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Abdelmalak N, Burns J, Suhlrie L, Laxy M, Stephan AJ. Consideration of inequalities in effectiveness trials of mHealth applications - a systematic assessment of studies from an umbrella review. Int J Equity Health 2024; 23:181. [PMID: 39261871 DOI: 10.1186/s12939-024-02267-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Accepted: 09/01/2024] [Indexed: 09/13/2024] Open
Abstract
BACKGROUND The growing use of mobile health applications (apps) for managing diabetes and hypertension entails an increased need to understand their effectiveness among different population groups. It is unclear if efficacy and effectiveness trials currently provide evidence of differential effectiveness, and if they do, a summary of such evidence is missing. Our study identified to what extent sociocultural and socioeconomic inequalities were considered in effectiveness trials of mobile health apps in diabetic and hypertensive patients and if these inequalities moderated app effectiveness. METHODS We built on our recent umbrella review that synthesized systematic reviews (SRs) of randomized controlled trials (RCTs) on the effectiveness of health apps. Using standard SR methodologies, we identified and assessed all primary RCTs from these SRs that focused on diabetes and/or hypertension and reported on health-related outcomes and inequality-related characteristics across intervention arms. We used the PROGRESS-Plus framework to define inequality-related characteristics that affect health opportunities and outcomes. We used harvest plots to summarize the subgroups (stratified analyses or interaction terms) on moderating effects of PROGRESS-Plus. We assessed study quality using the Risk of Bias 2 tool. RESULTS We included 72 published articles of 65 unique RCTs. Gender, age, and education were the most frequently described PROGRESS-Plus characteristics at baseline in more than half of the studies. Ethnicity and occupation followed in 21 and 15 RCTs, respectively. Seven trials investigated the moderating effect of age, gender or ethnicity on app effectiveness through subgroup analyses. Results were equivocal and covered a heterogenous set of outcomes. Results showed some concerns for a high risk of bias, mostly because participants could not be blinded to their intervention allocation. CONCLUSIONS Besides frequently available gender, age, and education descriptives, other relevant sociocultural or socioeconomic characteristics were neither sufficiently reported nor analyzed. We encourage researchers to investigate how these characteristics moderate the effectiveness of health apps to better understand how effect heterogeneity for apps across different sociocultural or socioeconomic groups affects inequalities, to support more equitable management of non-communicable diseases in increasingly digitalized systems. REGISTRATION https://osf.io/89dhy/ .
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Affiliation(s)
- Nancy Abdelmalak
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - Jacob Burns
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Laura Suhlrie
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Michael Laxy
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - Anna-Janina Stephan
- Professorship of Public Health and Prevention, TUM School of Medicine and Health, Technical University of Munich, Munich, Germany
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Holtz BE, Mitchell KM, Holmstrom AJ, Hershey DS, Cotten SR, Dunneback JK, Ellis DA, Wood MA. The effect of an mHealth intervention for adolescents with Type 1 diabetes and their parents. J Telemed Telecare 2024; 30:1155-1162. [PMID: 36177538 DOI: 10.1177/1357633x221125835] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Past research has demonstrated that adolescents with Type 1 diabetes (T1D) typically have a decline in health outcomes as they begin to assume more self-management activities. Mobile app interventions have been suggested as one possible way to improve this behavior. PURPOSE The primary aim of this study was to address declines in health outcomes by pilot testing the satisfaction, use and feasibility of an app-based family communication intervention aimed to assist in adolescent self-management of T1D. METHODS Thirty-three adolescent-parent pairs were enrolled in and completed the 12-week pilot study. Participants were randomized 2:1 to intervention (app use) or control group. Pre/post quantitative and qualitative data were collected, including HbA1c and surveys. Paired-sample t-tests and ANOVA statistics were conducted. RESULTS The parents and adolescents reported high satisfaction with the app, and that it was easy to use. Results showed HbA1c stability in the intervention group and significant worsening in the control group. There were also significant improvements in adherence to diabetes management and quality of life for the parents in the intervention group. The adolescents did not show any improvement in quality-of-life measures. CONCLUSION This study suggests that the app intervention is acceptable, shows promise for improving health outcomes for adolescents with T1D, and may improve family communication. The public health implications of this work are that app interventions have a potential role in positively influencing chronic disease outcomes. Additional research with a more extensive and diverse sample is needed to determine generalizability.
