Connecting Smartphone and Wearable Fitness Tracker Data with a Nationally Used Electronic Health Record System for Diabetes Education to Facilitate Behavioral Goal Monitoring in Diabetes Care: Protocol for a Pragmatic Multi-Site Randomized Trial

Abstract

BackgroundMobile and wearable technology have been shown to be effective in improving diabetes self-management; however, integrating data from these technologies into clinical diabetes care to facilitate behavioral goal monitoring has not been explored.ObjectiveThe objective of this paper is to report on a study protocol for a pragmatic multi-site trial along with the intervention components, including the detailed connected health interface. This interface was developed to integrate patient self-monitoring data collected from a wearable fitness tracker and its companion smartphone app to an electronic health record system for diabetes self-management education and support (DSMES) to facilitate behavioral goal monitoring.MethodsA 3-month multi-site pragmatic clinical trial was conducted with eligible patients with diabetes mellitus from DSMES programs. The Chronicle Diabetes system is currently freely available to diabetes educators through American Diabetes Association–recognized DSMES programs to set patient nutrition and physical activity goals. To integrate the goal-setting and self-monitoring intervention into the DSMES process, a connected interface in the Chronicle Diabetes system was developed. With the connected interface, patient self-monitoring information collected from smartphones and wearable fitness trackers can facilitate educators’ monitoring of patients’ adherence to their goals. Feasibility outcomes of the 3-month trial included hemoglobin A1c levels, weight, and the usability of the connected system.ResultsAn interface designed to connect data from a wearable fitness tracker with a companion smartphone app for nutrition and physical activity self-monitoring into a diabetes education electronic health record system was successfully developed to enable diabetes educators to facilitate goal setting and monitoring. A total of 60 eligible patients with type 2 diabetes mellitus were randomized into either group 1) standard diabetes education or 2) standard education enhanced with the connected system. Data collection for the 3-month pragmatic trial is completed. Data analysis is in progress.ConclusionsIf results of the pragmatic multi-site clinical trial show preliminary efficacy and usability of the connected system, a large-scale implementation trial will be conducted.Trial RegistrationClinicalTrials.gov NCT02664233; https://clinicaltrials.gov/ct2/show/NCT02664233 (Archived by WebCite at http://www.webcitation.org/6yDEwXHo5)

Diabetes Educators’ Insights Regarding Connecting Mobile Phone– and Wearable Tracker–Collected Self-Monitoring Information to a Nationally-Used Electronic Health Record System for Diabetes Education: Descriptive Qualitative Study

“…Diabetes educators’ perspectives need to be incorporated as we develop future mobile and connected systems to support team-based diabetes care and education in clinical practice. The study findings were used to inform the development of a connected interface in the Chronicle Diabetes system to integrate Jawbone-collected self-monitoring diet and physical activity information, and the connected system is currently being tested in a multisite randomized clinical trial [ 16 ].…”

Technology-Based Interventions for Nursing Home Residents: Implications for Nursing Home Practice Amid and Beyond the Influence of COVID-19: A Systematic Review Protocol

“…There is a growing body of technology-based interventions designed to support the health and quality of life of nursing home residents [56][57][58][59][60][61][62]. The onset of COVID-19 and recommended social distancing policy led to an increased interest in reliance on technology-based solutions [81,82].…”

“…Technology-based interventions can be considered as the use of technology (e.g., digital devices like tablets and wearable devices, communication platforms) to manage or support health promotion strategies that aim to produce accessible and affordable health solutions to a target audience. Compared to traditional health solutions, such as face-to-face consultations, technology-based interventions have the potential to deliver healthcare more effectively and can mitigate geographic and access-related limitations that, as studies show, can play a signi cant role within nursing homes [56][57][58][59][60][61][62]. The evidence further suggests that technology-based interventions can help free healthcare professionals from repetitive work and allow them to make more meaningful contributions in delivering healthcare solutions to the care recipients [63][64][65].…”

An Effective Model of Diabetes Care and Education: The ADCES7 Self-Care Behaviors™

“…Research shows the use of electronic health records and wearables, along with the resulting patient-generated health data, can improve clinical outcomes and engagement. 20-23 Mobile health interventions for obesity anddiabetes have promoted behavior change, 24 and technology-enabled diabetes support has demonstrated clinically significant results in clinical settings. 4,25 In people with type 1 diabetes, studies have validated that the use of continuous glucose monitoring can increase time in range and lower risk for severe hypoglycemia.…”