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Park S, Lee H, Cho W, Woo HG, Lim H, Kim S, Rhee SY, Yon DK. Efficacy of information and communication technology interventions for the management of diabetes mellitus: An umbrella review and evidence map. Obes Rev 2024; 25:e13714. [PMID: 38350665 DOI: 10.1111/obr.13714] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 01/05/2024] [Accepted: 01/07/2024] [Indexed: 02/15/2024]
Abstract
INTRODUCTION We validated the quality of evidence and potential benefits of information and communication technology interventions on diabetes-related health outcomes. METHODS We systematically searched PubMed/MEDLINE, Embase, Google Scholar, and CINAHL and manually searched the reference lists of the retrieved review articles from each database's inception to October 2022. Randomized controlled trials were included to determine the benefits of information and communication technology interventions on diabetes outcomes. RESULTS Ten meta-analyses of randomized controlled trials were included, with 37 unique outcomes encompassing 379 studies and >70,000 participants across 47 countries and six continents. Information and communication technology intervention was associated with reduced HbA1c levels in patients with type 1 (moderate certainty), type 2 (moderate certainty), and gestational diabetes (low certainty) and showed potential benefits for type 2 diabetes, demonstrating a reduction in systolic blood pressure (high certainty), low-density lipoprotein cholesterol (low certainty), and body weight (low certainty), whereas those for gestational diabetes demonstrated a reduction in fasting (low certainty) and 2-h postprandial blood glucose levels (low certainty). CONCLUSION This umbrella review and evidence map revealed varying evidence on the potential benefits of information and communication technology interventions for diabetes-related outcomes. Our results demonstrate these interventions to be novel treatment options for policymakers and physicians to establish personalized health strategies.
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Affiliation(s)
- Sangil Park
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Neurology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, South Korea
| | - Hyeri Lee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
| | - Wonyoung Cho
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyunjung Lim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Medical Nutrition, Graduate School of East-West Medical Science, Kyung Hee University, Yongin, South Korea
| | - Sunyoung Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Family Medicine, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, Seoul, South Korea
- Department of Regulatory Science, Kyung Hee University, Seoul, South Korea
- Department of Pediatrics, Kyung Hee University College of Medicine, Seoul, South Korea
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Schubert TJ, Clegg K, Karalis D, Desai NR, Marrs JC, McNeal C, Mintz GL, Romagnoli KM, Jones LK. Impact of telehealth on the current and future practice of lipidology: a scoping review. J Clin Lipidol 2023; 17:40-54. [PMID: 36577629 PMCID: PMC9757920 DOI: 10.1016/j.jacl.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/15/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
Telehealth services have been implemented to deliver care for patients living with many chronic conditions and have expanded greatly during the COVID-19 pandemic. Little is known about the current or future impacts of telehealth on lipid management practices. The PubMed database was searched from inception to June 25, 2021, with the keywords "lipids or cholesterol" and "telehealth," which yielded 376 published articles. Telehealth was defined as a synchronous visit between a patient and clinician that replaced an in-office appointment. Studies that solely used remote monitoring, mobile health technologies, or callbacks of results, were excluded. Articles must have measured lipid values. Review articles and protocol papers were not included. After evaluation, 128 abstracts were included for full text evaluation, with 55 full-text articles eventually included. Of the articles, 29 were randomized clinical trials, 15 were pre-post evaluations, and 11 were other study designs. Telehealth had positive to neutral impacts on lipid management. Reported facilitators include easier implementation of multidisciplinary approaches to care, and utilization of patient-centered programs. Reported barriers to telehealth services include technological barriers, such as various skill levels with technology; systems barriers, such as cost and reimbursement; patient-related barriers, including patient non-adherence; and clinician-related barriers, such as difficulty standardizing care. Clinicians reported improved satisfaction among patients but had mixed feelings regarding their ability to deliver quality care. Telemedicine use to provide care for individuals with lipid conditions has expanded during the COVID-19 pandemic, but more research is needed to determine its potential as a sustainable tool for lipid management.
