Patient Input for Design of a Type 1 Diabetes (T1D) Decision Support Smartphone Application

The complexity of T1D results in inadequate glucose control for patients which can lead to acute and chronic complications. We are developing a decision support smartphone application (app) for patients using multiple daily injection (MDI) therapy and continuous glucose monitoring (CGM). This app will use glucose trends, insulin dosing, and physical activity to provide recommendations for titration of insulin dosing to improve glycemic control. We performed an online survey of patients age 18-80 with T1D from a diabetes specialty clinic, targeting MDI users, to determine current needs and preferences of candidates for decision support tools. Twenty-seven respondents are included in the analysis: mean age of 39.4 years, 54% female, 17.5 years mean duration of T1D, 89% use MDI. A total of 41% of respondents used CGM 50-100% of the time with all checking their CGM >6 times per day. Over 90% use a smartphone, 88% have the phone with them 75-100% of the time. Only 19% used an app to calculate insulin doses, while 81% were interested in using an app to manage diabetes. Participants wanted the following features in a decision support app: hypoglycemia avoidance (89%), insulin dose calculation (78%), behavioral change suggestions (74%), predicted glucose trends (70%), and insulin-on-board (70%). Many expressed low confidence in their ability to manage glucose during exercise (51%). Most respondents were interested in viewing predicted glucose trends prior to exercise (85%). Preferences about alerts to improve glucose control were varied with 44% saying they would be comfortable with 1-3 alerts per day. Preferences about alerts for predicted hypoglycemia were also varied; 11% would want to be alerted 5 minutes prior, 19% 15 minutes, 44% 30 minutes, and 26% >1 hour. These survey results confirm the need for and interest in a smartphone-based decision support app that will assist with management of T1D. The results will enable intelligent app design to better meet the needs of end users.