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Mori H, Taniguchi S, Tamaki Y, Tamaki M, Akehi Y, Kuroda A, Matsuhisa M. Telenutrition Education Is Effective for Glycemic Management in People with Type 2 Diabetes Mellitus: A Non-Inferiority Randomized Controlled Trial in Japan. Nutrients 2024; 16:268. [PMID: 38257162 PMCID: PMC10819819 DOI: 10.3390/nu16020268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/06/2024] [Accepted: 01/14/2024] [Indexed: 01/24/2024] Open
Abstract
This study examined the non-inferior efficacy of telenutrition education compared with face-to-face nutrition education in managing glycemic control in people with type 2 diabetes mellitus (T2DM). Participants had T2DM and a glycated hemoglobin (HbA1c) ranged 6.5-9.5%. Thirty participants were randomly assigned to either the telenutrition or face-to-face nutrition education group. During the 32-week intervention period, the participants received four sessions on nutrition education from a registered dietitian at the hospital. The telenutrition group received remote education via a videoconferencing platform. Face-to-face nutrition education was conducted using paper-based instructions. The main outcome measure was the non-inferiority of HbA1c levels in the telenutrition group compared to the face-to-face nutrition group. The non-inferiority of telenutrition education was considered valid if the intergroup difference in the mean values of the change in HbA1c had a bilateral 95% confidence interval (CI) upper limit below 0.40%. The intergroup difference in the mean HbA1c change from baseline to the fourth nutrition education session was -0.11 (95% CI -0.54-0.32) for both groups. The upper limit of the bilateral 95% CI was 0.32%, which was below the 0.40% non-inferiority margin (non-inferiority test; p = 0.011). Telenutrition education was not inferior to face-to-face nutrition education for glycemic management in people with T2DM.
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Affiliation(s)
- Hiroyasu Mori
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Satoshi Taniguchi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yu Tamaki
- Medical IT Center, Tokushima University Hospital, 2-50-1 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Motoyuki Tamaki
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Yuko Akehi
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, 3-18-15 Kuramoto-cho, Tokushima 770-8503, Japan
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De Luca V, Bozzetto L, Giglio C, Tramontano G, De Simone G, Luciano A, Lucibelli L, Maffettone A, Riccio M, Romano G, Rossi E, Chiatti CJ, Berler A, Iaccarino G, Illario M, Annuzzi G. Clinical outcomes of a digitally supported approach for self-management of type 2 diabetes mellitus. Front Public Health 2023; 11:1219661. [PMID: 37663860 PMCID: PMC10469625 DOI: 10.3389/fpubh.2023.1219661] [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: 05/18/2023] [Accepted: 08/07/2023] [Indexed: 09/05/2023] Open
Abstract
Background Self-management of Type 2 diabetes mellitus (T2D) is challenging. Regular self-monitoring of blood glucose and healthy lifestyles are required to improve glycometabolic control, thus delaying diabetes complications, and reducing hospitalizations. Digital technologies can empower patients in their disease management promoting self-management and motivation to change behaviors. We report the results of an exploratory trial aimed at evaluating the metabolic outcomes of using digital solutions for T2D self-management developed in the ProEmpower project, a European Commission funded Pre-Commercial Procurement. Methods Two digital solutions, DM4All and DiaWatch, which were codesigned with providers, patients, and caregivers, enabled the collection of clinical parameters by the patient using a smartphone integrated with the medical devices (glucometer, sphygmomanometer, scale, smart watch for heart rate monitoring and step counter). Data were automatically sent to the shared care plan allowing professionals to monitor adherence to treatment, set goals, and communicate more effectively with patients. At baseline and after an average follow-up of 8 months, glycosylated hemoglobin (HbA1c), body weight, blood pressure, and blood lipids were measured in 100 T2D patients using the ProEmpower solutions across different diabetes centers in Campania Region, age 45-79 years, both genders, and compared with a Control cohort of T2D patients (n = 100) with similar clinical characteristics and followed for a comparable period of observation in the same centers. Results At baseline, the ProEmpower participants and the Control subjects were on average overweight, with a similar BMI in the two cohorts, and mean HbA1c was at acceptable levels (around 7.0%). After the 8 month exploratory trial, body weight, HbA1c, systolic and diastolic blood pressure, and plasma and LDL-cholesterol significantly decreased in the ProEmpower participants compared to baseline (p < 0.05 for all). The changes in systolic and diastolic blood pressure, and plasma and LDL-cholesterol were significantly different from those observed in the Control cohort (p < 0.05 for all). Conclusion This pilot study showed positive effects on metabolic outcomes relevant to cardiovascular risk in T2D of adopting digital telemedicine self-monitoring solutions based on automation of measurements and coaching on healthy lifestyles promotion.
