Fig. 1Smart phone application outline. (A) The "Diabetes Notepad" application records personal information, blood glucose levels and test records for comorbidities and includes additional features such as diabetes education materials and a cardiovascular risk calculator. (B) The application allows easy access to the saved blood glucose history through the blood glucose record sheet and a graph.
Fig. 2Users of the application were widely distributed across the nation. Users were from Seoul (28.9%), Gyeonggi (24.4%), Incheon (5.6%), Gangwon (0.0%), Chungcheong (5.6%), Jeolla (5.6%), Daejeon (3.3%), Daegu (8.9%), Gwangju (2.2%), Gyeongsang (7.8%), Ulsan (2.2%), Busan (5.6%), and Jeju (0.0%).
Table 1Demographic characteristics of the study subjects
Characteristic |
Value |
Sex, male/female |
71 (78.9)/19 (21.1) |
Age, yr |
|
Mean±SD |
43.5±10.5 |
Median (range) |
44.0 (14-74) |
Duration of diabetes, yr |
|
<1 |
33 (36.7) |
1 to <3 |
18 (20.0) |
3 to <5 |
12 (13.3) |
5 to <10 |
11 (12.2) |
≥10 |
16 (17.8) |
Period of 'Diabetes Notepad' application usage |
|
<6 mo |
73 (82.0) |
6 mo to <1 yr |
13 (14.6) |
≥1 yr |
3 (3.4) |
Smartphone model |
|
iPhone |
12 (13.3) |
Android phone |
78 (86.7) |
Education level |
|
Primary school |
2 (2.2) |
Junior high school |
1 (1.1) |
High school |
15 (16.7) |
University or higher |
72 (80.0) |
Income/mo (Korean won) |
|
≤1,000,000 |
15 (16.9) |
1,010,000-2,000,000 |
13 (14.6) |
2,010,000-3,000,000 |
15 (16.9) |
3,010,000-5,000,000 |
25 (28.1) |
≥5,010,000 |
21 (23.6) |
Comorbidities |
|
None |
38 (56.7) |
Hypertension |
13 (19.4) |
Dyslipidemia |
12 (17.9) |
Other |
4 (6.0) |
Table 2Results for user satisfaction
|
Strongly agree |
Agree |
Disagree |
Strongly disagree |
Have there been positive changes in the clinical course of diabetes after the use of the application? |
22 (24.7) |
52 (58.4) |
14 (15.7) |
1 (1.1) |
Are you satisfied with the structure and completeness of the application? |
28 (31.1) |
50 (55.6) |
12 (13.3) |
0 |
Is the application easy to use? |
44 (48.9) |
43 (47.8) |
3 (3.3) |
0 |
Are you willing to actively recommend the application to others? |
48 (53.3) |
40 (44.4) |
2 (2.2) |
0 |
Will you keep using the application to manage diabetes? |
62 (69.7) |
24 (27.0) |
2 (2.2) |
1 (1.1) |
Table 3User satisfaction with the application according to demographic characteristics
Characteristic |
Have there been positive changes in the clinical course of diabetes after the use of the application? |
Are you satisfied with the structure and completeness of the application? |
Is the application easy to use? |
Are you willing to actively recommend the application to others? |
