title: Design of an mHealth app for the self-management of adolescent type 1 diabetes: a pilot study.
abstract: BACKGROUND
  The use of mHealth apps has shown improved health outcomes in adult populations with type 2 diabetes mellitus. However, this has not been shown in the adolescent type 1 population, despite their predisposition to the use of technology. We hypothesized that a more tailored approach and a strong adherence mechanism is needed for this group.
  
  
  OBJECTIVE
  To design, develop, and pilot an mHealth intervention for the management of type 1 diabetes in adolescents.
  
  
  METHODS
  We interviewed adolescents with type 1 diabetes and their family caregivers. Design principles were derived from a thematic analysis of the interviews. User-centered design was then used to develop the mobile app bant. In the 12-week evaluation phase, a pilot group of 20 adolescents aged 12-16 years, with a glycated hemoglobin (HbA(1c)) of between 8% and 10% was sampled. Each participant was supplied with the bant app running on an iPhone or iPod Touch and a LifeScan glucometer with a Bluetooth adapter for automated transfers to the app. The outcome measure was the average daily frequency of blood glucose measurement during the pilot compared with the preceding 12 weeks.
  
  
  RESULTS
  Thematic analysis findings were the role of data collecting rather than decision making; the need for fast, discrete transactions; overcoming decision inertia; and the need for ad hoc information sharing. Design aspects of the resultant app emerged through the user-centered design process, including simple, automated transfer of glucometer readings; the use of a social community; and the concept of gamification, whereby routine behaviors and actions are rewarded in the form of iTunes music and apps. Blood glucose trend analysis was provided with immediate prompting of the participant to suggest both the cause and remedy of the adverse trend. The pilot evaluation showed that the daily average frequency of blood glucose measurement increased 50% (from 2.4 to 3.6 per day, P = .006, n = 12). A total of 161 rewards (average of 8 rewards each) were distributed to participants. Satisfaction was high, with 88% (14/16 participants) stating that they would continue to use the system. Demonstrating improvements in HbA(1c) will require a properly powered study of sufficient duration.
  
  
  CONCLUSIONS
  This mHealth diabetes app with the use of gamification incentives showed an improvement in the frequency of blood glucose monitoring in adolescents with type 1 diabetes. Extending this to improved health outcomes will require the incentives to be tied not only to frequency of blood glucose monitoring but also to patient actions and decision making based on those readings such that glycemic control can be improved.
authors.affiliation: Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada. joe.cafazzo@uhn.ca
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Cafazzo
authors.forename: Mark
authors.initials: M
authors.lastname: Casselman
authors.forename: Nathaniel
authors.initials: N
authors.lastname: Hamming
authors.forename: Debra K
authors.initials: DK
authors.lastname: Katzman
authors.forename: Mark R
authors.initials: MR
authors.lastname: Palmert
mesh_terms: D000293:Adolescent; D040421:Cell Phone; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D010865:Pilot Projects; D012648:Self Care; D012984:Software
chemical_list: D006442:Glycated Hemoglobin