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O'Connor S, Cave L, Philips N. Informing nursing policy: An exploration of digital health research by nurses in England. Int J Med Inform 2024; 185:105381. [PMID: 38402804 DOI: 10.1016/j.ijmedinf.2024.105381] [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: 11/05/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 02/27/2024]
Abstract
AIMS Digital health technologies are designed, implemented, and evaluated to support clinical practice, enable patients to self-manage illness, and further public and global health. Nursing and health policies often emphasise the importance of evidence-based digital health services to deliver better care. However, the contribution nurses make to digital health research in many countries is unknown. Hence, this study aims to examine digital health research conducted by nurses in England. DESIGN A bibliometric analysis. METHODS The CINAHL, MEDLINE, and Scopus databases were searched between 2000 and 2022, and supplemented with a hand search of nurses' research profiles. Results were screened by title, abstract, and full text against eligibility criteria. Data were extracted and bibliometric analysis used to summarise the findings. RESULTS Mental health nurses produced the most digital health research in England, followed by nurses working in community care, with several disciplines underrepresented or missing. Web/online health services or information was the most researched technology, followed by mobile health and telehealth. Nurses based in the south-east and north-west of England produced the most digital health research, with other regions less well represented. CONCLUSION Nurse leaders should support nurses to conduct more digital health research by providing dedicated time, funding, and professional development opportunities, particularly in under researched clinical areas, technologies, and geographic regions to further evidence-based practice and patient care. More digital nursing data is needed to support nurse led research in areas like artificial intelligence and data science. The findings supported the national Philips Ives Review by identifying areas of digital nursing research that need more investment in England.
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Affiliation(s)
- Siobhan O'Connor
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, United Kingdom.
| | - Louise Cave
- NHS England Transformation Directorate, NHS England, United Kingdom.
| | - Natasha Philips
- School of Health & Society, University of Salford, United Kingdom.
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Chrysi MS, Michopoulos I, Dimitriadis G, Peppa M. A modern web-based health promotion program for patients in Greece with diabetes 2 and obesity: an interventional study. BMC Public Health 2023; 23:639. [PMID: 37013500 PMCID: PMC10069363 DOI: 10.1186/s12889-023-15557-3] [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: 08/28/2022] [Accepted: 03/29/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Health promotion programs are most beneficial in chronic diseases such as diabetes and morbid obesity, which can be positively affected by changes in attitudes, beliefs, and lifestyle. OBJECTIVES This study aimed to develop an internet-based modern Health Promotion model using interactive online applications through continuing education and participation. METHODS The goal was to positively impact knowledge, behavior, and quality of life for patients with obesity and/or diabetes. This is a prospective interventional study on patients with obesity or type 2 diabetes. Seventeen two patients who met the inclusion criteria were distributed randomly into two groups (control and intervention) from 2019 to 2021 in Greece. All the participants were given questionaries concerning quality of life anxiety and depression (HADS) attitudes and beliefs, knowledge about their condition and general questions to establish a baseline. A traditional health promotion model was followed for the control group. For participants in the intervention group, a web-based health promotion program was created according to the goals of the research. Participants were instructed to log on 1-2 times a week for 5-15 min, with the understanding that the research team would be monitoring their activities. The website included two knowledge games and personalized educational material based on their needs. RESULTS The sample comprised 72 patients (36 in control and 36 in the intervention groups). The mean age was 47.8 years for the control group and 42.7 years for the intervention group (p = 0.293). Both study groups had a significant increase in knowledge score on diabetes (Control group:3,24, Intervention group 11,88 p < 0,001) and obesity (Control group:4,9, Intervention group 51,63 p < 0,001) along with a positive attitude score towards fighting obesity (Control group: 1,8, Intervention group 13,6 p < 0,001). Still, the overall change was more remarkable for the intervention group, as indicated by the significant interaction effect of the analysis. Anxiety was decreased only in the intervention group (Control group:0,11, Intervention group - 0,17 p < 0,005). Analysis for QOL during follow-up showed that Physical Health and Level of Independence was improved in both study groups but the degree of improvement was more significant in the intervention group (Control group 0,31,Intervention group 0,73 p < 0,001). Psychological Health was improved only in the intervention group, with better scores at 6 and 12 months compared to controls (Control group 0,28,Intervention group 1,42 p < 0,001). Furthermore, Social relationships were improved only in the intervention group (Control group 0,02, Intervention group 0,56 p < 0,001). CONCLUSIONS The results of the present study showed that the participants in the intervention group showed significant improvement in knowledge, attitudes, and beliefs after using the internet as a learning tool. The intervention group also showed significantly reduced anxiety and depression arising from chronic illness. All of this resulted in an improved quality of life regarding physical Health, mental Health, and social relationships. Technology and online-based health promotion programs can revolutionize how we approach the prevention and management of chronic and terminal illnesses by improving accessibility, personalizing care, increasing engagement and motivation, improving data analysis, and disease management.