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Affiliation(s)
- Vincenzo De Luca
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
- Dipartimento Assistenziale Integrato di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Lutgarda Bozzetto
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Clemente Giglio
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Giovanni Tramontano
- Unità Operativa Semplice Ricerca e Sviluppo, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | | | | | | | - Ada Maffettone
- Azienda Ospedaliera di Rilievo Nazionale dei Colli, Naples, Italy
| | | | | | - Ernesto Rossi
- Azienda Sanitaria Locale Benevento, Benevento, Italy
| | | | | | - Guido Iaccarino
- Dipartimento Assistenziale Integrato di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Dipartimento di Scienze Biomediche Avanzate, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Maddalena Illario
- Dipartimento di Sanità Pubblica, Università degli Studi di Napoli Federico II, Naples, Italy
- Dipartimento Assistenziale Integrato di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Giovanni Annuzzi
- Dipartimento Assistenziale Integrato di Endocrinologia, Diabetologia, Andrologia e Nutrizione, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Dipartimento di Medicina Clinica e Chirurgia, Università degli Studi di Napoli Federico II, Naples, Italy
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Ju HH, Momin R, Cron S, Jularbal J, Alford J, Johnson C. A Nurse-Led Telehealth Program for Diabetes Foot Care: Feasibility and Usability Study. JMIR Nurs 2023; 6:e40000. [PMID: 37279046 DOI: 10.2196/40000] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 03/14/2023] [Accepted: 04/30/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Diabetes mellitus can lead to severe and debilitating foot complications, such as infections, ulcerations, and amputations. Despite substantial progress in diabetes care, foot disease remains a major challenge in managing this chronic condition that causes serious health complications worldwide. OBJECTIVE The primary aim of this study was to examine the feasibility and usability of a telehealth program focused on preventive diabetes foot care. A secondary aim was to descriptively measure self-reported changes in diabetes knowledge, self-care, and foot care behaviors before and after participating in the program. METHODS The study used a single-arm, pre-post design in 2 large family medical practice clinics in Texas. Participants met individually with the nurse practitioner once a month for 3 months using synchronous telehealth videoconferencing. Each participant received diabetes foot education guided by the Integrated Theory of Health Behavior Change. Feasibility was measured with rates of enrollment and program and assessment completion. Usability was measured with the Telehealth Usability Questionnaire. Diabetes knowledge, self-care, and foot care behaviors were measured with validated survey instruments at baseline, 1.5 months, and 3 months. RESULTS Of 50 eligible individuals, 39 (78%) enrolled; 34 of 39 (87%) completed the first videoconference and 29 of 39 (74%) completed the second and third videoconferences. Of the 39 who consented, 37 (95%) completed the baseline assessment; 50% (17/34) of those who attended the first videoconference completed the assessment at 1.5 months, and 100% (29/29) of those who attended the subsequent videoconferences completed the final assessment. Overall, participants reported a positive attitude toward the use of telehealth, with a mean Telehealth Usability Questionnaire score of 6.24 (SD 0.98) on a 7-point scale. Diabetes knowledge increased by a mean of 15.82 (SD 16.69) points of 100 (P<.001) from baseline to 3 months. The values for the Summary of Diabetes Self-Care Activities measure demonstrated better self-care, with participants performing foot care on average 1.74 (SD 2.04) more days per week (P<.001), adhering to healthy eating habits on average 1.57 (SD 2.12) more days per week (P<.001), and being physically active on average 1.24 (SD 2.21) more days per week (P=.005). Participants also reported an improvement in the frequency of foot self-examinations and general foot care behaviors. The mean scores for foot care increased by a mean of 7.65 (SD 7.04) points (scale of 7 to 35) from baseline to 3 months postintervention (P<.001). CONCLUSIONS This study demonstrates that a nurse-led telehealth educational program centered on diabetes foot care is feasible, acceptable, and has the potential to improve diabetes knowledge and self-care, which are precursors to preventing debilitating foot complications.