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Affiliation(s)
- Bree E Holtz
- Department of Advertising & Public Relations, Michigan State University, East Lansing, MI, USA
| | - Katharine M Mitchell
- Department of Advertising & Public Relations, Michigan State University, East Lansing, MI, USA
| | - Amanda J Holmstrom
- Department of Communication, Michigan State University, East Lansing, MI, USA
| | - Denise S Hershey
- College of Nursing, Michigan State University, East Lansing, MI, USA
| | | | | | - Deborah A Ellis
- Department of Family Medicine, Wayne State University, Detroit, MI, USA
| | - Michael A Wood
- Pediatric Endocrinology, University of Michigan Medical School, Ann Arbor, MI, USA
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3
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Zhang WH, Wang CF, Wang H, Tang J, Zhang HQ, Zhu JY, Zheng XY, Luo SH, Ding Y. Association between glucose levels of children with type 1 diabetes and parental economic status in mobile health application. World J Diabetes 2024; 15:1477-1488. [PMID: 39099806 PMCID: PMC11292339 DOI: 10.4239/wjd.v15.i7.1477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/25/2024] [Accepted: 05/20/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND The glycemic control of children with type 1 diabetes (T1D) may be influenced by the economic status of their parents. AIM To investigate the association between parental economic status and blood glucose levels of children with T1D using a mobile health application. METHODS Data from children with T1D in China's largest T1D online community, Tang-TangQuan®. Blood glucose levels were uploaded every three months and parental economic status was evaluated based on annual household income. Children were divided into three groups: Low-income (< 30000 Yuan), middle-income (30000-100000 Yuan), and high-income (> 100000 yuan) (1 Yuan = 0.145 United States Dollar approximately). Blood glucose levels were compared among the groups and associations were explored using Spearman's correlation analysis and multivariable logistic regression. RESULTS From September 2015 to August 2022, 1406 eligible children with T1D were included (779 female, 55.4%). Median age was 8.1 years (Q1-Q3: 4.6-11.6) and duration of T1D was 0.06 years (0.02-0.44). Participants were divided into three groups: Low-income (n = 320), middle-income (n = 724), and high-income (n = 362). Baseline hemoglobin A1c (HbA1c) levels were comparable among the three groups (P = 0.072). However, at month 36, the low-income group had the highest HbA1c levels (P = 0.036). Within three years after registration, glucose levels increased significantly in the low-income group but not in the middle-income and high-income groups. Parental economic status was negatively correlated with pre-dinner glucose (r = -0.272, P = 0.012). After adjustment for confounders, parental economic status remained a significant factor related to pre-dinner glucose levels (odds ratio = 13.02, 95%CI: 1.99 to 126.05, P = 0.002). CONCLUSION The blood glucose levels of children with T1D were negatively associated with parental economic status. It is suggested that parental economic status should be taken into consideration in the management of T1D for children.
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Affiliation(s)
- Wen-Hao Zhang
- Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Chao-Fan Wang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510000, Guangdong Province, China
| | - Hao Wang
- Graduate School, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Jie Tang
- Graduate School, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Hong-Qiang Zhang
- Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Jiang-Yu Zhu
- Graduate School, Bengbu Medical College, Bengbu 233000, Anhui Province, China
| | - Xue-Ying Zheng
- Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Si-Hui Luo
- Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Yu Ding
- Department of Endocrinology, The First Affiliated Hospital of University of Science and Technology of China, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
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Hölgyesi Á, Luczay A, Tóth-Heyn P, Muzslay E, Világos E, Szabó AJ, Baji P, Kovács L, Gulácsi L, Zrubka Z, Péntek M. The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study. JMIR Pediatr Parent 2024; 7:e54807. [PMID: 38506893 PMCID: PMC10993131 DOI: 10.2196/54807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents' skills to deal with electronic health information sources. OBJECTIVE We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children's outcomes. METHODS A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents' electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children's treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c. RESULTS Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents' average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children's treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=-0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children's HbA1c (r=-0.143; P=.08), PedsQL Diab (r=-0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=-0.13; P=.12). Regression analysis revealed significant associations of the child's HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=-0.66; P=.03; pump + sensor: β=-0.93; P=.007), and parents' self-efficacy (PSESDM; β=-0.08; P=.001). CONCLUSIONS Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents' diabetes management attitude but not with the child's glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.
