1
|
Hadlandsmyth K, Conrad M, Steffensmeier KS, Van Tiem J, Obrecht A, Cullen JJ, Vander Weg MW. Enhancing the Biopsychosocial Approach to Perioperative Care: A Pilot Randomized Trial of the Perioperative Pain Self-management (PePS) Intervention. Ann Surg 2022; 275:e8-e14. [PMID: 33351478 DOI: 10.1097/sla.0000000000004671] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The current study aimed to pilot the PePS intervention, based on principles of cognitive behavioral therapy (CBT), to determine feasibility and preliminary efficacy for preventing chronic pain and long-term opioid use. SUMMARY BACKGROUND DATA Surgery can precipitate the development of both chronic pain and long-term opioid use. CBT can reduce distress and improve functioning among patients with chronic pain. Adapting CBT to target acute pain management in the postoperative period may impact longer-term postoperative outcomes. METHODS This was a mixed-methods randomized controlled trial in a mixed surgical sample with assignment to standard care or PePS, with primary outcomes at 3-months postsurgery. The sample consisted of rural-dwelling United States Military Veterans. RESULTS Logistic regression analyses found a significant effect of PePS on odds of moderate-severe pain (on average over the last week) at 3-months postsurgery, controlling for preoperative moderate-severe pain: Adjusted odds ratio = 0.25 (95% CI: 0.07-0.95, P < 0.05). At 3-months postsurgery, 15% (6/39) of standard care participants and 2% (1/45) of PePS participants used opioids in the prior seven days: Adjusted Odds ratio = 0.10 (95% CI: 0.01-1.29, P = .08). Changes in depression, anxiety, and pain catastrophizing were not significantly different between arms. CONCLUSIONS The findings from this study support the feasibility and preliminary efficacy of the PePS intervention.
Collapse
Affiliation(s)
- Katherine Hadlandsmyth
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa
- Center for Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- University of Iowa, Carver College of Medicine, Department of Anesthesia, Iowa City, Iowa
| | - Mandy Conrad
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa
- University of Iowa, College of Education, Department of Psychological and Quantitative Foundations, Iowa City, Iowa
- Stanford University School of Medicine, Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford, California
| | - Kenda Stewart Steffensmeier
- Center for Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Jennifer Van Tiem
- Center for Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
| | - Ashlie Obrecht
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa
- University of Iowa, College of Education, Department of Psychological and Quantitative Foundations, Iowa City, Iowa
| | - Joseph J Cullen
- University of Iowa, Carver College of Medicine, Department of Surgery, Iowa City, Iowa
| | - Mark W Vander Weg
- Office of Rural Health, Veterans Rural Health Resource Center, Iowa City VA Health Care System, Iowa City, Iowa
- Center for Center for Access and Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa
- University of Iowa, College of Public Health, Department of Community and Behavioral Health, Iowa City, Iowa
| |
Collapse
|
2
|
Kumah E, Otchere G, Ankomah SE, Fusheini A, Kokuro C, Aduo-Adjei K, A. Amankwah J. Diabetes self-management education interventions in the WHO African Region: A scoping review. PLoS One 2021; 16:e0256123. [PMID: 34403455 PMCID: PMC8370626 DOI: 10.1371/journal.pone.0256123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 08/01/2021] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Diabetes mellitus (DM) is one of the commonest chronic diseases worldwide. Self-Management Education (SME) is regarded as a critical element of treatment for all people with diabetes, as well as those at risk of developing the condition. While a great variety of diabetes self-management education (DSME) interventions are available in high-income countries, limited information exists on educational programs for the prevention and management of diabetes complications in Africa. This study, therefore, aimed at synthesizing information in the literature to describe the state of the science of DSME interventions in the WHO African Region. MATERIALS AND METHODS The study is a scoping review, which followed the standard PRISMA guidelines for conducting and reporting scoping reviews. A systematic keyword and subject headings searches were conducted on six electronic databases (PubMed, Scopus, MEDLINE, EMBASE, PsychINFO and the Cochrane Central Register of Controlled Trials) to identify relevant English language publications on DSME from 2000 through 2020. Titles and abstracts of the search results were screened to select eligible papers for full text reading. All eligible papers were retrieved and full text screening was done by three independent reviewers to select studies for inclusion in the final analysis. RESULTS Nineteen studies were included in the review. The interventions identified were individually oriented, group-based, individually oriented & group-based, and information technology-based DSME programs. Outcomes of the interventions were mixed. While the majority yielded significant positive results on HbA1c, diabetes knowledge, blood pressure, blood sugar and foot care practices; few demonstrated positive outcomes on self-efficacy, BMI, physical activity; self-monitoring of blood glucose, medication adherence, smoking and alcohol consumption. CONCLUSIONS The limited studies available indicate that DSME interventions in the WHO African Region have mixed effects on patient behaviors and health outcomes. That notwithstanding, the majority of the interventions demonstrated statistically significant positive effects on HbA1c, the main outcome measure in most DSME intervention studies.
