691302

research-article2017
DSTXXX10.1177/1932296817691302Journal of Diabetes Science and TechnologyClements and Staggs

Special Section: Adherence and Diabetes

Journal of Diabetes Science and Technology

A Mobile App for Synchronizing

2017, Vol. 11(3) 461­–467
© 2017 Diabetes Technology Society
Reprints and permissions:
Glucometer Data: Impact on Adherence sagepub.com/journalsPermissions.nav
DOI: 10.1177/1932296817691302
https://doi.org/10.1177/1932296817691302

and Glycemic Control Among Youths journals.sagepub.com/home/dst

With Type 1 Diabetes in Routine Care

Mark A. Clements, MD, PhD, CPI, FAAP1

and Vincent S. Staggs, PhD2

Abstract
Background: Many individuals with type 1 diabetes (T1D) upload and review blood glucose data between clinic visits.
Mobile phone applications that receive data from a “connected” glucometer and that support pattern management are
available and have the capacity to make data upload and review less burdensome. Whether mobile apps can improve diabetes
self-management among individuals with type 1 diabetes remains unknown.

Method: We analyzed retrospective data on 81 youths with T1D who were trained to use a glucometer-connected
mobile app in their self-management. To assess the effect of glucometer synchronization (“sync”) rate on hemoglobin A1c
(HbA1c), mean blood glucose (mBG), and daily frequency of SMBG, we regressed those clinical outcomes on the frequency
of glucometer syncs with the mobile app after controlling for other clinical care variables.

Results: Median age was 14.0 (IQR 10.4-15.9) years, median duration of diabetes was 4.9 (2.7, 7.5) years, and median baseline
HbA1c was 8.6% (7.9, 9.8). The sample was 49% male and 86% white. Youths with T1D synchronized glucometer data with the
mobile app an average of 0.22 times per week (range 0-2.25). The glucometer sync rate did not have a statistically significant
association with HbA1c or mean BG; in contrast, data sync frequency was associated with the frequency of self-monitoring
of blood glucose (SMBG) such that each additional sync was associated with a 2.3-fold increase in SMBG frequency (P < .01).

Conclusion: A glucometer-connected mobile app may increase an individual’s engagement with other aspects of care (eg,
SMBG frequency). Whether diabetes device-connected mobile apps can improve glycemic control remains to be determined.

Keywords
adherence, children, glucometer, glycemic control, hemoglobin A1c, mobile application, type 1 diabetes

