mobile Health Applications to Assist Patients with Diabetes: Lessons Learned and Design Implications , 2012, Journal of diabetes science and technology.

[6]  R. Heptulla,et al.  Glycemic Control in Pediatric Type 1 Diabetes: Role of Caregiver Literacy , 2010, Pediatrics.

[7]  Mona Patel,et al.  Performance of a Glucose Meter with a Built-in Automated Bolus Calculator versus Manual Bolus Calculation in Insulin-Using Subjects , 2012, Journal of diabetes science and technology.

[8]  B. Holtz,et al.  Diabetes management via mobile phones: a systematic review. , 2012, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[9]  James T Tufano,et al.  Designing mobile dietary management support technologies for people with diabetes , 2008, Journal of telemedicine and telecare.

[10]  K. Nørgaard,et al.  Use of an Automated Bolus Calculator in MDI-Treated Type 1 Diabetes , 2012, Diabetes Care.

[11]  D. Golicki,et al.  The effect of using the insulin pump bolus calculator compared to standard insulin dosage calculations in patients with type 1 diabetes mellitus - systematic review. , 2013, Experimental and clinical endocrinology & diabetes : official journal, German Society of Endocrinology [and] German Diabetes Association.

[12]  Mansoor Ashraf,et al.  Use of an Automated Bolus Calculator Reduces Fear of Hypoglycemia and Improves Confidence in Dosage Accuracy in Patients with Type 1 Diabetes Mellitus Treated with Multiple Daily Insulin Injections , 2012, Journal of diabetes science and technology.

[13]  S. Shiffman,et al.  Patient non-compliance with paper diaries , 2002, BMJ : British Medical Journal.

[14]  A. Szypowska,et al.  Bolus calculator and wirelessly communicated blood glucose measurement effectively reduce hypoglycaemia in type 1 diabetic children – randomized controlled trial , 2014, Diabetes/metabolism research and reviews.

[15]  Sidney Fels,et al.  A framework for evaluating usability of clinical monitoring technology , 2007, Journal of Clinical Monitoring and Computing.

[16]  F. Zaccardi,et al.  Effect of carbohydrate counting and medical nutritional therapy on glycaemic control in Type 1 diabetic subjects: a pilot study , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[17]  K. Barnard,et al.  Perceptions and experiences of using automated bolus advisors amongst people with type 1 diabetes: A longitudinal qualitative investigation , 2014, Diabetes research and clinical practice.

[18]  G. Oswald,et al.  Transfer to a patient centred, carbohydrate counting and insulin matching programme in a shortened time frame , 2004 .

[19]  H. McIntyre,et al.  DAFNE (Dose Adjustment for Normal Eating): structured education in insulin replacement therapy for type 1 diabetes , 2006, The Medical journal of Australia.

[20]  L. Delahanty,et al.  The Role of Diet Behaviors in Achieving Improved Glycemic Control in Intensively Treated Patients in the Diabetes Control and Complications Trial , 1993, Diabetes Care.

[21]  S. Heller,et al.  Type 1 diabetes structured education: what are the core self‐management behaviours? , 2013, Diabetic medicine : a journal of the British Diabetic Association.

[22]  V. Braun,et al.  Using thematic analysis in psychology , 2006 .

[23]  Chandra Y Osborn,et al.  Self-Efficacy Links Health Literacy and Numeracy to Glycemic Control , 2010, Journal of health communication.

[24]  Patient perspectives on personalized glucose advisory systems for type 1 diabetes management. , 2012, Diabetes technology & therapeutics.

[25]  Carbohydrate counting with an automated bolus calculator helps to improve glycaemic control in children with type 1 diabetes using multiple daily injection therapy: an 18-month observational study. , 2014, Diabetes research and clinical practice.