scholarly journals Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial (Preprint)

2020 ◽  
Author(s):  
Jeffrey E Alfonsi ◽  
Elizabeth E Y Choi ◽  
Taha Arshad ◽  
Stacie-Ann S Sammott ◽  
Vanita Pais ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Digital Health ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Mobile App ◽  
Thinking Aloud ◽  
Carbohydrate Counting ◽  
Scale Scores

BACKGROUND Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. OBJECTIVE Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. METHODS Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA<sub>1c</sub> level was also assessed. RESULTS Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, <i>P</i>=.008), reduced frequency of individual counting errors greater than 10 g (<i>P</i>=.047), and lower HbA<sub>1c</sub> levels (<i>P</i>=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. CONCLUSIONS Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. CLINICALTRIAL ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142

scholarly journals Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial

10.2196/22074 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e22074
Author(s):  
Jeffrey E Alfonsi ◽  
Elizabeth E Y Choi ◽  
Taha Arshad ◽  
Stacie-Ann S Sammott ◽  
Vanita Pais ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Digital Health ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Mobile App ◽  
Thinking Aloud ◽  
Carbohydrate Counting ◽  
Scale Scores

Background Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142

scholarly journals A Time-Friendly, Feasible Measure of Nutrition Knowledge in Type 1 Diabetes: The Electronic Nutrition and Carbohydrate Counting Quiz (eNCQ)

2018 ◽  
Vol 13 (1) ◽  
pp. 68-74
Author(s):  
Arwen M. Marker ◽  
Amy E. Noser ◽  
Nicole Knecht ◽  
Mark A. Clements ◽  
Susana R. Patton
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Nutrition Education ◽  
Diabetes Management ◽  
Clinical Care ◽  
Nutrition Knowledge ◽  
Diabetes Diagnosis ◽  
Carbohydrate Counting ◽  
One Year

Background: Greater knowledge about nutrition and carbohydrate counting are associated with improved glycemic control and quality of life in youth with type 1 diabetes (T1D). However, limited assessments of nutrition and carbohydrate knowledge have been developed, and existing measures can be time-consuming, overly broad, or not conducive to routine clinical use. To fill this gap, we developed and examined the feasibility of administering the electronic Nutrition and Carbohydrate Counting Quiz (eNCQ). Method: Ninety-two caregivers and 70 youth with T1D (mean age 12.5 years; mean time since diagnosis 5 years; English speaking) completed the 19-item eNCQ via tablet during a routine clinical visit. Completion time and item completion rates were used to assess feasibility. Relationships between eNCQ scores and patient demographics, diabetes management, and health outcomes were examined. Results: Participants took 10 minutes, on average, to complete the eNCQ. Total and Carbohydrate subscale scores (youth report) were negatively correlated with youth hemoglobin A1c (total r = –.38, carbohydrate r = –.38, Ps < .05), indicating that greater nutrition knowledge related to better glycemic control. Nutrition knowledge scores were generally high, but knowledge was negatively related to time since diabetes diagnosis ( r = –.276, P < .05). Conclusions: Findings support feasibility of the eNCQ to assess nutrition knowledge in routine clinical care. Following additional acceptability and validity testing, the eNCQ may identify families in need of further nutrition education. Nutrition assessment is particularly indicated for youth over one year since T1D diagnosis, as these families displayed lower nutrition knowledge and may need continuing education to maintain diabetes-specific nutrition knowledge over time.

scholarly journals One Drop App With an Activity Tracker for Adults With Type 1 Diabetes: Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Chandra Y Osborn ◽  
Ashley Hirsch ◽  
Lindsay E Sears ◽  
Mark Heyman ◽  
Jennifer Raymond ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Type 1 Diabetes ◽  
Controlled Trial ◽  
Mobile App ◽  
Analysis Of Covariance ◽  
Activity Tracker ◽  
Randomized Controlled ◽  
Hemoglobin A ◽  
The One

