Reversing Type 2 Diabetes in a Primary Care-Anchored eHealth Lifestyle Coaching Programme in Denmark: A Randomised Controlled Trial

Managing cardiovascular risk factors with telemedicine in primary care: A systematic review and meta-analysis of patients with arterial hypertension and type 2 diabetes

OBJECTIVES

To review the effect of telemedicine interventions on cardiovascular risk factors control in people with arterial hypertension (AH), type 2 diabetes (T2D), or both in primary care.

METHODS

We conducted a systematic review in February 2024 using PubMed/MEDLINE, Cochrane Library, and EMBASE databases. We included randomised controlled trials from 2010 onwards, lasting ≥3 months, comparing telemedicine to standard care for managing cardiovascular risk factors in adults with AH, T2D, or both.

RESULTS

Among 1803 records, 54 were included. Telemonitoring with teleconsultations showed the best outcomes. For AH, systolic blood pressure decreased by -5.63 mmHg (95% CI -9.13 to -2.13) at 6 months and -5.59 mmHg (95% CI -10.03 to -1.14) at 12 months compared to standard care. For T2D, HbA1c decreased by -0.45% (95% CI -0.90 to 0.00) at 6 months and -0.18% (95% CI -0.41 to 0.05) at 12 months compared to standard care. Blood glucose self-monitoring was as effective as telemonitoring for T2D at 6 months. The effect on diastolic blood pressure, low-density lipoprotein, triglycerides, and body mass index was non-significant.

DISCUSSION

Telemedicine offers short-term benefits but lacks long-term effectiveness. Optimal outcomes require a combined telemedicine approach, health education co-intervention, ≥12-month follow-up, and careful patient selection.

Demystifying diabetes health coaching: A scoping review unveiling the 'who' and 'where' of health coaching for adults with type 2 diabetes

Type 2 diabetes (T2D) is a complex chronic condition that requires ongoing self-management. Diabetes health coaching interventions provide personalized healthcare programming to address physical and psychosocial aspects of diabetes self-management.

AIMS

This scoping review aims to explore the contexts and settings of diabetes health coaching interventions for adults with T2D, using the RE-AIM framework.

METHODS

A search was completed in MEDLINE, PsycINFO, Emcare, Embase and Cochrane. Included citations described adults with exclusively T2D who had received a health coaching intervention. Citations were excluded if they focused on any other types of diabetes or diabetes prevention.

RESULTS

A total of 3418 records were identified through database and manual searches, with 29 citations selected for data extraction. Most health coaching interventions were delivered by health professionals, many employed lay health workers and a few included peer coaches. While many health coaching interventions were delivered remotely, in-person intervention settings were distributed among primary care, community health settings and non-healthcare sites.

CONCLUSION

The findings of this review suggest that diabetes health coaching may be implemented by a variety of providers in different settings. Further research is required to standardize training and implementation of health coaching and evaluate its long-term effectiveness.

Telenursing needs and influencing factors in patients with type 2 diabetes mellitus: A cross-sectional study

AIMS AND OBJECTIVES

This study aimed to determine the relationship between the demand for telenursing and the chronic illness resources available to patients with type 2 diabetes mellitus (T2DM), as well as the factors that affect this requirement.

DESIGN

Cross-sectional.

METHODS

This study included 586 participants with T2DM. A telenursing needs questionnaire developed by the research team was used to assess the telenursing needs of patients with T2DM, and the Chinese version of the Chronic Illness Resources Survey was used to assess the participants' community chronic disease resources. A one-way ANOVA and multiple regression analysis were used to determine the factors influencing the demand for telenursing and to estimate the relationship between chronic illness resources and the need for telenursing. The STROBE checklist was followed.

RESULTS

The patients' telenursing needs, ranked from high to low, are as follows: individualized skills and safety; basic disease care; psychological and spiritual needs; respect and social support; and high-level health management. The chronic disease resource score was 3.47 ± .02, which suggested that patients with T2DM have relatively rich disease resources. Multiple regression analyses showed that resources for chronic diseases, the course of diabetes and complications, family income and other chronic diseases accounted for 79.6% of the variance in T2DM patients' telenursing needs.

CONCLUSIONS

The telenursing needs of patients with T2DM are prominent, and primarily focus on basic nursing needs for the disease. To some extent, chronic disease resources affect the telenursing needs of patients with T2DM.

RELEVANCE TO CLINICAL PRACTICE

It is crucial to pay attention to research on telenursing for T2DM patients from the patients' perspective. Enhancing resources for chronic diseases may help meet the telenursing needs of T2DM patients.

PATIENT OR PUBLIC CONTRIBUTION

Parents and diabetes management specialists participated in designing the telenursing needs questionnaire.

Effectiveness of the Telemedical Lifestyle Intervention Program TeLIPro for Improvement of HbA1c in Type 2 Diabetes: A Randomized-Controlled Trial in a Real-Life Setting

