The Challenges and Potential of Digital Therapeutic Solutions for Long-Acting Insulin Management

Starting on long acting insulin (LAI) can be difficult for people with type 2 diabetes (PWT2D). Delayed treatment initiation, imprecise titration, and poor adherence to therapy can lead to inadequate glycemic control. While emerging digital therapeutic solutions aim to help clinicians and PWT2D achieve optimal individualized LAI regimens, real world use of these solutions remains unknown. In this human factors validation study, we present findings on the Mobile Insulin Dosing System (MIDS), a mobile app module designed to reduce the manual burden of LAI titration. Sixteen PWT2Ds (age: 35-70 years) participated in the study. Participants were introduced to MIDS without training. Six real world use scenarios related to LAI management were presented with simulated data. Participants worked through each task using MIDS without assistance. Task performance was measured. Three out of six tasks had 100% success rates and the remaining three tasks had success rates from 73.3-87.5%. Three participants had 100% success rate despite having no prior experience with insulin therapy. All participants endorsed MIDS to be straightforward, easy to use, and effective for insulin management. Among unsuccessful tasks, the individual’s mental model of LAI adjustment was the common root cause. Some PWT2Ds did not understand that LAI is adjusted based on the fasting blood glucose (BG) only and assumed that non-fasting BG readings should also be included. Confidence in self titration was also a risk factor. Overall, MIDS proved to be simple, effective, and easy to use for PWT2Ds of varying ages, LAI experience, and smartphone use. Observed failure risks were related to poor understanding of diabetes and insulin regimens in general and not with the mobile implementation per se. Minimizing these risks, in addition to those inherent to manual recall and entry of BG readings, can enhance the use of digital therapeutic solutions for LAI therapy management. Disclosure A. Kanchi: Employee; Self; Glooko, Inc. L. Parks: Employee; Self; Glooko, Inc. T. Sheng: Employee; Self; Glooko, Inc.. J. Smith: None. M. Greenfield: Stock/Shareholder; Self; Glooko, Inc..