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Affiliation(s)
- Tyler J Schubert
- Department of Genomic Health, Geisinger, Danville, PA, 17822; Geisinger Commonwealth School of Medicine, Scranton, PA, 18510
| | - Katarina Clegg
- Department of Genomic Health, Geisinger, Danville, PA, 17822; Geisinger Commonwealth School of Medicine, Scranton, PA, 18510
| | - Dean Karalis
- Division of Cardiology, Thomas Jefferson University Hospital
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine
| | - Joel C Marrs
- Department of Pediatrics, University of Colorado School of Medicine
| | - Catherine McNeal
- Division of Cardiology, Baylor Scott & White Health, Temple, TX, 76502
| | - Guy L Mintz
- Director of Cardiovascular Health & Lipidology, Sandra Atlas Bass Heart Hospital, North Shore University Hospital
| | - Katrina M Romagnoli
- Department of Translational Data Science and Informatics, Geisinger, Danville, PA, 17822
| | - Laney K Jones
- Department of Genomic Health, Geisinger, Danville, PA, 17822; Heart and Vascular Institute, Geisinger, Danville, PA, 17822.
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Chai S, Wang D, Yao B, Xu L, Ji L, Zhang X. The effect of education and mobile health management on improvement of blood glucose with type 2 diabetes mellitus. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01210-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Parise M, Tartaglione L, Cutruzzolà A, Maiorino MI, Esposito K, Pitocco D, Gnasso A, Irace C. Teleassistance for Patients With Type 1 Diabetes During the COVID-19 Pandemic: Results of a Pilot Study. J Med Internet Res 2021; 23:e24552. [PMID: 33769945 PMCID: PMC8025914 DOI: 10.2196/24552] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 12/29/2020] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Background Telemedicine use in chronic disease management has markedly increased during health emergencies due to COVID-19. Diabetes and technologies supporting diabetes care, including glucose monitoring devices, software analyzing glucose data, and insulin delivering systems, would facilitate remote and structured disease management. Indeed, most of the currently available technologies to store and transfer web-based data to be shared with health care providers. Objective During the COVID-19 pandemic, we provided our patients the opportunity to manage their diabetes remotely by implementing technology. Therefore, this study aimed to evaluate the effectiveness of 2 virtual visits on glycemic control parameters among patients with type 1 diabetes (T1D) during the lockdown period. Methods This prospective observational study included T1D patients who completed 2 virtual visits during the lockdown period. The glucose outcomes that reflected the benefits of the virtual consultation were time in range (TIR), time above range, time below range, mean daily glucose, glucose management indicator (GMI), and glycemic variability. This metric was generated using specific computer programs that automatically upload data from the devices used to monitor blood or interstitial glucose levels. If needed, we changed the ongoing treatment at the first virtual visit. Results Among 209 eligible patients with T1D, 166 completed 2 virtual visits, 35 failed to download glucose data, and 8 declined the visit. Among the patients not included in the study, we observed a significantly lower proportion of continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) users (n=7/43, 16% vs n=155/166, 93.4% and n=9/43, 21% vs n=128/166, 77.1%, respectively; P<.001) compared to patients who completed the study. TIR significantly increased from the first (62%, SD 18%) to the second (65%, SD 16%) virtual visit (P=.02); this increase was more marked among patients using the traditional meter (n=11; baseline TIR=55%, SD 17% and follow-up TIR=66%, SD 13%; P=.01) than among those using CGM, and in those with a baseline GMI of ≥7.5% (n=46; baseline TIR=45%, SD 15% and follow-up TIR=53%, SD 18%; P<.001) than in those with a GMI of <7.5% (n=120; baseline TIR=68%, SD 15% and follow-up TIR=69%, SD 15%; P=.98). The only variable independently associated with TIR was the change of ongoing therapy. The unstandardized beta coefficient (B) and 95% CI were 5 (95% CI 0.7-8.0) (P=.02). The type of glucose monitoring device and insulin delivery systems did not influence glucometric parameters. Conclusions These findings indicate that the structured virtual visits help maintain and improve glycemic control in situations where in-person visits are not feasible.