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Affiliation(s)
- Maria S Chrysi
- Intensive Care Unit, Hellenic Anticancer Institute, "Saint Savvas" Hospital, Athens, Greece.
| | - Ioannis Michopoulos
- 2nd Department of Psychiatry, Attikon University Hospital, National and Kapodistrian Athens University Medical School, Athens, 12462, Greece
| | - George Dimitriadis
- 2nd Propaedeutic Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian Athens University Medical School, Athens, 12462, Greece
- Endocrine Unit, 2nd Propaedeutic Department of Internal Medicine, Attikon Univeristy Hospital, National and Kapodistrian Athens University Medical School, Athens, Greece
| | - Melpomeni Peppa
- 2nd Propaedeutic Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian Athens University Medical School, Athens, 12462, Greece
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Moody L, Wood E, Needham A, Booth A, Jimenez-Aranda A, Tindale W. Identifying individual enablers and barriers to the use of digital technology for the self-management of long-term conditions by older adults. J Med Eng Technol 2022; 46:448-461. [PMID: 35748238 DOI: 10.1080/03091902.2022.2089249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Evidence suggests that much of the digital technology available and provided to older adults to enable self-management of long-term conditions is under-utilised. This research focuses on three conditions prevalent amongst older adults: diabetes, dementia and chronic kidney disease and explores the individual enablers and barriers to the use of digital self-management technology. The paper reports findings from a series of three systematic reviews of qualitative research (qualitative evidence syntheses). These reviews informed the design of a Delphi study. The first round of the Delphi involving 15 expert interviews is reported. The findings highlight common themes across the three conditions: how technology is used; barriers to use; assessing individual needs when selecting technology; support requirements; multi-functional self-management technologies; trust, privacy and data sharing; achieving accessible and aspirational design. Some emerging recommendations have been suggested to guide the design, and provision of technology to older adults. These will extended and refined through subsequent rounds of the Delphi method.
