Little is known about how adults with type 1 diabetes (T1D) engage with technology to make positive changes in diabetes self-management. We explored the qualitative experiences of T1D adults after a clinical intervention that included FreeStyle Libre (FSL) linked to “Sugar Sleuth,” a mobile-based system that prompted patients to reflect on the causes of daily glycemic excursions in real time. Ten T1D adults (baseline A1c 8.0% ± 0.4; 60% male, 52±16 years old, T1D duration 31±14 years, 40% insulin pump) met with clinicians 5 times over 14 weeks initially to learn to use Sugar Sleuth and then to collaboratively review glucose data. They also completed an online nutrition education module focused on the impact of food on postprandial glycemia. Research psychologist conducted semi-structured interviews that were transcribed, coded, and analyzed using content analysis to derive themes. Three main themes emerged regarding the integrated FSL + Sugar Sleuth system: Empowering Tool, provided constant information for preemptive actions with hypo/hyperglycemia, immediate feedback for food choices, and useful data to discuss with clinicians; Psychosocial Support, promoted a sense of normalcy and relief from worry, and aided diabetes coping; Approaches to Glycemic Data, 50% described using FSL + Sugar Sleuth to review data, problem-solve, understand cause and effect, and plan for future self-care; the remainder focused only on immediate glucose numbers, trend arrows, and graphs but rarely reviewed data retrospectively. At study end, A1c was reduced by 0.4±0.14% (P<0.005) without a significant change in total daily insulin dose.

Overall, participants perceived distinct benefits from this intervention, which incorporated the use of FSL + Sugar Sleuth and clinical support to facilitate changes in diabetes self-management. These qualitative results are supported by improvement in A1c. Further study of FSL + Sugar Sleuth can inform more personalized clinical and mobile-based interventions for T1D adults.


M.D. Ritholz: None. O. Henn: None. A. Atakov-Castillo: None. L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck & Co., Inc.. E. Toschi: None.

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