Evaluation of a Mobile Application to Optimize Self-decision on Metabolic Control in Persons With Type 1 Diabetes

Metabolic lack of control in patients with type 1 diabetes Mellitus (T1DM) leads to kidney failure, non-traumatic amputations, blindness, and reduced life expectancy. In addition, determining the content of macronutrients in food is not the domain of many patients, particularly adolescents, or some physicians, making insulin adjustment difficult, one of the main failures of optimal metabolic control. One way to bridge the knowledge gaps in T1D self-management is by using technology to optimize metabolic control and reduce the risks of associated comorbidities, with a mobile application that helps optimize decision-making in self-management. And a reduction of complications in adolescents (14-18 years) with T1DM. This project aims to develop this application that contributes to decision-making and the reduction of comorbidities of adolescents with T1DM, following the policies of the Dominican state through Digital systems, together with its educational mission, technological access, and national competitiveness.

There are no mobile applications in use in the Dominican Republic for the self-management of chronic diseases. Therefore, the investigators have designed a mobile application with a postprandial insulin bolus calculator. In addition, the developers has added a list of foods from the region where users can select their foods and adjust them with the amount of insulin to metabolize them. The methodology includes a mixed approach (qualitative and quantitative) before starting the study and after three months of using the application.

To evaluate the acceptability and effectiveness of the application, we will carry out a pilot evaluation test. The participants in this pilot test will be 20 people between 14 and 18 years old with T1DM, users of INDEN. This experimental study has a systematized probabilistic sample from the center's master list. They were randomized, not controlled. Therefore, the participants are users of the pediatric diabetology service, and included prior explanation and approval of informed consent. These 20 participants will be recruited, ensuring the equitable distribution between gender and sociodemographic data of the mentioned group while maintaining the intention to treat.

Inclusion criteria:

-Patients between 14-18 years old with diabetes type 1.

Exclusion criteria

• Patients with Glomerular filtration rate less than 60 mL/min
• Inability to use electronic devices.
• Admission due to acute decompensation of T1DM in previous 3 months, presence of more than one severe monthly hypoglycemia, or any other circumstance that requires frequent visits and intensive care.
• Inability to sign the informed consent.

The investigators invited the participants to select foods and routinely use the mobile app's insulin bolus calculator for three months.

For data analysis, the researchers are going to perform the normality test for numerical variables. Then, the categorical data presentation will be with frequencies and percentages tables and the quantitative data as means and standard deviation, and use a non-Gaussian distribution, Kruskal-Wallis and Mann-Whitney tests.

The primary endpoint, HbA1c at the beginning of the study and the end of the third month of use of the application, will be analyzed with Kruskal-Wallis and Mann-Whitney tests and for pre-test and post-test comparisons of the study group, and the multifactorial analysis of variance (ANCOVA), baseline HbA1c level and at 3 months after using the application, taking into account age as covariates. The investigators are going to use for statistical analysis the Statistical Package for the Social Sciences (SPSS), and Excel of the data obtained.