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Affiliation(s)
- Áron Hölgyesi
- Doctoral School, Semmelweis University, Budapest, Hungary
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Andrea Luczay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | | | - Eszter Muzslay
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Eszter Világos
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Attila J Szabó
- Pediatric Center, Semmelweis University, Budapest, Hungary
| | - Petra Baji
- Musculoskeletal Research Unit, University of Bristol, Bristol, United Kingdom
| | - Levente Kovács
- Physiological Controls Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - László Gulácsi
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Zsombor Zrubka
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
| | - Márta Péntek
- Health Economics Research Center, University Research and Innovation Center, Óbuda University, Budapest, Hungary
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Whitehead L, Robinson S, Arabiat D, Jenkins M, Morelius E. The Report of Access and Engagement With Digital Health Interventions Among Children and Young People: Systematic Review. JMIR Pediatr Parent 2024; 7:e44199. [PMID: 38231560 PMCID: PMC10831666 DOI: 10.2196/44199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 06/06/2023] [Accepted: 11/29/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Digital health interventions are increasingly used to deliver health-related interventions for children and young people to change health behaviors and improve health outcomes. Digital health interventions have the potential to enhance access to and engagement with children and young people; however, they may also increase the divide between those who can access technology and are supported to engage and those who are not. This review included studies that reported on the access to or engagement with digital health interventions among children and young people. OBJECTIVE This review aims to identify and report on access and engagement in studies involving digital health interventions among children and young people. METHODS A systematic review following the Joanna Briggs Institute methods for conducting systematic reviews was conducted. An electronic literature search was conducted for all studies published between January 1, 2010, and August 2022, across sources, including MEDLINE, CINAHL, and PsycINFO. Studies were included if they examined any aspect of access or engagement in relation to interventions among children and young people. The quality of the included papers was assessed, and data were extracted. Data were considered for meta-analysis, where possible. RESULTS A total of 3292 references were identified using search terms. Following the exclusion of duplicates and review by inclusion criteria, 40 studies were independently appraised for their methodological quality. A total of 16 studies were excluded owing to their low assessed quality and flawed critical elements in the study design. The studies focused on a variety of health conditions; type 1 diabetes, weight management and obesity, mental health issues, and sexual health were the predominant conditions. Most studies were conducted in developed countries, with most of them being conducted in the United States. Two studies reported data related to access and considered ethnicity and social determinants. No studies used strategies to enhance or increase access. All studies included in the review reported on at least 1 aspect of engagement. Engagement with interventions was measured in relation to frequency of engagement, with no reference to the concept of effective engagement. CONCLUSIONS Most digital health interventions do not consider the factors that can affect access and engagement. Of those studies that measured either access or engagement or both, few sought to implement strategies to improve access or engagement to address potential disparities between groups. Although the literature to date provides some insight into access and engagement and how these are addressed in digital health interventions, there are major limitations in understanding how both can be enhanced to promote equity. Consideration of both access and engagement is vital to ensure that children and young people have the ability to participate in studies. TRIAL REGISTRATION PROSPERO CRD42020170874; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=170874.
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Affiliation(s)
- Lisa Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
- The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Suzanne Robinson
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- The Centre for Evidence Informed Nursing, Midwifery and Healthcare Practice, Joondalup, Australia
| | - Diana Arabiat
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Maternal and Child Nursing Department, Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Mark Jenkins
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Evalotte Morelius
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
- Australian Research Council Centre of Excellence for the Digital Child, Joondalup, Australia
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Holtz BE, Mitchell K. Best Practices for Developing a Diabetes mHealth App. J Diabetes Sci Technol 2024; 18:39-45. [PMID: 37644831 PMCID: PMC10899849 DOI: 10.1177/19322968231195849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
The widespread use of smartphones in the United States has led to a surge in mHealth apps designed to support people with various health issues. Yet the effectiveness and long-term impacts of these apps still need to be determined. This article presents a case study of the development of MyT1DHero, an mHealth app for people with type 1 diabetes, to identify best practices for app development. We propose four essential best practices based on the insights gained from this case study: incorporating theoretical frameworks, prioritizing user feedback, engaging key stakeholders, and establishing a robust data-collection foundation. These findings have practical implications for researchers and developers seeking to create effective mHealth interventions. Furthermore, we suggest future research directions to advance the development and implementation of innovative health technologies.
