How adults with diabetes use new technologies to support diabetes self-management: A mixed methods study (Preprint)

BACKGROUND New technologies like mobile applications (apps), continuous glucose monitors (CGM), and activity trackers are available to support adults with diabetes (AWD) but it is not clear how these tools are used together for diabetes self-management. This mixed-methods study assessed how AWD use technology to relate health behaviors to glucose and diabetes self-management goals. OBJECTIVE To understand how AWD use new technologies like apps, CGMs, and activity trackers in daily diabetes self-management. METHODS 61 adults aged 18-70 with type 1 or 2 diabetes who used at least one diabetes medication responded to an online survey about health app and monitor use in six categories: glucose, diet, exercise/activity, weight, sleep, and stress. Digital health literacy was assessed using the Digital Health Care Literacy Scale (DHLS), and general health literacy using the Brief Health Literacy Screener (BHLS). 18 respondents also completed semi-structured interviews examining how these technologies were and could be used to support daily diabetes self-management. RESULTS Survey respondents were 34% Black, 38% female, and 48% were ≥45 years old. 72% had tType II 2 dDiabetes, 59% used insulin, and 56% had used a CGM. On average, respondents had high levels of digital and general health literacy. 87% used at least 1 health app; 59% had used an activity tracker; and 47% had used apps to track at least 3 separate health behaviors. CGM and non-CGM users used non-CGM health apps at similar rates (57% vs. 60%). Wearable activity tracker use was also similar between those using CGM vs. not (61% vs. 64%). Participants also reported sharing self-monitored data with their providers at similar rates across age groups (53% for those aged 18-44 vs. 55% for those aged 45-70, p = 0.873). Interviewees described using glucose-tracking apps to personalize dietary choices, but less often used data from other apps or activity monitors to meet other diabetes self-management goals. For apps to be helpful for diabetes self-management, interviewees desired data that was passively collected, relevant to personal self-management priorities, easily integrated across monitors/data sources, and visually presented, and .tailorable to personal self-management priorities. CONCLUSIONS Adults with diabetes commonly used apps and wearable activity monitors to track multiple behaviors that impact diabetes self-management, often alongside glucose monitor use, but found it challenging to link tracked behaviors to their glycemic and diabetes self-management goals. Findings indicate there are untapped opportunities to integrate data from apps and monitors to support patient-centered diabetes self-management. CLINICALTRIAL Not applicable