Blood glucose monitoring is a critical component of diabetes management [1,2]. Self-monitoring of blood glucose involves the individual utilising a blood glucose monitoring device, which provides snapshots of their glycaemic state at the time of blood sampling [1,2]. The achievement and maintenance of blood glucose levels as close as possible to normal, as mirrored by glycosylated haemoglobin, has been demonstrated to be one of the factors that reduce complication rate and improve life expectancy in people with type 2 diabetes (T2DM) [3,4].
Traditionally, manual logbooks were used to record blood glucose. Errors are common. Patients may forget to bring their logbooks to clinic visits. The use of mobile phone technologies such as cloud solutions and specialised applications for diabetes self-management can significantly improve blood glucose control.
One approach is to deploy a diabetes self-managing system which combines a blood sampling device/blood glucose meter/insulin pen in a single cloud-connected device. An example of this is the Actiste diabetes management as a service (ADMS) ‘internet of things’ (IoT) device Actiste which automatically logs and shares real-life data on blood glucose values and actual injected insulin doses while also providing the opportunity for the recording of lifestyle data.
In this study, we evaluated the impact of ADMS on a person’s everyday life and diabetes self-management. The impact of ADMS was assessed by a validated questionnaire MedTech20  that includes 20 questions, corresponding to 20 benefit attributes when using a medical device. These attributes are allocated into four domains – sense of security/social-participation/integrity/convenience and here we focussed on ‘Sense of security’. We also compared it with the current standard of care (SOC) devices.
Feedback was rated based on five levels: excellent , very good , good , not so good  and poor .
Twenty people with insulin-treated T2DM started the study across two primary care centres; 17 completed all 90 days. However, 94% of patients rated ADMS insulin reminders, missed dose identifier and 88% engaged in diabetes management, as 3–5 (good to excellent).
All attributes in the ‘sense of security’ domain obtained high or very high scores. ‘Perceived safety” and ‘sense of control of the condition’ obtained the highest scores at 94% and 88%, respectively, when the answers ‘Agree’, ‘Agree a lot’ and ‘completely agree’ were combined. The corresponding results for ‘perceived reliability’ and ‘aid to remember tasks’ were 76.5% and 71%, respectively. These results indicated a high degree of patient confidence in the ADMS for attributes that were associated with ‘sense of security’.
Participants indicated poor ability for current SOC devices to remind them to take insulin (16%), identify missed doses (26%) and engage them in diabetes treatment (21%). In total 82% of patients would recommend the ADMS approach to a relative/friend with insulin-treated T2DM.
In conclusion, feedback on Service User Experience is a powerful tool to understand more clearly the strengths and weaknesses of current blood glucose monitoring technology. The ADMS was perceived by the majority of respondents as reliable/well-tolerated to use and in addition was reported as offering users a sense of control of their diabetes, providing overall a higher degree of confidence for all attributes vs. SOC devices. This is important for anyone who self-administers insulin as part of their diabetes management and highlights the value of the Actiste device in supporting effective person-centred blood glucose management in people with T2DM.
The data used in the analyses presented were fully anonymised before being made available to the investigators for analysis.
Conflicts of interest
There are no conflicts of interest.
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