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Affiliation(s)
- Martina Parise
- Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy
| | | | - Antonio Cutruzzolà
- Department of Experimental and Clinical Medicine, University Magna Graecia Catanzaro, Catanzaro, Italy
| | - Maria Ida Maiorino
- Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy
| | - Katherine Esposito
- Department of Advanced Medical and Surgical Science, University Vanvitelli, Napoli, Naples, Italy
| | | | - Agostino Gnasso
- Department of Advanced Medical and Surgical Science, University Magna Graecia Catanzaro, Naples, Italy
| | - Concetta Irace
- Department of Health Science, University Magna Graecia Catanzaro, Catanzaro, Italy
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[Telemedicine satisfaction of primary care patients during COVID-19 pandemics]. Semergen 2021; 47:248-255. [PMID: 33781673 PMCID: PMC7951945 DOI: 10.1016/j.semerg.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 11/26/2022]
Abstract
Objetivo Evaluar el grado de satisfacción de los pacientes con la telemedicina durante la pandemia de la COVID-19 en la Unidad de Salud Familiar Vitrius. Este trabajo podría obtener información sobre la aceptación de la teleconsulta (TC). Material y métodos Estudio transversal con 253 individuos. Se realizó un cuestionario mediante escala Likert (entre 1-nada satisfecho a 5-totalmente satisfecho) en pacientes con diabetes, hipertensión y en sujetos con otras patologías, entre el primero de abril del 2020 y el primero de mayo de ese mismo año. Se recopilaron datos sociodemográficos, citas previas de telemedicina, niveles de satisfacción con la TC y de aclaración de dudas e interés en un mayor seguimiento de telemedicina. Además, se realizó un análisis comparativo entre los períodos de enero-febrero y abril-mayo de 2020 en relación con la edad, el sexo, la hipertensión arterial (HTA), la diabetes mellitus (DM) y el tipo de contacto (presencial o telemático). Las estadísticas se realizaron con el SPSS® y Excel®. Resultados y discusión Las consultas de seguimiento de diabetes representaron el 34,4% del total. Mayoritariamente hubo un alto nivel de satisfacción e interés en el seguimiento futuro con telemedicina. Sin embargo, los individuos diabéticos y mayores estaban menos interesados en este tipo de seguimiento. Se encontraron diferencias estadísticamente significativas en satisfacción para la edad, sexo y presencia/ausencia de diabetes. El 70,6% de los pacientes sanos prefirió el contacto por correo electrónico al teléfono. Ha sido analizado el número de consultas entre enero-febrero y abril-mayo de 2020 donde se destaca: una reducción significativa del número de consultas presenciales por diabetes (-50,1%) y por hipertensión (-94,1%). Las consultas presenciales por cualquier razón disminuyeron un 72,6% y las no presenciales aumentaron un 61,9%. Existe un sesgo de selección porque la muestra no fue aleatoria. La mayor prevalencia de consultas de diabetes y la falta de ajuste por factores de confusión también pueden afectar los resultados. Conclusiones Este estudio permitió confirmar la importancia de la telemedicina en atención primaria, sobre todo durante la pandemia. En general, los participantes se quedaron satisfechos con la telemedicina y reconocieron su utilidad en el acceso a los cuidados de salud.
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Cipolla M, Capello F, Gaddi AV. Telemedicine and ehealth to empower patients with diabetes mellitus, fostering and enhancing the results of a functional diet. MEDITERRANEAN JOURNAL OF NUTRITION AND METABOLISM 2020. [DOI: 10.3233/mnm-200408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Maurizio Cipolla
- President of SIT Calabria, Medical Director of UCCP Catanzaro, Italy
| | - Fabio Capello
- Community Paediatrics, Department of Primary Care, AUSL Bologna, Italy
| | - Antonio V. Gaddi
- President of Digital SIT-EMR (Italian Society of Digital Health and Telemedicine, Emilia Romagna Region), Bologna, Italy
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Cai X, Zhang F, Lin C, Zhang X, Wang Z, Xing H, Nie L, Han X, Ji L. Achieving Effective and Efficient Basal Insulin Optimal Management by Using Mobile Health Application (APP) for Type 2 Diabetes Patients in China. Diabetes Metab Syndr Obes 2020; 13:1327-1338. [PMID: 32368124 PMCID: PMC7185643 DOI: 10.2147/dmso.s244826] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/14/2020] [Indexed: 01/19/2023] Open
Abstract
AIM To evaluate the effectiveness of the mobile health application (APP) education in basal insulin optimal management program for insulin-naive type 2 diabetes (T2D) patients in China. METHODS The basal insulin optimal management program was launched in 297 hospitals in China, throughout the six main regions of China. A total of 17,208 insulin-naive patients with T2D who started to use basal insulin were screened. The mobile health APP was downloaded in each recruited patient's mobile phone and the doctor's mobile phone. Then, according to the instructions and education materials in the APP, these patients began their self-management of insulin dosage titrations and contacted their doctors by APP if they need help. RESULTS Overall, 12,530 patients with T2D were finally included in the analysis. The average age was 51.97±12.76 years, and 58% of them were males. The average body mass index is 24.46±3.83 kg/m2, and the average HbA1c at baseline was 8.33±2.11% with 24% of the subjects reaching the target of HbA1c<7.0% at baseline. After 3 months of treatment and educations through the APP, HbA1c decreased significantly from baseline (-1.02±1.72%), with 59% of the patients reaching HbA1c<7.0%. After 6 months, the glycemic control of HbA1c also decreased from baseline significantly (-1.01±1.67%). Dosage of insulin daily was 0.23±0.09 IU/kg at baseline, and 0.23±0.23 IU/kg after 6 months of treatment. Regarding the profiles of hypoglycemia treatment, 3145 patients received basal insulin in combination with mono oral anti-diabetic drug (OAD), 1204 patients with dual OADs, 208 patients with triple OADs, and 17 patients with quarter OADs. CONCLUSION Patients could benefit from the basal insulin optimal management program in self-management by using mobile health APP educations. For T2D patients who are going to start insulin treatment, mobile health APP can help them to reach the target of glycemic control with appropriate dosage of insulin.
