Advancing Diabetes Self‑Management: A Novel Smartphone Application Featuring a Scoring Algorithm for Tailored User Engagement

Mohammad A. Tebianian, Soodeh Razeghi Jahromi

Abstract


Background: We developed and evaluated an intelligent diabetes assistant application (Diabetter) for the self‑management of diabetes. It suggested that increasing the patient’s interest and participation in using smartphone apps is important for the effectiveness of diabetes management apps. Methods: After evaluating all‑encompassing features for diabetes management, we divided the selected factors into sub-factors for use in the application. Then, we created the first high‑fidelity prototype using related programs and conducted early user testing to validate and improve Diabetter. To handle the user transaction time and keep them motivated, we designed and implemented a scoring system based on the nudge theory rules within the app. Results: To evaluate Diabetter’s impact on diabetes self‑management, we measured HbA1c levels after a prolonged period. The Diabetter prototype was developed and modified in a revised version for better user interaction with the app. The scoring system increased the input of users’ information, which resulted in more analysis and recommendations to users. Clinical studies showed that as a result of continuous input of information from users who had been using the application for a longer period of time, their HbA1c levels were within the healthy range. Conclusions: The results demonstrate that the Diabetter application has been able to play an effective role in diabetes self‑management by increasing users’ app usage time. However, future study is needed to provide a better interpretation.

 

International Journal of Preventive Medicine 15():20, April 2024. | DOI: 10.4103/ijpvm.ijpvm_268_23

Corresponding Author: Dr. Mohammad A. Tebianian

Email: tebianianmohammadamin@gmail.com

 

 


Keywords


Diabetes; HbA1c; mobile application; self‑management

Full Text:

PDF

References


American Diabetes Association Classification and diagnosis

of diabetes. Section 2. Standards of Medical Care in

Diabetes—2018. Diabetes Care 2018;41(Suppl 1):S13–27.

Cho NH, Shaw JE, Karuranga S, Huang Y,

da Rocha Fernandes JD, Ohlrogge AW, et al. IDF diabetes atlas:

Global estimates of diabetes prevalence for 2017 and projections

for 2045. Diabetes Res Clin Pract 2018;138:271–81.

Lin X, Xu Y, Pan X, Xu J, Ding Y, Sun X, et al. Global,

regional, and national burden and trend of diabetes in 195

countries and territories: An analysis from 1990 to 2025. Sci Rep

;10:14790.

International Diabetes Federation. IDF Diabetes Atlas. 9th ed. Brussels, Belgium; 2019. Available from: https://diabetesatlas.

org/upload/resources/material/20200302_133351_IDFATLAS9efinal-web.pdf

Wu Y, Yao X, Vespasiani G, Nicolucci A, Dong Y, Kwong J,

et al. Mobile app‑based interventions to support diabetes self

management: A systematic review of randomized controlled

trials to identify functions associated with glycemic efficacy.

JMIR mHealth uHealth 2017;5:e35.

Funnell MM, Brown TL, Childs BP, Haas LB, Hosey GM,

Jensen B, et al. National standards for diabetes self‑management

education. Diabetes Educ 2007;33:599‑614.

Svedbo Engström M, Leksell J, Johansson U‑B,

Gudbjörnsdottir S. What is important for you? A qualitative

interview study of living with diabetes and experiences of

diabetes care to establish a basis for a tailored Patient‑ Reported

Outcome Measure for the Swedish National Diabetes Register.

BMJ Open 2016;6:e010249. doi: 10.1136/bmjopen‑2015‑010249.

Cochran J, Conn VS. Meta‑analysis of quality of life outcomes

following diabetes self‑management training. Diabetes Educ

;34:815‑23.

Doupis J, Festas G, Tsilivigos C, Efthymiou V, Kokkinos A.

Smartphone‑based technology in diabetes management. Diabetes

Ther 2020;11:607‑19.

Debon R, Coleone JD, Bellei EA, De Marchi ACB. Mobile

health applications for chronic diseases: A systematic review

of features for lifestyle improvement. Diabetes Metab Syndr

;13:2507–12.

Whitehead L, Seaton P. The effectiveness of self‑management

mobile phone and tablet apps in long‑term condition

management: A systematic review. J Med Internet Res

;18:e97. doi: 10.2196/jmir.4883.

Holtz B, Lauckner C. Diabetes management via mobile phones:

A systematic review. Telemed J E Health 2012;18:175–84.

