-Keep your blood pressure under control. The same lifestyle changes that control blood glucose levels (dietary modifications and exercise) may also help you keep your blood pressure at safe levels. The American Diabetes Association recommends that people with diabetes keep their blood pressure below 140/80, but check with your health care professional about what target is best for you.
The look of the Dario appealed straight away to me. Small and compact. Easy for me to carry with my phone which goes everywhere with me. Love the fantastic app on my phone. Clear, informative and easy to use. Love it! I can look back at previous readings to see any patterns. Sara and Assaf have been brilliant at helping out with any issues I have come across, which I thank them hugely for. The Dario Lounge is a great community for all users, who all share advice.

The incidence of type 1 diabetes mellitus has been increasing worldwide [1], [2], [3], and it appears to have been particularly pronounced among children <5 years of age (yr) [3], [4], [5]. This increase has been suggested to be associated with the ‘accelerator hypothesis’ [6]. Although this hypothesis is not universally accepted [7], it predicts that higher BMI is associated with younger age at type 1 diabetes diagnosis [8], which has been demonstrated in some studies [9], [10], [11].


The average reduction of 4.2 mmol/mol (0.4%) in HbA1c seen in this study did not reach the level chosen to signify clinical significance in the initial power calculation (5.5 mmol/mol (0.5%) reduction in HbA1c). Therefore, this study is unable to conclude that the effects of the SMS4BG intervention are clinically significant. Although further investigation is needed, we believe the results have the potential to still be clinically relevant in practice, particularly among individuals with high levels of HbA1c, such as the participants with poorly controlled diabetes in this study. The unadjusted group difference on change in HbA1c from baseline was −5.89, −3.05 and −5.24 mmol/mol at three, six, and nine months, respectively. The main analysis, with adjustment for baseline value and stratification factors, showed a smaller treatment effect, although both results were significant at three and nine months. Similar results were found across major subgroups of interest despite the fact that these analyses were not specifically powered. These consistent findings led us to believe that the intervention shows promising effects on treating people with poorly controlled diabetes and warrants further investigation.

The features most frequently used by current app users were blood glucose diaries (87%, 32/37), followed by carbohydrate/meal diaries (38%, 14/37) with 22% (8/37) reporting insulin dose calculation devices to be useful (Table 3). Table 3 demonstrates the features app users found useful in their current apps. App users reported the most desired feature for future use in an app was an insulin dose calculator (46%, 17/37; Table 4). Table 5 shows that non-app users reported insulin dose calculators to be the third most desired feature (54.6%, n=83/152). Blood glucose diaries were the most desired app feature amongst non-app users (64.4%, 98/152; Table 5). Non app users with T1DM were more likely to desire an insulin dose calculation device, than non-app users with T2DM, P=.01).
For example, adjusting to having diabetes; difficulty in making the life changes necessary to stay well; difficulty managing anger, conflict and other emotions related to your health; depression, sadness and grief; anxiety, worries, panic and phobias related to your health; eating difficulties; and difficulty with coping with the complications of diabetes.
This cross-sectional observational study used two surveys (see Multimedia Appendices 1 and 2), one for people with diabetes attending a secondary care diabetes outpatient clinic and the second for HPs (who treat people with diabetes) attending a national diabetes conference. Both surveys were multi-choice format, collected, and managed using REDCap electronic data capture tools. REDCap (Research Electronic Data Capture) is a secure, Web-based app designed to support data capture for research studies [24]. The survey questions were derived from criteria in the Mobile app rating scale [25] to address attitudes and practices of both the people with diabetes and HPs. The list of apps was compiled by searching Apple and Android App stores and included the first consecutive ten diabetes apps. We eliminated any apps not specific to diabetes by reviewing app store descriptions. We reviewed the main features from these apps to develop the list of app features. The patient survey asked responders to select any useful app features from a list. Responders could select more than one useful app feature. The HP survey listed app features and used a scale to assess usefulness of app features (from 1 [not at all useful] to 5 [extremely useful]) and their confidence in recommending apps (from 1 [not at all confident] to 5 [extremely confident]).
Before my type1 insulin dependent diagnosis, I had a pancreas that worked, going out for dinner was ...really exciting. I didn’t even know what type one autoimmune disease was. Id pick whatever I wanted from the menu. Didn’t think of my blood sugars at all! Sitting at the table and I would drink my drink without a thought of what it will be doing when the drink rushes into my blood stream. I wouldn’t be calculating in my head if carbs totals and portion sizes are going to bring me into hyper or hypoglycaemia . I wouldn’t be hoping that the exercise id just done before going to the restaurant will change my blood glucose reading....Now....my pancreas hasn’t worked for 11years and while everyone’s chatting away at the table I’m half there in mind and half of me is not living in the moment of enjoying myself because I’m caught up in the complete intensity of trying to deal with my type one condition. Very overwhelming and my mind plays a 🤹‍♂️ juggling game where One ball is exercise, one ball is long and Quick acting insulin and one ball is carbs/food portion. Also, my will power either is good or it’s shocking. The others get their big portions while I’m still at bg testing stage and haven’t injected for the meal yet!! Everyone is trying each others food next to me and across the table. I have invisible blinkers on my eyes so I’m not aware of food sharing that’s going on. Once my food arrived it’s then that I can calculate how many units of my insulin that I inject depending on how many carbohydrates in the meal , making sure I inject in a different area to my lunchtime injection. Finally I begin to eat and the other people are almost finished their meal!!! I am a type one hero in more ways than one. See More
Contributors: RW obtained funding for this trial. All coauthors had input into the study protocol. RD, RW, RMu, and MS contributed to the development of the intervention content. RD managed the day-to-day running of the trial and delivery of the intervention. RD and RW collected the data. YJ and RD did the data analyses. All coauthors were involved in the interpretation of the results. RD wrote the article with input from all coauthors. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of this manuscript. RD is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
In this large sample of people with diabetes attending a secondary care clinic in NZ, 19.6% (37/189) of patients reported using diabetes apps to support their self-management. Diabetes app users were younger and more often had T1DM. The most used app feature in current app users was a blood glucose diary (87%, 32/37). The most desirable feature of a future app was an insulin dose calculation function in app users (46%) and a blood glucose diary in non-app users (64.4%). A Scottish survey has reported similar results and observed that people with T1DM were more likely to desire insulin calculators in an app [23].
Overall, all five potential app features were considered useful, with more than 60% of responders selecting that these features were useful, very useful, or extremely useful on the scale of scale 1 (not at all useful) to 5 (extremely useful). Equally, the mean usefulness score was higher than 3 for all 5 features. Blood glucose and carbohydrate intake diaries were rated as being the most useful app feature (Figure 1), with the highest mean score of 3.64 (SD 0.948) for usefulness (Table 7).
The annual incidence of type 1 diabetes in children <15 yr in the Auckland population in 1990–2009 was 16.4/100,000 (95% CI 15.3–17.5). Considering the underlying 36% population growth over the 1990–2009 period, there was still a progressive increase in the incidence of new cases (p<0.0001; Figure 1A). By Poisson regression the type 1 diabetes incidence in children <15 yr in 2009 was 22.5 per 100,000 (95% CI 17.5–28.4), in comparison to 10.9 per 100,000 in 1990 (95% CI 7.0–16.1) (Figure 1A). Overall incidence among males and females across the 20-year period was similar (p = 0.49). The increase in incidence was greatest among children 10–14 yr (average increase of +0.81/year; p<0.0001) and lowest among children 0–4 yr (+0.32/year; p = 0.02); incidences by 2009 were 27.0 (95% CI 18.1–38.8) for children 10–14 yr, 25.4 (95% CI 16.5–37.3; +0.66/year; p = 0.0002) for children 5–9 yr, and 14.9 per 100,000 (95% CI 8.4–24.5) for those aged 0–4 yr (Figure 1B).

