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The behaviour change behind a successful pilot of hypoglycaemia reduction with HYPO-CHEAT
Chris Worth1,2, Paul W Nutter1, Maria Salomon-Estebanez2
1Department of Computer Science, University of Manchester, Manchester, UK.
Insights
This study introduces HYPO-CHEAT, a novel technology using continuous glucose monitoring data to help children with congenital hyperinsulinism (CHI) proactively prevent hypoglycemia. The approach successfully reduced hypoglycemia by linking glucose patterns to behavior, enabling personalized prevention strategies.
Area of Science:
- Pediatric Endocrinology
- Behavioral Science
- Health Informatics
Background:
- Congenital hyperinsulinism (CHI) poses a constant risk of hypoglycemia and potential brain injury in children.
- Current hypoglycemia management relies on reactive measures and has limited success with machine learning (ML) forecasting due to overlooking behavioral factors.
- Persuasive technology (PT) offers a promising avenue for theory-informed, technologically advanced hypoglycemia prevention.
Purpose of the Study:
- To develop a PT intervention to proactively prevent hypoglycemia in children with CHI.
- To address barriers in current hypoglycemia management by shifting from reactive to proactive strategies.
Main Methods:
- Developed HYPO-CHEAT (HYpoglycaemia-Prevention-thrOugh-Cgm-HEatmap-Assisted-Technology), utilizing behavior change techniques and persuasive systems design.
- Aggregated continuous glucose monitoring (CGM) data into easily interpretable visualizations to facilitate behavior change.
- Piloted HYPO-CHEAT in 10 pediatric patients with CHI over 12 weeks.
Main Results:
- Successfully identified weekly hypoglycemia patterns correlated with specific behaviors.
- Observed a significant reduction in aggregated hypoglycemia from 7.1% to 5.4%.
- Four out of five patients demonstrated clinically meaningful reductions in hypoglycemia, with changes in fingerprick behavior.
Conclusions:
- HYPO-CHEAT represents a novel, personalized approach to proactive hypoglycemia prevention in children with CHI.
- This technology-driven, behavior-focused strategy marks a significant step forward in managing hypoglycemia in this vulnerable population.
Background:
Children with hypoglycaemia disorders, such as congenital hyperinsulinism (CHI), are at constant risk of hypoglycaemia (low blood sugars) with the attendant risk of brain injury. Current approaches to hypoglycaemia detection and prevention vary from fingerprick glucose testing to the provision of continuous glucose monitoring (CGM) to machine learning (ML) driven glucose forecasting. Recent trends for ML have had limited success in preventing free-living hypoglycaemia, due to a focus on increasingly accurate glucose forecasts and a failure to acknowledge the human in the loop and the essential step of changing behaviour. The wealth of evidence from the fields of behaviour change and persuasive technology (PT) allows for the creation of a theory-informed and technologically considered approach.
Objectives:
We aimed to create a PT that would overcome the identified barriers to hypoglycaemia prevention for those with CHI to focus on proactive prevention rather than commonly used reactive approaches.
Methods:
We used the behaviour change technique taxonomy and persuasive systems design models to create HYPO-CHEAT (HYpoglycaemia-Prevention-thrOugh-Cgm-HEatmap-Assisted-Technology): a novel approach that presents aggregated CGM data in simple visualisations. The resultant ease of data interpretation is intended to facilitate behaviour change and subsequently reduce hypoglycaemia.
Results:
HYPO-CHEAT was piloted in 10 patients with CHI over 12 weeks and successfully identified weekly patterns of hypoglycaemia. These patterns consistently correlated with identifiable behaviours and were translated into both a change in proximal fingerprick behaviour and ultimately, a significant reduction in aggregated hypoglycaemia from 7.1% to 5.4% with four out of five patients showing clinically meaningful reductions in hypoglycaemia.
Conclusions:
We have provided pilot data of a new approach to hypoglycaemia prevention that focuses on proactive prevention and behaviour change. This approach is personalised for individual patients with CHI and is a first step in changing our approach to hypoglycaemia prevention in this group.
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