Adu MD, Malabu UH, Callander EJ, Malau‑Aduli AE,

Malau‑Aduli BS. Considerations for the development of mobile

phone apps to support diabetes self‑management: Systematic

review. JMIR Mhealth Uhealth 2018;6:e10115. doi: 10.2196/10115.

Kwan YH, Ong ZQ, Choo DYX, Phang JK, Yoon S, Low LL.

A mobile application to improve diabetes self‑management using

rapid prototyping: Iterative co‑design approach in Asian settings.

Patient Prefer Adherence 2023;17:1‑11.

Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden KB,

et al. Rapid evidence review of mobile applications for

self‑management of diabetes. J Gen Intern Med 2018;33:1167‑76.

Ehrmann D, Eichinger V, Vesper I, Kober J, Kraus M,

Schäfer V, et al. Health care effects and medical benefits of a

smartphone‑based diabetes self‑management application: Study

protocol for a randomized controlled trial. Trials 2022;23:282.

Istepanian RSH, Zitouni K, Harry D, Moutosammy N,

Sungoor A, Tang B, et al. Evaluation of a mobile phone

telemonitoring system for glycaemic control in patients with

diabetes. J Telemed Telecare 2009;15:125–8.

Chomutare T, Fernandez‑Luque L, Arsand E, Hartvigsen G.

Features of mobile diabetes applications: Review of the

literature and analysis of current applications compared against

evidence‑based guidelines. J Med Internet Res 2011;13:e65. doi:

2196/jmir.1874.

Arsand E, Tufano JT, Ralston JD, Hjortdahl P. Designing mobile

dietary management support technologies for people with

diabetes. J Telemed Telecare 2008;14:329–32.

Moses JC, Adibi S, Shariful Islam SM, Wickramasinghe N,

Nguyen L. Application of smartphone technologies in

disease monitoring: A systematic review. Healthcare (Basel)

;9:889.

Song M, Choe MA, Kim KS, Yi MS, Lee I, Kim J, et al.

An evaluation of Web‑based education as an alternative to

group lectures for diabetes self‑management. Nurs Health Sci

;11:277–84.

Sunil Kumar D, Prakash B, Subhash Chandra BJ, Kadkol PS,

Arun V, Thomas JJ. An android smartphone‑based randomized

intervention improves the quality of life in patients with type 2

diabetes in Mysore, Karnataka, India. Diabetes Metab Syndr

;14:1327‑32.

Priesterroth L, Grammes J, Holtz K, Reinwarth A, Kubiak T.

Gamification and behavior change techniques in diabetes

self‑management apps. J Diabetes Sci Technol 2019;13:954‑8.

Cafazzo JA, Casselman M, Hamming N. Design of an mHealth

app for the self‑management of adolescent type 1 diabetes:

A pilot study. J Med Internet Res 2012;14:e70. doi: 10.2196/jmir.

Martos‑Cabrera MB, Velando‑Soriano A, Pradas‑Hernández L,

Suleiman‑Martos N, Cañadas‑De la Fuente GA,

Albendín‑García L, et al. Smartphones and apps to control

glycosylated hemoglobin (HbA1c) level in diabetes: A systematic

review and meta‑analysis. J Clin Med 2020;9:693.

Hou C, Carter B, Hewitt J, Francisa T, Mayor S. Do mobile

phone applications improve glycemic control (HbA1c) in

the self‑management of diabetes? A systematic review,

meta‑analysis, and GRADE of 14 randomized trials. Diabetes

Care 2016;39:2089‑95.

Kirwan M, Vandelanotte C, Fenning A, Duncan MJ. Diabetes

self‑management smartphone application for adults with type 1

diabetes: Randomized controlled trial. J Med Internet Res

;15:1–14.

Zhai Y, Yu W. A mobile app for diabetes management: Impact on

self‑efficacy among patients with type 2 diabetes at a community

hospital. Med Sci Monit 2020 26:e926719. doi: 10.12659/

MSM.926719.

Joachim S, Forkan ARM, Jayaraman PP, Morshed A,

Wickramasinghe N. A Nudge‑inspired AI‑driven health

platform for self‑management of diabetes. Sensors (Basel)

;22:4620.

Kwan YH, Cheng TY, Yoon S, Ho LYC, Huang CW, Chew EH,

et al. A systematic review of nudge theories and strategies used

to influence adult health behaviour and outcome in diabetes

management. Diabetes Metab 2020;46:450‑60