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Affiliation(s)
- Louise Moody
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK.,NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Esmé Wood
- Centre for Arts, Memory and Communities, Coventry University, Coventry, UK
| | - Abigail Needham
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Angel Jimenez-Aranda
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Wendy Tindale
- NIHR Devices for Dignity MedTech Co-operative, UK, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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A parallel randomised controlled trial of the Hypoglycaemia Awareness Restoration Programme for adults with type 1 diabetes and problematic hypoglycaemia despite optimised self-care (HARPdoc). Nat Commun 2022; 13:2229. [PMID: 35484106 PMCID: PMC9050729 DOI: 10.1038/s41467-022-29488-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 03/18/2022] [Indexed: 02/02/2023] Open
Abstract
Impaired awareness of hypoglycaemia (IAH) is a major risk for severe hypoglycaemia in insulin treatment of type 1 diabetes (T1D). To explore the hypothesis that unhelpful health beliefs create barriers to regaining awareness, we conducted a multi-centre, randomised, parallel, two-arm trial (ClinicalTrials.gov NCT02940873) in adults with T1D and treatment-resistant IAH and severe hypoglycaemia, with blinded analysis of 12-month recall of severe hypoglycaemia at 12 and/or 24 months the primary outcome. Secondary outcomes included cognitive and emotional measures. Adults with T1D, IAH and severe hypoglycaemia despite structured education in insulin adjustment, +/- diabetes technologies, were randomised to the "Hypoglycaemia Awareness Restoration Programme despite optimised self-care" (HARPdoc, n = 49), a psychoeducation programme uniquely focussing on changing cognitive barriers to avoiding hypoglycaemia, or the evidence-based "Blood Glucose Awareness Training" (BGAT, n = 50), both delivered over six weeks. Median [IQR] severe hypoglycaemia at baseline was 5[2-12] per patient/year, 1[0-5] at 12 months and 0[0-2] at 24 months, with no superiority for HARPdoc (HARPdoc vs BGAT incident rate ratios [95% CI] 1.25[0.51, 3.09], p = 0.62 and 1.26[0.48, 3.35], p = 0.64 respectively), nor for changes in hypoglycaemia awareness scores or fear. Compared to BGAT, HARPdoc significantly reduced endorsement of unhelpful cognitions (Estimated Mean Difference for Attitudes to Awareness scores at 24 months, -2.07 [-3.37,-0.560], p = 0.01) and reduced scores for diabetes distress (-6.70[-12.50,-0.89], p = 0.02); depression (-1.86[-3.30, -0.43], p = 0.01) and anxiety (-1.89[-3.32, -0.47], p = 0.01). Despite positive impact on cognitive barriers around hypoglycaemia avoidance and on diabetes-related and general emotional distress scores, HARPdoc was not more effective than BGAT at reducing severe hypoglycaemia.
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Persson M, Leksell J, Ernersson Å, Rosenqvist U, Hörnsten Å. 'Striving for freedom or remaining with what is well-known': a focus-group study of self-management among people with type 1 diabetes who have suboptimal glycaemic control despite continuous subcutaneous insulin infusion. BMJ Open 2022; 12:e057836. [PMID: 35365536 PMCID: PMC8977750 DOI: 10.1136/bmjopen-2021-057836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Continuous subcutaneous insulin infusion (CSII) treatment is beneficial for obtaining glycaemic control for many persons with type 1 diabetes mellitus (T1DM). Still, some individuals do not obtain improved HbA1C levels despite CSII treatment, and there is a lack of evidence regarding how psychosocial factors may influence glycaemic control. Thus, we aimed to explore the attitudes and experiences of self-management among people with T1DM and suboptimal glycaemic control despite CSII treatment. RESEARCH DESIGN AND METHODS A qualitative inductive design was applied, and four FGDs were performed with 37 adult men and women of various ages and duration of T1DM. All participants had suboptimal glycaemic control despite CSII treatment. Transcripts were analysed using qualitative manifest and latent content analysis. RESULTS AND CONCLUSION The themes Searching for freedom and flexibility and Preferring safety and the well-known illustrated the divergent psychosocial strategies adapted, which both resulted in suboptimal glycaemic control. The technical devices and their effects on glycaemic levels may be challenging to understand and adjust to fit people's lifestyles. The rapid advances of technology devices in diabetes care can potentially change peoples' lives, but is the educational support developing as fast? Multifaceted web-based education of high quality, including tailored support with a person-centred focus, is more important than ever before as the need for technical knowledge and understanding may put further disease burdens to patients with T1DM on CSII treatment.
