JMIR Publications

JMIR Diabetes

Emerging Technologies, Medical Devices, Apps, Sensors, and Informatics to Help People with Diabetes.


Journal Description

JMIR Diabetes (JD) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2016: 5.175), focusing on technologies, medical devices, apps, engineering, informatics and patient education for diabetes prevention, self-management, care, and cure, to help people with diabetes. As open access journal we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies, as well as on diabetes epidemiology. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews) covering for example wearable devices and trackers, mobile apps, glucose monitoring (including emerging technologies such as Google contact lens), medical devices for insulin and metabolic peptide delivery, closed loop systems and artificial pancreas, telemedicine, web-based diabetes education and elearning, innovations for patient self-management and "quantified self", diabetes-specific EHR improvements, clinical or consumer-focused software, diabetes epidemiology and surveillance, crowdsourcing and quantified self-based research data, new sensors and actuators to be applied to diabetes.


Recent Articles:

  • Diabetic foot care. Source: Image created by the Authors; Copyright: The Authors; URL:; License: Creative Commons Attribution (CC-BY).

    Views of Patients on Using mHealth to Monitor and Prevent Diabetic Foot Ulcers: Qualitative Study


    Background: People with diabetes are at risk for diabetic foot ulcers (DFUs), which can lead to limb loss and a significant decrease in quality of life. Evidence suggests that mHealth can be an effective tool in diabetes self-management. mHealth presents an opportunity for the prevention and monitoring of DFUs. However, there is a paucity of research that explores its effectiveness in the DFU patient population, as well as the views and attitudes of these patients toward technology and mHealth. Objective: This study aimed to explore the views, attitudes, and experiences of a diabetic patient population with or at risk of DFUs regarding technology, mHealth, and the diabetic foot. Methods: We used a qualitative research approach using in-depth interviews with 8 patients with DFUs. Questions were structured around experience with technology, current health practices related to diabetic foot care, and thoughts on using an mHealth device that prevents and monitors DFUs. We transcribed and thematically analyzed all interviews. Results: All patients had positive responses for an mHealth intervention aimed at preventing and monitoring DFUs. We found 4 themes in the data: diversity in use of technology, feet-checking habits, 2-way communication with health care professionals (HCPs), and functionality. There were varying levels of familiarity with and dependence on technology within this patient population. These relationships correlated with distinct generations found in North America, including baby boomers and Generation X. Furthermore, we found that most patients performed daily feet checks to monitor any changes in health. However, some did not perform feet checks prior to the development of a DFU. Patients expressed interest in 2-way communication with HCPs that would allow for easier appointment scheduling, sharing of medical data, decreased number of visits, and use of alerts for when medical attention is required. Patients also identified conditions of functionality for the mHealth intervention. These included consideration of debilitating complications because of diabetes, such as retinopathy and decreased mobility; ease of use of the intervention; and implementation of virtual communities to support continued use of the intervention. Conclusions: Our patient population expressed an interest in mHealth for preventing and monitoring DFUs, although some participants were not frequent users of technology. mHealth continues to show potential in improving patient outcomes, and this study provides a foundation for designing interventions specific to a DFU population. Further research is needed to confirm these findings.

  • Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    The Effect of Telehealth on Quality of Life and Psychological Outcomes Over a 12-Month Period in a Diabetes Cohort Within the Whole Systems Demonstrator...