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Affiliation(s)
- Bree E. Holtz
- Department of Advertising and
Public Relations, Michigan State University, East Lansing, MI, USA
| | - Katharine Mitchell
- Department of Advertising and
Public Relations, Michigan State University, East Lansing, MI, USA
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Pan L, Yeung NCY. Positive Psychology Interventions for Improving Self-management Behaviors in Patients with Type 1 and Type 2 Diabetes: a Narrative Review of Current Evidence. Curr Diab Rep 2023; 23:329-345. [PMID: 37910312 DOI: 10.1007/s11892-023-01525-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE OF REVIEW Interests have been emerging in using positive psychology interventions (PPIs) to improve diabetes self-management (DSM) behaviors (e.g., blood glucose monitoring, physical activity). To explore the impact of those interventions on DSM behaviors, we summarized the evidence of PPIs on self-management behaviors among both type 1 diabetes (T1D) and type 2 diabetes (T2D) patients between 2012 and 2022. RECENT FINDINGS Among the eight studies identified, different study designs and types of PPIs were apparent. Typical PPIs (e.g., activities enhancing positive affect/gratitude/self-affirmation/optimism) were usually applied to T1D patients (N = 5); PPIs were usually combined with motivational interviewing for T2D patients (N = 3). Contrary to expectations, PPIs did not consistently demonstrate positive effects on self-management behaviors' change regardless of the types of diabetes patients, compared to the control groups. Improvements in diabetes patients' self-management behaviors from PPIs are still unclear. Future studies should more rigorously evaluate and identify the active ingredients of PPIs for behavioral changes among diabetes patients.
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Affiliation(s)
- Lihua Pan
- JC School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Nelson C Y Yeung
- JC School of Public Health and Primary Care, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, School of Medicine, The Chinese University of Hong Kong, Hong Kong, Hong Kong.
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LeStourgeon L, Bergner E, Datye K, Streisand R, Jaser S. Evaluation of Study Engagement With an mHealth Intervention (THR1VE) to Treat Diabetes Distress in Teens With Type 1 Diabetes: Randomized Clinical Trial. JMIR Pediatr Parent 2023; 6:e47089. [PMID: 37800881 PMCID: PMC10594399 DOI: 10.2196/47089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 10/07/2023] Open
Abstract
Background Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. Objective This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. Methods Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. Results Adolescents in both groups reported high levels of satisfaction with the study, with 95% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5% of intervention messages, and their caregivers responded to 88.5% of messages. There were no significant differences in rates of engagement related to adolescents' sex, age, device use, or race/ethnicity. Conclusions A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination.
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Affiliation(s)
- Lauren LeStourgeon
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Erin Bergner
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Karishma Datye
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Randi Streisand
- Department of Pyschology and Behavioral Health, Children's National Hospital, WashingtonDC, United States
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, WashingtonDC, United States
| | - Sarah Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
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Pi L, Shi X, Wang Z, Zhou Z. Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis. Front Public Health 2023; 11:1074946. [PMID: 37064701 PMCID: PMC10097897 DOI: 10.3389/fpubh.2023.1074946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesAchieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.ResultsOf 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).ConclusionThe current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.
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Wang J, Wu W, Dong G, Huang K, Fu J. Pediatric diabetes in China: Challenges and actions. Pediatr Diabetes 2022; 23:545-550. [PMID: 35419896 DOI: 10.1111/pedi.13344] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 03/05/2022] [Accepted: 04/11/2022] [Indexed: 11/26/2022] Open
Abstract
Pediatric diabetes is growing in China. The annual incidence of childhood type 1 diabetes is about 2.02-5.3 per 100,000 person-years. Type 2 diabetes in children and adolescents is increasing dramatically with the high-speed urbanization of China. The prevalence of type 2 diabetes varies from 1.64/100, 000 to 15.16/100,000 based on the geography and economy. Monogenic diabetes used to be underestimated in China and now more cases are emerging. In this review, we give an overview of pediatric diabetes in China, present the progresses and challenges in management of pediatric diabetes, and discuss the government policy and potential actions in China, for better life quality of diabetic families.
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Affiliation(s)
- Jinling Wang
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Wei Wu
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Guanping Dong
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Ke Huang
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Junfen Fu
- Department of Endocrinology, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
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Bergmame L, Shaw S. Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review. CONTINUITY IN EDUCATION 2021; 2:76-108. [PMID: 38774890 PMCID: PMC11104390 DOI: 10.5334/cie.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 04/03/2021] [Indexed: 05/24/2024]
Abstract
Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.
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