Despite advances in both insulin therapeutics and technology
to improve insulin delivery and glucose monitoring, many
children and adolescents with type 1 diabetes (T1D) fail to
meet established targets for glycemic control.1 Recent data
suggest that individuals with T1D who download and review
their blood glucose data for patterns between clinic visits
exhibit better glycemic control than those who do not.2
Unfortunately, the majority of individuals with T1D do not
regularly download data between clinic visits or review those
data for patterns to inform insulin adjustment.2-5 Continuous
glucose monitors support real-time decision-making among
individuals with T1D, but their associated mobile phone appli-
cations do not currently archive data across multiple days,
incorporate software tools to support pattern management, or
display complete glucometer or insulin pump information.
Multiple mobile applications (ie, “apps”) to support diabetes
self-management have been described; some of these also sup-
port direct data synchronization between glucometers and the
mobile app on a mobile phone.6-9 Few studies have evaluated
the effect of data synchronization to a mobile app on glycemic
control or other self-care behaviors in T1D.
1
Children’s Mercy Hospital, Center for Children’s Healthy Lifestyles
& Nutrition, University of Missouri–Kansas City, University of Kansas
Medical Center, Kansas City, MO, USA
2
Children’s Mercy Hospital, University of Missouri–Kansas City, Health
Services & Outcomes Research, Kansas City, MO, USA
Corresponding Author:
Mark A. Clements, MD, PhD, CPI, FAAP, Children’s Mercy Hospital,
Center for Children’s Healthy Lifestyles & Nutrition, University of
Missouri–Kansas City, University of Kansas Medical Center, 2401 Gillham
Rd, Kansas City, MO, 64108, USA.
Email: maclements@cmh.edu
462 Journal of Diabetes Science and Technology 11(3)
The Glooko software application for mobile phones (fur-
ther referred to as “the mobile app”) supports data upload
from many glucometers, as well as several continuous glu-
cose monitors and insulin pumps.10 The software includes
data visualizations designed to assist with the identification of
patterns in blood glucose, insulin, carbohydrate, and exercise
data. The data are also shared from the mobile app to a cloud
data management system to facilitate review by caregivers
and health care teams. In general, mobile apps to support dia-
betes self-management have the potential to ease the burden
of data upload and review by individuals with T1D. But
whether mobile apps can improve diabetes self-management
remains unknown. It is important to answer this question,
because there are a proliferation of mobile medical apps
intended to support diabetes self-management. The impact of
a mobile app on self-management, disease control, and qual-
ity of life must be examined before investigators can discern
the mechanisms by which the mobile app impacts care, and
before clinicians and patients can make informed decisions
about incorporating mobile medical applications into diabetes
self-care.
To begin to answer this question, we retrospectively
reviewed the records of 81 youths who were provided access
to the mobile app during routine clinical care from March
2015 to April 2016 and instructed to share data from their
glucometer(s). The purpose of the present study was to
assess the impact of the frequency of glucometer-based data
synchronization events via the mobile app on HbA1c (pri-
mary endpoint). We also examined effects on two secondary
endpoints: mean blood glucose and frequency of blood glu-
cose monitoring.
Methods
Institutional review board approval was obtained, and the
study was conducted according to the Declaration of
Helsinki.
Data Source
Data were extracted from the Children’s Mercy database on
Type One Diabetes in Pediatrics (the Children’s Mercy on
TODP database).11,12 The Children’s Mercy on TODP data-
base is a longitudinal database containing demographic,
clinical, and laboratory data extracted from the electronic
health records and medical device downloads of youth and
young adults with T1D receiving care since June 1, 1993, at
the Children’s Mercy Kansas City (Kansas City, MO, USA)
diabetes center, which is a network of 13 clinic sites in two
states in the United States.
Inclusion/Exclusion Criteria for Data Source
All individuals diagnosed with T1D who had at least one
appointment in the diabetes clinic were included. Those with
other types of diabetes (such as type 2, monogenic, cystic-
fibrosis-related, or iatrogenic diabetes) or with other comor-
bid diagnoses that might impact their diabetes care or
complications (eg, sickle cell disease, leukemia, congenital
syndromes and heart disease) were excluded. In total, 5923
individuals were included in the database.
Variable Definitions for Data Source
HbA1c.  Youths’ HbA1c levels were measured on either
the Tosoh G8 HPLC (Tosoh Bioscience Inc, San Fran-
cisco, CA, USA) or the Afinion AS100 Analyzer (Orlando,
FL, USA). Both instruments have demonstrated trace-
ability to the Diabetes Control and Complications Trial
(DCCT) standard.13,14 Results were reported as percent-
ages (%; NGSP standard). Conversions to SI units (mmol/
mol; IFCC standard) can be performed using the NGSP’s
HbA1c converter at http://www.ngsp.org/convert1.asp.
Baseline HbA1c was the value obtained at the time the
individual was first offered access to and educated to use
the mobile app. End-of-study HbA1c was the subsequent
HbA1c value obtained ≥60 days after the baseline HbA1c
measurement.
Duration of diabetes.  This was calculated as the age at base-
line HbA1c for the study minus the age at diagnosis; it was
expressed in decimal years. Age at diagnosis was calculated
to the nearest one-hundredth year by counting the number of
days between date of diagnosis and the date of birth. When
not documented, date of diagnosis was determined as the first
date at which (1) the patient met ADA criteria for a diagnosis
of diabetes and (2) C peptide and/or auto-antibody screening
indicated T1D.
Demographic characteristics.  Sex (male/female) and race/
ethnicity (Caucasian, African American, Hispanic, Asian,
American Indian or Alaska Native, Native Hawaiian or
Pacific Islander, Multiracial, or Other) were self-reported by