    Background: Much is written about the promise of telehealth and there is great enthusiasm about its potential. However, many studies of telehealth do not meet orthodox quality standards and there are few studies examining quality of life in diabetes as an outcome. Objective:  To assess the impact of home-based telehealth (remote monitoring of physiological, symptom and self-care behavior data for long-term conditions) on generic and disease-specific health-related quality of life, anxiety, and depressive symptoms over 12 months in patients with diabetes. Remote monitoring provides the potential to improve quality of life, through the reassurance it provides patients. Methods: The study focused on participant-reported outcomes of patients with diabetes within the Whole Systems Demonstrator (WSD) Telehealth Questionnaire Study, nested within a pragmatic cluster-randomized trial of telehealth (the WSD Telehealth Trial), held across 3 regions of England. Telehealth was compared with usual-care, with general practice as the unit of randomization. Participant-reported outcome measures (Short-Form 12, EuroQual-5D, Diabetes Health Profile scales, Brief State-Trait Anxiety Inventory, and Centre for Epidemiological Studies Depression Scale) were collected at baseline, short-term (4 months) and long-term (12months) follow-ups. Intention-to-treat analyses testing treatment effectiveness, were conducted using multilevel models controlling for practice clustering and a range of covariates. Analyses assumed participants received their allocated treatment and were conducted for participants who completed the baseline plus at least one follow-up assessment (n=317).  Results:  Primary analyses showed differences between telehealth and usual care were small and only reached significance for 1 scale (diabetes health profile-disinhibited eating, P=.006). The magnitude of differences between trial arms did not reach the trial-defined minimal clinically important difference of 0.3 standard deviations for most outcomes. Effect sizes (Hedge's g) ranged from 0.015 to 0.143 for Generic quality of life (QoL) measures and 0.018 to 0.394 for disease specific measures. Conclusions: Second generation home-based telehealth as implemented in the WSD evaluation was not effective in the subsample of people with diabetes. Overall, telehealth did not improve or have a deleterious effect quality of life or psychological outcomes for patients with diabetes over a 12-month period.

  • The One Drop | Mobile app for Apple iOS, Apple Watch, or Android. Source: Image created by the authors; Copyright: The authors; URL:; License: Creative Commons Attribution (CC-BY).

    One Drop | Mobile: An Evaluation of Hemoglobin A1c Improvement Linked to App Engagement


    Background: Three recent reviews evaluated 19 studies testing the hemoglobin A1c (HbA1c) benefit of 16 diabetes apps, including 5 publicly available apps. Most studies relied on small samples and did not link app engagement with outcomes. Objective: This study assessed both HbA1c change in a large sample of people using the One Drop | Mobile app and associations between app engagement and changes in HbA1c. Methods: The One Drop | Mobile app for iOS and Android is designed to manually and passively (via Apple HealthKit, Google Fit, and the One Drop | Chrome blood glucose meter) store, track, and share data. Users can schedule medication reminders, view statistics, set goals, track health outcomes, and get data-driven insights. In June 2017, we queried data on people with diabetes using the app who had entered at least 2 HbA1c values in the app >60 and ≤365 days apart. Multiple imputation corrected for missing data. Unadjusted and adjusted mixed effects repeated measures models tested mean HbA1c change by time, diabetes type, and their interaction. Multiple regression models assessed relationships between using the app to track food, activity, blood glucose, and medications and HbA1c change. Results: The sample (N=1288) included people with type 1 diabetes (T1D) (n=367) or type 2 diabetes (T2D) (n=921) who were 35% female, diagnosed with diabetes for a mean 9.4 (SD 9.9) years, and tracked an average 1646.1 (SD 3621.9) self-care activities in One Drop | Mobile between their first (mean 8.14% [SD 2.06%]) and second HbA1c entry (mean 6.98% [SD 1.1%]). HbA1c values were significantly associated with user-entered average blood glucose 90 days before the second HbA1c entry (rho=.73 to .75, P<.001). HbA1c decreased by an absolute 1.07% (unadjusted and adjusted F=292.03, P<.001) from first to second HbA1c entry. There was a significant interaction between diabetes type and HbA1c. Both groups significantly improved, but users with T2D had a greater HbA1c decrease over time than users with T1D (F=10.54, P<.001). For users with T2D (n=921), HbA1c decreased by an absolute 1.27% (F=364.50, P<.001) from first to second HbA1c entry. Finally, using One Drop | Mobile to record food was associated with greater HbA1c reductions even after adjusting for covariates and after also adjusting for insulin use for users with T2D (all P<.05). Conclusions: People with T1D and T2D reported a 1.07% to 1.27% absolute reduction in HbA1c during a median 4 months of using the One Drop | Mobile app. Using the app to track self-care was associated with improved HbA1c. More research is needed on the health benefits of publicly available diabetes apps, particularly studies associating app engagement with short- and long-term effects.

