An International, Mixed-Methods Study of the Perceived Intrusiveness of Remote Digital Diabetes Monitoring

Oikonomidi, Theodora; Ravaud, Philippe; James, Arthur; Cosson, E.; Montori, Víctor M.; Tran, Viet-Thi

doi:10.1016/j.mayocp.2020.07.040

Cited by 6 publications

(5 citation statements)

References 30 publications

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“…This is in keeping with the studies on the perceived intrusiveness of frequent feedback of clinical parameters, showing that people find CBG monitoring to be less intrusive than food monitoring. 30 Features associated with a successful interactive technology include perception of benefit, convenience of use, and integration into existing consumer technologies. 11 The system we used integrated well into the existing day-to-day device use pattern for both participants and doctors.…”

Section: Discussionmentioning

confidence: 99%

Telemonitoring With a Connected Glucose Meter Improves Glycemia Among People With Insulin-Treated Type 2 Diabetes

Chandran

Tan

Chen

et al. 2023

J Diabetes Sci Technol

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Background: Delayed initiation and inadequate titration remain critical challenges to optimizing insulin therapy in type 2 diabetes (T2D). We aimed to study whether hemoglobin A1c (HbA1c) can be lowered in people with insulin-treated T2D using telemonitoring. Methods: This single-center study recruited adults with greater than or equal to six months of diabetes, greater than or equal to three months of insulin therapy, HbA1c ≥8.5% and ≤12.5%, and body mass index (BMI) ≤40 kg/m2. All participants received a connected glucose meter and the accompanying smartphone application. Participants sent weekly blood glucose (BG) diary to their primary endocrinologist via email. Adjustments in insulin doses were communicated to the participants. HbA1c, proportion of BG readings in range (70-180 mg/dL, PIR), below range (<70 mg/dL, PBR) and above range (>180 mg/dL, PAR), and glycemic variability as the coefficient of variation (% CV) were measured at baseline, week 12, and week 24 and compared using repeated-measures analysis of variance (ANOVA) or Friedman’s ANOVA. Results: We recruited 40 people (55% women). Mean age was 57.9 years, BMI 27.8 kg/m2, and baseline HbA1c 9.8% (83.7 mmol/mol). Mean HbA1c improved by 1.7%, % CV reduced from 32.9% to 30.7%, PIR increased from 58.8% to 67.1% (all P <.01) by week 24, without any change in PBR. This was achieved with a 0.04 U/kg/d median increase in total daily dose of insulin and 0.9 kg weight gain over 24 weeks. Conclusion: Telemonitoring and titration of insulin using a connected glucose meter resulted in significant improvements in glycemia, characterized by a reduction in HbA1c, increase in PIR, and reduction in glycemic variability without any increase in hypoglycemia.

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Section: Discussionmentioning

confidence: 99%

Telemonitoring With a Connected Glucose Meter Improves Glycemia Among People With Insulin-Treated Type 2 Diabetes

Chandran

Tan

Chen

et al. 2023

J Diabetes Sci Technol

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“…We collected participants’ demographic characteristics and diabetes-related data as well as their perceived intrusiveness for each vignette to examine the association between intrusiveness and minimum required effectiveness (eAppendix 2 in the Supplement). Exploring the association between RDM modalities and intrusiveness was a separate objective and is reported in a different paper …”

Section: Methodsmentioning

confidence: 99%

“…Exploring the association between RDM modalities and intrusiveness was a separate objective and is reported in a different paper. 28…”

