1
|
Peng P, Shen Y, Xiong H. Wearable monitoring device based on an internet management platform improves metabolic parameters in type 2 diabetes patients: a prospective pilot study. Postgrad Med 2024:1-10. [PMID: 38870076 DOI: 10.1080/00325481.2024.2366156] [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: 10/16/2023] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
OBJECTIVES This pilot study aimed to prospectively investigate the effects of a wearable monitoring device, based on an Internet management platform, on the comprehensive management of type 2 diabetes mellitus (T2DM) patients. METHODS A total of 120 hospitalized patients with T2DM were enrolled and randomly divided into the control group and the intervention group. Patients in the control group only received conventional diabetes treatments, while patients in the intervention group were provided with a wearable monitoring device in addition to conventional diabetes treatments. Moreover, the wearable device could connect to an Internet platform for diabetes management and upload self-monitoring data. All patients were followed for 3 months. The changes in parameters representing glucose metabolism, blood lipids, renal function, and patient satisfaction were compared between the two groups. All results were analyzed on an intention-to-treat basis. RESULTS One hundred twenty subjects met all criteria and agreed to participate in this study. During the follow-up period, 5 and 4 subjects were lost to follow-up in the intervention and control groups, respectively. Compared with the control group, the blood glucose of the intervention group decreased significantly after 3 months (p < 0.05). Subgroup analysis found that females, those younger than 60 years, with baseline glycated hemoglobin A1c (HbA1c) levels of 8% or greater, and patients with good adherence showed significant improvements in HbA1c (p < 0.05). However, there was no significant difference in blood lipid and renal function. The intervention group showed a better adherence rate to blood glucose, comprehensive adherence rate, and diabetes treatment satisfaction (p < 0.05). One subject in the intervention group and two subjects in the control group reported mild hypoglycemia. No other adverse events such as infections and skin allergies occurred in the two groups. CONCLUSION The intervention of a wearable monitoring device based on an Internet management platform significantly improved blood glucose control in T2DM patients, as well as the overall adherence rate and patient satisfaction with treatment. CLINICAL TRIAL REGISTRATION NCT04973644.
Collapse
Affiliation(s)
- Ping Peng
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Endocrinology and Metabolism, The Wanjiang Hospital, Dongguan, China
| | - Yunfeng Shen
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Department of Endocrinology, The Eighth Affiliated Hospital, Sun Yat-Sen University, Shenzhen, China
| | - Haixia Xiong
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| |
Collapse
|
2
|
Jahan E, Almansour R, Ijaz K, Baptista S, Giordan LB, Ronto R, Zaman S, O'Hagan E, Laranjo L. Smartphone Applications to Prevent Type 2 Diabetes: A Systematic Review and Meta-Analysis. Am J Prev Med 2024; 66:1060-1070. [PMID: 38272243 DOI: 10.1016/j.amepre.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 01/10/2024] [Accepted: 01/15/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Evidence supporting the use of apps for lifestyle behavior change and diabetes prevention in people at high risk of diabetes is lacking. The aim of this systematic review was to determine the acceptability and effectiveness of smartphone applications (apps) for the prevention of type 2 diabetes. METHODS PubMed, Embase, CINAHL and PsychInfo were searched from 2008 to 2023. Included studies involved adults at high risk of developing diabetes evaluating an app intervention with the aim of preventing type 2 diabetes. Random-effects meta-analyses were conducted for weight loss, body mass index (BMI), glycated hemoglobin, and waist circumference. Narrative synthesis was conducted for all studies, including qualitative studies exploring user perspectives. RESULTS Twenty-four studies (n=2,378) were included in this systematic review, including 9 randomized controlled trials (RCTs) with an average duration of 6 months, 10 quasi-experimental and 7 qualitative studies. Socially disadvantaged groups were poorly represented. Six RCTs were combined in meta-analyses. Apps were effective at promoting weight loss [mean difference (MD) -1.85; 95% CI -2.90 to -0.80] and decreasing BMI [MD -0.90, 95% CI -1.53 to -0.27], with no effect on glycated hemoglobin and waist circumference. No studies reported on diabetes incidence. Qualitative studies highlighted the need for app personalization. DISCUSSION Smartphone apps have a promising effect on preventing type 2 diabetes by supporting weight loss. Future robust trials should include diverse populations in co-design and evaluation of apps and explore the role of artificial intelligence in further personalizing interventions for higher engagement and effectiveness.
Collapse
Affiliation(s)
- Esrat Jahan
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia; Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
| | - Rawan Almansour
- College of Applied Medical Sciences, King Faisal University, Al Ahsa, Saudi Arabia
| | - Kiran Ijaz
- Affective Interactions lab, School of Architecture, Design and Planning, University of Sydney, Sydney, NSW, Australia
| | - Shaira Baptista
- The Australian Centre for Behavioural Research in Diabetes, Deakin University and the University of Melbourne, Melbourne, Victoria, Australia
| | - Leticia Bezerra Giordan
- Northern Beaches Hospital, 105 French's Forest Rd W, French's Forest, Sydney, NSW, Australia
| | - Rimante Ronto
- Department of Health Systems and Population, Macquarie University, Sydney, NSW, Australia
| | - Sarah Zaman
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Edel O'Hagan
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Liliana Laranjo
- Westmead Applied Research Centre, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.