  • Source: The Authors; Copyright: Cheryl Conway; URL:; License: Creative Commons Attribution (CC-BY).

    Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review


    Background: Optimal management of chronic diseases, such as type 2 diabetes and hypertension, often include prescription medications. Medication adherence (MA) is one component of self-management. Optimization through digital health—eHealth and mHealth—could enhance patient awareness and/or communication between the patient and provider. Objective: Medication adherence is a major issue that affects 50%-60% of chronically ill adults. Digital health refers to eHealth and mHealth, collectively, and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence; communicate with patients and providers; and provide education to patients, families, and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension. Methods: An integrative review was conducted using databases within EBSCOhost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, had to contain digital health interventions to improve medication adherence to prescription medications in adults 18 years or older, and had to focus on diabetes or hypertension. Results: Of the 337 located studies, 13 (3.9%) used a digital health intervention for medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model. Conclusions: The 13 studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as interactive voice response (IVR), short message service (SMS) text messaging, telemonitoring, and interactive software technology. Among the 13 studies were digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and health care provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.

  • TOC for JMIR website. Source: vividfix; Copyright: vividfix ( Copy approval# NACO/VFX/0217/0089; License: Licensed by the authors.

    Diabetes App-Related Text Messages From Health Care Professionals in Conjunction With a New Wireless Glucose Meter With a Color Range Indicator Improves...


    Background: Mobile diabetes apps enable health care professionals (HCPs) to monitor patient progress, offer remote consultations, and allow more effective and informed treatment decisions between patients and HCPs. The OneTouch Reveal app aggregates data from a blood glucose meter and provides analytics to help patients and HCPs visualize glycemic trends and patterns, enabling more informed treatment and lifestyle decisions. The app also allows patients and HCPs to keep connected by exchanging text messages (short message service [SMS]) or progress reports via email. Objective: The primary objective of our study was to assess changes in glycemic control and overall experiences of patients and HCPs using the app in conjunction with the wireless OneTouch Verio Flex blood glucose meter. Methods: We randomly assigned 137 adults with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) and a glycated hemoglobin (HbA1c) level of ≥7.5% and ≤11.0% to use the glucose meter alone or glucose meter plus the app for 24 weeks. The meter + app group were scheduled to receive diabetes-related text messages from their HCP every 2 weeks (total of 12 texts). Clinical measures and self-reported outcomes were assessed during face-to-face clinic visits between the participant and a diabetes nurse at baseline, week 12, and week 24. Results: In 128 completed participants, HbA1c decreased after 12 and 24 weeks in both the meter-only (n=66) (0.56% and 0.55%, respectively) and meter + app groups (n=62) (0.78% and 0.67%, respectively) compared with baseline (each P<.001). The difference in HbA1c reduction between the 2 groups was not statistically significant at 12 or 24 weeks (P=.12 and P=.45, respectively). However, the decrease in HbA1c was greater in T2DM participants using the meter + app after 12 weeks (1.04%) than in T2DM participants using the meter alone (0.58%; P=.09). In addition, decrease in HbA1c in participants using the meter + app who received at least 10 diabetes-related text messages (1.05%) was significantly greater than in meter-only participants (P<.01). Conclusions: Use of the OneTouch Verio Flex glucose meter alone or in combination with the OneTouch Reveal diabetes app was associated with significant improvements in glycemic control after 12 and 24 weeks. Improvements using the app were greatest in participants with T2DM and those participants who received the highest number of HCP text messages. This study suggests that real-time availability of patient data and the ability to send personalized diabetes-related text messages can assist HCPs to improve glycemic control in patients between scheduled visits. Trial Registration: NCT02429024; (Archived by WebCite at

  • Source: Pixabay; Copyright: Alexandra / München; URL:; License: Public Domain (CC0).

    Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation


    Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months.

  • Source: Dreamstime; Copyright: Rawpixelimages; URL:; License: Public Domain (CC0).