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Affiliation(s)
| | - Janeth Leksell
- Department of Medical Science, Clinical Diabetology and Metabolism, Uppsala University Faculty of Medicine, Uppsala, Sweden
| | - Åsa Ernersson
- Department of Health, Medicine and Caring Sciences, Division of Nursing Science and Reproductive Health, Linköping University, Linkoping, Sweden
| | - Ulf Rosenqvist
- Division of Medicine and Endocrinology, Linköping University, Linkoping, Sweden
- Medical Clinic, Motala Hospital, Motala, Sweden
| | - Åsa Hörnsten
- Nursing, Umeå Universitet Medicinska fakulteten, Umea, Sweden
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Huhn F, Lange K, Jördening M, Ernst G. Real-World Use of Continuous Glucose Monitoring (CGM) Systems Among Adolescents and Young Adults With Type 1 Diabetes: Reduced Burden, but Little Interest in Data Analysis. J Diabetes Sci Technol 2022:19322968221081216. [PMID: 35255729 DOI: 10.1177/19322968221081216] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Since 2016, German health insurance companies reimburse continuous glucose monitoring (CGM) systems for persons with insulin-dependent diabetes, leading to a tremendous increase of CGM use. This study assessed the use of CGM, the satisfaction with, and the data analysis behavior among young people. METHODS During a diabetes camp for young people from all over Germany, participants anonymously answered a questionnaire on their method of glucose monitoring, satisfaction and quality of CGM use, HbA1c, and diabetes distress (Problem Areas in Diabetes Scale [PAID]-5). RESULTS A total of 308 participants (age 21.4 ± 3.5 years; 73% female; diabetes duration 10.1 ± 5.9 years) completed the questionnaire. Approximately, 25% used self-monitoring of blood glucose (SMBG), 46% intermittent-scanning continuous glucose monitoring (iscCGM), and 30% real-time continuous glucose monitoring (rtCGM). Mean HbA1c was slightly, but not significantly, higher among SMBG users compared with CGM users (8.0% ± 1.9% vs. 7.7% ± 1.4%; P = .791). Diabetes distress was not associated with the method of glucose monitoring (SMBG 5.6 vs. iscCGM 6.2 vs. rtCGM 6.5; P = .386). Overall, satisfaction with CGM use was very high; 98% of the CGM users reported better well-being with CGM compared with previous SMBG use. Only 19% of CGM users reported regular data analyses; their HbA1c was lower compared with other CGM users (7.2% ± 1.2% vs. 7.7% ± 1.4%; P = .039). CONCLUSIONS In this large sample of young people, 75% were using a CGM system. Treatment satisfaction was very high, but CGM use was not associated with reduced diabetes distress or better glycemic control. However, young people who regularly analyzed their CGM data reported lower HbA1c levels.
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Affiliation(s)
- Friederike Huhn
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Mia Jördening
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - Gundula Ernst
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
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Women's Usage Behavior and Perceived Usefulness with Using a Mobile Health Application for Gestational Diabetes Mellitus: Mixed-Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126670. [PMID: 34205744 PMCID: PMC8296439 DOI: 10.3390/ijerph18126670] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/08/2021] [Accepted: 06/17/2021] [Indexed: 12/17/2022]
Abstract
The prevalence of gestational diabetes mellitus (GDM) is increasing, and only a few mobile health (mHealth) applications are specifically designed to manage GDM. In this mixed-methods study, a follow-up study of a randomized controlled trial (RCT) analyzed a largely automated mHealth application-based lifestyle coaching program to (a) measure the application's usage behavior and (b) explore users' perceptions of its usefulness in GDM management. Quantitative data were collected from the 170 application users who had participated in the intervention arm of the RCT. Semi-structured interviews (n = 14) captured users' experiences when using the application. Data were collected from June 2019 to January 2020. Quantitative data were analyzed descriptively, and interviews were analyzed thematically. Only 57/170 users (34%) logged at least one meal, and only 35 meals on average were logged for eight weeks because of the incorrectly worded food items and limited food database. On the contrary, an average of 1.85 (SD = 1.60) weight values were logged per week since the weight tracking component was easy to use. Many users (6/14 (43%)) mentioned that the automatic coach messages created an immediate sense of self-awareness in food choices and motivated behavior. The findings suggest that for GDM management, a largely automated mHealth application has the potential to promote self-awareness of healthy lifestyle choices, reducing the need for intensive human resources. Additionally, several gaps in the application's design were identified which need to be addressed in future works.