the patient or family at the first encounter with the institu-
tion. Race (but not ethnicity) was used in the present analy-
sis and was categorized as white/nonwhite. Age at baseline,
BMI z-score, insulin pump use (yes/no), and continuous glu-
cose monitoring (CGM) use (yes/no) were determined at the
time each individual was first offered access to, and educated
to use, the mobile app.
Synchronization rate.  Each patient’s count of synchroni-
zations during the observation period was divided by the
length of the patient’s time in the observation period (age
at end-of-study HbA1c minus age at baseline HbA1c) to
yield the rate of synchronizations per week. The synchroni-
zation that occurred in clinic at the time the patient/family
were trained to use the mobile app was not included in this
calculation. Synchronization rate was the focal explanatory
variable.
Clements and Staggs 463
Mean blood glucose.  This was calculated as the arithmetic
mean of all blood glucose values obtained during the study
period.
Blood glucose monitoring frequency.  The count of blood
glucose monitoring episodes using all available blood glu-
cose values during the study period was recorded and used as
a dependent variable in negative binomial regressions. The
study day count was treated as an exposure variable in the
regression model, allowing us to effectively model the blood
glucose monitoring frequency (see the Statistical Analysis
section).
Study Cohort
The study cohort represents a convenience sample of indi-
viduals introduced to a mobile app to support diabetes self-
care. Only individuals who were introduced to, and educated
to use, the mobile app (Glooko, Mountain View, CA, USA)
between March 2015 and April 2016 were included in the
present analyses. Of an initial sample of 95, 8 individuals
with missing data on covariates were excluded, as were 5
individuals who also synchronized CGM data with the
mobile app. An additional patient with a severely outlying
synchronization count (8 standard deviations above the
mean) was also excluded. The remaining 81 patients were
included in the HbA1c analysis. Of these, data on blood glu-
cose were available for 70 patients. The sample used in ana-
lyzing blood glucose monitoring frequency was further
limited to the 59 patients for whom monitoring data were
available for at least 14 days.
For comparison to the larger clinic population, informa-
tion was also collected on all individuals with T1D receiving
care from March 2015 and April 2016 (N = 2294).
Mobile App Training
Parents and youths were trained to use the mobile app during
a routinely scheduled clinic visit by a physician or certified
diabetes educator (CDE). The training protocol included
guiding parents and youths through the processes of down-
loading the app to their mobile devices, creating an account
in the mobile app, and connecting their account to the clinic’s
professional account. They were provided a cable or
Bluetooth adapter as needed to permit connection of the glu-
cometer with their mobile phone. The teaching procedure
used included (1) a demonstration of device synchronization
by the physician or CDE, (2) reviewing each page of the
mobile app with a talk-out loud-protocol to explain the func-
tion of and data presentations on each page, (3) a practice
device synchronization by the parent or youth, and (4) teach-
back by the parent or youth (if 13 years or greater). Parents
and youths were instructed that the youth or either parent
could be responsible for data synchronization. While syn-
chronized data were potentially visible to the health care
team, the present study did not record or evaluate whether
synchronized data were reviewed for patterns by youths,
their parents, or their health care team due to limited avail-
ability of such information.
Statistical Analysis
Covariates included patient sex, race (white or nonwhite),
age at baseline, duration of diabetes, BMI z-score, and indi-
cators for use of insulin pump (yes or no) and continuous
glucose monitoring (yes or no). To evaluate how representa-
tive the cohort using the mobile app was of the entire clinic
population, demographic variables of the study cohort were
compared to demographic variables of the clinic population.
Analyses were carried out in SAS 9.4 except as otherwise
indicated.
We assessed the effect of synchronization frequency on
HbA1c by regressing final HbA1c measurement on synchro-
nizations per week, baseline HbA1c measurement, and the
covariates listed above using the lm package in R. Model
residuals were not Gaussian so confidence intervals and P
values were computed by nonparametric bootstrapping using
the R boot package with 15 000 bootstrap samples.
To assess the effect of synchronization frequency on mean
blood glucose we regressed mean blood glucose on synchro-
nization frequency and the set of covariates, again using the
lm and boot packages in R.
We used negative binomial regression to assess the effect
of synchronization frequency on the frequency of blood glu-
cose monitoring, effectively modeling the blood glucose
monitoring rate by modeling the count of monitoring epi-
sodes as the dependent variable and treating study day count
as an exposure variable (taken into account by including the
log of the study day count as an offset in the model).
Synchronization frequency and the set of covariates were
included as explanatory variables. The model was fit using
the GLIMMIX Procedure in SAS.
Results
Cohort Characteristics
Characteristics of the study cohort and larger clinic popula-
tion are provided in Table 1. In Wilcoxon two-sample tests
for the four continuous variables, age (P = .06) and BMI
z-score (P = .06) had P values suggesting differences that
may not be attributable to chance. Fisher exact tests for the
dichotomous variables yielded a statistically significant
result only for insulin pump use (P = .02), which was higher
in the sample (78%) than in the clinic population (65%).
Of the 70 patients with blood glucose data, the 11 without
at least 14 days of monitoring data were slightly older than the
59 with at least 14 days of monitoring data (median 14.8 [IQR
14.0-16.2] vs 13.7 [8.8, 15.9] years) and had longer duration
of diabetes (6.1 [3.1, 8.9] vs 4.7 [2.5, 7.3] years). They were
464 Journal of Diabetes Science and Technology 11(3)