| |
Collapse
|
3
|
Stowell M, Dobson R, Garner K, Baig M, Nehren N, Whittaker R. Digital interventions for self-management of prediabetes: A scoping review. PLoS One 2024; 19:e0303074. [PMID: 38728296 PMCID: PMC11086829 DOI: 10.1371/journal.pone.0303074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 04/18/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Rates of prediabetes, which can lead to type 2 diabetes, are increasing worldwide. Interventions for prediabetes mainly focus on lifestyle changes to diet and exercise. While these interventions are effective, they are often delivered face-to-face, which may pose a barrier to those with limited access to healthcare. Given the evidence for digital interventions addressing other noncommunicable diseases, these may also be effective for prediabetes self-management. The aim of this scoping review was to assess the breadth of evidence around digital interventions for prediabetes self-management. METHODS We developed a targeted search strategy and relevant studies were identified through searches conducted in four bibliographic databases (Medline, Embase, PsycInfo, and Scopus). Published studies were eligible if they included a digital intervention to support adults aged 18+ with prediabetes self-management. Titles and abstracts were first screened for relevance by one researcher. Full texts of selected records were assessed against the review criteria independently by two researchers for inclusion in the final analysis. RESULTS Twenty-nine studies were included, of which nine were randomised controlled trials. Most efficacy studies reported significant changes in at least one primary and/or secondary outcome, including participants' glycaemic control, weight loss and/or physical activity levels. About one-third of studies reported mixed outcomes or early significant outcomes that were not sustained at long-term follow-up. Interventions varied in length, digital modalities, and complexity. Delivery formats included text messages, mobile apps, virtually accessible dietitians/health coaches, online peer groups, and web-based platforms. Approximately half of studies assessed participant engagement/acceptability outcomes. CONCLUSION Whilst the evidence here suggests that digital interventions to support prediabetes self-management are acceptable and have the potential to reduce one's risk of progression to type 2 diabetes, more research is needed to understand which interventions, and which components specifically, have the greatest reach to diverse populations, are most effective at promoting user engagement, and are most effective in the longer term.
Collapse
Affiliation(s)
- Melanie Stowell
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - Rosie Dobson
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Katie Garner
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | | | - Robyn Whittaker
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
- Institute for Innovation and Improvement, Te Whatu Ora Waitematā, Auckland, New Zealand
| |
Collapse
|
4
|
Liu W, Zhang D, Wang R, Chen J, Zhang J, Tao D, Liu C. Global trends in the burden of chronic kidney disease attributable to type 2 diabetes: An age-period-cohort analysis. Diabetes Obes Metab 2024; 26:602-610. [PMID: 37936340 DOI: 10.1111/dom.15349] [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] [Received: 09/12/2023] [Revised: 10/11/2023] [Accepted: 10/13/2023] [Indexed: 11/09/2023]
Abstract
AIM To assess temporal trends of chronic kidney disease (CKD) attributable to type 2 diabetes (T2D) globally and in five sociodemographic index (SDI) regions. MATERIALS AND METHODS We extracted the population data and CKD burden attributable to T2D from the Global Burden of Disease Study 2019. We evaluated the trends of disability-adjusted life years (DALYs), mortality, prevalence and incidence through age-period-cohort modelling, and calculated net drifts (overall annual percentage changes), local drifts (annual percentage changes in each age group), longitudinal age curves (fitted longitudinal age-specific rates), period relative risks (RRs) and cohort RRs. RESULTS From 1990 to 2019, the global burden of CKD attributable to T2D showed increasing trends in general. The burden of CKD attributable to T2D was highest in the middle SDI region and lowest in the low SDI region. Age effects increased with age, and peaked at the ages of 75-79 and 80-84 years for incidence and prevalence, respectively. Period RRs in the burden of CKD attributable to T2D increased, with the high SDI being the most remarkable in DALYs and mortality, and the middle SDI being the most notable in incidence. Cohort RRs showed unfavourable trends in incidence and prevalence among recent cohorts. CONCLUSIONS After a lengthy period of multi-initiative diabetes management, the high-middle SDI region exhibited improvement. However, unresolved issues and improvement gaps were still remarkable. Future efforts to reduce the burden of CKD attributable to T2D in the population should prioritize addressing the unfavourable patterns identified.
Collapse
Affiliation(s)
- Wenli Liu
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Duo Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Ruobing Wang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Junhui Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Jiaqi Zhang
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Di Tao
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Chaonan Liu
- Department of Endocrinology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| |
Collapse
|
5
|
Isa RM, Chong MC, Lee WL, Iqbal T, Mansor M, Zainudin AA, Suhardi MIS. Developing and evaluating the usability of a web-based Diabetic Retinopathy Health Education Program for patients with type 2 diabetes mellitus. Saudi Med J 2023; 44:1290-1294. [PMID: 38016754 PMCID: PMC10712792 DOI: 10.15537/smj.2023.44.12.202320029] [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: 09/13/2023] [Accepted: 11/05/2023] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVES To describe the development of a webpage based on the Intervention Mapping (IM) protocol and usability testing of the Diabetic Retinopathy Health Education Profram (DRHEP). METHODS The mixed methods pilot feasibility study was carried out between April and September 2021, involving 16 patients with type 2 diabetes mellitus and 5 experts. The usability score was rated according to the System Usability Scale (SUS). RESULTS The average SUS score by the experts was 88. The patients gave a higher score of 85 for SUS, with 58 as the lowest. The average SUS score was 72. The findings indicate that the webpage is acceptable, good, and highly usable for users. CONCLUSION The outcomes of this study signify the relationship between effective health applications and how their design might hamper their effectiveness in changing patients' behavior.