The {Dario} device has been perfect, I love it. I love that it’s small and discreet enough. I can now test my sugars within 20 seconds, all from the bottom of my iPhone and no one around is none the wiser… I also love that it’s “all in one”. I’ve been using it now for around 4 – 5 months. The app is great at logging and motivation with its % scoring system.
Some of the most vocal diabetes stories come from blogs and other social media platforms which create a broad online community of people who have diabetes or whose loved ones are living with the disease.  “By means of this blog,” noted Hausner, “we hope to add our voice to this dialogue and further engage with those who may be well aware of the effects diabetes can have on their lives.”
This study shows the potential of SMS4BG to provide a low cost, scalable solution for increasing the reach of diabetes self management support. It showed that a text messaging programme can increase a patient’s feelings of support without the need for personal contact from a healthcare professional. Half of the intervention group reported sharing the messages with others. Traditional education for diabetes self management is delivered to individual patients, but there is benefit of support from other people being involved.45 This is particularly pertinent to ethnic populations such as Māori groups, in whom family have an important role in supporting diabetes self management.46
This patient sample came from patients in secondary care diabetes clinics, and therefore, app use may be different amongst patients managed in primary care. Similarly, findings may not generalize to patients with poorer glycemic control as responders had statistically significantly lower HbA1c than non-responders. This was a cross-sectional survey that is useful to assess app use at one point in time, but it is likely that people vary their app use and recommendations over time. It was therefore not possible to assess whether the introduction of an app has significant effect on clinical outcomes. Our study did not address the difference in needs in app features between responders on insulin and those not on insulin. Overall the response rates for both surveys were low and responses were limited by self-report and therefore liable to responder bias.
There were 884 new cases of type 1 diabetes, and age at diagnosis rose from 7.6 yr in 1990/1 to 8.9 yr in 2008/9 (r2 = 0.31, p = 0.009). There was a progressive increase in type 1 diabetes incidence among children <15 yr (p<0.0001), reaching 22.5 per 100,000 in 2009. However, the rise in incidence did not occur evenly among age groups, being 2.5-fold higher in older children (10–14 yr) than in the youngest group (0–4 yr). The incidence of new cases of type 1 diabetes was highest in New Zealand Europeans throughout the study period in all age groups (p<0.0001), but the rate of increase was similar in New Zealand Europeans and Non-Europeans. Type 1 diabetes incidence and average annual increase were similar in both sexes. There was no change in BMI SDS shortly after diagnosis, and no association between BMI SDS and age at diagnosis.
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