Collapse
Affiliation(s)
- Emmanuel Kumah
- Department of Health Administration and Education, Faculty of Science Education, University of Education, Winneba, Ghana
| | - Godfred Otchere
- Policy, Planning, Monitoring and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
- Faculty of Humanities, Center for Medicine and Society, University of Freiburg, Freiburg im Breisgau, Germany
| | - Samuel Egyakwa Ankomah
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Adam Fusheini
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Center for Health Literacy and Rural Health Promotion, Accra, Ghana
| | - Collins Kokuro
- Department of Medicine, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Kofi Aduo-Adjei
- Center for Health Services Management, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Joseph A. Amankwah
- Department of Administration, Ankaase Methodist Hospital, Ankaase, Ghana
| |
Collapse
|
3
|
Khan MM, Roberson S, Reid K, Jordan M, Odoi A. Geographic disparities and temporal changes of diabetes prevalence and diabetes self-management education program participation in Florida. PLoS One 2021; 16:e0254579. [PMID: 34270601 PMCID: PMC8284795 DOI: 10.1371/journal.pone.0254579] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Although Diabetes Self-Management Education (DSME) programs are recommended to help reduce the burden of diabetes and diabetes-related complications, Florida is one of the states with the lowest DSME participation rates. Moreover, there is evidence of geographic disparities of not only DSME participation rates but the burden of diabetes as well. Understanding these disparities is critical for guiding control programs geared at improving participation rates and diabetes outcomes. Therefore, the objectives of this study were to: (a) investigate geographic disparities of diabetes prevalence and DSME participation rates; and (b) identify predictors of the observed disparities in DSME participation rates. METHODS Behavioral Risk Factor Surveillance System (BRFSS) data for 2007 and 2010 were obtained from the Florida Department of Health. Age-adjusted diabetes prevalence and DSME participation rates were computed at the county level and their geographic distributions visualized using choropleth maps. Significant changes in diabetes prevalence and DSME participation rates between 2007 and 2010 were assessed and counties showing significant changes were mapped. Clusters of high diabetes prevalence before and after adjusting for common risk factors and DSME participation rates were identified, using Tango's flexible spatial scan statistics, and their geographic distribution displayed in maps. Determinants of the geographic distribution of DSME participation rates and predictors of the identified high rate clusters were identified using ordinary least squares and logistic regression models, respectively. RESULTS County level age-adjusted diabetes prevalence varied from 4.7% to 17.8% while DSME participation rates varied from 26.6% to 81.2%. There were significant (p≤0.05) increases in both overall age-adjusted diabetes prevalence and DSME participation rates from 2007 to 2010 with diabetes prevalence increasing from 7.7% in 2007 to 8.6% in 2010 while DSME participation rates increased from 51.4% in 2007 to 55.1% in 2010. Generally, DSME participation rates decreased in rural areas while they increased in urban areas. High prevalence clusters of diabetes (both adjusted and unadjusted) were identified in northern and central Florida, while clusters of high DSME participation rates were identified in central Florida. Rural counties and those with high proportion of Hispanics tended to have low DSME participation rates. CONCLUSIONS The findings confirm that geographic disparities in both diabetes prevalence and DSME participation rates exist. Specific attention is required to address these disparities especially in areas that have high diabetes prevalence but low DSME participation rates. Study findings are useful for guiding resource allocation geared at reducing disparities and improving diabetes outcomes.
