Bryan Gibson, DPT, PhD, Assistant Professor, Department of Biomedical Information at the University of Utah School of Medicine, talks about the development of a new application that would help type II diabetes patients see just how much exercise can affect their blood glucose levels.
Interview conducted by Ivanhoe Broadcast News in December 2017.
First let’s talk about diabetes and exercise and how it affects glucose levels and quality of life?
Dr. Gibson: Exercise in both type I and type II, but we’re focusing on type II, has an immediate positive effect on glucose. Generally you see around a twenty four, twenty five percent drop in blood glucose within say a half an hour of the walk. So you have these immediate effects and then they last for several hours afterwards. Most people find one of the problems with type II diabetes is when your blood sugar is high you tend to feel very fatigued and that’s in most cases the only symptom that people with type II diabetes experience. So their quality of life is improved because when you exercise and you lower your blood sugar your energy is actually better.
Is it more difficult for a type II diabetic to get into a regular exercise routine?
Dr. Gibson: Well it all depends on the person. I don’t think there’s anything unique about type II diabetes and starting an exercise routine, it’s the same for most people; it’s hard to get into a new habit. It takes time, it takes reinforcement, it takes motivation, so I don’t think there’s really anything unless someone has complications like neuropathy or has significant arthritis or things like that it’s not any different than anyone else.
Tell me about the web study that you did, it’s very interesting.
Dr. Gibson: Yeah. Years ago I used to work in cardiac rehabilitation and so I would test people’s blood sugar before and after and show them this positive effect. And it struck me that so many people were not aware of this, they didn’t really understand it. There was this immediate positive effect that lasted for hours afterwards. So I got the idea could we use simulation to show people this on a large scale. So we created this website where people first are shown a daily glucose curve; which most people with type II diabetes they’ve never seen before, they just usually get point readings. Then we have them draw, what do you think would happen to that daily glucose curve if you were to exercise? So we get an idea of what is their baseline belief. Then we show them a simulation where they can move some sliders and they can change the time of day that they would exercise and how long they would exercise for. And then that simulation shows the expected change in the curve, then we have them draw again. There’s two ideas here, one is we want to motivate people by showing them this positive effect. That’s kind of our main interest. But also we want to measure people’s beliefs with this drawing task of them drawing what do they think would happen. What it turned out to be was that we did motivate people. People’s intentions increased, which is what we were after, which is nice. And the interesting part was that their drawings became closer to the simulation so that their beliefs became more in line with what we believed to be at least the scientific average. The average affect across people.
Did people get to comment, did you leave comments?
Dr. Gibson: We did yeah.
What was the overwhelming comment?
Dr. Gibson: We had a variety of comments but overall people were wondering when this would be released so they could play with it. There were really a lot of very positive comments about they wanted this for use in their daily lives. And a couple of more perceptive people, this is we’re showing average treatment affects across many people right but there is huge variation across people, some of the more perspective comments were things along the lines of I’d like to see this personalized to me. And so that’s where we’re going with this, we’re shooting towards integrating data from mobile sensors and what’s called a continuous glucose monitor to make this be your daily glucose curve. The truth for you not just an average and the expected effect for you based on your prior responses.
What did you find surprising from the responses from folks? From their graft?
Dr. Gibson: From the first drawing task people actually overestimated the effect, which was not what we expected. We from our own prior work and from other people’s work expected that people would underestimate and then the simulation would be bigger and then they would say, oh it’s better than I thought. But it turns out that people overestimated and we don’t know for sure. This is something we’re digging into in our future work, but we suspect that people were kind of guessing. They’re saying, oh you know they’re asking me this question it must be good so I’ll just draw something right. They had never seen a daily glucose curve; they had never done this kind of a drawing before it’s kind of a novel thing. So our expectation is that people were kind of guessing at first then they watched the simulation and then see that it is about this so that’s why their belief became closer to the simulation. We believe what we’ll do in these follow-up studies is measure how certain are you about that belief. So probably in the beginning they’re not very certain then afterwards hopefully they’re more certain.
How many folks took that?
Dr. Gibson: It was thirteen hundred and thirty five had complete data.
Where are you now doing, just crunching all that data or did you already do that?
Dr. Gibson: No all the data has all been crunched the paper written and hopefully released soon.
From here does it go straight to try to develop an app for people to make it more personal or is there more study first?
Dr. Gibson: Well frankly it’s a little bit of seeking funding to do some of this personalization, because that takes time and money to do that kind of thing. We need to collect data on a large number of people using these sensors to customize the simulations. Then based on some of the feedback we got from people in this web-based study we want to redesign the interface a little bit to make sure everyone can understand it, even people who maybe aren’t so great with numbers or their health literacy isn’t so great, or English isn’t their first language and we can translate it into other languages.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Stacy Kish
Bryan Gibson
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