Collapse
Affiliation(s)
- Rif’atunnailah Mat Isa
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Mei Chan Chong
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Wan Ling Lee
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Tajunisah Iqbal
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Mardiana Mansor
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Airul Azizan Zainudin
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| | - Mohd Iman Saiful Suhardi
- From the Department of Nursing Science (Mat Isa, Chong, Lee, Mansor) and from the Department of Ophthalmology (Iqbal), Faculty of Medicine,University of Malaya, Kuala Lumpur; from the Department of Nursing (Mansor), Faculty of Medicine, University Sultan Zainal Abidin, Terengganu; from the Department of Medical Surgical Nursing (Mat Isa); from the Department of Professional Nursing Studies (Zainudin); and from the Department of Emergency Medicine (Suhardi), Kulliyyah of Medicine, International Islamic University Malaysia, Bander Indera Mahkota Campus Pahang, Malaysia.
| |
Collapse
|
6
|
Eghtedari M, Goodarzi-Khoigani M, Shahshahani MS, Javadzade H, Abazari P. Is Web-Based Program Effective on Self-Care Behaviors and Glycated Hemoglobin in Patients with Type 2 Diabetes: A Randomized Controlled Trial. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2023; 28:723-729. [PMID: 38205411 PMCID: PMC10775860 DOI: 10.4103/ijnmr.ijnmr_59_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/22/2023] [Accepted: 07/23/2023] [Indexed: 01/12/2024]
Abstract
Background Diabetes Self-Management Education and Support (DSMES) as a framework focuses on seven self-care behaviors. Moreover, technology-assisted self-care education is increasingly suggested for patients with Type 2 Diabetes Mellitus (T2DM). Therefore, we examined the effect of a web-based program on self-care behaviors and glycated hemoglobin values in patients with diabetes mellitus. Materials and Methods This randomized controlled clinical trial was conducted at Alzahra Hospital in Isfahan, Iran, between April and November 2020 and included 70 patients with T2DM. Data were collected using a questionnaire that included a demographic information section and a diabetes self-management section with 21 questions on a Likert scale. Fasting blood samples (2.50 ml) were collected before and after the interventions to measure HbA1c levels. The study intervention involved a web-based program that included multimedia educational content (such as videos, lectures, educational motion graphics, text files, posters, and podcasts) presented in seven sections based on DSMES over a 21-day period with monitoring by an instructor. Results The mean scores for healthy eating (F = 3.48, p = 0.034) and medication adherence (F = 6.70, p < 0.001) significantly increased in the interventional group, while the mean scores for being active, monitoring, reducing risks, problem-solving, and healthy coping did not significantly change. Additionally, the mean differences in HbA1c values significantly improved in the interventional group compared to the control (F = 5,1, p = 0.026). Conclusions A web-based program in accordance with DSMES improved HbA1c levels and increased scores for healthy eating and medication adherence in patients with T2DM. However, further research with larger sample sizes and qualitative interviews is needed.
Collapse
Affiliation(s)
- Maryam Eghtedari
- Department of Community Health Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoomeh Goodarzi-Khoigani
- Child Growth and Development Research Center, Research Institute for Primordial Prevention of Non-Communicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Sadat Shahshahani
- Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Homamodin Javadzade
- Department of Health Education and Health Promotion, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Parvaneh Abazari
- Department of Adult Health, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
7
|
Han S, Luo Y, Liu B, Guo T, Qin D, Luo F. Dietary flavonoids prevent diabetes through epigenetic regulation: advance and challenge. Crit Rev Food Sci Nutr 2023; 63:11925-11941. [PMID: 35816298 DOI: 10.1080/10408398.2022.2097637] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The pathophysiology of diabetes has been studied extensively in various countries, but effective prevention and treatment methods are still insufficient. In recent years, epigenetics has received increasing attention from researchers in exploring the etiology and treatment of diabetes. DNA methylation, histone modifications, and non-coding RNAs play critical roles in the occurrence, maintenance, and progression of diabetes and its complications. Therefore, preventing or reversing the epigenetic alterations that occur during the development of diabetes may reduce the individual and societal burden of the disease. Dietary flavonoids serve as natural epigenetic modulators for the discovery of biomarkers for diabetes prevention and the development of alternative therapies. However, there is limited knowledge about the potential beneficial effects of flavonoids on the epigenetics of diabetes. In this review, the multidimensional epigenetic effects of different flavonoid subtypes in diabetes were summarized. Furthermore, it was discussed that parental flavonoid diets might reduce diabetes incidence in offspring, which represent a promising opportunity to prevent diabetes in the future. Future work will depend on exploring anti-diabetic effects of different flavonoids with different epigenetic regulation mechanisms and clinical trials.Highlights• "Epigenetic therapy" could reduce the burden of diabetic patients• "Epigenetic diet" ameliorates diabetes• Targeting epigenetic regulations by dietary flavonoids in the diabetes prevention• Dietary flavonoids prevent diabetes via transgenerational epigenetic inheritance.
