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Li S, Tao J, Tang J, Chu Y, Wu H. Digital therapeutics as an emerging new therapy for diabetes mellitus: potentials and concerns. Endocr Connect 2024; 13:EC-24-0219. [PMID: 38963663 PMCID: PMC11378137 DOI: 10.1530/ec-24-0219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 07/04/2024] [Indexed: 07/05/2024]
Abstract
The global burden of controlling and managing diabetes mellitus (DM) is a significant challenge. Despite the advancements in conventional DM therapy, there remain hurdles to overcome, such as enhancing medication adherence and improving patient prognosis. Digital therapeutics (DTx), an innovative digital application, has been proposed to augment the traditional disease management workflow, particularly in managing chronic diseases like DM. Several studies have explored DTx, yielding promising results. However, certain concerns about this innovation persist. In this review, we aim to encapsulate the potential of DTx and its applications in DM management, thereby providing a comprehensive overview of this technique for public health policymakers.
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Affiliation(s)
| | - Jincheng Tao
- J Tao, Department of Medical Informatics, Nantong University Medical School, Nantong, China
| | - Jie Tang
- J Tang, Department of Medical Informatics, Nantong University Medical School, Nantong, China
| | - Yanting Chu
- Y Chu, Department of Medical Informatics, Nantong University Medical School, Nantong, China
| | - Huiqun Wu
- H Wu, Department of Medical Informatics, Nantong University Medical School, Nantong, China
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Rodriguez DV, Lawrence K, Gonzalez J, Brandfield-Harvey B, Xu L, Tasneem S, Levine DL, Mann D. Leveraging Generative AI Tools to Support the Development of Digital Solutions in Health Care Research: Case Study. JMIR Hum Factors 2024; 11:e52885. [PMID: 38446539 PMCID: PMC10955400 DOI: 10.2196/52885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/27/2023] [Accepted: 12/15/2023] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Generative artificial intelligence has the potential to revolutionize health technology product development by improving coding quality, efficiency, documentation, quality assessment and review, and troubleshooting. OBJECTIVE This paper explores the application of a commercially available generative artificial intelligence tool (ChatGPT) to the development of a digital health behavior change intervention designed to support patient engagement in a commercial digital diabetes prevention program. METHODS We examined the capacity, advantages, and limitations of ChatGPT to support digital product idea conceptualization, intervention content development, and the software engineering process, including software requirement generation, software design, and code production. In total, 11 evaluators, each with at least 10 years of experience in fields of study ranging from medicine and implementation science to computer science, participated in the output review process (ChatGPT vs human-generated output). All had familiarity or prior exposure to the original personalized automatic messaging system intervention. The evaluators rated the ChatGPT-produced outputs in terms of understandability, usability, novelty, relevance, completeness, and efficiency. RESULTS Most metrics received positive scores. We identified that ChatGPT can (1) support developers to achieve high-quality products faster and (2) facilitate nontechnical communication and system understanding between technical and nontechnical team members around the development goal of rapid and easy-to-build computational solutions for medical technologies. CONCLUSIONS ChatGPT can serve as a usable facilitator for researchers engaging in the software development life cycle, from product conceptualization to feature identification and user story development to code generation. TRIAL REGISTRATION ClinicalTrials.gov NCT04049500; https://clinicaltrials.gov/ct2/show/NCT04049500.
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Affiliation(s)
- Danissa V Rodriguez
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Katharine Lawrence
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Medical Center Information Technology, Department of Health Informatics, New York University Langone Health, New York, NY, United States
| | - Javier Gonzalez
- Medical Center Information Technology, Department of Health Informatics, New York University Langone Health, New York, NY, United States
| | - Beatrix Brandfield-Harvey
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Lynn Xu
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Sumaiya Tasneem
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Defne L Levine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
| | - Devin Mann
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, United States
- Medical Center Information Technology, Department of Health Informatics, New York University Langone Health, New York, NY, United States
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Rodriguez DV, Chen J, Viswanadham RVN, Lawrence K, Mann D. Leveraging Machine Learning to Develop Digital Engagement Phenotypes of Users in a Digital Diabetes Prevention Program: Evaluation Study. JMIR AI 2024; 3:e47122. [PMID: 38875579 PMCID: PMC11041485 DOI: 10.2196/47122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 07/25/2023] [Accepted: 01/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND Digital diabetes prevention programs (dDPPs) are effective "digital prescriptions" but have high attrition rates and program noncompletion. To address this, we developed a personalized automatic messaging system (PAMS) that leverages SMS text messaging and data integration into clinical workflows to increase dDPP engagement via enhanced patient-provider communication. Preliminary data showed positive results. However, further investigation is needed to determine how to optimize the tailoring of support technology such as PAMS based on a user's preferences to boost their dDPP engagement. OBJECTIVE This study evaluates leveraging machine learning (ML) to develop digital engagement phenotypes of dDPP users and assess ML's accuracy in predicting engagement with dDPP activities. This research will be used in a PAMS optimization process to improve PAMS personalization by incorporating engagement prediction and digital phenotyping. This study aims (1) to prove the feasibility of using dDPP user-collected data to build an ML model that predicts engagement and contributes to identifying digital engagement phenotypes, (2) to describe methods for developing ML models with dDPP data sets and present preliminary results, and (3) to present preliminary data on user profiling based on ML model outputs. METHODS Using the gradient-boosted forest model, we predicted engagement in 4 dDPP individual activities (physical activity, lessons, social activity, and weigh-ins) and general activity (engagement in any activity) based on previous short- and long-term activity in the app. The area under the receiver operating characteristic curve, the area under the precision-recall curve, and the Brier score metrics determined the performance of the model. Shapley values reflected the feature importance of the models and determined what variables informed user profiling through latent profile analysis. RESULTS We developed 2 models using weekly and daily DPP data sets (328,821 and 704,242 records, respectively), which yielded predictive accuracies above 90%. Although both models were highly accurate, the daily model better fitted our research plan because it predicted daily changes in individual activities, which was crucial for creating the "digital phenotypes." To better understand the variables contributing to the model predictor, we calculated the Shapley values for both models to identify the features with the highest contribution to model fit; engagement with any activity in the dDPP in the last 7 days had the most predictive power. We profiled users with latent profile analysis after 2 weeks of engagement (Bayesian information criterion=-3222.46) with the dDPP and identified 6 profiles of users, including those with high engagement, minimal engagement, and attrition. CONCLUSIONS Preliminary results demonstrate that applying ML methods with predicting power is an acceptable mechanism to tailor and optimize messaging interventions to support patient engagement and adherence to digital prescriptions. The results enable future optimization of our existing messaging platform and expansion of this methodology to other clinical domains. TRIAL REGISTRATION ClinicalTrials.gov NCT04773834; https://www.clinicaltrials.gov/ct2/show/NCT04773834. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/26750.