    The Value of Children's Voices for a Video Game Development in the Context of Type 1 Diabetes: Focus Group Study


    Background: Children with type 1 diabetes mellitus (T1DM) face daily challenges performing self-care tasks, controlling symptoms, and dealing with psychosocial issues. The use of video games to improve health is a successful support for persons with chronic diseases, promoting adequate self-management through simulations of real life. Involving future users in the development of games is essential to generating innovative, creative, and effective programs. Objective: Our goal is to identify what children with T1DM need to know about their disease and their self-care tasks as well as their preferences in video games. Methods: Children with T1DM provided input about their learning needs, self-care tasks, and preferences in video games. Three categories were identified through qualitative content analysis: dealing with emotions and knowledge, practical skills and awareness, and game preferences. Results: Children expressed concerns about the difficulties of self-care, lack of knowledge about diabetes, and lack of awareness about the consequences of behaviors related to self-care, which contribute to inappropriate behaviors and significantly impact self-management of their disease. They expressed enthusiasm for a video game for children with diabetes that considered their needs and preferences. Conclusions: Findings support the potential benefits when children’s input is considered in game design. Consideration of customer needs and preferences is a powerful resource in the development of video games with enhanced learning experience.

  • Students in community health worker training program learning to use patient portals. Source: The Authors; Copyright: Amy Sheon; URL:; License: Creative Commons Attribution (CC-BY).

    Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and Use


    Type 2 diabetes (T2D) is one of the nation’s leading drivers of disability and health care utilization, with elevated prevalence among individuals with lower education, income, and racial/ethnic minorities. Health information technology (HIT) holds vast potential for helping patients, providers, and payers to address T2D and the skyrocketing rates of chronic illness and associated health care costs. Patient portals to electronic health records (EHRs) serve as a gateway to consumer use of HIT. We found that disparities in portal use portend growing T2D disparities. Little progress has been made in addressing identified barriers to technology adoption, especially among populations with elevated risk of T2D. Patients often lack digital literacy skills and continuous connectivity and fear loss of the relationship with providers. Providers may experience structural disincentives to promoting patient use of HIT and apply hidden biases that inhibit portal use. Health care systems often provide inadequate training to patients and providers in use of HIT, and lack resources devoted to obtaining and optimizing use of data generated by HIT. Lastly, technology-related barriers include inadequate consideration of user perspectives, lack of evidence for patient-focused apps, and lack of features to enable providers and health care systems to readily obtain aggregate data to improve care and facilitate research. After discussing these barriers in detail, we propose possible solutions and areas where further research is needed to ensure that individuals and health care systems obtain the full benefit of the nation’s planned $38 billion HIT investment. A digital inclusion framework sheds new light on barriers posed for patients with social health inequalities. We have determined that partnerships with community organizations focused on digital inclusion could help health systems explore and study new approaches, such as universal screening and referral of patients for digital skills, health literacy, and Internet connectivity.

  • Good data? Source: istock; Copyright: ©; URL:; License: Licensed by the authors.

    Assessing Diabetes-Relevant Data Provided by Undergraduate and Crowdsourced Web-Based Survey Participants for Honesty and Accuracy