Collapse
Affiliation(s)
- Shuai Han
- Hunan Key Laboratory of Grain-oil Deep Process and Quality Control, Hunan Key Laboratory of Forestry Edible Resources Safety and Processing, National Research Center of Rice Deep Processing and Byproducts, Central South University of Forestry and Technology, Changsha, China
| | - Yi Luo
- Department of Clinic Medicine, Xiangya School of Medicine, Central South University, Changsha, China
| | - Bo Liu
- Central South Food Science Institute of Grain and Oil Co., Ltd., Hunan Grain Group Co., Ltd, Changsha, China
| | - Tianyi Guo
- Hunan Key Laboratory of Grain-oil Deep Process and Quality Control, Hunan Key Laboratory of Forestry Edible Resources Safety and Processing, National Research Center of Rice Deep Processing and Byproducts, Central South University of Forestry and Technology, Changsha, China
| | - Dandan Qin
- Hunan Key Laboratory of Grain-oil Deep Process and Quality Control, Hunan Key Laboratory of Forestry Edible Resources Safety and Processing, National Research Center of Rice Deep Processing and Byproducts, Central South University of Forestry and Technology, Changsha, China
| | - Feijun Luo
- Hunan Key Laboratory of Grain-oil Deep Process and Quality Control, Hunan Key Laboratory of Forestry Edible Resources Safety and Processing, National Research Center of Rice Deep Processing and Byproducts, Central South University of Forestry and Technology, Changsha, China
| |
Collapse
|
8
|
Kruse CS, Mileski M, Heinemann K, Huynh H, Leafblad A, Moreno E. Analyzing the Effectiveness of mHealth to Manage Diabetes Mellitus Among Adults Over 50: A Systematic Literature Review. J Multidiscip Healthc 2023; 16:101-117. [PMID: 36660039 PMCID: PMC9842522 DOI: 10.2147/jmdh.s392693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/05/2022] [Indexed: 01/13/2023] Open
Abstract
Purpose A total of 537 million suffered from diabetes mellitus in 2021, and the aging of the population will not abate this number in the future. Diabetes predisposes people to ailments and doubles the risk of COVID-19 mortality. mHealth has shown promise to help manage diabetes. The aim of this review is to objectively analyze research from the last 2.5 years to assess effectiveness where mHealth has been used as an intervention to help manage diabetes in older patients. We also analyzed patient satisfaction, quality, and barriers to adoption of mHealth to manage diabetes. Patients and Methods No human subjects were involved in this review. We queried four research databases for mHealth to manage diabetes in older adults. We conducted the review based on the Kruse Protocol for writing as systematic review and we reported our findings in accordance with PRISMA (2020). Results Thirty research articles from 11 countries were analyzed. Five interventions of mHealth were identified. Of these mHealth Short Message service (SMS) helped change behavior and encouraged self-care. mHealth SMS coupled with telemedicine for coaching showed positive effects on weight loss, BMI, diet, exercise, HbA1C, disease awareness, blood pressure, cholesterol, medication adherence, and foot care. Conclusion mHealth SMS coupled with telemedicine for coaching shows the greatest promise for educating, changing behavior, and realizing positive outcomes across a broad spectrum of health factors. The largest drawback is the cost of acquiring equipment and training users.
Collapse
Affiliation(s)
- Clemens Scott Kruse
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Michael Mileski
- School of Health Administration, Texas State University, San Marcos, TX, USA,Correspondence: Michael Mileski, Texas State University, School of Health Administration, 601 University Drive, Encino Hall—250, San Marcos, TX, 78666, USA, Tel +1 512 245 3556, Email
| | - Katharine Heinemann
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Hung Huynh
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Abigail Leafblad
- School of Health Administration, Texas State University, San Marcos, TX, USA
| | - Emmanuel Moreno
- School of Health Administration, Texas State University, San Marcos, TX, USA
| |
Collapse
|
9
|
Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ. Type 2 diabetes. Lancet 2022; 400:1803-1820. [PMID: 36332637 DOI: 10.1016/s0140-6736(22)01655-5] [Citation(s) in RCA: 227] [Impact Index Per Article: 113.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 08/10/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022]
Abstract
Type 2 diabetes accounts for nearly 90% of the approximately 537 million cases of diabetes worldwide. The number affected is increasing rapidly with alarming trends in children and young adults (up to age 40 years). Early detection and proactive management are crucial for prevention and mitigation of microvascular and macrovascular complications and mortality burden. Access to novel therapies improves person-centred outcomes beyond glycaemic control. Precision medicine, including multiomics and pharmacogenomics, hold promise to enhance understanding of disease heterogeneity, leading to targeted therapies. Technology might improve outcomes, but its potential is yet to be realised. Despite advances, substantial barriers to changing the course of the epidemic remain. This Seminar offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions.