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Affiliation(s)
- Xiaoling Cai
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Fang Zhang
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Chu Lin
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Xiaomei Zhang
- Department of Endocrinology and Metabolism, Peking University International Hospital, Beijing, People’s Republic of China
| | - Zhufeng Wang
- Department of Endocrinology and Metabolism, Guanganmen Traditional Medicine Hospital, Beijing, People’s Republic of China
| | - Huifang Xing
- Department of Endocrinology and Metabolism, Beijing Mentougou Hospital, Beijing, People’s Republic of China
| | - Lin Nie
- Department of Endocrinology and Metabolism, Beijing Airport Hospital, Beijing, People’s Republic of China
| | - Xueyao Han
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
| | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, People’s Republic of China
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de Vasconcelos HCA, Lira Neto JCG, de Araújo MFM, Carvalho GCN, de Souza Teixeira CR, de Freitas RWJF, Damasceno MMC. Telecoaching programme for type 2 diabetes control: a randomised clinical trial. ACTA ACUST UNITED AC 2019; 27:1115-1120. [PMID: 30346819 DOI: 10.12968/bjon.2018.27.19.1115] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND: People with diabetes have a high risk of developing micro and macrovascular complications that increase treatment costs and shorten life expectancy. Telecoaching programmes can improve short-term control of diabetes and reduce disease burden. AIMS: To analyse the effect of a health telecoaching programme in the control of type 2 diabetes. METHODS: A pragmatic clinical trial was carried out. Thirty-one patients with type 2 diabetes were divided into control and intervention groups. The control group received usual nursing care, and those in the intervention group received usual care and telecoaching for 24 weeks. FINDINGS: The intervention group improved: measurements of abdominal circumference, systolic and diastolic blood pressure and body mass index; variables related to glycaemic control (fasting venous glucose and glycated haemoglobin/HbA1c); and high-density lipoprotein levels. CONCLUSION: The data indicate that telecoaching is an effective tool for diabetes management. It is recommended that the study should be developed to include more people and run over the long term.
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Blanco-Cornejo M, Riva-Palacio-Chiang-Sam IL, Sánchez-Díaz I, Cerritos A, Tena-Tamayo C, López-Hernández D. New model for diabetes primary health care based on patient empowerment and the right to preventive health: the MIDE program. Rev Panam Salud Publica 2017; 41:e128. [PMID: 31384261 PMCID: PMC6645172 DOI: 10.26633/rpsp.2017.128] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 02/02/2017] [Indexed: 12/29/2022] Open
Abstract
Objective. To evaluate Mexico’s national Integrated Management of Diabetes in Stages (Manejo Integral de la Diabetes por Etapas, MIDE) program using three types of indicators: process, structure, and impact. Methods. A cross-sectional study was conducted using data for 97 452 people with diabetes (PWD) who participated in the MIDE patient empowerment program (PEP) at “MIDE modules” (standardized diabetes health care units) at Mexico’s Institute for Social Security and Services for State Workers (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE) hospital clinics and family medical clinics nationwide between 2007 and 2014. The program promotes diabetes patient empowerment and self-care through outpatient consultations with a multidisciplinary health care team supported by continuous training. Baseline data were compared with results post-program for the following indicators: process (metabolic control (MetC), based on glycated hemoglobin (HbA1c), triglyceride (TG), and total cholesterol (TC) levels); structure (number of MIDE modules installed at ISSSTE clinics and number of patients/health personnel accredited as diabetes experts/awarded diplomas); and impact (average number of patient illness days (IDs) and hospitalization episodes (HEs) per PWD over a 12-month period). Results. Over the seven-year study period, the proportion of patients with MetC (HbA1c < 7.0%, TG < 150 mg/dL, and TC < 200 mg/dL) increased significantly (from 35.4% to 60% (with a peak level of 62% in 2013); P < 0.001); average HbA1c, triglycerides, and total cholesterol per PWD dropped by 25%, 31%, and 11% respectively; average number of IDs and HEs per PWD over a 12-month period dropped by 38% and 41% respectively; a total of 140 MIDE modules were installed at ISSSTE clinics; and a total of 1 117 diplomas were awarded to 826 health professionals, and 2 613 PWD were accredited as “patient experts in diabetes.” Conclusions. The MIDE PEP is feasible, usable, and acceptable to PWD. The program improves MetC; reduces the frequency of IDs and HEs; and facilitates patient participation, the involvement of health personnel, and shared decision-making.