Will you keep using the application to manage diabetes? |
Sex |
|
|
|
|
|
Male (n=71) |
3.08±0.69 |
3.20±0.62 |
3.54±0.50 |
3.55±0.56 |
3.70±0.55 |
Female (n=19) |
3.00±0.59 |
3.11±0.74 |
3.16±0.69 |
3.37±0.50 |
3.44±0.71 |
P value |
0.556 |
0.642 |
0.026a
|
0.144 |
0.106 |
Age, yr |
|
|
|
|
|
<40 (n=28) |
3.00±0.68 |
3.18±0.72 |
3.46±0.58 |
3.61±0.50 |
3.63±0.63 |
≥40 (n=62) |
3.10±0.67 |
3.18±0.62 |
3.45±0.56 |
3.47±0.56 |
3.66±0.57 |
P value |
0.477 |
0.914 |
0.905 |
0.299 |
0.951 |
Duration of diabetes, yr |
|
|
|
|
|
<1 (n=33) |
3.06±0.72 |
3.24±0.66 |
3.61±0.50 |
3.58±0.50 |
3.63±0.55 |
1 to <3 (n=18) |
3.11±0.76 |
3.11±0.68 |
3.28±0.58 |
3.50±0.62 |
3.67±0.77 |
3 to <5 (n=12) |
3.00±0.74 |
2.92±0.29 |
3.25±0.45 |
3.33±0.65 |
3.58±0.52 |
5 to <10 (n=11) |
3.00±0.63 |
3.18±0.60 |
3.55±0.52 |
3.36±0.50 |
3.55±0.69 |
≥10 (n=16) |
3.13±0.50 |
3.31±0.79 |
3.44±0.73 |
3.63±0.50 |
3.81±0.40 |
P value |
0.961 |
0.411 |
0.177 |
0.564 |
0.634 |
Period of 'Diabetes Notepad' application usage |
|
|
|
|
|
<6 mo (n=73) |
3.07±0.65 |
3.16±0.66 |
3.46±0.55 |
3.50±0.56 |
3.60±0.62 |
6 mo to <1 yr (n=13) |
3.15±0.80 |
3.23±0.60 |
3.46±0.66 |
3.62±0.51 |
3.92±0.28 |
≥1 yr (n=3) |
2.67±0.58 |
3.33±0.58 |
3.33±0.58 |
3.33±0.58 |
3.67±0.58 |
P value |
0.484 |
0.89 |
0.888 |
0.658 |
0.158 |
Smartphone model |
|
|
|
|
|
iPhone (n=12) |
3.00±0.85 |
2.92±0.52 |
3.33±0.49 |
3.50±0.67 |
3.67±0.65 |
Android phone (n=78) |
3.08±0.64 |
3.22±0.66 |
3.47±0.58 |
3.51±0.53 |
3.65±0.58 |
P value |
0.724 |
0.113 |
0.331 |
0.881 |
0.764 |
Education level |
|
|
|
|
|
High school or lower (n=18) |
3.06±0.54 |
3.39±0.61 |
3.22±0.65 |
3.39±0.50 |
3.78±0.43 |
University or higher (n=72) |
3.07±0.70 |
3.13±0.65 |
3.51±0.53 |
3.54±0.56 |
3.62±0.62 |
P value |
0.835 |
0.121 |
0.077 |
0.22 |
0.366 |
Income/mo (Korean won) |
|
|
|
|
|
≤1,000,000 (n=15) |
3.07±0.62 |
3.33±0.62 |
3.40±0.63 |
3.40±0.51 |
3.67±0.49 |
1,010,000-2,000,000 (n=13) |
2.92±0.50 |
2.77±0.73 |
3.15±0.69 |
3.46±0.52 |
3.46±0.66 |
2,010,000-3,000,000 (n=15) |
3.07±0.70 |
3.27±0.70 |
3.60±0.51 |
3.67±0.49 |
3.79±0.58 |
3,010,000-5,000,000 (n=25) |
3.08±0.69 |
3.19±0.69 |
3.50±0.51 |
3.50±0.65 |
3.46±0.71 |
≥5,010,000 (n=21) |
3.14±0.79 |
3.24±0.43 |
3.52±0.51 |
3.52±0.51 |
3.90±0.30 |
P value |
0.883 |
0.206 |
0.399 |
0.697 |
0.020a
|
Comorbidities |
|
|
|
|
|
None (n=38) |
3.12±0.67 |
3.18±0.62 |
3.48±0.57 |
3.54±0.57 |
3.63±0.64 |
Hypertension (n=13) |
3.15±0.69 |
3.23±0.73 |
3.31±0.63 |
3.54±0.52 |
3.69±0.48 |
Dyslipidemia (n=12) |
2.67±0.65 |
3.17±0.72 |
3.58±0.52 |
3.42±0.52 |
3.67±0.49 |
Other (n=4) |
3.25±0.50 |
3.00±0.82 |
3.25±0.50 |
3.25±0.50 |
3.75±0.50 |
P value |
0.141 |
0.943 |
0.556 |
0.591 |
0.993 |