Collapse
Affiliation(s)
- Ehtasham Ahmad
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea
| | - Roberta Lamptey
- Family Medicine Department, Korle Bu Teaching Hospital, Accra Ghana and Community Health Department, University of Ghana Medical School, Accra, Ghana
| | - David R Webb
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK
| | - Melanie J Davies
- Diabetes Research Centre, University of Leicester and the Leicester NIHR Biomedical Research Centre, Leicester General Hospital, Leicester, UK.
| |
Collapse
|
10
|
Jeem YA, Andriani RN, Nabila R, Emelia DD, Lazuardi L, Koesnanto H. The Use of Mobile Health Interventions for Outcomes among Middle-Aged and Elderly Patients with Prediabetes: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13638. [PMID: 36294218 PMCID: PMC9603799 DOI: 10.3390/ijerph192013638] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 09/30/2022] [Accepted: 10/12/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND There are currently limited systematic reviews of mobile health interventions for middle-aged and elderly patients with prediabetes from trial studies. This review aimed to gather and analyze information from experimental studies investigating the efficacy of mobile health usability for outcomes among middle-aged and elderly patients with prediabetes. METHODS We conducted a literature search in five databases: Clinicaltrials.gov, the International Clinical Trials Registry Platform (ICTRP), PubMed, ProQuest, and EBSCO, with a date range of January 2007 to July 2022 written in English, following a registered protocol on PROSPERO (CRD42022354351). The quality and possibility of bias were assessed using the Jadad score. The data extraction and analysis were conducted in a methodical manner. RESULTS A total of 25 studies were included in the qualitative synthesis, with 19 studies using randomized trial designs and 6 studies with non-randomized designs. The study outcomes were the incidence of diabetes mellitus, anthropometric measures, laboratory examinations, measures of physical activity, and dietary behavior. During long-term follow-up, there was no significant difference between mobile health interventions and controls in reducing the incidence of type 2 diabetes. The findings of the studies for weight change, ≥3% and ≥5% weight loss, body mass index, and waist circumference changes were inconsistent. The efficacy of mobile health as an intervention for physical activity and dietary changes was lacking in conclusion. Most studies found that mobile health lacks sufficient evidence to change hbA1c. According to most of these studies, there was no significant difference in blood lipid level reduction. CONCLUSIONS The use of mobile health was not sufficiently proven to be effective for middle-aged and elderly patients with prediabetes.
Collapse
Affiliation(s)
- Yaltafit Abror Jeem
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Russy Novita Andriani
- Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
- Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Refa Nabila
- Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Dwi Ditha Emelia
- Faculty of Medicine, Universitas Islam Indonesia, Yogyakarta 55584, Indonesia
| | - Lutfan Lazuardi
- Department of Health Policy and Management, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| | - Hari Koesnanto
- Department of Family and Community Medicine, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta 55281, Indonesia
| |
Collapse
|
11
|
Nagata T, Aoyagi SS, Takahashi M, Nagata M, Mori K. Effects of Feedback From Self-Monitoring Devices on Lifestyle Changes in Workers with Diabetes: 3-Month Randomized Controlled Pilot Trial. JMIR Form Res 2022; 6:e23261. [PMID: 35943766 PMCID: PMC9399840 DOI: 10.2196/23261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 03/02/2021] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Although lifestyle interventions are useful in the prevention and management of diabetes, they can be expensive and time-consuming. There is some evidence on the effectiveness of automated mobile technology for health self-monitoring; however, few studies have used such devices in the occupational health field.
Objective
We aimed to examine the effectiveness of a digital self-monitoring device on glucose levels and activity of workers with diabetes in Japan. The primary outcomes were changes in blood glucose levels, and the secondary outcomes were changes in weight and BMI.
Methods
A 2-arm randomized controlled pilot trial was conducted with workers from 23 organizations. The intervention group (n=50) wore an armband activity monitor, a body composition monitor, and a blood pressure monitor for 3 months and received semiautomated weekly email messages tailored to their device data. The control group (n=53) engaged in no self-monitoring. Messages were developed by a physician and a dietician. Postintervention changes in blood glucose levels, weight, and BMI were compared between the intervention and control groups, using blood tests and questionnaires.
Results
At the end of 3 months, the intervention group showed significantly lower blood glucose levels (HbA1c: intervention group mean 6.4% (SD 0.3%) vs control group mean 6.6% (SD 0.3%); Cohen d=0.7, 95% CI 0.2-1.1; P=.009). There were no significant between-group differences in weight and BMI.
Conclusions
Mobile digital self-monitoring was effective in improving blood glucose levels in workers with diabetes. The use of digital health devices is a cost-effective way of implementing health self-monitoring for large numbers of individuals in the workplace. However, due to the large volume of missing values in this study, we need to be careful in interpreting the results, and well-designed intervention studies need to be conducted.