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Affiliation(s)
- Margarita Blanco-Cornejo
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Irma Luz Riva-Palacio-Chiang-Sam
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Iyari Sánchez-Díaz
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Antonio Cerritos
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
| | - Carlos Tena-Tamayo
- Hospital Regional de Alta Especialidad del Bajío Ministry of Health León, GJ Mexico Hospital Regional de Alta Especialidad del Bajío, Ministry of Health, León, GJ, Mexico
| | - Daniel López-Hernández
- Health Protection and Prevention Sub-Directorate Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado Mexico City Mexico Health Protection and Prevention Sub-Directorate, Medical Directorate, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, Mexico City, Mexico
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Irace C, Schweitzer MA, Tripolino C, Scavelli FB, Gnasso A. Diabetes Data Management System to Improve Glycemic Control in People With Type 1 Diabetes: Prospective Cohort Study. JMIR Mhealth Uhealth 2017; 5:e170. [PMID: 29162560 PMCID: PMC5717448 DOI: 10.2196/mhealth.8532] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 09/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background Smartphone and Web technology can improve the health care process, especially in chronic diseases. Objective The aim of this study was to investigate whether the use of blood glucose (BG) data management system, which enables connection to smartphones, the Web, the cloud, and downloading, can improve glycemic control in subjects with type 1 diabetes mellitus (T1DM). Methods This study was a prospective, single-arm, cohort feasibility study with 6 months of duration. T1DM subjects enrolled had experience in self-monitoring blood glucose, but were download data naïve. Fasting BG and glycated hemoglobin (HbA1c) were collected at the enrollment and at follow-up. Subjects were divided into Downloader (DL) and No-downloader (NDL). Results A total of 63 subjects were analyzed, of which 30 were classified as DL and 33 as NDL. At the end of the study, DL had significantly lower HbA1c, mean daily glucose, standard deviation, percentage of BG values above target, and pre- and postprandial (lunch and dinner) values compared with NDL (all P<.05). The percentage of BG values within treatment target was significantly higher in DL compared with NDL (47% [SD 9] vs 37% [SD 13]; P=.001). Conclusions The findings suggest that, in T1DM, downloading of BG from data management system, which enables connection to smartphones, the Web, and the cloud, might be a valuable contributor to improved glycemic control.
