Unmet Needs and Communication Preferences for mHealth Self-Management Solutions in People with Type 1 Diabetes and Insulin Resistance

Insulin resistance (IR) is prevalent within type 1 diabetes (T1D) and associated with increased morbidity and mortality. Mobile health (mHealth) applications are useful platforms for delivering health behaviour interventions, but technologies focusing on addressing IR in T1D are absent. The aim of this formative study was to identity salient unmet patient needs, communication preferences, and barriers for mHealth self-management solutions in people with T1D and IR. 70 adults with type 1 diabetes (male=57%; HbA1c 8.1±3.4%; 28±5years) completed an online survey evaluating skills gaps in self-management and priorities for diabetes mHealth apps. Survey responses were ranked using a 9-point scale and analysed using descriptive and inferential statistics. Qualitative write-in responses were subsequently coded and analysed using inductive thematic analysis. IR was assessed using estimated glucose disposal rate (eGDR). Among all respondents, 49% (n=34) identified glycemic control/variability as the principle unmet self-management need. Fewer than 5% (n=3) reported having no self-perceived skills gaps. 89% (n=62) identified paternalistic communication and weight stigmatization as barriers to mHealth use. Real-life/situational feedback for glucose control/variability was reported as the single largest facilitator of mHealth use (65%, n=46). Preferred communication strategies were empathy, concern, and compassion (81%, n=57), and informal, open, and direct (77%, n=54). Our results highlight that glucose control/variability is the principle unmet self-management need in T1D adults with IR. Several communication barriers negatively impact mHealth acceptability and efficacy in this group, particularly paternalistic and weight-stigmatizing language. mHealth solutions that target glycemic control/variability and are non-weight stigmatizing are urgently needed for people with T1D and IR. Disclosure A.R.Wilson: None. M.Farrar: None. M.D.Campbell: None.