BACKGROUND In 2017, mobile app support for managing diabetes was available to 64% of the global population of adults with diabetes. One Drop’s digital therapeutics solution includes an evidence-based mobile app with global reach, a Bluetooth-connected glucometer, and in-app coaching from Certified Diabetes Educators. Among people with type 1 diabetes and an estimated hemoglobin A<sub>1c</sub> level≥7.5%, using One Drop for 3 months has been associated with an improved estimated hemoglobin A<sub>1c</sub> level of 22.2 mg/dL (–0.80%). However, the added value of integrated activity trackers is unknown. OBJECTIVE We conducted a pragmatic, remotely administered randomized controlled trial to evaluate One Drop with a new-to-market activity tracker against One Drop only on the 3-month hemoglobin A<sub>1c</sub> level of adults with type 1 diabetes. METHODS Social media advertisements and online newsletters were used to recruit adults (≥18 years old) diagnosed (≥1 year) with T1D, naïve to One Drop’s full solution and the activity tracker, with a laboratory hemoglobin A<sub>1c</sub> level≥7%. Participants (N=99) were randomized to receive One Drop and the activity tracker or One Drop only at the start of the study. The One Drop only group received the activity tracker at the end of the study. Multiple imputation, performed separately by group, was used to correct for missing data. Analysis of covariance models, controlling for baseline hemoglobin A<sub>1c</sub>, were used to evaluate 3-month hemoglobin A<sub>1c</sub> differences in intent-to-treat (ITT) and per protocol (PP) analyses. RESULTS The enrolled sample (N=95) had a mean age of 41 (SD 11) years, was 73% female, 88% White, diagnosed for a mean of 20 (SD 11) years, and had a mean hemoglobin A<sub>1c</sub> level of 8.4% (SD 1.2%); 11% of the participants did not complete follow up. Analysis of covariance assumptions were met for the ITT and PP models. In ITT analysis, participants in the One Drop and activity tracker condition had a significantly lower 3-month hemoglobin A<sub>1c</sub> level (mean 7.9%, SD 0.60%, 95% CI 7.8-8.2) than that of the participants in the One Drop only condition (mean 8.4%, SD 0.62%, 95% CI 8.2-8.5). In PP analysis, participants in the One Drop and activity tracker condition also had a significantly lower 3-month hemoglobin A<sub>1c</sub> level (mean 7.9%, SD 0.59%, 95% CI 7.7-8.1) than that of participants in the One Drop only condition (mean 8.2%, SD 0.58%, 95% CI 8.0-8.4). CONCLUSIONS Participants exposed to One Drop and the activity tracker for the 3-month study period had a significantly lower 3-month hemoglobin A<sub>1c</sub> level compared to that of participants exposed to One Drop only during the same timeframe. One Drop and a tracker may work better together than alone in helping people with type 1 diabetes. CLINICALTRIAL ClinicalTrials.gov NCT03459573; https://clinicaltrials.gov/ct2/show/NCT03459573.

scholarly journals The dietary education trial in carbohydrate counting (DIET-CARB Study): study protocol for a randomised, parallel, open-label, intervention study comparing different approaches to dietary self-management in patients with type 1 diabetes

BMJ Open ◽  
2019 ◽  
Vol 9 (9) ◽  
pp. e029859
Author(s):  
Bettina Ewers ◽  
Tina Vilsbøll ◽  
Henrik Ullits Andersen ◽  
Jens Meldgaard Bruun
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Controlled Trial ◽  
Mean Amplitude ◽  
Study Groups ◽  
Estimation Accuracy ◽  
Haemoglobin A1c ◽  
Open Label ◽  
Carbohydrate Counting

IntroductionClinical guidelines recommend that patients with type 1 diabetes (T1D) learn carbohydrate counting or similar methods to improve glycaemic control. Although systematic educating in carbohydrate counting is still not offered as standard-of-care for all patients on multiple daily injections (MDI) insulin therapy in outpatient diabetes clinics in Denmark. This may be due to the lack of evidence as to which educational methods are the most effective for training patients in carbohydrate counting. The objective of this study is to compare the effect of two different educational programmes in carbohydrate counting with the usual dietary care on glycaemic control in patients with T1D.Methods and analysisThe study is designed as a randomised controlled trial with a parallel-group design. The total study duration is 12 months with data collection at baseline, 6 and 12 months. We plan to include 231 Danish adult patients with T1D. Participants will be randomised to one of three dietician-led interventions: (1) a programme in basic carbohydrate counting, (2) a programme in advanced carbohydrate counting including an automated bolus calculator or (3) usual dietary care. The primary outcome is changes in glycated haemoglobin A1c or mean amplitude of glycaemic excursions from baseline to end of the intervention period (week 24) between and within each of the three study groups. Other outcome measures include changes in other parameters of plasma glucose variability (eg, time in range), body weight and composition, lipid profile, blood pressure, mathematical literacy skills, carbohydrate estimation accuracy, dietary intake, diet-related quality of life, perceived competencies in dietary management of diabetes and perceptions of an autonomy supportive dietician-led climate, physical activity and urinary biomarkers.Ethics and disseminationThe protocol has been approved by the Ethics Committee of the Capital Region, Copenhagen, Denmark. Study findings will be disseminated widely through peer-reviewed publications and conference presentations.Trial registration numberClinicalTrials.gov Registry (NCT03623113).

scholarly journals A Mobile App for the Self-Management of Type 1 Diabetes Among Adolescents: A Randomized Controlled Trial

2017 ◽  
Vol 5 (6) ◽  
pp. e82 ◽  
Author(s):  
Shivani Goyal ◽  
Caitlin A Nunn ◽  
Michael Rotondi ◽  
Amy B Couperthwaite ◽  
Sally Reiser ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Type 1 Diabetes ◽  
Controlled Trial ◽  
Mobile App ◽  
The Self ◽  
Self Management ◽  
Randomized Controlled

scholarly journals Exploration of Users’ Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study

10.2196/11400 ◽  
2018 ◽  
Vol 6 (9) ◽  
pp. e11400 ◽  
Author(s):  
Yiyu Zhang ◽  
Xia Li ◽  
Shuoming Luo ◽  
Chaoyuan Liu ◽  
Fang Liu ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Mixed Methods ◽  
Diabetes Management ◽  
Mobile App ◽  
Mixed Methods Study