    Background: To eliminate health disparities, research will depend on our ability to reach select groups of people (eg, samples of a particular racial or ethnic group with a particular disease); unfortunately, researchers often experience difficulty obtaining high-quality data from samples of sufficient size. Objective: Past studies utilizing MTurk applaud its diversity, so our initial objective was to capitalize on MTurk’s diversity to investigate psychosocial factors related to diabetes self-care. Methods: In Study 1, a “Health Survey” was posted on MTurk to examine diabetes-relevant psychosocial factors. The survey was restricted to individuals who were 18 years of age or older with diabetes. Detection of irregularities in the data, however, prompted an evaluation of the quality of MTurk health-relevant data. This ultimately led to Study 2, which utilized an alert statement to improve conscientious behavior, or the likelihood that participants would be thorough and diligent in their responses. Trap questions were also embedded to assess conscientious behavior. Results: In Study 1, of 4165 responses, 1246 were generated from 533 unique IP addresses completing the survey multiple times within close temporal proximity. Ultimately, only 252 responses were found to be acceptable. Further analyses indicated additional quality concerns with this subsample. In Study 2, as compared with the MTurk sample (N=316), the undergraduate sample (N=300) included more females, and fewer individuals who were married. The samples did not differ with respect to race. Although the presence of an alert resulted in fewer trap failures (mean=0.07) than when no alert was present (mean=0.11), this difference failed to reach significance: F1,604=2.5, P=.11, ƞ²=.004, power=.35. The modal trap failure response was zero, while the mean was 0.092 (SD=0.32). There were a total of 60 trap failures in a context where the potential could have exceeded 16,000. Conclusions: Published studies that utilize MTurk participants are rapidly appearing in the health domain. While MTurk may have the potential to be more diverse than an undergraduate sample, our efforts did not meet the criteria for what would constitute a diverse sample in and of itself. Because some researchers have experienced successful data collection on MTurk, while others report disastrous results, Kees et al recently identified that one essential area of research is of the types and magnitude of cheating behavior occurring on Web-based platforms. The present studies can contribute to this dialogue, and alternately provide evidence of disaster and success. Moving forward, it is recommended that researchers employ best practices in survey design and deliberately embed trap questions to assess participant behavior. We would strongly suggest that standards be in place for publishing the results of Web-based surveys—standards that protect against publication unless there are suitable quality assurance tests built into the survey design, distribution, and analysis.

  • Woman with iPhone showing a diabetes management app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in Medication Adherence


    Background: Currently, various phone apps have been developed to assist patients. Many of these apps are developed to assist patients in the self-management of chronic diseases such as diabetes. It is essential to analyze these various apps to understand the key features that would potentially be instrumental in helping patients successfully achieve goals in disease self-management. Objective: The objective of this study was to conduct a review of all the available diabetes-related apps in the iOS App Store to evaluate which diabetic app is more interactive and offers a wide variety of operations such as monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI), medication, blood pressure (BP) levels, reminders or push notifications, food database, charts, exercise management, email, sync between devices, syncing data directly to the prescribers, and other miscellaneous functions such as (Twitter integration, password protection, retina display, barcode scanner, apple watch functionality, and cloud syncing). Methods: Data was gathered using the iOS App Store on an iPad. The search term “diabetes” resulted in 1209 results. Many of the results obtained were remotely related to diabetes and focused mainly on diet, exercise, emergency services, refill reminders, providing general diabetes information, and other nontherapeutic options. We reviewed each app description and only included apps that were meant for tracking blood glucose levels. All data were obtained in one sitting by one person on the same device, as we found that carrying out the search at different times or on different devices (iPhones) resulted in varying results. Apps that did not have a feature for tracking glucose levels were excluded from the study. Results: The search resulted in 1209 results; 85 apps were retained based on the inclusion criteria mentioned above. All the apps were reviewed for average customer ratings, number of reviews, price, and functions. Of all the apps surveyed, 18 apps with the highest number of user ratings were used for in-depth analysis. Of these 18 apps, 50% (9/18) also had a medication adherence function. Our analysis revealed that the Diabetes logbook used by the mySugr app was one of the best; it differentiated itself by introducing fun as a method of increasing adherence. Conclusions: A large variation was seen in patient ratings of app features. Many patient reviewers desired simplicity of app functions. Glucose level tracking and email features potentially helped patients and health care providers manage the disease more efficiently. However, none of the apps could sync data directly to the prescribers. Additional features such as graph customization, availability of data backup, and recording previous entries were also requested by many users. Thus, the use of apps in disease management and patient and health-care provider involvement in future app refinement and development should be encouraged.

  • My Dietitian web-based weight loss intervention study logo. Source: Image created by the authors; Copyright: The authors; License: Creative Commons Attribution (CC-BY).

