Abstract: SUN 008

Evaluation of Bant, a Self-Management Mobile Health Application for Adolescents with Type 1 Diabetes

Presenter: Caitlin Nunn


Abstract


Optimal Blood Glucose (BG) control is known to reduce the long-term complications associated with Type 1 Diabetes Mellitus (T1DM). Adolescents often struggle to achieve their BG targets, but they do demonstrate a strong propensity for new technology. Thus, to support T1DM self-management in this population, we developed a smartphone application, bant, which includes wireless BG reading transfer, out-of-range BG trend alerts, coaching around out-of-range trend causes and fixes, and a point-based incentive system.

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Optimal Blood Glucose (BG) control is known to reduce the long-term complications associated with Type 1 Diabetes Mellitus (T1DM). Adolescents often struggle to achieve their BG targets, but they do demonstrate a strong propensity for new technology. Thus, to support T1DM self-management in this population, we developed a smartphone application, bant, which includes wireless BG reading transfer, out-of-range BG trend alerts, coaching around out-of-range trend causes and fixes, and a point-based incentive system.

Ninety-two adolescents were enrolled into a 12-month Randomized Controlled Trial, with 46 receiving usual care and 46 receiving usual care plus bant. Clinical outcome data were collected at quarterly visits via validated tools, electronic chart review, glucometer downloads and semi-structured interviews. App satisfaction was assessed at 6 and 12 months using a 7-point Likert scale, and at trial end, users ranked bant’s 12 components based on perceived usefulness. Mobile analytics tracked frequency of BG uploads and was used to categorize subjects into high, moderate, low or very low engagement levels.

Post-hoc analysis demonstrated a statistically significant association between increased self-monitoring blood glucose (SMBG) and improved hemoglobin A1c (A1c) in the intervention group. This relationship strengthened over trial duration in bant users (p<0.05), indicating bant may positively impact glycemic control; however, the effect of this interaction was not large enough to lead to significant overall changes in A1c in bant versus control subjects.

Seventy-nine percent (30/38) and 76% (34/45) of respondents reported being “satisfied” or “very satisfied” with bant at 6 and 12 months, respectively. The trending feature was ranked the most useful component by 45% (20/44) and second most useful by 38% (15/39) of subjects. Although usage did diminish over the trial, on average, 35% (16/46 subjects) were classified as moderately or highly engaged (uploaded ≥3 days a week) over the 12 months.

In summary, high satisfaction and component usefulness scores suggest users found utility with bant, especially in features related to trend management. Bant also demonstrated the ability to engage a subset of users over an extend timeframe. Although primary analysis of clinical outcomes did not demonstrate differences between the bant group and controls, exploratory analysis suggests bant may positively impact use of SMBG data among youth. Future versions of bant should aim to remove barriers to use, including deployment on personal devices (instead of secondary research phones) and exploring the utility of embedding bant in routine clinical care (instead of as a standalone self-management tool).

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