Trial Registration
University Hospital Medical Information Network UMIN000023651;
https://upload.umin.ac.jp/cgi-open-bin/icdr/ctr_view_cb.cgi?recptno=R000027244&flwp_key=1008PYbOcXKmk7CAg4Th1FWS
Collapse
Affiliation(s)
- Tomohisa Nagata
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Sona-Sanae Aoyagi
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Minekazu Takahashi
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Masako Nagata
- Department of Occupational Medicine, School of Medicine, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| | - Koji Mori
- Institute of Industrial Ecological Sciences, University of Occupational and Environmental Health, Japan, Kitakyushu, Japan
| |
Collapse
|
12
|
Sun C, Lei Y, Lin Z, Li S, Wang M, Gu J. Effects of self-care programs on the incidence of diabetes among adults with prediabetes: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2022; 32:2193-2207. [PMID: 35655374 DOI: 10.1111/jocn.16384] [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: 01/05/2022] [Revised: 04/16/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To verify the effects of self-care programs among adults with prediabetes, to identify the preferable structure components and to summarise the core content components of self-care programs. DESIGN A systematic review and meta-analysis of randomised controlled trials. METHODS PubMed, Embase, Cochrane, CINAHL, PsycINFO, Wanfang, CNKI, Chinese Biomedical Database and Open Grey were searched for studies published from January 2002 to December, 2021. Meta-analysis was conducted to verify the effects of self-care programs on diabetes incidence. Subgroup analyses based on structure components were performed to contrast the effects. We made a critical analysis to generalise the core elements of content components. The study was reported according to PRISMA statement. RESULTS Totally, 15 studies were included in systematic review, of which 14 studies were eligible for meta-analysis. The results of meta-analysis showed the incidence of diabetes for prediabetic adults receiving self-care programs was significantly lower than those who received usual care (OR 0.58; 95% CI 0.46 to 0.73). The results of subgroup analyses based on delivery mode, intervention implementer, health education brochures provided, and follow-up duration showed statistically significant reduction in incidence compared with control group (p < .05). However, the differences of these pair-wise comparisons (face-to-face or remote, individual or interdisciplinary team, with or without brochures provided, ≤1 year or >1 year) were not statistically significant (p > .05). Three core content elements were generalised: cognitive education, behaviour guidance and psychological support. CONCLUSIONS Self-care programs can effectively delay the progression of prediabetes to diabetes. Regardless of the diversified structure components, self-care programs can achieve better effects on the diabetes incidence than usual care, while the optimal structure components still remain unknown. Cognitive education, behaviour guidance and psychological support are core elements for these programs. RELEVANCE TO CLINICAL PRACTICE More clinical trials with rigorous study design are needed to provide further evidence.
Collapse
Affiliation(s)
- Caiyun Sun
- School of Nursing, Nanjing Medical University, Nanjing, China.,Nursing department, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yang Lei
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Zheng Lin
- School of Nursing, Nanjing Medical University, Nanjing, China.,Nursing department, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Sha Li
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Mi Wang
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Junyi Gu
- School of Nursing, Nanjing Medical University, Nanjing, China
| |
Collapse
|
13
|
Michalopoulou M, Ferrey AE, Harmer G, Goddard L, Kebbe M, Theodoulou A, Jebb SA, Aveyard P. Effectiveness of Motivational Interviewing in Managing Overweight and Obesity : A Systematic Review and Meta-analysis. Ann Intern Med 2022; 175:838-850. [PMID: 35344379 DOI: 10.7326/m21-3128] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Motivational interviewing (MI) is potentially useful in management of overweight and obesity, but staff training and increased delivery time are barriers, and its effectiveness independent of other behavioral components is unclear. PURPOSE To assess the independent contribution of MI as part of a behavioral weight management program (BWMP) in controlling weight and improving psychological well-being. DATA SOURCES 6 electronic databases and 2 trial registries, searched from database inception through 24 September 2021. STUDY SELECTION Randomized controlled trials in adults or adolescents aimed at weight loss or maintenance and comparing programs incorporating MI versus interventions without MI. DATA EXTRACTION Two reviewers independently screened studies, extracted data, and assessed risk of bias. Outcomes included weight, anxiety, depression, quality of life, and other aspects of psychological well-being. Pooled mean differences or standardized mean differences were obtained using random- and fixed-effects meta-analyses. DATA SYNTHESIS Forty-six studies involving 11 077 participants, predominantly with obesity, were included. At 6 months, BWMPs using MI were more effective than no/minimal intervention (-0.88 [95% CI, -1.27 to -0.48] kg; I 2 = 0%) but were not statistically significantly more effective than lower-intensity (-0.88 [CI, -2.39 to 0.62] kg; I 2 = 55.8%) or similar-intensity (-1.36 [CI, -2.80 to 0.07] kg; I 2 = 18.8%) BWMPs. At 1 year, data were too sparse to pool comparisons with no/minimal intervention, but MI did not produce statistically significantly greater weight change compared with lower-intensity (-1.16 [CI, -2.49 to 0.17] kg; I 2 = 88.7%) or similar-intensity (-0.18 [CI, -2.40 to 2.04] kg; I 2 = 72.7%) BWMPs without MI. Studies with 18-month follow-up were also sparse; MI did not produce statistically significant benefit in any of the comparator categories. There was no evidence of subgroup differences based on study, participant, or intervention characteristics. Too few studies assessed effects on psychological well-being to pool, but data did not suggest that MI was independently effective. LIMITATIONS High statistical heterogeneity among studies, largely unexplained by sensitivity and subgroup analyses; stratification by comparator intensity and follow-up duration resulted in pooling of few studies. CONCLUSION There is no evidence that MI increases effectiveness of BWMPs in controlling weight. Given the intensive training required for its delivery, MI may not be a worthwhile addition to BWMPs. PRIMARY FUNDING SOURCE National Institute for Health Research Biomedical Research Centre. (PROSPERO: CRD42020177259).