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Kamusheva M, Tachkov K, Dimitrova M, Mitkova Z, García-Sáez G, Hernando ME, Goettsch W, Petrova G. A Systematic Review of Collective Evidences Investigating the Effect of Diabetes Monitoring Systems and Their Application in Health Care. Front Endocrinol (Lausanne) 2021; 12:636959. [PMID: 33796074 PMCID: PMC8008960 DOI: 10.3389/fendo.2021.636959] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 02/11/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Diabetes monitoring systems (DMS) are a possible approach for regular control of glucose levels in patients with Type 1 or 2 diabetes in order to improve therapeutic outcomes or to identify and modify inappropriate patient behaviors in a timely manner. Despite the significant number of studies observing the DMS, no collective evidence is available about the effect of all devices. GOAL To review and consolidate evidences from multiple systematic reviews on the diabetes monitoring systems and the outcomes achieved. MATERIALS AND METHODS Internet-based search in PubMed, EMBASE, and Cochrane was performed to identify all studies relevant to the research question. The data regarding type of intervention, type of diabetes mellitus, type of study, change in clinical parameter(s), or another relevant outcome were extracted and summarized. RESULTS Thirty-three out of 1,495 initially identified studies, involving more than 44,100 patients with Type 1, Type 2, or gestational diabetes for real-time or retrospective Continuous Glucose Monitoring (CGMS), Sensor Augmented Pump Therapy (SAPT), Self-monitoring Blood Glucose (SMBG), Continuous subcutaneous insulin infusion (CSII), Flash Glucose Monitoring (FGM), Closed-loop systems and telemonitoring, were included. Most of the studies observed small nominal effectiveness of DMS. In total 11 systematic reviews and 15 meta-analyses, with most focusing on patients with Type 1 diabetes (10 and 6, respectively), reported a reduction in glycated hemoglobin (HbA1c) levels from 0.17 to 0.70% after use of DMS. CONCLUSION Current systematic review of already published systematic reviews and meta-analyses suggests that no statistically significant difference exists between the values of HbA1c as a result of application of any type of DMS. The changes in HbA1c values, number and frequency of hypoglycemic episodes, and time in glucose range are the most valuable for assessing the appropriateness and effectiveness of DMS. Future more comprehensive studies assessing the effectiveness, cost-effectiveness, and comparative effectiveness of DMS are needed to stratify them for the most suitable diabetes patients' subgroups.
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Affiliation(s)
- Maria Kamusheva
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
- *Correspondence: Maria Kamusheva,
| | | | - Maria Dimitrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Zornitsa Mitkova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
| | - Gema García-Sáez
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
| | - M. Elena Hernando
- Bioengineering and Telemedicine Group, Centro de Tecnología Biomédica, Escuela Técnica Superior de Ingenieros de Telecomunicación, Universidad Politécnica de Madrid, Madrid, Spain
- CIBER-BBN: Networking Research Centre for Bioengineering, Biomaterials and Nanomedicine, Madrid, Spain
| | - Wim Goettsch
- Utrecht Centre for Pharmaceutical Policy, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, Netherlands
- National Health Care Institute (ZIN), Diemen, Netherlands
| | - Guenka Petrova
- Faculty of Pharmacy, Medical University of Sofia, Sofia, Bulgaria
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Rodrigues AK, Melo AE, Domingueti CP. Association between reduced serum levels of magnesium and the presence of poor glycemic control and complications in type 1 diabetes mellitus: A systematic review and meta-analysis. Diabetes Metab Syndr 2020; 14:127-134. [PMID: 32088645 DOI: 10.1016/j.dsx.2020.01.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 01/30/2020] [Accepted: 01/30/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To evaluate the association between reduced serum magnesium levels and poor glycemic control and/or complications in patients with type 1 diabetes mellitus through a systematic review and meta-analysis. METHODS The articles were selected using the Medline/PubMed, Web of Science, Scopus and Scielo databases. Eligibility criteria were cross-sectional, cohort or case-control observational studies that assessed the association between reduced magnesium levels and poor glycemic control and/or complications in patients with type 1 diabetes mellitus. RESULTS Nine articles were included in the systematic review and two in the meta-analysis, all articles being cross-sectional. Among the seven studies that were designed to evaluate glycemic control, five showed an association between reduced levels of magnesium and poor glycemic control, and these findings were corroborated by the meta-analysis. Among the two studies in which dyslipidemia was evaluated, both showed higher levels of triglycerides, total cholesterol and LDL cholesterol, and lower levels of HDL cholesterol in patients with lower levels of magnesium as compared to those with higher magnesium levels. The three studies that evaluated diabetes kidney disease and the two studies that evaluated diabetic retinopathy found divergent results. CONCLUSION There is an association between reduced levels of magnesium and poor glycemic control in patients with type 1 diabetes mellitus, however, this needs further studies.