MyT1DHero, an mHealth-Based Intervention, For Adolescents with Type 1 Diabetes and Their Parents: A Pilot Study (Preprint)

2020 ◽  
Author(s):  
Bree E Holtz ◽  
Katharine M Mitchen ◽  
Amanda J Holmstrom ◽  
Shelia R Cotten ◽  
Julie K Dunneback ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
Pilot Study ◽  
Controlled Trial ◽  
Final Analysis ◽  
The United States ◽  
Mobile App ◽  
The Stability

BACKGROUND Type 1 diabetes (T1D) impacts more than 165,000 individuals under the age of 20 in the United States. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. A mobile app intervention, MyT1DHero was designed to facilitate diabetes specific positive parent-adolescent communication. OBJECTIVE To conduct a pilot test to determine the efficacy of the MyT1DHero app intervention. METHODS This pilot study included 30 adolescent-parent pairs in a 12-week single arm clinical trial. RESULTS The final analysis included 25 families. The mean age of the adolescents was 12.281.62 years old. Half of the participants reported a diagnosis of fewer than five years. After 12-weeks, diabetes adherence significantly improved (P=.02) as did quality of life (P=0.01). HbA1c level (P=.51) and family conflict (P=0.14) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c, (F(1, 20)=9.74, P<.01, R2=.33). Overall, the adolescents were satisfied with app intervention. CONCLUSIONS In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication, significant benefits were demonstrated in adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and determine the stability of intervention effects. CLINICALTRIAL NCT03436628

scholarly journals Modeling Carbohydrate Counting Error in Type 1 Diabetes Management

2020 ◽  
Vol 22 (10) ◽  
pp. 749-759 ◽  
Author(s):  
Chiara Roversi ◽  
Martina Vettoretti ◽  
Simone Del Favero ◽  
Andrea Facchinetti ◽  
Giovanni Sparacino
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Carbohydrate Counting ◽  
Counting Error

The design and development of MyT1DHero: A mobile app for adolescents with type 1 diabetes and their parents

2017 ◽  
Vol 25 (3) ◽  
pp. 172-180 ◽  
Author(s):  
Bree E Holtz ◽  
Katharine M Murray ◽  
Denise D Hershey ◽  
Joshua Richman ◽  
Julie K Dunneback ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Sugar ◽  
Family Communication ◽  
Diabetes Management ◽  
Smartphone Application ◽  
Mobile App ◽  
Ease Of Use ◽  
Post Test ◽  
Adolescent Groups

Introduction Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition. Methods Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage. Results The parents’ perceptions of conflict around the results of the blood sugar tests increased ( t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results ( t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results ( t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback. Discussion Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.

scholarly journals Designing Online and Mobile Diabetes Education for Fathers of Children With Type 1 Diabetes: Mixed Methods Study

JMIR Diabetes ◽  
10.2196/13724 ◽  
2019 ◽  
Vol 4 (3) ◽  
pp. e13724 ◽  
Author(s):  
Anastasia Albanese-O'Neill ◽  
Desmond A Schatz ◽  
Nicole Thomas ◽  
Jay M Bernhardt ◽  
Christa L Cook ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Scientific Evidence ◽  
Diabetes Education ◽  
Qualitative Interviews ◽  
Unmet Need ◽  
Future Research ◽  
Exploratory Research ◽  
Text Content

Background Fathers make unique and central contributions to the health of their children. However, research in type 1 diabetes (T1D) education largely ignores the needs of fathers, including during the development of online and mobile educational materials. Objective The purpose of this study was to solicit and incorporate input from fathers of children with T1D into the design, content, and infrastructure of a suite of online diabetes self-management education and support (DSMES) resources. Methods The study took part in three phases: (1) exploratory research, (2) website and subdomain development, and (3) evaluation. Fathers of children with T1D (n=30) completed surveys and semistructured qualitative interviews. Thematic content analysis was used to identify fathers’ content and design preferences. An online DSMES website (T1DToolkit.org) and a separate mobile subdomain targeting fathers (Mobile Diabetes Advice for Dads, or mDAD) were developed. A prototype of the site for fathers was evaluated by 33 additional father participants. End user feedback was elicited via survey. Results Participants in the exploratory phase were enthusiastic about the online diabetes resources. Preferences included high-quality design, availability via mobile phone and tablet, brief text content supplemented with multimedia and interactive features, reminders via text or email, endorsement by medical professionals, and links to scientific evidence. The mDAD subdomain received high usability and acceptability ratings, with 100% of participants very likely or likely to use the site again. Conclusions The development of eHealth educational platforms for fathers of children with T1D remains an unmet need in optimizing diabetes management. This study incorporated fathers’ feedback into the development of a suite of online diabetes education resources. The findings will serve as the basis for future research to assess the clinical efficacy of the website, its subdomain targeting fathers, and additional subdomains targeting unique populations.

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