The effectiveness of the multimodal Telemedical Lifestyle Intervention Program (TeLIPro) was proven in the advanced stages of type 2 diabetes mellitus (T2DM). Since its therapeutic potential focusing on telemedical coaching without using a formula diet is unknown, we evaluated improvements in HbA1c, HbA1c normalisation rate, cardiometabolic risk factors, quality-of-life, and eating behaviour in real life. In this randomized-controlled trial, AOK Rhineland/Hamburg insured T2DM patients (n = 1163) were randomized (1:1) into two parallel groups, and 817 received the allocated intervention. In addition to routine care, all participants got scales, step counters, and access to an online portal. The TeLIPro group additionally received equipment for self-monitoring of blood glucose and telemedical coaching. Data were collected at baseline, after 6 and 12 months of intervention as well as after a 6-month follow-up. The primary endpoint after 12 months was (i) the estimated treatment difference (ETD) in HbA1c change and (ii) the HbA1c normalisation rate in those with diabetes duration < 5 years. The TeLIPro group demonstrated significantly stronger improvements in HbA1c (ETD -0.4% (-0.5; -0.2); p < 0.001), body weight, body-mass-index, quality-of-life, and eating behaviour, especially in T2DM patients with diabetes duration ≥ 5 years (ETD -0.5% (-0.7; -0.3); p < 0.001). The HbA1c normalisation rate did not significantly differ between groups (25% vs. 18%). Continuous addition of TeLIPro to routine care is effective in improving HbA1c and health-related lifestyle in T2DM patients with longer diabetes duration in real life.

Developing a complex vocational rehabilitation intervention for patients with inflammatory arthritis: the WORK-ON study

BACKGROUND

People with inflammatory arthritis often experience challenges at work and balancing paid work and energy in everyday life. Low work ability is common, and people with inflammatory arthritis face high risks of losing their jobs and permanent exclusion from the labour market. Context-specific tailored rehabilitation targeting persons with inflammatory arthritis is limited. The aim of this study is to describe the development of WORK-ON - a vocational rehabilitation for people with inflammatory arthritis.

METHODS

Following the Medical Research Council's framework for complex interventions, WORK-ON was developed based on existing evidence, interviews with patients and rehabilitation clinicians, a workshop, and an iterative process.

RESULTS

The six-month vocational rehabilitation, WORK-ON, consists of 1) an initial assessment and goal setting by an occupational therapist experienced in rheumatology rehabilitation, 2) coordination by the same occupational therapist and individual support, including navigating across the primary and secondary health sectors, as well as social care, 3) group sessions for peer support, and 4) optionally individually tailored consultations with physiotherapists, nurses, or social workers.

CONCLUSION

WORK-ON is ready to be tested in a feasibility study.

TRIAL REGISTRATION

The Regional Committees on Health Ethics for Southern Denmark stated that no formal ethical approval was necessary in this study (20,192,000-105).

Enhancing knowledge of Diabetes self-management and quality of life in people with Diabetes Mellitus by using Guru Diabetes Apps-based health coaching

Introduction

Virtual diabetes coaching through applications has the potential to improve self-management in people with Type 2 Diabetes Mellitus. However, applications designed for Asian's diabetic have never been studied. Therefore, our study aimed to identify the effect of Guru Diabetes Apps-Based Health Coaching on the level of glycemic hemoglobin, knowledge, and quality of life in Indonesians, as one of Asian ethnicities.

Materials and methods

This study used an experimental design. Participants with T2DM were recruited from three primary care health centers. The intervention included 3 months of virtual health coaching through the Guru Diabetes application. The daily monitoring of glycemic blood glucose, blood pressure, body weight, nutrition intake, and activity provided were used as baseline to conduct virtual in-person coaching. The glycemic hemoglobin level, knowledge level, and quality of life were assessed at baseline and post-enrollment. A multilevel modeling approach was used for statistical analysis.

Results

A total of 66 respondents were enrolled, and 62 respondents (93.93%) remained in the study at 3 months. After completing the intervention, the HbA1c level decreased in all groups, however it did not differ among the groups. On the other hand, the results indicate significant improvement in the average diabetes self-management knowledge score (pre = 14.97 vs post = 19.07, p < 0.05) and quality of life score (pre = 54.34 vs post = 60.28, p < 0.05), with significant difference among the groups (p < 0.05).

Conclusion

Participants in the Android Application-Based Health Coaching experienced a significant improvement in diabetes self-management knowledge and quality of life scores at 3 months. In conclusion, the Guru Diabetes Apps-Based Health Coaching has the potential to support people with T2DM in performing diabetes self-management at home.

Long-term weight loss in a 24-month primary care-anchored telehealth lifestyle coaching program: Randomized controlled trial

Long-term weight loss can reduce the risk of type 2 diabetes for people living with obesity and reduce complications for patients diagnosed with type 2 diabetes. We investigated whether a telehealth lifestyle-coaching program (Liva) leads to long-term (24 months) weight loss compared to usual care. In a randomized controlled trial, n = 340 participants living with obesity with or without type 2 diabetes were enrolled and randomized via an automated computer algorithm to an intervention group ( n = 200) or to a control group ( n = 140). The telehealth lifestyle-coaching program comprised of an initial one-hour face-to-face motivational interview followed by asynchronous telehealth coaching. The behavioural change techniques used were enabled by individual live monitoring. The primary outcome was a change in body weight from baseline to 24 months. Data were assessed for n = 136 participants (40%), n = 81 from the intervention group and n = 55 from the control group, who completed the 24-month follow-up. After 24 months mean body weight and body mass index were reduced significantly for completers in both groups, but almost twice as much was registered for those in the intervention group which was not significant between groups −4.4 (CI −6.1; −2.8) kg versus −2.5 (CI −3.9; −1.1) kg, P = 0.101. Haemoglobin A1c was significantly reduced in the intervention group −3.1 (CI −5.0; −1.2) mmol/mol, but not in the control group −0.2 (CI −2.4; −2.0) mmol/mol without a significant between group difference ( P = 0.223). Low completion was partly due to coronavirus disease 2019. Telehealth lifestyle coaching improve long-term weight loss (> 24 months) for obese people with and without type 2 diabetes compared to usual care.