Table 1.  Characteristics of Study Cohort and Clinic Population.

Study cohort (n = 81) Clinic population (n = 2294) P value

a
Age 14.0 (10.4, 15.9) 14.4 (10.9, 17.0) .06a
Duration of diabetes 4.9 (2.7, 7.5) 4.4 (2.0, 7.9) .67a
Baseline HbA1c 8.6 (7.9, 9.8) 8.7 (7.8, 10.0) .94a
BMI z-score 0.46 (–0.26, 1.08) 0.68 (0.00, 1.27) .06a
Male (%) 49 51 .82b
White (%) 86 82 .38b
Insulin pump user (%) 78 65 .02b
CGM user (%) 30 22 .14b

Values are median (interquartile range), unless otherwise noted.

a
Wilcoxon two-sample test. bFisher’s exact test.

Table 2.  Model for HbA1c.

Estimate (95% CI) P value

Syncs per week –0.75 (–1.72, 0.52) .44
Baseline HbA1c 0.73 (0.47, 0.91) .00
Male 0.41 (–0.17, 1.05) .22
White 0.46 (–0.7, 1.24) .27
Age at baseline –0.02 (–0.11, 0.05) .57
Duration 0.06 (–0.05, 0.2) .34
Insulin pump 0.15 (–0.65, 1.25) .83
CGM –0.47 (–1.25, 0.13) .26
BMI Z Score 0.08 (–0.24, 0.42) .59

The frequency of synchronizing glucometer data to the

Figure 1.  Synchronizations per week.
also disproportionately male (64% vs 51%) and less likely to
be users of an insulin pump (64% vs 80%) or CGM (9% vs
31%). None of these differences was statistically significant.
Synchronization Frequency
Among individuals in the study cohort, the interval between
baseline HbA1c and end-of-study HbA1c varied to some
degree, with the average observation period being 0.3 years (3.6
months; mean age at end-of-study HbA1c minus mean age at
baseline HbA1c), and the minimum observation period being
0.2 years (2.4 months). We thus calculated the weekly rate of
data synchronization to the mobile app. Individuals shared data
between their glucometers and the mobile app an average of
0.22 ± 0.40 times per week (range 0-2.25) during the observa-
tion period. Of the 81 individuals, 35 (43%) did not synchronize
at all during the study period (see Figure 1); the mean among the
46 who synchronized at least once postbaseline was 0.39 ± 0.47.
Main Outcomes
We first related synchronization frequency to end-of-study
HbA1c while controlling for baseline HbA1c and covariates.
mobile app did not relate to end-of-study HbA1c in a statisti-
cally significant way, although modeling yielded an esti-
mated 0.75 percentage point (0.43 SD) decrease in HbA1c
per additional synchronization per week, after controlling for
baseline HbA1c and covariates (Table 2). Next, we related
data synchronization frequency to mean blood glucose while
controlling for baseline HbA1c and covariates. Although we
observed an estimated 20.3 mg/dL (0.40 SD) decrease in
mean blood glucose concentration per additional synchroni-
zation per week was observed, this effect was similarly non-
significant (Table 3). In contrast, there was a strong and
statistically significant association between frequency of
data synchronization to the mobile app and frequency of self-
monitoring of blood glucose, which is a measure of treat-
ment adherence. Each additional synchronization per week
was associated with an estimated 2.3-fold increase in the rate
of blood glucose checks per day (P < .01), assuming model
covariates are held constant (Table 4).
Discussion
In the present study, we discovered that the frequency of
daily SMBG changed as a function of the rate with which
youths with T1D or their parents synchronized data from
their glucometers to a mobile phone app. While a causal
relationship cannot be determined from these data, the
Clements and Staggs 465