Section: Data Collectionmentioning

confidence: 99%

Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management

et al. 2021

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IMPORTANCE Patients will decide whether to adopt remote digital monitoring (RDM) for diabetes by weighing its health benefits against the inconvenience it may cause. OBJECTIVE To identify the minimum effectiveness patients report they require to adopt 36 different RDM scenarios. DESIGN, SETTING, AND PARTICIPANTSThis survey study was conducted among adults with type 1 or type 2 diabetes living in 30 countries from February to July 2019. EXPOSURES Survey participants assessed 3 randomly selected scenarios from a total of 36.Scenarios described different combinations of digital monitoring tools (glucose, physical activity, food monitoring), duration and feedback loops (feedback in consultation vs real-time telefeedback by a health care professional or by artificial intelligence), and data handling modalities (by a public vs private company), reflecting different degrees of RDM intrusiveness in patients' personal lives. MAIN OUTCOMES AND MEASURESParticipants assessed the minimum effectiveness for 2 diabetes-related outcomes (reducing hypoglycemic episodes and preventing ophthalmologic complications) for which they would adopt each RDM (from much less effective to much more effective than their current monitoring). RESULTSOf 1577 individuals who consented to participate, 1010 (64%; 572 [57%] women, median [interquartile range] age, 51 [37-63] years, 524 [52%] with type 1 diabetes) assessed at least 1 vignette. Overall, 2860 vignette assessments were collected. In 1025 vignette assessments (36%), participants would adopt RDM only if it was much more effective at reducing hypoglycemic episodes compared with their current monitoring; in 1835 assessments (65%), participants would adopt RDM if was just as or somewhat more effective. The main factors associated with required effectiveness were food monitoring (β = 0.32; SE, 0.12; P = .009), real-time telefeedback by a health care professional (β = 0.49; SE, 0.15; P = .001), and perceived intrusiveness (β = 0.36; SE, 0.06; P < .001).Minimum required effectiveness varied among participants; 34 of 36 RDM scenarios (94%) were simultaneously required to be just as or less effective by at least 25% of participants and much more effective by at least 25% of participants. Results were similar for participant assessments of scenarios regarding the prevention of ophthalmologic complications. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that patients require greater health benefits to adopt more intrusive RDM modalities, food monitoring, and real-time feedback by a health care professional. Patient monitoring devices should be designed to be minimally intrusive.The variability in patients' requirements points to a need for shared decision-making.

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“…Studies suggest that data access may enhance communication by fostering a sense of intimacy and “seamless connectedness” between user and practitioner 7 and, in turn, improve glycemic control 8 . However, while access to glucose/insulin dose data can help HCPs provide better advice and support, the level of insight this allows into private routines and behaviors may make users feel scrutinized or judged 9,10 . Survey studies exploring remote data review and support by HCPs in pediatric populations have reported no notable impact on parent/child psychosocial outcomes, but suggest that it may substantially reduce HCP contact times during and between clinic visits 11,12 …”

Section: Introductionmentioning

confidence: 99%

“…8 However, while access to glucose/insulin dose data can help HCPs provide better advice and support, the level of insight this allows into private routines and behaviors may make users feel scrutinized or judged. 9,10 Survey studies exploring remote data review and support by HCPs in pediatric populations have reported no notable impact on parent/child psychosocial outcomes, but suggest that it may substantially reduce HCP contact times during and between clinic visits. 11,12 Given the potential for the delivery of routine pediatric diabetes care to be enhanced by HCPs having remote data access, we sought to clarify the above equivocal findings.…”

Section: Introductionmentioning

confidence: 99%

Parents' views about healthcare professionals having real‐time remote access to their young child's diabetes data: Qualitative study

et al. 2022

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Objectives: We explored parents' views about healthcare professionals having remote access to their young child's insulin and glucose data during a clinical trial to inform use of data sharing in routine pediatric diabetes care.Research Design and Methods: Interviews with 33 parents of 30 children (aged 1-7 years) with type 1 diabetes participating in a randomized trial (KidsAP02) comparing hybrid closed-loop system use with sensor-augmented pump therapy. Data were analyzed using a qualitative descriptive approach.Results: Parents reported multiple benefits to healthcare professionals being able to remotely access their child's glucose and insulin data during the trial, despite some initial concerns regarding the insights offered into everyday family life. Key benefits included: less work uploading/sharing data; improved consultations; and, better clinical input and support from healthcare professionals between consultations. Parents noted how healthcare professionals' real-time data access facilitated remote delivery of consultations during the COVID-19 pandemic, and how these were more suitable for young children than face-to-face appointments. Parents endorsed use of real-time

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An International, Mixed-Methods Study of the Perceived Intrusiveness of Remote Digital Diabetes Monitoring

Cited by 6 publications

References 30 publications

Telemonitoring With a Connected Glucose Meter Improves Glycemia Among People With Insulin-Treated Type 2 Diabetes

Telemonitoring With a Connected Glucose Meter Improves Glycemia Among People With Insulin-Treated Type 2 Diabetes

Evaluation of Patient Willingness to Adopt Remote Digital Monitoring for Diabetes Management

Parents' views about healthcare professionals having real‐time remote access to their young child's diabetes data: Qualitative study

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