An international scientific study has evaluated the acceptability of diabetes surveillance using connected objects. The results show that many of the solutions offered through these are considered too intrusive, for example food surveillance and data management by a private organization.

Diabetes:, monitoring, via, connected, objects, considered, too, intrusive


Connected objects and artificial intelligence represent hope in the management of diabetic patients. The former enables continuous, real-time monitoring of patients' health, while the latter enables the processing of this massive data, with the possibility of relocating part of the care to the home and fine-tuning the monitoring of the latter. To date, however, no studies have examined the acceptability of these monitoring technologies for patients and their intrusiveness in their lives. This is now the case with a team of physicians from the Hôtel-Dieu AP-HP Clinical Epidemiology Center and the University of Paris, with the Mayo Clinic.

 Researchers conducted a large international study involving 1,010 diabetic patients from 30 countries to assess the acceptability of diabetes surveillance using connected objects. In France, the 360 French patients selected were participants of "ComPaRe", the AP-HP Research Patient Community. This collaborative platform brings together patients who have chosen to advance research on chronic diseases by responding via the Internet to researchers' questionnaires and contributing their experience and testimonials. The goal is to improve quality of life and patient care.

 Several monitoring methods tested

The study was the subject of two publications in January in the journals Mayo Clinic Proceedings andJAMA Network Open. "The study identified what follow-up arrangements would be acceptable or unacceptable to participants and the factors that might influence acceptability, including the intrusiveness of follow-up into patients' lives," the authors said. The participants evaluated the acceptability of 36 scenarios presenting diabetes monitoring using different connected tools (e.g., a patch to monitor blood glucose levels, an accelerometer, etc.) and different methods of action based on this data (via their physician, monitoring platforms, automatic algorithms, etc.).

Specifically, each patient evaluated three randomly selected scenarios from the 36 proposed. Each scenario described a monitoring of their disease combining: different sensors (blood glucose sensors, accelerometers measuring physical activity, food monitoring through photographs of the plates, different monitoring times (one week before consultations, permanently...) and different ways of reporting results (in consultation, in real time via the patient's smartphone, etc.). Finally, the different methods of data hosting by a public or private actor (private insurance or digital company) were also taken into account.

When are these tools too intrusive?

A total of 2,860 scenarios were evaluated by all study participants. Of these, 40% were considered extremely or very intrusive. It turns out that "continuous monitoring of blood glucose levels and physical activity, allowing real-time advice by artificial intelligence, was considered the most acceptable," the researchers said. "On the other hand, adding photographs of their plates to monitor their diet using a smartphone application was considered intrusive," they add. During the analysis, they then identified factors associated with a sense of intrusiveness in personal life.

The results showed that those associated with a greater "sense of intrusion" were food monitoring, direct information from the personal physician or another physician (as opposed to just the intervention of an artificial intelligence), and hosting of the data by a private company. While the researchers reported a wide range of participant acceptability, they found that some factors influenced acceptability: acceptability was better among men, patients with a sense of "burn out" from their diabetes management, and people who frequently use new technologies.

In their conclusions, they emphasize that "there is potential for widespread implementation of digital remote monitoring in diabetes care. But the study also suggests that "if it is considered intrusive by patients, it may lead to greater demands for health benefits to offset the psychological costs of its adoption". This is why dialogue with a physician remains essential to help each patient identify the digital health tool that would best fit their values and lifestyle. According to Santé Publique France, 3.5 million people are treated for diabetes in France.