Table 3.  Model for Mean Blood Glucose. disparate findings. First, the present study captured informa-
tion only on data synchronization events with the mobile
Estimate (95% CI) P value
app; there is no way to know from the available data whether
Syncs per week –20.3 (–56.0, 23.2) .62 parents or youth actually performed data review in conjunc-
Baseline HbA1c 19.5 (10.4, 26.0) .00 tion with the data synchronization episodes. Second, the
Male 3.3 (–14.6, 25.8) .90 present study captured observations on individuals for only a
White 15.8 (–30.2, 47.5) .29 short period (for 0.3 years, on average) after introduction to,
Age at baseline –1.6 (–4.9, 0.9) .32 and training on, the mobile app, while the prior study evalu-
Duration 2.9 (0.1, 6.6) .11 ated individuals’ behaviors over a year. Third, the prior study
Insulin pump 4.2 (–24.4, 40.6) .90 was larger (N = 340) and thus had greater statistical power.
CGM –11.2 (–40.5, 12.2) .57 Finally, despite the fact that the diabetes care team trained
BMI Z Score 6.7 (–5.6, 17.9) .23
families on using the mobile app and provided encourage-
ment to share glucometer data with the app, the rate of data
synchronization remained relatively low, with a significant
Table 4.  Model for Blood Glucose Monitoring Frequency. proportion of individuals failing to synchronize data during
95% lower 95% upper the observation period. Previous studies have evaluated the
Exp(B)a for exp(B) for exp(B) P value impact of mobile apps for diabetes self-management on
HbA1c; however, those studies also included telehealth or
Syncs per week 2.30 1.82 2.90 <.01
text messaging from the health care team15,16 or incorporated
Baseline HbA1c 0.96 0.90 1.01 .13
incentives for using the app;6 these features of the prior stud-
Male 0.99 0.79 1.23 .89
ies make it impossible to isolate the effect of data synchroni-
White 0.92 0.68 1.24 .56
zation or data visualization within the mobile app from the
Age at baseline 0.93 0.90 0.96 <.01
Duration 1.03 1.00 1.06 .03
effect of the associated interventions. Notably, one of those
Insulin pump 0.85 0.64 1.13 .26 studies was a nonrandomized prospective pilot study (N =
CGM 0.95 0.75 1.20 .64 20) which identified a relationship between mobile app use
BMI Z Score 1.06 0.95 1.19 .31 and adherence to SMBG. That study also failed to see an
effect of mobile app use on HbA1c.6
a
The exponentiated regression coefficient is the estimated multiplicative The present study did identify a correlation between data
effect on the rate of blood glucose checks per day associated with a 1-unit
synchronization rate and daily frequency of SMBG. No prior
increase in the explanatory variable.
studies in the literature evaluate potential associations
between the frequency of data synchronization with a mobile
results support the possibility that engagement in one aspect device and the frequency of other adherence behaviors,
of T1D self-care (data synchronization between visits) including frequency of SMBG.
could have a positive effect on engagement in another The present findings are clinically important because
aspect of T1D self-care (self-monitoring of blood glucose). multiple mobile apps have been developed or are currently
In contrast, we did not find a statistically significant rela- under development to support diabetes self-management;
tionship between the rate of glucometer-based data syn- some of these also support data synchronization between
chronization and glycemic control in this small convenience glucometers and a mobile device.6-8 In the present study,
sample. Specifically, although model estimates suggest 43% of individuals failed to synchronize glucometer data to
meaningful effect sizes, neither mean blood glucose nor the mobile app at all after receiving training, indicating that
HbA1c was significantly related to synchronization fre- either additional support/training may be needed, or patients/
quency. To our knowledge, the present study is the first to families may not be convinced of a significant “payoff” for
examine the frequency of data synchronization to a com- their effort. As such, families might need additional motiva-
mercially available mobile app in relation to both adher- tors, (like attention from the diabetes care team or financial
ence and glycemic control. incentives) to drive synchronization behavior. Alternatively,
While there was insufficient evidence in the present study efforts by manufacturers to further reduce the burden of data
to conclude that an association exists between frequent data synchronization by allowing passive data synchronization
synchronization to a mobile app and glycemic control, previ- between glucometers and mobile apps may be warranted.
ous studies have found that individuals who frequently The key features that support improvements in patient
upload and review data between clinic visits using any engagement and glycemic control must be rigorously evalu-
upload method exhibit lower HbA1c values than those who ated. If the frequency of SMBG is found to be increased dur-
do not. In one study that included 340 adults and children ing mobile app use in prospective interventional studies, that
with T1D, “routine reviewers” were found to have a signifi- could have a positive impact on glycemic control, especially
cantly lower HbA1c than nonroutine reviewers (7.2 vs among adolescents. Prior studies have demonstrated that
8.1%).2 There are several potential explanations for these among children and adolescents with T1D, an increase of
466 Journal of Diabetes Science and Technology 11(3)
one blood glucose check per day is associated with a 0.19%
decrease in HbA1c.17 Whether engagement with data syn-
