Research and commentary

Type 1 diabetes in children: how effective is using a smartphone app?

A study examined the efficacy of an app aimed at helping children and young people with type 1 diabetes to calculate bolus insulin doses. Heather Rostron takes a look at its findings
Diabetes app

A study examined the efficacy of an app aimed at helping children and young people with type 1 diabetes to calculate bolus insulin doses. Heather Rostron takes a look at its findings

Chatzakis C, Floros D, Papagianni M et al (2019) The beneficial effect of the mobile application Euglyca in children and adolescents with type 1 diabetes mellitus: a randomized controlled trial. Diabetes Technology & Therapeutics. 21, 11, 627-634. doi.org/10.1089/dia.2019.0170

Aim

To evaluate the efficacy of the Euglyca mobile app on patients glycaemic control and satisfaction.

Methods

...

A study examined the efficacy of an app aimed at helping children and young people with type 1 diabetes to calculate bolus insulin doses. Heather Rostron takes a look at its findings

Chatzakis C, Floros D, Papagianni M et al (2019) The beneficial effect of the mobile application Euglyca in children and adolescents with type 1 diabetes mellitus: a randomized controlled trial. Diabetes Technology & Therapeutics. 21, 11, 627-634. doi.org/10.1089/dia.2019.0170


Picture: iStock

Aim

To evaluate the efficacy of the Euglyca mobile app on patients’ glycaemic control and satisfaction.

Methods

Children and young people aged 7-17 years with type 1 diabetes mellitus attending consecutive appointments at an endocrinology clinic in Greece were approached to take part in a randomised controlled trial. Participants were randomly and equally assigned to one of two groups: group E were asked to use the app for bolus insulin dose calculations, and group C were asked to continue with standard methods of bolus insulin calculations. HbA1c values and percentages of hypoglycaemia, hyperglycaemias and normoglycaemias were collected at baseline at three, six and 12 months. The Diabetes Treatment Satisfaction Questionnaire (DTSQ) was used to assess participants’ treatment satisfaction at baseline and at six and 12 months.

Findings

In total, 80 children and young people with type 1 diabetes – mean age 13.5 years ± 2.8 years standard deviation – took part, with gender split almost equally across both study arms. All participants completed the study. Compliance with the app was 95% ±2.5%. There was a statistically significant difference in positive linear correlation between DTSQ and normoglycaemia percentage at six months in group E, whereas the opposite was true at all time points for group C. There was a statistically significant negative correlation between percentage of normoglycaemia changes and HbA1c changes from baseline to 12 months in Group E.

Conclusion

The use of this app contributes towards an improvement in glycaemic control and treatment satisfaction in children and young people with type 1 diabetes.

Patients enjoy Euglyca app, but concerns remain about effectiveness

Self-care and individualised care in children and young people can be complex and intensive, for example with carbohydrate counting and logging physical activity, so the idea of having all the elements necessary for self-care contained in one app appears attractive. However, in a world where technology changes constantly, it is important to consider the safe and effective integration of it into healthcare systems.

This trial builds on previous work by others including Goyal et al (2017) and Klee et al (2018).

Insulin bolus dose was based on food fat content as well as carbohydrates, and the researchers discuss and justify this decision. The app contained more than 7,000 food products based on a typical Greek diet. It is unknown how far the findings of this study could be generalised to other populations.

There are ethical considerations regarding this study, particularly the fact that participants could only take part if they had an Android smartphone. This raises questions about how all potential participants who were approached to take part consented to the study and whether the researchers knew which patients had access to Android smartphones. The lack of inclusion of patients with no access to Android smartphones does not appear to be fair selection of research participants.

The researchers acknowledge that use of the app was not monitored or assessed, and this could have provided vital data for evaluating its usability. However, usage has now been integrated into the app for future projects.

This study showed an increase over time in satisfaction with using the app, but more research is required into its effectiveness.


References


Heather Rostron, a senior research nurse with Leeds Children’s Hospital Clinical Research Team at Leeds Teaching Hospitals NHS Trust, provided this commentary on behalf of the RCNi’s Research in Child Health community

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