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J. Clin. Med. 2019, 8(1), 109;

The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey

Health Sciences, University of Bremen, Grazerstrasse 2, D-28359 Bremen, Germany
Leibniz Institute for Prevention Research and Epidemiology—BIPS, Achterstrasse 30, D-28359 Bremen, Germany
Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
Institute of Medical Sociology, Centre for Health and Society, Medical Faculty, University of Duesseldorf, Universitätsstrasse 1, D-40225 Duesseldorf, Germany
Author to whom correspondence should be addressed.
Received: 19 November 2018 / Revised: 10 January 2019 / Accepted: 14 January 2019 / Published: 17 January 2019
(This article belongs to the Section Endocrinology & Metabolism)
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Background: This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). Methods: A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. Results: The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones (n = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents (n = 549, 52.2%) and one third the respondents with type 2 DM (n = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21–2.39); smokers (1.63, 95% CI: 1.15–2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15–2.32). CGM use (AOR = 0.66, 95% CI: 0.44–1.00); “general diet” (AOR = 0.86, 95% CI: 0.79–0.94); and “blood glucose monitoring” (AOR = 0.88, 95%CI: 0.80–0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09–0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04–3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00–1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74–3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07–5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41–0.96) and “general diet” self-care (AOR = 0.84, 95% CI: 0.75–0.94), were significantly associated with the reduced odds of hyperglycemia. Conclusion: Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control. View Full-Text
Keywords: diabetes; CGM; self-care; glycemic control; hyperglycemia; hypoglycemia diabetes; CGM; self-care; glycemic control; hyperglycemia; hypoglycemia

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).

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Kebede, M.M.; Schuett, C.; Pischke, C.R. The Role of Continuous Glucose Monitoring, Diabetes Smartphone Applications, and Self-Care Behavior in Glycemic Control: Results of a Multi-National Online Survey. J. Clin. Med. 2019, 8, 109.

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