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Affiliation(s)
- Ana Kelen Rodrigues
- Universidade Federal de São João del Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
| | - Ana Elisa Melo
- Universidade Federal de São João del Rei, Campus Centro Oeste Dona Lindu, Divinópolis, MG, Brazil
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Kubiak T, Priesterroth L, Barnard-Kelly KD. Psychosocial aspects of diabetes technology. Diabet Med 2020; 37:448-454. [PMID: 31943354 DOI: 10.1111/dme.14234] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2020] [Indexed: 12/14/2022]
Abstract
AIM To identify key psychosocial research in the domain of diabetes technology. RESULTS Four trajectories of psychosocial diabetes technology research are identified that characterize research over the past 25 years. Key evidence is reviewed on psychosocial outcomes of technology use as well as psychosocial barriers and facilitating conditions of diabetes technology uptake. Psychosocial interventions that address modifiable barriers and psychosocial factors have proven to be effective in improving glycaemic and self-reported outcomes in diabetes technology users. CONCLUSIONS Psychosocial diabetes technology research is essential for designing interventions and education programmes targeting the person with diabetes to facilitate optimized outcomes associated with technology uptake. Psychosocial aspects of diabetes technology use and related research will be even more important in the future given the advent of systems for automated insulin delivery and the increasingly widespread digitalization of diabetes care.
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Affiliation(s)
- T Kubiak
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - L Priesterroth
- Health Psychology, Institute of Psychology, Johannes Gutenberg University, Mainz, Germany
| | - K D Barnard-Kelly
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
- BHR Limited, Fareham, UK
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Benioudakis ES. Perceptions in Type 1 Diabetes Mellitus with or Without the Use of Insulin Pump: An Online Study. Curr Diabetes Rev 2020; 16:874-880. [PMID: 31057119 DOI: 10.2174/1573399815666190502115754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/17/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Technological developments concerning the treatment of Type 1 Diabetes Mellitus have been rapid in the latest years. Insulin infusion systems along with continuous glucose monitoring, as well as long-acting insulin analogues, are part of this progress. OBJECTIVE The aim of this study is to present the illness perceptions in type 1 diabetes mellitus, with or without the use of an insulin pump. Sexual life and body image among therapy groups subjected to subcutaneous insulin infusion (CSII) therapy and multiple daily injections (MDI) therapy were also examined. METHODS A modified version of the Brief Illness Perception Questionnaire was used. One hundred and nine adults with type 1 diabetes mellitus, (males / females ratio 1:2.3) completed the online survey. Thirty six of them (33%) used CSII therapy and 73 of them (67%) used MDI therapy. RESULTS Statistically important differences among the CSII and MDI therapy groups were found in treatment control, illness comprehensibility, representations of control, representation of body image and in the perception of sex life. There was no statistically significant difference among the different types of therapy for participants' negative perception of diabetes. DISCUSSION AND CONCLUSION Negative perceptions of MDI users in treatment control, illness comprehensibility, representations of control, body image and sex life with the insulin pump, differentiate CSII and MDI therapy groups to a significant degree. According to the research, these parameters seem to interfere with accepting CSII therapy for MDI users and discourage them.
