Artificial intelligence and diabetes experts work together to study blood sugar management

To help the roughly 1.
45 million Americans with type 1 diabetes better manage their blood sugar levels, Oregon Health & Science University combines
the power of an AI-powered smartphone app with the support of human experts.

Leona S.
The M.
and Harry B.
Helmsley Charitable Trust has awarded OHSU more than $4.
3 million to support this effort
.
Leading the project are OHSU biomedical engineer Peter G.
Jacobs, Ph.
D.
, and OHSU endocrinologist Leah M.
Wilson, Ph.
D.
, who are organizing a randomized clinical trial to evaluate the effects of
using their enhanced app with diabetes education specialists.

People with type 1 diabetes can't regulate their blood sugar levels, so they must take insulin
throughout the day.
Poorly controlled diabetes can lead to serious complications such as heart and kidney disease, nerve damage, vision and hearing loss, coma and even death
.

To help people with type 1 diabetes who inject themselves with insulin several times a day, Jacobs, Wilson and colleagues developed the DailyDose app, which uses artificial intelligence algorithms to evaluate blood glucose data, identify relevant trends, and suggest steps
to help patients keep their blood sugar levels within a healthy range.

Over the past decade, the federal government has approved small-scale wearable technologies, such as continuous glucose monitors and automated insulin delivery systems, to make it easier
to manage type 1 diabetes.
But insulin delivery devices — which can cost thousands of dollars depending on the model and insurance coverage — are beyond the financial means
of many patients.
While the number of diabetes apps has grown dramatically in recent years, none offer advice like DailyDose on how to adjust insulin dosage or behavior
.

A study published in 2020 by Jacobs, Wilson, and others showed that the recommendations for their app largely aligned
with those of physicians who specialize in diabetes care.
In November 2022, the team published a follow-up study that found significant improvements in blood sugar levels when people followed the app's recommendations, but those who followed the app's recommendations less often did not have similar benefits
.

Jacobs, associate professor in the Department of Biomedical Engineering at OHSU School of Medicine, said: "Our recent research has found that some people do not accept the recommended changes provided by the app because they do not understand how the recommendations can improve their blood sugar management, or because they mistakenly believe that making the recommended changes will negatively
affect their health.
"

Jacobs added: "We also found that other barriers prevent some people from changing their blood sugar management
.
" "For example, if you're stressed or wear multiple hats, controlling your blood sugar and spending time doing new things can seem overwhelming or even impossible
.
"

To push more people to act on the app's recommendations, the research team took a two-pronged approach: First, they are updating the app to use a new glucose prediction algorithm and an improved user interface, which should make its recommendations more transparent and easier to understand; Second, the app connects people who can't improve blood sugar control with the app alone with diabetes educators or behavioral health clinicians to help them overcome challenges
that prevent them from making changes.

The clinical trial will first put participants on the DailyDose app, only if necessary to get them mentored by a diabetes educator, because one-on-one education, while effective, can be expensive and time-consuming
.
The researchers devised a method that is affordable and scalable
.

The multicenter clinical trial will follow 93 patients with type 1 diabetes for 38 weeks
.
After the initial 12 weeks, study participants who did not benefit from using the app alone were also connected
to diabetes educators or psychologists.
The OHSU team has also developed an online mentoring platform designed to work with DailyDose to further help diabetes educators and psychologists support study participants
.

"Some people struggling with blood sugar management may benefit from personalized guidance," said
Wilson, assistant professor in the Department of Medicine in the Division of Endocrinology, Diabetes and Clinical Nutrition at the OHSU School of Medicine.
"However, we know that coaching is resource-intensive and our research will only be available to those who
need it.
We call this combined approach App-Based Certified Diabetes Educational Therapy, or AB-CDE
.
”

The study will begin recruiting participants through six institutions in 2024: OHSU Harold Schnizer Diabetes Health Center, Harvard Jocelyn Diabetes Center, University of Southern California, UC San Diego, Mount Sinai Hospital and University of Colorado Barbara Davis Diabetes Center
.

"Decision support, like the one provided through the Daily Dose app, greatly improves access to high-quality diabetes treatment regardless of where people live," said
Dr.
Sean Sullivan, program officer at the Helmsley Charitable Trust.
"However, for many people, one app is not enough
.
The project will assess who benefits most from app-based decision support and who may need additional personal contact
with diabetes education and behavioral health specialists.
Ultimately, we hope this project will improve care for all people with type 1 diabetes and make it easier for them to manage the disease
in their daily lives.
”