Collapse
Affiliation(s)
- Md Marufuzzaman Khan
- Department of Public Health, College of Education, Health, and Human Sciences, The University of Tennessee, Knoxville, Tennessee, United States of America
| | - Shamarial Roberson
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Keshia Reid
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Melissa Jordan
- Florida Department of Health, Tallahassee, Florida, United States of America
| | - Agricola Odoi
- Department of Biomedical and Diagnostic Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Tennessee, United States of America
| |
Collapse
|
4
|
Abstract
With the recent pivot to telehealth as a direct result of the COVID-19 pandemic, there is an imperative to ensure that access to affordable devices and technologies with remote monitoring capabilities for people with diabetes becomes equitable. In addition, expanding the use of remote Diabetes Self-Management Education and Support (DSMES) and Medical Nutrition Therapy (MNT) services will require new strategies for achieving long-term, effective, continuous, data-driven care. The current COVID-19 pandemic has especially impacted underserved US communities that were already disproportionately impacted by diabetes. Historically, these same communities have faced barriers in accessing timely and effective diabetes care including access to DSMES and MNT services, and diabetes technologies. Our call to action encourages all involved to urge US Federal representatives to widen access to the array of technologies necessary for successful telehealth-delivered care beyond COVID-19.
Collapse
Affiliation(s)
- David Kerr
- Sansum Diabetes Research Institute, Santa Barbara, CA, USA
| | | |
Collapse
|
5
|
Singhai K, Swami MK, Nebhinani N, Rastogi A, Jude E. Psychological adaptive difficulties and their management during COVID-19 pandemic in people with diabetes mellitus. Diabetes Metab Syndr 2020; 14:1603-1605. [PMID: 32862099 PMCID: PMC7443210 DOI: 10.1016/j.dsx.2020.08.025] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND AIMS People with diabetes have multiple psychosocial issues related to diabetes and its complications and this may be exacerbated during the COVID-19 pandemic. METHODS We reviewed the psychological adaptative difficulties in people with diabetes especially during natural disasters including the prevailing COVID-19 pandemic. RESULTS There are significant concerns regarding worsening of glycemic control, unavailability of appropriate medicines, inaccessibility to health care or acquiring SARS- CoV-2 infection and subsequent poorer outcomes during the COVID-19 pandemic. Although there are some guidance documents for managing diabetes and associated complications during COVID-19 pandemic but very few address the psychological issues in people with diabetes. We discuss the psychological adaptive difficulties and an approach to address the psychosocial concerns in people with diabetes during the COVID-19 pandemic. CONCLUSIONS People with diabetes have significant diabetes distress and psychological adaptive difficulties that is aggravated by the COVID-19 pandemic. An integrated multidisciplinary approach is needed to manage the prevailing psychological issues amongst people with diabetes during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Kartik Singhai
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Mukesh Kumar Swami
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, 342005, India
| | - Ashu Rastogi
- Department of Endocrinology and Metabolism, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, 160012, India
| | - Edward Jude
- Consultant Diabetologist, Diabetes and Endocrinology Department, Tameside and Glossop Integrated Care NHS FT, Ashton under Lyne, Lancs, OL69RW, UK.
