Data-Driven Personalized Feedback to Patients with Type 1 Diabetes: A Randomized Trial.
BACKGROUND
A mobile phone-based application can be useful for patients with type 1 diabetes in managing their disease. This results in large datasets accumulated on the patient's devices, which can be used for individualized feedback. The effect of such feedback is investigated in this article.


METHODS
We developed an application that included a data-driven feedback module known as Diastat for patients on self-measured blood glucose regimens. Using a stepped-wedge design, both groups initially received an application without Diastat. Group 1 activated Diastat after 4 weeks, whereas Group 2 activated Diastat 12 weeks after startup (T1). End points were glycated hemoglobin (HbA1c) level and number of out-of-range (OOR) measurements (i.e., outside the range 72-270 mg/dL).


RESULTS
Thirty patients were recruited to the study, and 15 were assigned to each group after the initial meeting. There were no significant differences between groups at T1 in HbA1c or OOR events. Overall, all patients had a decrease of 0.6 percentage points in mean HbA1c (P < 0.001) and 14.5 in median OOR events over 2 weeks (P < 0.001).


CONCLUSIONS
The study does not provide evidence that data-driven feedback improves glycemic control. The decrease in HbA1c was sizeable and significant, even though the study was not powered to detect this. The overall improvement in glycemic control suggests that, in general, mobile phone-based interventions can be useful in diabetes self-management.
1 Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø, Norway .|2 Department of Mathematics and Statistics, University of Tromsø , Tromsø, Norway .
Stein Olav
SO
Skrøvseth
1 Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway , Tromsø, Norway .|3 Department of Computer Science, University of Tromsø , Tromsø, Norway .
Eirik
E
Årsand
2 Department of Mathematics and Statistics, University of Tromsø , Tromsø, Norway .
Fred
F
Godtliebsen
4 Division of Internal Medicine, University Hospital of North Norway , Tromsø, Norway .|5 Department of Clinical Medicine, University of Tromsø , Tromsø, Norway .
Ragnar M
RM
Joakimsen
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D040421:Cell Phone; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000628:therapy*; D005246:Feedback; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D012648:Self Care / Q000379:methods / Q000706:statistics & numerical data*; D017216:Telemedicine / Q000379:methods*
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human