Table 4Changes in diabetes related self-care activities as assessed by the Summary of Diabetes Self-Care Activities
Variable |
Before, day |
After, day |
P value |
Blood sugar testing |
3.60±2.67 |
5.53±1.78 |
0.000a
|
Diet |
4.97±2.05 |
5.70±1.52 |
0.000a
|
Alcohol |
1.26±1.69 |
1.07±1.71 |
0.054 |
Smoking |
2.31±3.16 |
1.80±2.83 |
0.002a
|
Exercise |
2.67±2.14 |
3.78±2.23 |
0.000a
|
Medication |
4.64±2.83 |
5.55±2.31 |
0.000a
|
Weight measurement |
1.80±2.04 |
2.66±2.29 |
0.000a
|
Comply with regular lifestyle |
3.61±2.15 |
5.00±1.94 |
0.000a
|
Table 5Changes in the Summary of Diabetes Self-Care Activities items according to demographic characteristics
ΔVariable |
ΔBlood sugar testing |
ΔDiet |
ΔAlcohol |
ΔSmoking |
ΔExercise |
ΔMedication |
Δweight measurement |
ΔComply with regular lifestyle |
Sex |
|
|
|
|
|
|
|
|
Male (n=71) |
2.26±2.89 |
0.73±1.58 |
-0.20±1.77 |
-0.66±1.80 |
1.33±2.21 |
0.86±2.23 |
0.99±1.49 |
1.68±1.96 |
Female (n=19) |
0.74±1.94 |
0.74±1.05 |
-0.16±0.38 |
0.00±0.00 |
0.26±2.28 |
1.11±2.18 |
0.37±1.64 |
0.32±0.75 |
P value |
0.020a
|
0.709 |
0.578 |
0.088 |
0.170 |
0.728 |
0.076 |
0.006a
|
Age, yr |
|
|
|
|
|
|
|
|
<40 (n=28) |
1.39±2.49 |
0.82±1.66 |
0.21±2.52 |
-0.78±2.24 |
0.96±2.74 |
1.04±2.15 |
0.82±2.04 |
1.11±1.91 |
≥40 (n=62) |
2.18±2.89 |
0.69±1.40 |
-0.37±0.85 |
-0.40±1.26 |
1.16±2.03 |
0.85±2.25 |
0.87±1.26 |
1.52±1.84 |
P value |
0.113 |
0.936 |
0.285 |
0.948 |
0.600 |
0.892 |
0.271 |
0.198 |
Duration of diabetes, yr |
|
|
|
|
|
|
|
|
<1 (n=33) |
2.30±3.32 |
0.76±1.64 |
-0.15±2.46 |
-1.00±2.22 |
1.94±2.72 |
1.61±2.57 |
0.85±1.87 |
1.58±2.09 |
1 to <3 (n=18) |
1.22±2.92 |
0.72±1.13 |
-0.17±0.71 |
-0.71±1.83 |
0.33±2.09 |
1.12±2.50 |
0.83±1.92 |
1.06±1.59 |
3 to <5 (n=12) |
1.91±2.39 |
0.00±1.13 |
-0.50±1.00 |
-0.08±0.29 |
0.64±1.36 |
0.17±0.94 |
1.00±1.13 |
1.17±1.64 |
5 to <10 (n=11) |
2.36±2.46 |
0.73±1.35 |
-0.09±0.54 |
0.00±0.00 |
0.45±0.82 |
0.18±2.27 |
1.00±1.00 |
1.45±1.75 |
≥10 (n=16) |
1.69±1.78 |
1.25±1.69 |
1.25±1.69 |
0.00±0.00 |
1.00±2.19 |
0.27±1.03 |
0.69±0.79 |
1.50±2.00 |
P value |
0.723 |
0.492 |
0.875 |
0.195 |
0.585 |
0.206 |
0.860 |
0.945 |
Period of 'Diabetes Notepad' application usage |
|
|
|
|
|
|
|
|
<6 mo (n=73) |
2.22±2.88 |
0.80±1.54 |
-0.31±1.41 |
-0.51±1.68 |
1.12±2.33 |
0.97±2.27 |
0.78±1.42 |
1.50±1.93 |
6 mo to <1 yr (n=13) |
0.42±1.83 |
0.38±1.21 |
0.31±2.39 |
-0.69±1.44 |
1.08±2.02 |
0.69±2.10 |
1.38±2.18 |
0.92±1.32 |
≥1 yr (n=3) |
1.00±1.00 |
0.67±1.16 |
0.67±0.58 |
0.00±0.00 |
0.67±2.08 |
0.33±0.58 |
0.33±0.58 |
0.67±2.08 |
P value |
0.196 |
0.713 |
0.065 |
0.467 |
0.810 |
0.926 |
0.702 |
0.475 |
Smartphone model |
|
|
|
|
|
|
|
|
iPhone (n=12) |
2.83±2.86 |