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Affiliation(s)
- Concetta Irace
- Metabolic Diseases Unit, Department of Health Science, University of Catanzaro, Catanzaro, Italy
| | | | - Cesare Tripolino
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Faustina Barbara Scavelli
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
| | - Agostino Gnasso
- Metabolic Diseases Unit, Department of Clinical and Experimental Medicine, University of Catanzaro, Catanzaro, Italy
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Kooij L, Groen WG, van Harten WH. The Effectiveness of Information Technology-Supported Shared Care for Patients With Chronic Disease: A Systematic Review. J Med Internet Res 2017. [PMID: 28642218 PMCID: PMC5500776 DOI: 10.2196/jmir.7405] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background In patients with chronic disease, many health care professionals are involved during treatment and follow-up. This leads to fragmentation that in turn may lead to suboptimal care. Shared care is a means to improve the integration of care delivered by various providers, specifically primary care physicians (PCPs) and specialty care professionals, for patients with chronic disease. The use of information technology (IT) in this field seems promising. Objective Our aim was to systematically review the literature regarding the effectiveness of IT-supported shared care interventions in chronic disease in terms of provider or professional, process, health or clinical and financial outcomes. Additionally, our aim was to provide an inventory of the IT applications' characteristics that support such interventions. Methods PubMed, Scopus, and EMBASE were searched from 2006 to 2015 to identify relevant studies using search terms related to shared care, chronic disease, and IT. Eligible studies were in the English language, and the randomized controlled trials (RCTs), controlled trials, or single group pre-post studies used reported on the effects of IT-supported shared care in patients with chronic disease and cancer. The interventions had to involve providers from both primary and specialty health care. Intervention and IT characteristics and effectiveness—in terms of provider or professional (proximal), process (intermediate), health or clinical and financial (distal) outcomes—were extracted. Risk of bias of (cluster) RCTs was assessed using the Cochrane tool. Results The initial search yielded 4167 results. Thirteen publications were used, including 11 (cluster) RCTs, a controlled trial, and a pre-post feasibility study. Four main categories of IT applications were identified: (1) electronic decision support tools, (2) electronic platform with a call-center, (3) electronic health records, and (4) electronic communication applications. Positive effects were found for decision support-based interventions on financial and health outcomes, such as physical activity. Electronic health record use improved PCP visits and reduced rehospitalization. Electronic platform use resulted in fewer readmissions and better clinical outcomes—for example, in terms of body mass index (BMI) and dyspnea. The use of electronic communication applications using text-based information transfer between professionals had a positive effect on the number of PCPs contacting hospitals, PCPs’ satisfaction, and confidence. Conclusions IT-supported shared care can improve proximal outcomes, such as confidence and satisfaction of PCPs, especially in using electronic communication applications. Positive effects on intermediate and distal outcomes were also reported but were mixed. Surprisingly, few studies were found that substantiated these anticipated benefits. Studies showed a large heterogeneity in the included populations, outcome measures, and IT applications used. Therefore, a firm conclusion cannot be drawn. As IT applications are developed and implemented rapidly, evidence is needed to test the specific added value of IT in shared care interventions. This is expected to require innovative research methods.
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Affiliation(s)
- Laura Kooij
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
| | - Wim G Groen
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands
| | - Wim H van Harten
- The Netherlands Cancer Institute, Division of Psychosocial Research and Epidemiology, Amsterdam, Netherlands.,University of Twente, Department of Health Technology and Services Research, Enschede, Netherlands.,Rijnstate hospital, Arnhem, Netherlands
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Malkani S, Keitz SA, Harlan DM. Redesigning Diabetes Care: Defining the Role of Endocrinologists Among Alternative Providers. Curr Diab Rep 2016; 16:121. [PMID: 27766581 DOI: 10.1007/s11892-016-0818-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The current diabetes epidemic threatens to overwhelm the healthcare system unless we redesign how diabetes care is delivered. The number of endocrinologists is grossly inadequate to provide care for all individuals with diabetes, but with the appropriate utilization of the primary care workforce and alternative healthcare providers working together in teams, effective diabetes care can be provided to all. We propose a patient-centered, goal-based approach with resources devoted to care coordination, measurement of outcomes, appropriate use of technology, and measurement of patient satisfaction. Financial incentives to healthcare systems and providers need to be based on defined outcome measures and reducing long-term total medical expenditures, rather than reimbursement based on number of visits and lengthy documentation. Endocrinologists have a responsibility in setting up effective diabetes care delivery systems within their organizations, in addition to delivering diabetes care and serving as a resource for the educational needs for other medical professionals in the community. There are major challenges to implementing such systems, both at the financial and organizational levels. We suggest a stepwise implementation of discrete components based on the local priorities and resources and provide some examples of steps we have taken at our institution.