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Affiliation(s)
- Hsiao-Hui Ju
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Rashmi Momin
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Stanley Cron
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
| | - Jed Jularbal
- Affiliates of Family Medicine, Spring, TX, United States
| | - Jeffery Alford
- Sweetwater Medical Associates, Sugar Land, TX, United States
| | - Constance Johnson
- The University of Texas Health Science Center at Houston Cizik School of Nursing, Houston, TX, United States
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Cole MB, Jones N, Lee EK, Kim JH. The Association of Telehealth Availability and Quality of Care Measures for Patients With Diabetes at Federally Qualified Health Centers: Retrospective Cohort Study. J Med Internet Res 2023; 25:e40827. [PMID: 36862476 PMCID: PMC10020900 DOI: 10.2196/40827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 01/20/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Affiliation(s)
- Megan B Cole
- Boston University School of Public Health, Boston, MA, United States
| | - Nicholas Jones
- Brown University School of Public Health, Providence, RI, United States
| | - Eun Kyung Lee
- Boston University School of Public Health, Boston, MA, United States
| | - June-Ho Kim
- Ariadne Labs, Harvard T H Chan School of Public Health, Boston, MA, United States.,Division of General Internal Medicine & Primary Care, Brigham and Women's Hospital, Boston, MA, United States
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Agastiya IMC, Kurianto E, Akalili H, Wicaksana AL. The impact of telehealth on self-management of patients with type 2 diabetes: A systematic review on interventional studies. Diabetes Metab Syndr 2022; 16:102485. [PMID: 35512521 DOI: 10.1016/j.dsx.2022.102485] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/29/2022] [Accepted: 04/10/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND AND AIMS Self-management is critical to manage the glycemic and metabolic outcomes for patients with diabetes. Telehealth applications are recognized as a potential approach to promote self-management of people with type 2 diabetes. This study aimed to investigate the impact of telehealth on self-management among patients with type 2 diabetes. METHODS A systematic review was conducted on several databases, including PubMed, EbscoHost Medline, and Science Direct, with the keywords: Diabetes Mellitus AND Mobile-phone based OR Telemedicine OR Telehealth OR Web-based OR Telenursing AND Self-management. Inclusion criteria were articles with type 2 diabetic respondents, published between 2015 and 2020, open-access articles, and had self-management as outcomes. Hence, qualitative, protocol, or review articles, commentaries, letters to editors, and case study/reports were excluded. The Joanna Briggs Institute critical appraisal tools and Cochrane collaboration's tools were used for assessing risk of bias. RESULTS The total of six studies were included in the qualitative synthesis, with five randomized control trials and one cross-sectional study. Telehealth applications were formed as an online or app-based platform with the key features of educational programs, text or voice messages, consultations and counseling, and active participation of the subjects. Besides improving the self-management outcomes, the telehealth also indicated improvements in positive behaviors, attitudes, and the intention of self-management. CONCLUSION The study concluded that implementation of telehealth provided positive self-management results among patients with type 2 diabetes. The users need to consider an intensive training, peer or family support, and provision of full support for the patients during the implementation of telehealth.
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Affiliation(s)
| | - Endar Kurianto
- Master Program in Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Hanifati Akalili
- Master Program in Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
| | - Anggi Lukman Wicaksana
- Department of Medical Surgical Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia; The Sleman Health and Demographic Surveillance System, Universitas Gadjah Mada, Yogyakarta, Indonesia; School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan, ROC.
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