0.25±1.42 |
-0.83±2.13 |
-0.33±1.16 |
1.08±2.28 |
1.00±2.13 |
1.25±2.30 |
1.33±1.88 |
Android phone (n=78) |
1.79±2.76 |
0.81±1.48 |
-0.09±1.47 |
-0.55±1.68 |
1.10±2.27 |
0.89±2.23 |
0.79±1.39 |
1.40±1.87 |
P value |
0.242 |
0.286 |
0.161 |
0.681 |
0.576 |
0.935 |
0.670 |
0.775 |
Education level |
|
|
|
|
|
|
|
|
High school or lower (n=18) |
1.17±1.98 |
0.61±1.09 |
0.06±2.10 |
0.00±0.00 |
0.83±1.76 |
0.29±1.05 |
0.28±1.45 |
1.00±1.85 |
University or higher (n=72) |
2.13±2.93 |
0.76±1.56 |
-0.25±1.43 |
-0.65±1.79 |
1.17±2.37 |
1.06±2.38 |
1.00±1.53 |
1.49±1.86 |
P value |
0.186 |
0.716 |
0.239 |
0.100 |
0.474 |
0.315 |
0.302 |
0.150 |
Income/mo (Korean won) |
|
|
|
|
|
|
|
|
≤1,000,000 (n=15) |
0.67±1.95 |
0.87±1.25 |
0.47±1.81 |
0.00±0.00 |
0.07±2.69 |
0.93±1.91 |
0.47±1.64 |
0.40±1.21 |
1,010,000-2,000,000 (n=13) |
1.62±2.53 |
1.00±2.04 |
-0.77±1.54 |
-0.38±0.96 |
1.67±2.64 |
1.23±2.65 |
0.77±1.74 |
1.77±2.09 |
2,010,000-3,000,000 (n=15) |
3.13±2.85 |
1.47±1.89 |
-0.07±2.02 |
-1.67±2.94 |
2.53±3.16 |
1.93±2.71 |
1.47±1.92 |
2.20±2.78 |
3,010,000-5,000,000 (n=25) |
1.04±2.41 |
0.08±0.85 |
-0.08±1.52 |
-0.38±1.39 |
0.58±1.21 |
0.92±1.98 |
0.96±1.37 |
1.04±1.43 |
≥5,010,000 (n=21) |
3.35±3.10 |
0.76±1.30 |
-0.52±0.98 |
-0.30±1.13 |
1.14±1.35 |
-0.10±1.68 |
0.62±1.61 |
1.71±1.52 |
P value |
0.003a
|
0.049a
|
0.146 |
0.225 |
0.185 |
0.127 |
0.411 |
0.067 |
Comorbidities |
|
|
|
|
|
|
|
|
None (n=38) |
1.50±2.69 |
0.87±1.54 |
-0.08±1.44 |
-0.38±1.45 |
1.07±2.32 |
0.63±2.03 |
0.70±1.54 |
1.28±1.86 |
Hypertension (n=13) |
3.08±2.66 |
0.38±1.76 |
-0.46±2.57 |
-0.77±1.96 |
1.46±2.18 |
1.00±2.13 |
1.46±1.56 |
2.15±2.30 |
Dyslipidemia (n=12) |
2.75±2.99 |
0.50±0.67 |
-0.42±1.17 |
-0.83±2.13 |
1.17±2.48 |
2.00±2.76 |
1.08±1.62 |
0.75±0.75 |
Other (n=4) |
2.25±3.30 |
0.50±1.29 |
-0.25±0.50 |
-0.75±1.50 |
0.25±0.50 |
1.50±3.00 |
0.50±0.58 |
2.50±1.92 |
P value |
0.165 |
0.936 |
0.674 |
0.500 |
0.766 |
0.430 |
0.420 |
0.280 |
Table 6Changes in the Summary of Diabetes Self-Care Activities items according to the satisfaction with the application
ΔVariable |
Two groups according to the satisfaction with the application |
P value |
Groups with high satisfaction with the application (n=53) |
Groups with low satisfaction with the application (n=37) |
ΔBlood sugar testing |
2.43±2.77 |
1.19±2.66 |
0.024a
|
ΔDiet |
0.85±1.66 |
0.57±1.17 |
0.781 |
ΔAlcohol |
-0.23±1.67 |
-0.14±1.46 |
0.249 |
ΔSmoking |
-0.85±2.05 |
-0.05±0.23 |
0.092 |
ΔExercise |
1.58±2.43 |
0.43±1.82 |
0.000a
|
ΔMedication |
0.92±2.42 |
0.89±1.89 |
0.516 |
ΔWeight measurement |
1.21±1.83 |
0.35±0.72 |
0.003a
|
ΔComply with regular lifestyle |
1.91±1.94 |
0.65±1.46 |
0.000a
|