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Affiliation(s)
- Samir Malkani
- Diabetes Center of Excellence, UMass Medical School, AC4-127, 55 Lake Avenue, Worcester, MA, 01655, USA.
| | - Sheri A Keitz
- Department of Medicine, UMass Medical School, 55 Lake Avenue, Worcester, MA, 01655, USA
| | - David M Harlan
- Diabetes Center of Excellence, UMass Medical School, AC4-127, 55 Lake Avenue, Worcester, MA, 01655, USA
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Wang G, Zhang Z, Feng Y, Sun L, Xiao X, Wang G, Gao Y, Wang H, Zhang H, Deng Y, Sun C. Telemedicine in the Management of Type 2 Diabetes Mellitus. Am J Med Sci 2016; 353:1-5. [PMID: 28104096 DOI: 10.1016/j.amjms.2016.10.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 10/18/2016] [Accepted: 10/24/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To explore a model of Internet-based integrated management of diabetes, we established a remote diabetes medical service platform (U-Healthcare) and evaluated its effectiveness and practicality. MATERIALS AND METHODS In total, 212 patients with type 2 diabetes mellitus were randomly assigned to 2 groups. Data from the intervention group were automatically transmitted through a glucometer; furthermore, this group received information regarding medicines, diet, exercise and other management through U-Healthcare. The control group received conventional medical treatment without any additional intervention. All patients were regularly followed up every 3 months for half a year. RESULTS At the 3-month follow-up, fasting plasma glucose levels of the intervention group were significantly lower than those at the baseline as well as those of the control group. Triglyceride levels of the intervention group were much lower than those at the baseline. At the 6-month follow-up, 2-hour postprandial plasma glucose levels of the intervention group significantly improved compared with those of the control group. HbA1c levels gradually decreased every 3 months in the intervention group, and the mean change in the levels was significantly greater in this group than in the control group (from 1.27-0.68%). At the end of the study, more than 80% of the patients in the intervention group adhered to blood glucose monitoring 2-3 days per week, and their compliance degree was 72%. CONCLUSIONS The Internet-based U-Healthcare system of integrated management in diabetes not only achieved better glycemic control, effectively improved HbA1c levels and decreased triglyceride levels but also enhanced patients' adherence to the medical team's instructions.
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Affiliation(s)
- Guixia Wang
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Zhengyun Zhang
- Department of Surgery, Shanghai Sixth People's Hospital, Shanghai JiaoTong University, Shanghai, China
| | - Yakun Feng
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Lin Sun
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Xianchao Xiao
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Gang Wang
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Yuan Gao
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Huan Wang
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Hong Zhang
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Yufeng Deng
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China
| | - Chenglin Sun
- Department of Endocrinology, First Hospital of Jilin University, Changchun, China.
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Type 2 Diabetes Patients Benefit from the COMODITY12 mHealth System: Results of a Randomised Trial. J Med Syst 2016; 40:259. [PMID: 27722974 DOI: 10.1007/s10916-016-0619-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 09/18/2016] [Indexed: 12/13/2022]
Abstract
Patient acceptance is one of the major barriers toward widespread use of mHealth systems. The aim of this study was to assess system operability and whole trial feasibility, including patients' experience with their use of COMMODITY12 mHealth system under. Secondary study aims included assessment of several metabolic parameters as well as patient adherence to the treatment. This was a prospective parallel-arm randomized controlled trial in outpatients diagnosed with DM2, being treated in the primary care settings in Lodz region, Poland, with 6 weeks period of follow-up. Patients opinions were collected with 7-item questionnaire, assessing different aspects of system use, as well as EuroQol-5D-5 L questionnaire, assessing health-related quality of life. Sixty patients (female, 24, male, 36, mean age +/- SD 59.5 +/- 6.8) completed study. All four layers of the COMMODITY12 system proved to work smooth under real-life conditions, without major problems. All dimensions of experience with system use were assessed well, with maximum values for clearness of instructions, and ease of use (4.80, and 4.63, respectively). Health related quality of life, as assessed with cumulative utility measure, improved significantly in COMMODITY12 system users (P < 0.05). mHealth system modestly improved glycaemic and blood pressure control, assuring high level of patient adherence with overall adherence reaching 92.9 %. Study proved that the COMODITY12 system is well accepted by type 2 diabetes patients taking part in clinical trial, leading to several clinical benefits, and improved quality of life. Nevertheless, before future commercialisation of the system, several minor problems identified during the study need to be addressed.
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Krishna MT, Knibb RC, Huissoon AP. Is there a role for telemedicine in adult allergy services? Clin Exp Allergy 2016; 46:668-77. [DOI: 10.1111/cea.12701] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- M. T. Krishna
- Birmingham Heartlands Hospital; Heart of England NHS Foundation Trust (HEFT); Birmingham UK
- Aston University; Birmingham UK
| | | | - A. P. Huissoon
- Birmingham Heartlands Hospital; Heart of England NHS Foundation Trust (HEFT); Birmingham UK
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