Use of the Tidepool Platform to Collect, Integrate, and Visualize Diabetes Device Data in a Pediatric Clinic Setting

Glucose meters, insulin pumps, and continuous glucose monitoring systems provide data needed for people with type 1 diabetes to modify insulin regimens, evaluate lifestyle changes, or troubleshoot unexpected glucose levels. Health care providers (HCPs) can use device-specific software to review data at patient visits, often using separate, proprietary applications for each device. Using mixed qualitative and quantitative methods, we examined the feasibility of using the Tidepool platform and web application to view diabetes data from multiple devices together, in a multidisciplinary pediatric diabetes center where it was standard practice to upload and view data using device-specific software for each patient visit. Participating HCPs (n=15) used the software with compatible devices in all patient visits for 6 months. To evaluate the effect of the application on workflow, registration desk activity and office visits were observed before and after introducing the software, and HCPs provided feedback by survey and focus groups. The time required to upload device data and the length of the office visit did not change. However, the number of times the provider referred to the device data with patients increased from a mean of 2.8 (±1.2) to 6.1 (±3.1) times per observed visit (p=0.0002). A significantly larger proportion of the children looked at the device data with the new application (61% at baseline vs. 94% at study end, p=0.015). HCPs liked the use of color to indicate glucose levels, the graphical web-based user interface, integration of the data in one application, and the ability to remotely access data via the web for telehealth. They found the application most useful for initiating patient conversations and education. Remaining challenges include the need for automated data upload and integration with electronic medical records. Future studies of HCP use of the application will focus on clinical outcomes and effects on patient engagement and self-management.