    Web-Based Weight Loss Intervention for Men With Type 2 Diabetes: Pilot Randomized Controlled Trial


    Background: Rising obesity levels remain a major public health concern due to the clear link with several comorbidities such as diabetes. Diabetes now affects 6% of the UK population. Modest weight loss of 5% to 10% has been shown to be associated with significant reductions in blood sugar, lipid, and blood pressure levels. Men have been shown to be attracted to programs that do not require extensive face-to-face time commitments, illustrating the potential audience available for health behavior change via the Web. Objective: The objective of our study was to evaluate the feasibility and acceptability of a Web-based weight loss intervention in men with type 2 diabetes. Methods: We conducted a pilot, parallel 2-arm, individually randomized controlled trial with embedded process evaluation. Participants were randomly assigned in a one-to-one ratio to the usual care group or the 12-month Web-based weight loss intervention, including dietitian and exercise expert feedback. Face-to-face recruitment and assessment were performed by the researcher unblinded. Data collected included weight, height, body mass index (BMI), and waist circumference, together with an audit trail of eligibility, recruitment, retention, and adherence rates. A process evaluation (website use data and qualitative interviews) monitored adherence, acceptability, and feasibility of the intervention. Results: General practice database searches achieved the recruitment target (n=61) for the population of men with type 2 diabetes, of whom 66% (40/61) completed 3-month follow-up measurements. By 12 months, the retention rate was 52% (32/61), with 12 of the 33 men allocated to the intervention group still active on the website. The intervention was seen as acceptable by the majority of participants. We gained insights about acceptability and use of the website from the parallel process evaluation. Conclusions: Recruitment to the Web-based weight loss intervention was successful. Results are descriptive, but there were positive indications of increased weight loss (in kilograms and as a percentage), and reduced waist circumference and BMI for the intervention group from 3 to 12 months, in comparison with control. This research adds to the evidence base in relation to incorporating a Web-based weight loss intervention within the UK National Health Service (NHS). NHS weight loss services are struggling to provide sufficient referrals. Therefore, alternative modes of delivery, with the potential to reduce health professional input and time per patient while still enabling individual and tailored care, need to be investigated to identify whether they can be effective and thus benefit the NHS. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 48086713; (Archived by WebCite at

  • Source: Joseph Keller/; Copyright: iMore; URL:; License: Creative Commons Attribution (CC-BY).

    Machine or Human? Evaluating the Quality of a Language Translation Mobile App for Diabetes Education Material


    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers are more likely to have limited English proficiency in the United States. One potential tool for facilitating language communication between diabetes patients and health care providers is technology, specifically mobile phones. Objective: Previous studies have assessed machine translation quality using only writing inputs. To bridge such a research gap, we conducted a pilot study to evaluate the quality of a mobile language translation app (iTranslate) with a voice recognition feature for translating diabetes patient education material. Methods: The pamphlet, “You are the heart of your family…take care of it,” is a health education sheet for diabetes patients that outlines three recommended questions for patients to ask their clinicians. Two professional translators translated the original English sentences into Spanish and Chinese. We recruited six certified medical translators (three Spanish and three Chinese) to conduct blinded evaluations of the following versions: (1) sentences interpreted by iTranslate, and (2) sentences interpreted by the professional human translators. Evaluators rated the sentences (ranging from 1-5) on four scales: Fluency, Adequacy, Meaning, and Severity. We performed descriptive analyses to examine the differences between these two versions. Results: Cronbach alpha values exhibited high degrees of agreement on the rating outcomes of both evaluator groups: .920 for the Spanish raters and .971 for the Chinese raters. The readability scores generated using MS Word’s Flesch-Kincaid Grade Level for these sentences were 0.0, 1.0, and 7.1. We found iTranslate generally provided translation accuracy comparable to human translators on simple sentences. However, iTranslate made more errors when translating difficult sentences. Conclusions: Although the evidence from our study supports iTranslate’s potential for supplementing professional human translators, further evidence is needed. For this reason, mobile language translation apps should be used with caution.

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  • A Novel Approach to Identifying Barriers and Facilitators in Raising a Child with Type 1 Diabetes: Qualitative Analysis of Caregiver Blogs

    Date Submitted: Sep 14, 2017

    Open Peer Review Period: Sep 14, 2017 - Sep 22, 2017

    Background: With rising incidence of type 1 diabetes (T1D) diagnoses among children and the high levels of distress experienced by the caregivers of these children, caregiver support is becoming incre...

