Diabetes self-management smartphone application: Could it be an alternative for continuous glucose monitoring in low resource settings?

Background: The "Rightest" app connected to Rightest glucose meter via Bluetooth, helps to set blood glucose target and customize measurements. The app is provided with ketone alert when BG is ≥ 240 mg/dl.

Aim Of The Work: To assess the role of the rightest app in improving glycaemic control as well as quality of life in a 6- month interval of its usage.

Patients And Methods: A clinical trial included 40 participants with type 1 diabetes, mean age 14.3 ± 1.42 years and diabetes duration of 4.5 ± 3.6 years regularly following up at Diabetes Unit. Rightest app was installed on the participants' smart phone on enrollment and 6 months later assessment of the glycemic control was done by HbA1c and time in range. Results collected from app Quality of life (PedsQL) and user experience (UEQ) Questionnaires were applied at the end of the study.

Results: Using smartphone app yielded a significant reduction in mean BG level (-17.64 %, p = 0.012) that decreased HbA1c ( -10.63 %, p = 0.000). Increase of SMBG frequency was observed (p = 0.04). This is reflected on a 20 % increment time in range generated by app. (p-value = 0.002) and lower time above range (TAR > 180 mg/dl, -18.75 %, P = 0.001) in intervention group compared to control. However, the number of hypoglycemic events (p = 0.71) or DKA(p = 0.59) did not differ between groups. PedsQL questionnaire total score has improved (p-value = 0.010) in favor of intervention group with good experience with app indicated by UEQ. The pragmatic total score (1.425) of UEQ was above average while the hedonic total score was good (1.250) and overall score was good (1.338). The higher score of UEQ was inversely correlated with mean BG (r = -0.414, P = 0.008) and positively correlated to glycemic control (r = 0.644, p = 0.002).

Conclusion: Using mobile apps as an alternative for CGM in low resource settings can help improve glycemic control and quality of life for those who don't have access to diabetes technology services because of unavailability or unaffordability.