ESPE Abstracts (2018) 89 RFC12.4

Use of Telemonitoring Via a Mobile Device App Reduces HbA1c in Type 1 Diabetic Children and Adolescents

Philippe Kleea,b, Catherine Bussiena, Montserrat Castellsaguea, Christophe Combescurea, Mirjam Dirlewangera,b, Céline Girardina, Jean-Luc Mandoc, Luz Perrenouda, Carole Salomona, Franck Schneidera & Valérie Schwitzgebela,b

aUniversity Hospitals of Geneva, Geneva, Switzerland; bUniversity of Geneva, Geneva, Switzerland; cKM Koncept, Veyrier, Switzerland

Background and Aims: Type 1 diabetes mellitus (T1DM) belongs to the most common chronic diseases affecting children and adolescents. Technological advances have improved metabolic control over the past decades, thereby decreasing the risk of long-term complications. However, only a minority of patients meets the treatment goals of maintaining a glycated hemoglobin (HbA1c) level below 7.5% (58 mmol/mol). Webdia is an application for mobile devices developed by the father of a diabetic child, in collaboration with our pediatric diabetology team. A simple interface allows children to calculate insulin doses and pictures representing selected meals help them estimating the carbohydrates on their plate. In addition, all glucose values entered into the program become instantly available to the child’s parents and healthcare professionals, thereby allowing remote monitoring.

Research Design and Methods: Fifty-five children aged 10–18 years were included into this randomized double-crossover one-center study. Intervention consisted of using Webdia during 3 months and getting feedback and monthly suggestions for the adaptation of the insulin regimen by the healthcare professionals. The control arm consisted of usual care. Primary outcome was modification of HbA1c. Secondary outcomes were frequency of self-reported hypoglycemia and quality of life (QoL).

Results: Fifty-five patients were included. 33 completed the study, nine dropped out and 13 were excluded because they used the app < four times/week. Risk factors for insufficient use of Webdia were older age (mean 15.1±2.4 vs 13.3±2.3 years in patients who completed the study, P=0.024) and longer duration of T1DM (mean 86±52 vs 52±35 months, P=0.014). The program was well accepted by the users (46.4% rated the program as good and 39.3% as excellent). The intervention lead to a reduction of HbA1c by 0.54%, as compared to the control group (P=0.048) in patients with HbA1c values > 8.0% (63.9 mmol/mol) at inclusion, without increasing the prevalence of hypoglycemia (8.52±9.45 hypoglycemia during last two weeks of intervention, vs 7.62±6.37 during last two weeks of observation, P=0.680). QoL scores were not modified by Webdia use.

Conclusions: The use of Webdia, in combination with remote regular review of glucose values and adaptation of the insulin regimen resulted in a significant reduction of HbA1c in patients with initial values >8.0% (63.9 mmol/mol), without increasing the prevalence of hypoglycemia. Low compliance among adolescents suggests that the app may need to be adapted to this age group.