    Background: With rising incidence of type 1 diabetes (T1D) diagnoses among children and the high levels of distress experienced by the caregivers of these children, caregiver support is becoming increasingly important. Historically, relatively few support resources have existed. Increasing use of the Internet, and blogs in particular, has seen a growth of peer support between caregivers of children with T1D. However, little is known about the type and quality of information shared on T1D caregiver blogs. At the same time, the information on such blogs offers a new window into what challenges and successes caregivers experience in helping to manage their children’s T1D. Objective: The purpose of this study was to (1) analyze blogs of caregivers to children with type 1 diabetes (T1D) to better understand the challenges and successes they face in raising a child with T1D, and (2) assess the blogs for the presence of unsafe or inaccurate clinical information or advice. Methods: An inductive thematic qualitative study was conducted of three blogs authored by caregivers to children living with T1D, which included 140 unique blog posts and 663 associated comments. Two physician investigators evaluated the blogs for presence of clinical or medical misinformation. Results: Five major themes emerged: (1) the impact of the child’s diagnosis, (2) the burden of intense self-management experienced in caring for a child with T1D, (3) caregivers’ use of technology to ease their fear of hypoglycemia, and impacts that device alarms associated with this technology have on caregiver burden, (4) caregivers’ perceptions of frequently missed or delayed diagnosis of T1D and the frustration this causes, and (5) the resilience that caregivers develop despite the burdens they experience. Misinformation was exceedingly rare and benign when it did occur. Conclusions: Blog analysis represents a novel approach to understand the T1D caregiver’s experience. This qualitative study found many challenges that caregivers face in raising a child with T1D. Despite the many barriers caregivers face in managing their children’s T1D, they find support through advocacy efforts and peer-to-peer blogging. Blogs provide a unique avenue for support, with only rare and benign findings of medical misinformation, and may be a resource that diabetes care providers can consider offering to families for support.

  • Exploring the Use of Personal Technology in Type 2 Diabetes Management Among Minority Patients: the LIFT Diabetes Study

    Date Submitted: Sep 9, 2017

    Open Peer Review Period: Sep 11, 2017 - Nov 6, 2017

    Background: Internet technology may afford a low-cost solution to chronic disease management. This study aims to assess use of information technology in a diverse sample. Objective: Here we seek to as...

    Background: Internet technology may afford a low-cost solution to chronic disease management. This study aims to assess use of information technology in a diverse sample. Objective: Here we seek to assess the feasibility of capitalizing on the pervasive use of technology as a secondary means of delivering diabetic counseling though an investigation of correlates to technology use within the context of an ongoing population health study. Methods: LIFT Diabetes randomized 260 overweight and obese adults with diabetes to two intervention arms. A survey evaluating access to and use of various technologies was administered at baseline and analyzed using descriptive statistics and logistic regression. Results: The sample had a mean age of 56, was 67% female and 54% non-white. Non-white participants had higher baseline mean BMI (p=0.0015) and HbA1c (p=.0034). Minority participants were less likely to have a home computer (75% vs. 93%, p<0.001) and less likely to have email access at home (p=0.032). Ownership of a home computer was correlated to higher income (p<0.001), education (p<0.001), full time employment (p=0.011), and ownership of a smartphone (p=0.001). Willingness to complete questionnaires online was correlated to higher income (p=0.001), education (p<0.001), full time employment (p=0.012), and home access to a computer, internet, and smartphone (p≤0.050). Racial disparities in having a home computer persisted after controlling for demographic variables and owning a smartphone (adjusted OR 0.26; 95%CI 0.10, 0.67; p=0.005). Willingness to complete questionnaires online was driven ownership of a home computer (adjusted OR 3.87; 95%CI 1.14, 13.2; p=0.030). Conclusions: Minority adults were more likely to report limited access to technology than white adults. As ownership of a home computer is central to a willingness to use online tools, racial disparities in access may limit the potential of web-based interventions to reach this population.