Collapse
Affiliation(s)
- Moscho Michalopoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Anne E Ferrey
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Georgina Harmer
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Lucy Goddard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Maryam Kebbe
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Annika Theodoulou
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, Oxford, United Kingdom (G.H., L.G., M.K., A.T.)
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| | - Paul Aveyard
- Nuffield Department of Primary Care Health Sciences, Radcliffe Primary Care Building, University of Oxford, and National Institute for Health Research Oxford Biomedical Research Centre, Oxford University Hospitals, Oxford, United Kingdom (M.M., A.E.F., S.A.J., P.A.)
| |
Collapse
|
14
|
MacPherson MM, Merry KJ, Locke SR, Jung ME. mHealth prompts within diabetes prevention programs: a scoping review. Mhealth 2022; 8:20. [PMID: 35449504 PMCID: PMC9014231 DOI: 10.21037/mhealth-21-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 11/04/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Mobile health (mHealth) prompts (e.g., text messaging, push notifications) are a commonly used technique within behaviour change interventions to prompt or cue a specific behaviour. Such prompts are being increasingly integrated into diabetes prevention programs (DPPs). While mHealth prompts provide a convenient and cost-effective way to reinforce behaviour change, no reviews to date have examined mHealth prompt use within DPPs. This scoping review aims to: (I) understand how mHealth prompts are being used within behaviour change interventions for individuals at risk for developing type 2 diabetes (T2D); and (II) provide recommendations for future mHealth prompt research, design, and application. METHODS The scoping review methodology outlined by Arksey and O'Malley were followed. Medline, CINAHL, PsycInfo, Web of Science, and SportDiscus were searched. The search strategy combined keywords relating to T2D risk and mHealth prompts in conjunction with database-controlled vocabulary when available (e.g., MeSH for Medline). RESULTS Of the 4,325 publications screened, 44 publications (based on 33 studies) met the inclusion criteria and were included for data extraction. Text messaging was the most widely used mHealth prompt (73%) followed by push notifications (21%). Only 30% of studies discussed the theoretical basis for prompt content and time of day messages were sent, and only 27% provided justification for prompt timing and frequency. Fourteen studies assessed participant satisfaction with mHealth prompts of which only two reported dissatisfaction due to either prompting frequency (hourly) or message content (solely focused on weight). Nine studies assessed behavioural outcomes including weight loss, physical activity, and diabetes incidence, and found mixed effects overall. CONCLUSIONS While mHealth prompts were well-received by participants, there are mixed effects on the influence of mHealth prompts on behavioural outcomes and diabetes incidence. More thorough reporting of prompt content development and delivery is needed, and more experimental research is needed to identify optimal content, delivery characteristics, and impact on behavioural and clinical outcomes.
Collapse
Affiliation(s)
- Megan M. MacPherson
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| | - Kohle J. Merry
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, Canada
| | - Sean R. Locke
- Department of Kinesiology, Brock University, St. Catherines, Canada
| | - Mary E. Jung
- School of Health and Exercise Sciences, University of British Columbia, Kelowna, Canada
| |
Collapse
|
15
|
Luo J, Zhang K, Xu Y, Tao Y, Zhang Q. Effectiveness of Wearable Device-based Intervention on Glycemic Control in Patients with Type 2 Diabetes: A System Review and Meta-Analysis. J Med Syst 2021; 46:11. [PMID: 34951684 DOI: 10.1007/s10916-021-01797-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 12/06/2021] [Indexed: 10/19/2022]
Abstract
With the development of flexible electronics and chip technology, the application value of wearable devices in lifelong treatment of chronic diseases is increasing. In view of its rapid development and diversified forms, wearable device-based intervention seems to provide a promising option to solve the problems of long-term glycemic control in type 2 diabetes (T2D). However, to date, it is unclear whether the intervention based on wearable device is effective on glycemic control in patients with T2D. In order to explore whether this choice is effective in glycemic control in patients with T2D, after database search and study screening, 6 studies and 1001 patients were selected from 181studies for this meta-analysis. The results guided that the wearable device-based intervention may be more effective than usual care on glycemic control in patients with T2D. Subgroup analysis showed that when the duration of intervention was equal to or less than 12 weeks, the effect of wearable device-based intervention was significantly different from that of usual care, but when the intervention duration greater than 12 weeks, the effect was not significantly different. The intervention effect of wearable devices with goal-setting or encouragement functions was significantly better than that of usual care, and there was no significant difference between automatic drug delivery wearable devices and usual care. In conclusion, the wearable device-based intervention is effective on glycemic control in patients with T2D. In general, this choice of wearable devices for patients with T2D may be effective to some extent.
