Abstract
Keywords
In our Diabetes Centre at Sapienza University of Rome, Italy, we have been exploring the potential benefits of using technology in diabetes care, with a particular focus on T1DM patients receiving flexible intensive insulin therapy (MDI), who do not take advantage of automatic bolus calculators as do those treated with insulin pumps. Therefore, from its launch in 2016, we have been suggesting the mobile app RapidCalc 1 to T1DM subjects using MDI, and with knowledge and experience in technology. We have collected data from 16 patients using this app continuatively for at least 24 weeks (Table 1). These users have been reevaluated as per routine clinical practice and interviewed for assessing the adherence to the app’s calculation, specifying how often they used the app as a help for diabetes management (several times a day / once or twice a day / several times a week / once or twice a week) and for recording self-reported glucose variability (detection of blood glucose values above/below the optimal thresholds identified by the diabetologist and severe hypoglycemic events). Moreover, indicators of well-being and quality of life were evaluated in all the patients, especially fear of hypoglycemia, social interaction, and physical activity. In particular, patients were asked to report whether health status represented a limitation for daily activities and if this limitation resulted in emotional stress, with negative consequences on normal social interaction and on feelings and emotions, as assessed by the SF-36 Health Questionnaire. All these patients found it easy to use the app; 80% of the patients regularly calculated the insulin bolus through the app several times per day. They all noted a reduction of self-reported hypoglycemic events and an overall positive impact on the quality of glycemic control. Athletic patients (44%) were satisfied by the exercise bolus adjustment feature, which allowed them to plan more accurately carbohydrate intake and insulin dosage. Two T1DM individuals belonging to the “sedentary” group reported that they increased the time spent in physical activity and were consequently considered to be active (ie, subjects who were regularly exercising for more than 3.5 hours per week) after they started using the app, which significantly attenuated the fear of hypoglycemia.
Clinical Characteristics of the App Users.
From the prospective of clinical diabetologists the training for using a specific app, which covers several aspects of diabetes control, represents a valid educational tool and an incentive for boosting the motivation toward self-management in T1DM patients. Based on our initial experience, we believe that once all the specific parameters have been set by an expert diabetologist, then the use of a specific app as a bolus calculator may provide patients with an important support for diabetes self-management and may represent a novel interesting tool for clinicians who are going to approach technology for diabetes care.
Footnotes
Acknowledgements
We thank Menarini Diagnostics for supporting this study.
Abbreviations
BG, blood glucose; BMI, body mass index; DBP, diastolic blood pressure; eGRF, estimated glomerular filtration rate; HbA1C, glycated hemoglobin; MDI, flexible intensive insulin therapy; SBP, systolic blood pressure; T1DM, type 1 diabetes mellitus.