chronization is associated with an increase other self-man-
agement behaviors such as mealtime insulin bolusing should
also be determined in future prospective studies. Among
youths who miss at least one mealtime insulin bolus per day,
increasing the frequency of mealtime insulin boluses by one
has been associated with a 1.5% decrease in HbA1c.18
Reductions in HbA1c, in turn, are associated with decreased
T1D-related risk for micro- and macrovascular disease.19-22
The present study should be interpreted within the con-
text of certain significant limitations. First, the cohort of
individuals utilizing the mobile app was a convenience
sample and was not randomized. Individuals were offered
the opportunity to use the mobile app if their blood glucose
meter and mobile phone were compatible according to the
mobile app manufacturer. Sampling bias could therefore
influence the outcomes. Second, the cohort was small and
the observation period was short, essentially consisting of
the interval between two routine clinical care visits. A lon-
ger observation period may have revealed a significant
relationship between data synchronization and glycemic
control. This is especially true considering the nonsignifi-
cant trends toward lower HbA1c and mean blood glucose
observed during the short observation period for the present
sample. The size of the estimated effects of synchronization
frequency on HbA1c and mean blood glucose suggest asso-
ciations that might be statistically significant in a larger
sample of youths. Third, the frequency of data synchroniza-
tion with the mobile app by individuals with T1D remained
relatively low during the observation period. This has been
observed in other studies, with one recent study reporting
that only 12% of adults and 27% of children’s caregivers
routinely reviewed data from diabetes self-management
devices.2 Furthermore, we were unable to measure whether
(1) individuals reviewed their blood glucose data, (2)
reviewed data and also took action (eg, adjusting basal
insulin doses or mealtime insulin:carbohydrate ratios), or
(3) shared data with their health care team and received
feedback. Future studies of the efficacy of mobile medical
apps in diabetes care should be prospective and should
include a randomized clinical trial of the mobile app. Prior
work in adults with type 2 diabetes suggests that long-term
engagement with mobile apps that support diabetes self-
management can be problematic.23 Investigators should
therefore consider incentivizing frequent data synchroniza-
tion as part of initial trials to allow evaluation of the tech-
nology’s full potential to improve glycemic control. In
future prospective studies, investigators should also obtain
other objective measures of patient engagement with the
mobile app (ie, app-specific screen time on data visualiza-
tion screens), patient-reported measures of the frequency of
data review, and the frequency of action taken (eg, insulin
adjustment). Fourth, the present study would have been
improved if it had included a comparative analysis to a
matched cohort form the clinic who were not exposed to the
mobile app. The study would similarly have been improved
if the available data had allowed a comparison of baseline
frequency of SMBG to the frequency of SMBG at the end
of the observation period. Future prospective studies should
address these two design limitations. Finally, in the present
study we only evaluated the frequency of data synchroniza-
tion from a glucometer as a predictive variable; data syn-
chronization frequency from insulin pumps and continuous
glucose monitors was not evaluated. Whether data synchro-
nization and review of data from those devices relates to the
frequency of SMBG, mean blood glucose, or HbA1c
remains an unanswered question.
Several strengths of the present study are also notable.
First, the study cohort appears to be generally representative
of the larger clinic population, although there were more
insulin pump and CGM users in the study cohort. Second,
the study included multiple covariates collected from the
electronic health record. Third, the study employed multi-
variable analyses to control for potential confounding effects
of different patient characteristics. Finally, the study included
a small but reasonably sized and reasonably diverse sample
of individuals who were introduced to the mobile app.
Conclusions
These results add to the literature by providing initial evi-
dence that use of a mobile app to capture glucometer data,
which should allow more frequent pattern management, is
associated with increased adherence to blood glucose moni-
toring, an important aspect of self-management. The present
study also provides foundational knowledge to power future
prospective studies evaluating the efficacy of mobile apps
designed support pattern management in T1D.
Abbreviations
CDE, certified diabetes educator; CGM, continuous glucose moni-
toring; HbA1c, hemoglobin A1c; mobile app, mobile phone soft-
ware application; SMBG, self-monitoring of blood glucose; T1D,
type 1 diabetes.
Acknowledgment
The authors acknowledge Mitchell Barnes.
Declaration of Conflicting Interests
The author(s) declared the following potential conflicts of interest
with respect to the research, authorship, and/or publication of this
article: MAC is a volunteer (unpaid) member of the advisory board
for Glooko; Glooko has provided travel support to advisory board
meetings. VSS has none.
Funding
The author(s) received no financial support for the research, author-
ship, and/or publication of this article.
Clements and Staggs 467
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