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Affiliation(s)
| | - Ji Chen
- New York University Grosman School of Medicine, New York, NY, United States
| | | | - Katharine Lawrence
- New York University Grosman School of Medicine, New York, NY, United States
- New York University Langone Health, New York, NY, United States
| | - Devin Mann
- New York University Grosman School of Medicine, New York, NY, United States
- New York University Langone Health, New York, NY, United States
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Bahari NI, Ahmad N, Mahmud MH, Baharom M, Amir SM, Peng CS, Hassan MR, Nawi AM. Issues and Challenges in the Primary Prevention of Type 2 Diabetes Mellitus: A Systematic Review. JOURNAL OF PREVENTION (2022) 2023; 44:105-125. [PMID: 36129587 DOI: 10.1007/s10935-022-00707-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/06/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Primary prevention of type 2 diabetes mellitus (T2DM) is possible in at-risk populations, and prevention programmes have been shown to be effective in real-world scenarios. Despite this evidence, diabetes prevalence has tripled in recent decades and is expected to reach 700 million patients by 2045, making it one of the leading causes of death globally. This review is aimed at identifying the issues and challenges in the primary prevention of T2DM. METHODS Scopus, Web of Science, PubMed and Ovid MEDLINE were systematically searched for published articles. Articles were screened based of inclusion and exclusion criteria. The inclusion criteria were: (1) published in 2010-2020, (2) full original article, (3) written in English, (4) qualitative, mixed-methods article, observational or interventional study. The exclusion criteria were: (1) animal study, (2) in vivo/in vitro study, (3) type 1 diabetes or gestational DM and (4) conference abstract, book chapter, report, and systematic review. Eligible articles were assessed using Mixed Methods Appraisal Tool (MMAT) by three assessors. RESULTS A total of 11 articles were selected for qualitative synthesis from the initial 620 articles. The issues and challenges seen in T2DM primary prevention followed three themes: healthcare program (sub-themes: lack of resources, community partnership, participation, health literacy), health provider (sub-themes: lack of implementation, health care staff, collaboration, availability), individual (sub-themes: awareness, communication, misbehaviour, family conflict). CONCLUSION Factors relating to healthcare programmes, health providers, and individual issues are the main challenges in T2DM primary prevention. By establishing sustainable preventative initiatives that address these issues and challenges in the primary prevention of T2DM, a reduction in T2DM prevalence could be achievable.
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Affiliation(s)
- Nor Izyani Bahari
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Norfazilah Ahmad
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Muhammad Hilmi Mahmud
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mazni Baharom
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Siti Maisara Amir
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Chua Su Peng
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Bandar Tun Razak, 56000, Kuala Lumpur, Malaysia.
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Rodriguez DV, Lawrence K, Luu S, Yu JL, Feldthouse DM, Gonzalez J, Mann D. Development of a computer-aided text message platform for user engagement with a digital Diabetes Prevention Program: a case study. J Am Med Inform Assoc 2021; 29:155-162. [PMID: 34664647 PMCID: PMC8714274 DOI: 10.1093/jamia/ocab206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 11/12/2022] Open
Abstract
Digital Diabetes Prevention Programs (dDPP) are novel mHealth applications that leverage digital features such as tracking and messaging to support behavior change for diabetes prevention. Despite their clinical effectiveness, long-term engagement to these programs remains a challenge, creating barriers to adherence and meaningful health outcomes. We partnered with a dDPP vendor to develop a personalized automatic message system (PAMS) to promote user engagement to the dDPP platform by sending messages on behalf of their primary care provider. PAMS innovates by integrating into clinical workflows. User-centered design (UCD) methodologies in the form of iterative cycles of focus groups, user interviews, design workshops, and other core UCD activities were utilized to defined PAMS requirements. PAMS uses computational tools to deliver theory-based, automated, tailored messages, and content to support patient use of dDPP. In this article, we discuss the design and development of our system, including key requirements and features, the technical architecture and build, and preliminary user testing.
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Affiliation(s)
- Danissa V Rodriguez
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Katharine Lawrence
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Son Luu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Jonathan L Yu
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
| | - Dawn M Feldthouse
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Javier Gonzalez
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
| | - Devin Mann
- Department of Population Health, NYU Grossman School of Medicine, New York, New York, USA
- Medical Center Information Technology, NYU Langone Health, New York, New York, USA
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