Development of a novel mobile-health application to empower young people with type 1 diabetes to exercise safely: A co-design approach (Preprint)

BACKGROUND Managing blood glucose levels around exercise is one of the most challenging tasks for young people living with type 1 diabetes (T1D). Innovative interventions that include decision-support aids are required to better support young people to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) tools are a useful platform to deliver health behaviour interventions for young people living with T1D, given the use of technology for glucose monitoring, insulin dosing and carbohydrate counting. OBJECTIVE The aim of this study was to develop a novel prototype mHealth application (app) to support exercise management for young people with T1D. METHODS A co-design approach with a user-centred design thinking framework was used to develop a prototype mHealth app called “acT1ve”during the 18-month design process from March 2018 to September 2019. To better understand and respond to the challenges faced by young people with diabetes when physically active, ten focus groups were conducted with young people aged 13-25years living with T1D and parents of young people living with T1D. The next stage of development involved conducting participatory design workshops with young people to identify key features of the app that would support individual needs when physically active. These features were incorporated into a wireframe, which was presented to participants for critical review. A beta version of “acT1Ve” was built in iOS and android operating systems which underwent critical review by consumers, clinicians, researchers, experts in exercise and T1D and app designers. RESULTS Sixty young people (13-25y) living with T1D, 14 parents of young people living with T1D, 6 researchers and 10 clinicians were engaged in the development of “acT1ve”. The acT1ve app included key features identified by the young people which would support their individual needs when physically active. It provided carbohydrate and insulin advice during exercise, information on hypoglycaemia treatment, pre-and post-exercise advice, and an educational food guide in the context of exercise management. “acT1ve” contained an exercise advisor algorithm consisting of 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. The app is complemented by other features like an activity log which displays a complete record of the users’ activities and associated exercise advice provided by the app’s algorithm for later reference, and regular reminder notifications for users to check/monitor their glucose levels. CONCLUSIONS The co-design approach and the practical application of the user-centred design thinking framework was successfully applied to develop “acT1ve”, an app to support exercise management for young people living with T1D.