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Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Crete, Greece; 2Psychiatric Clinic, General Hospital of Chania, Chania, Greece
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12
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Lal RA, Ekhlaspour L, Hood K, Buckingham B. Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes. Endocr Rev 2019; 40:1521-1546. [PMID: 31276160 PMCID: PMC6821212 DOI: 10.1210/er.2018-00174] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 02/28/2019] [Indexed: 01/20/2023]
Abstract
Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an "artificial pancreas" that is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short-term and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep, and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems use a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin that has already been delivered to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day, alleviating meal announcements, carbohydrate counting, alerts, and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with the closed-loop system.
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Affiliation(s)
- Rayhan A Lal
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Division of Endocrinology, Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Laya Ekhlaspour
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California.,Department of Psychiatry, Stanford University School of Medicine, Stanford, California
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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Wu X, Guo X, Zhang Z. The Efficacy of Mobile Phone Apps for Lifestyle Modification in Diabetes: Systematic Review and Meta-Analysis. JMIR Mhealth Uhealth 2019; 7:e12297. [PMID: 30664494 PMCID: PMC6350094 DOI: 10.2196/12297] [Citation(s) in RCA: 119] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/21/2018] [Accepted: 12/29/2018] [Indexed: 12/19/2022] Open
Abstract
Background Diabetes and related complications are estimated to cost US $727 billion worldwide annually. Type 1 diabetes, type 2 diabetes, and gestational diabetes are three subtypes of diabetes that share the same behavioral risk factors. Efforts in lifestyle modification, such as daily physical activity and healthy diets, can reduce the risk of prediabetes, improve the health levels of people with diabetes, and prevent complications. Lifestyle modification is commonly performed in a face-to-face interaction, which can prove costly. Mobile phone apps provide a more accessible platform for lifestyle modification in diabetes. Objective This review aimed to summarize and synthesize the clinical evidence of the efficacy of mobile phone apps for lifestyle modification in different subtypes of diabetes. Methods In June 2018, we conducted a literature search in 5 databases (Cochrane Central Register of Controlled Trials, MEDLINE, Embase, CINAHL, and PsycINFO). We evaluated the studies that passed screening using The Cochrane Collaboration’s risk of bias tool. We conducted a meta-analysis for each subtype on the mean difference (between intervention and control groups) at the posttreatment glycated hemoglobin (HbA1c) level. Where possible, we analyzed subgroups for short-term (3-6 months) and long-term (9-12 months) studies. Heterogeneity was assessed using the I2 statistic. Results We identified total of 2669 articles through database searching. After the screening, we included 26 articles (23 studies) in the systematic review, of which 18 studies (5 type 1 diabetes, 11 type 2 diabetes, and 2 prediabetes studies) were eligible for meta-analysis. For type 1 diabetes, the overall effect on HbA1c was statistically insignificant (P=.46) with acceptable heterogeneity (I2=39%) in the short-term subgroup (4 studies) and significant heterogeneity between the short-term and long-term subgroups (I2=64%). Regarding type 2 diabetes, the overall effect on HbA1c was statistically significant (P<.01) in both subgroups, and when the 2 subgroups were combined, there was virtually no heterogeneity within and between the subgroups (I2 range 0%-2%). The effect remained statistically significant (P<.01) after adjusting for publication bias using the trim and fill method. For the prediabetes condition, the overall effect on HbA1c was statistically insignificant (P=.67) with a large heterogeneity (I2=65%) between the 2 studies. Conclusions There is strong evidence for the efficacy of mobile phone apps for lifestyle modification in type 2 diabetes. The evidence is inconclusive for the other diabetes subtypes.
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Affiliation(s)
- Xinghan Wu
- eHealth Research Institute, School of Management, Harbin Institute of Technology, Harbin, China
| | - Xitong Guo
- eHealth Research Institute, School of Management, Harbin Institute of Technology, Harbin, China
| | - Zhiwei Zhang
- Department of Statistics, University of California at Riverside, Riverside, CA, United States
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