Objective: The objective of the study is to identify predictors of utilization of a type 2 diabetes (T2D) management App over time for insulin users (IUs) and noninsulin users (NIUs). Research Design and Methods: We followed over 16 weeks a national sample of unselected T2D adults who independently elected to download and pair a CONTOUR DIABETES App with their CONTOUR NEXT ONE glucose meter. App use and frequency of glucose testing were recorded. Baseline surveys recorded participant demographic, disease status, distress, medication taking, and views of technology to predict utilization. Results: Mean age was 51.6 years (108 IUs; 353 NIUs), 48% were female, time with diabetes was 6.9 years, and self-reported HbA1c was 8.1% (36.3 mmol/mol). Mean duration of App use was 85.4 days and 40% stopped using the App before 16 weeks. Continuous users were older and reported higher distress, better medication taking, and more positive attitudes toward technology (all P < .01). IUs tested more frequently than NIUs, but frequency and intensity of testing decreased markedly for both groups over time. More predictors of App use frequency and testing occurred for NIUs than IUs: older age, higher HbA1c, lower distress, more medication taking (all P < .05). Conclusions: App use and testing decreased markedly over time. Variations in the predictors of frequency of App use suggest that the utilization of mobile technologies requires a tailored approach that addresses the specific needs of individual users, compared with adopting a one-size-fits-all strategy, and that IUs and NIUs may require very different strategies of customization.

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Cardiovascular disease (CVD) is a leading cause of death in people with type 2 diabetes (T2D). Recent cardiovascular (CV) outcomes trials have shown CV benefits for several GLP-1 receptor agonists and SGLT2 inhibitors. We aimed to evaluate T2D patients’ awareness, perceptions, and behaviors regarding CVD and cardioprotective T2D drugs. An online survey was completed by 927 T2D patients of diverse socioeconomic backgrounds from an opted-in patient research panel in the U.S. Median respondent age was 64 and median duration of diabetes was 15 years. Half were taking a GLP-1 or SGLT2, a statistically robust sample of patients on these therapies. Questions covered perceptions of CVD disease; awareness of and interest in diabetes drugs that reduce CVD risk; knowledge of their own health metrics; physicians seen and frequency of discussions about CVD; self-assigned ‘grades’ on lifestyle behaviors known to reduce CVD risk. Most patients recognized the link between T2D and CVD: 61% strongly agreed that T2D increases CVD risk. Yet, only 29% think often about their risk of CVD. Awareness of CV benefits from some T2D therapies was also low (34% overall; 42% for those on SGLT2 or GLP-1). Interest in taking an additional cardioprotective diabetes agent aligned with awareness (37% overall; 42% for those on SGLT2 or GLP-1). While almost all knew their HbA1c and blood pressure, over 25% did not know their LDL cholesterol or other lipid levels. In the prior year, 31% of patients had seen a cardiologist and 17% had discussed CVD risk with an endocrinologist. Respondents generally ranked themselves ‘average’ to ‘below average’ on heart-healthy behaviors like exercise, weight, sleep, diet, and stress management. Although a majority of T2D patients are aware of the link between T2D and CVD, most are not actively managing their CV health, and few know that some T2D therapies are cardioprotective. These data suggest a need to better inform T2D patients about their risk for CVD, and steps they can take to reduce that risk. Disclosure K.C. Stoner: Other Relationship; Self; Multiple companies and organizations in the diabetes field (greater than 10). E.N. Fitts: Other Relationship; Self; Various diabetes companies. D. Gopisetty: Other Relationship; Self; Various diabetes companies. A. Carracher: Other Relationship; Self; Other. C.S. Florissi: Other Relationship; Self; dQ&A has several clients (&gt;10) in the diabetes field. M.J. Kurian: Other Relationship; Self; Other Company. J. Kwon: Other Relationship; Self; Various diabetes companies. P. Marathe: Consultant; Self; Close Concerns. P. Rentzepis: Other Relationship; Self; Various Diabetes Companies. J.B. Rost: Other Relationship; Self; dQ&A has several clients (&gt;10) in the diabetes field. K.L. Close: Other Relationship; Self; Various diabetes companies. I.B. Hirsch: Consultant; Self; Abbott, Becton, Dickinson and Company, Big Foot, Roche Diabetes Care. Research Support; Self; Medtronic. M.N. Kosiborod: Consultant; Self; Amgen Inc., AstraZeneca, Bayer AG, Boehringer Ingelheim International GmbH, Eisai Co., Ltd., GlaxoSmithKline plc., Glytec, LLC, Intarcia Therapeutics, Inc., Janssen Pharmaceuticals, Inc., Merck & Co., Inc., Novartis AG, Novo Nordisk A/S, Sanofi. Research Support; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc. R. Wood: Other Relationship; Self; Multiple companies in the diabetes field (&gt;10 companies). Funding AstraZeneca

SGLT2 inhibitors are not approved for people with type 1 diabetes in the U.S. due to elevated risk of diabetic ketoacidosis (DKA), prompting interest in ketone testing education. This study surveyed 4,612 people with type 1 diabetes across the U.S., EU, and Canada regarding their preferred method and duration of ketone testing education if they were to start a new therapy that increased DKA risk. Overall, a phone app was the preferred method of education, with some country-level differences apparent. In the U.S., Germany, and the Netherlands, 15-30 minutes was the most selected training time duration, while the remaining countries most commonly selected 1-2 hours. When considering the safety of SGLT2 therapy for type 1 patients, this data lends important insights into the feasibility and optimal composition of ketone test training. Disclosure J.B. Rost: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. S. Suhl: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. K.C. Stoner: Other Relationship; Self; Various companies and organizations. C. Florissi: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Gowen: Employee; Self; This work was funded by dQ&A Diabetes Research, a provider of research services to multiple companies and patient organizations in the diabetes field. R. Wood: Consultant; Self; Abbott, ADOCIA, American Diabetes Association, Ascensia Diabetes Care, Boehringer Ingelheim Pharmaceuticals, Inc., CeQur Corporation, Dexcom, Inc., Eli Lilly and Company, Insulet Corporation. Employee; Self; dQ&A Market Research Inc.

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