Collapse
Affiliation(s)
- Jingsong Luo
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Ke Zhang
- Department of Psychology, Shanxi Datong University, Datong, 037000, China
| | - Yaxin Xu
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Yanmin Tao
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu, 611130, China
| | - Qi Zhang
- School of Nursing, Peking University, Beijing, 100191, China.
| |
Collapse
|
16
|
Lam B, Catt M, Cassidy S, Bacardit J, Darke P, Butterfield S, Alshabrawy O, Trenell M, Missier P. Using Wearable Activity Trackers to Predict Type 2 Diabetes: Machine Learning-Based Cross-sectional Study of the UK Biobank Accelerometer Cohort. JMIR Diabetes 2021; 6:e23364. [PMID: 33739298 PMCID: PMC8080299 DOI: 10.2196/23364] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 10/27/2020] [Accepted: 01/20/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Between 2013 and 2015, the UK Biobank collected accelerometer traces from 103,712 volunteers aged between 40 and 69 years using wrist-worn triaxial accelerometers for 1 week. This data set has been used in the past to verify that individuals with chronic diseases exhibit reduced activity levels compared with healthy populations. However, the data set is likely to be noisy, as the devices were allocated to participants without a set of inclusion criteria, and the traces reflect free-living conditions. OBJECTIVE This study aims to determine the extent to which accelerometer traces can be used to distinguish individuals with type 2 diabetes (T2D) from normoglycemic controls and to quantify their limitations. METHODS Machine learning classifiers were trained using different feature sets to segregate individuals with T2D from normoglycemic individuals. Multiple criteria, based on a combination of self-assessment UK Biobank variables and primary care health records linked to UK Biobank participants, were used to identify 3103 individuals with T2D in this population. The remaining nondiabetic 19,852 participants were further scored on their physical activity impairment severity based on other conditions found in their primary care data, and those deemed likely physically impaired at the time were excluded. Physical activity features were first extracted from the raw accelerometer traces data set for each participant using an algorithm that extends the previously developed Biobank Accelerometry Analysis toolkit from Oxford University. These features were complemented by a selected collection of sociodemographic and lifestyle features available from UK Biobank. RESULTS We tested 3 types of classifiers, with an area under the receiver operating characteristic curve (AUC) close to 0.86 (95% CI 0.85-0.87) for all 3 classifiers and F1 scores in the range of 0.80-0.82 for T2D-positive individuals and 0.73-0.74 for T2D-negative controls. Results obtained using nonphysically impaired controls were compared with highly physically impaired controls to test the hypothesis that nondiabetic conditions reduce classifier performance. Models built using a training set that included highly impaired controls with other conditions had worse performance (AUC 0.75-0.77; 95% CI 0.74-0.78; F1 scores in the range of 0.76-0.77 for T2D positives and 0.63-0.65 for controls). CONCLUSIONS Granular measures of free-living physical activity can be used to successfully train machine learning models that are able to discriminate between individuals with T2D and normoglycemic controls, although with limitations because of the intrinsic noise in the data sets. From a broader clinical perspective, these findings motivate further research into the use of physical activity traces as a means of screening individuals at risk of diabetes and for early detection, in conjunction with routinely used risk scores, provided that appropriate quality control is enforced on the data collection protocol.
Collapse
Affiliation(s)
- Benjamin Lam
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Michael Catt
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sophie Cassidy
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Jaume Bacardit
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Philip Darke
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Sam Butterfield
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Ossama Alshabrawy
- Department of Computer and Information Sciences, Northumbria University, Newcastle upon Tyne, United Kingdom
| | - Michael Trenell
- Faculty of Medical Sciences, The Medical School, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Paolo Missier
- School of Computing, Newcastle University, Newcastle upon Tyne, United Kingdom
| |
Collapse
|
17
|
van der Linden J, Welsh JB, Hirsch IB, Garg SK. Real-Time Continuous Glucose Monitoring During the Coronavirus Disease 2019 Pandemic and Its Impact on Time in Range. Diabetes Technol Ther 2021; 23:S1-S7. [PMID: 33470892 PMCID: PMC7957372 DOI: 10.1089/dia.2020.0649] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic disrupted the lives of people with diabetes. Use of real-time continuous glucose monitoring (rtCGM) helped manage diabetes effectively. Some of these disruptions may be reflected in population-scale changes to metrics of glycemic control, such as time-in-range (TIR). Methods: We examined data from 65,067 U.S.-based users of the G6 rtCGM System (Dexcom, Inc., San Diego, CA) who had uploaded data before and during the COVID-19 pandemic. Users associated with three counties that included the cities of Los Angeles, Chicago, and New York or with five regions designated by the Centers for Disease Control and Prevention (CDC) were compared. Public data were used to associate regions with prepandemic and intrapandemic glycemic parameters, COVID-19 mortality, and median household income. Results: Compared with an 8-week prepandemic interval before stay-at-home orders (January 6, 2020, to March 1, 2020), overall mean (standard deviation) TIR improved from 59.0 (20.1)% to 61.0 (20.4)% during the early pandemic period (April 20, 2020 to June 14, 2020, P < 0.001). TIR improvements were noted in all three counties and in all five CDC-designated regions. Higher COVID-19 mortality was associated with higher proportions of individuals experiencing TIR improvements of ≥5 percentage points. Users in economically wealthier zip codes had higher pre- and intrapandemic TIR values and greater relative improvements in TIR. TIR and pandemic-related improvements in TIR varied across CDC-designated regions. Conclusions: Population-level rtCGM data may be used to monitor changes in glycemic control with temporal and geographic specificity. The COVID-19 pandemic is associated with improvements in TIR, which were not evenly distributed across the United States.
Collapse
Affiliation(s)
| | | | - Irl B. Hirsch
- Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Satish K. Garg
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
- Address correspondence to: Satish K. Garg, MD, Departments of Medicine and Pediatrics, Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, 1775 Aurora Court, Aurora, CO 80045, USA
| |
Collapse
|