| |
Collapse
|
6
|
Philip K, Cumella A, Farrington-Douglas J, Laffan M, Hopkinson N. Respiratory patient experience of measures to reduce risk of COVID-19: findings from a descriptive cross-sectional UK wide survey. BMJ Open 2020; 10:e040951. [PMID: 32912958 PMCID: PMC7482474 DOI: 10.1136/bmjopen-2020-040951] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess the experience of people with long-term respiratory conditions regarding the impact of measures to reduce risk of COVID-19. DESIGN Analysis of data (n=9515) from the Asthma UK and British Lung Foundation partnership COVID-19 survey collected online between 1 and 8 April 2020. SETTING Community. PARTICIPANTS 9515 people with self-reported long-term respiratory conditions. 81% female, age ranges from ≤17 years to 80 years and above, from all nations of the UK. Long-term respiratory conditions reported included asthma (83%), chronic obstructive pulmonary disease (10%), bronchiectasis (4%), interstitial lung disease (2%) and 'other' (<1%) (eg, lung cancer and pulmonary endometriosis). OUTCOME MEASURES Study responses related to impacts on key elements of healthcare, as well as practical, psychological and social consequences related to the COVID-19 pandemic and social distancing measures. RESULTS 45% reported disruptions to care, including cancellations of appointments, investigations, pulmonary rehabilitation, treatment and monitoring. Other practical impacts such as difficulty accessing healthcare services for other issues and getting basic necessities such as food were also common. 36% did not use online prescriptions, and 54% had not accessed online inhaler technique videos. Psychosocial impacts including anxiety, loneliness and concerns about personal health and family were prevalent. 81% reported engaging in physical activity. Among the 11% who were smokers, 48% reported they were planning to quit smoking because of COVID-19. CONCLUSIONS COVID-19 and related social distancing measures are having profound impacts on people with chronic respiratory conditions. Urgent adaptation and signposting of services is required to mitigate the negative health consequences of the COVID-19 response for this group.
Collapse
Affiliation(s)
- Keir Philip
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Andrew Cumella
- Asthma UK and British Lung Foundation Partnership, London, UK
| | | | - Michael Laffan
- Asthma UK and British Lung Foundation Partnership, London, UK
| | - Nicholas Hopkinson
- National Heart and Lung Institute, Imperial College London, London, UK
- Asthma UK and British Lung Foundation Partnership, London, UK
| |
Collapse
|
7
|
Heller SR, Gianfrancesco C, Taylor C, Elliott J. What are the characteristics of the best type 1 diabetes patient education programmes (from diagnosis to long-term care), do they improve outcomes and what is required to make them more effective? Diabet Med 2020; 37:545-554. [PMID: 32034796 DOI: 10.1111/dme.14268] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2020] [Indexed: 12/17/2022]
Abstract
The last 20 years have witnessed a marked change in approaches to the management of type 1 diabetes in the UK. This is exemplified by National Institute of Health and Care Excellence (NICE) guidance which acknowledges that reaching and maintaining target glucose depends on people with type 1 diabetes effectively implementing flexible intensive insulin therapy. The guidance emphasizes that successful self-management requires the acquisition of complex skills and is best achieved by participation in high-quality structured education. Controlled trials and other research have shown that programmes teaching self-management can lower glucose levels while reducing hypoglycaemia, improve psychological outcomes and are highly cost-effective. An important principle of successful programmes is therapeutic education in which learning becomes a partnership between the professional and the person with diabetes who learns to fit diabetes into his/her everyday life. Other recommended elements of programmes include a written curriculum, group teaching by a professional multidisciplinary team and quality assurance. Yet many participants struggle post-course to implement and maintain skills, and overall HbA1c levels, particularly in the UK, remain far from target. Recent studies have identified the barriers to sustained effective self-management and concluded that even high-quality programmes generally lack critical components. These include incorporating evidence from behaviour change research, exploiting the promise of new technologies in reducing the burden of self-management, and providing structured professional support once people have completed the training. Studies are currently underway to evaluate structured training courses which have added these elements and examine whether they can lower glucose to levels closer to target without impairing quality of life.
Collapse
Affiliation(s)
- S R Heller
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - C Gianfrancesco
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - C Taylor
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| | - J Elliott
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- Department of Diabetes and Endocrinology, Sheffield Teaching Hospitals Foundation Trust, Sheffield, UK
| |
Collapse
|
8
|
Aschner P, Gagliardino JJ, Ilkova H, Lavalle F, Ramachandran A, Mbanya JC, Shestakova M, Chantelot JM, Chan JCN. Persistent poor glycaemic control in individuals with type 2 diabetes in developing countries: 12 years of real-world evidence of the International Diabetes Management Practices Study (IDMPS). Diabetologia 2020; 63:711-721. [PMID: 31901950 PMCID: PMC7054372 DOI: 10.1007/s00125-019-05078-3] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 11/26/2019] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS We evaluated the secular trend of glycaemic control in individuals with type 2 diabetes in developing countries, where data are limited. METHODS The International Diabetes Management Practices Study provides real-world evidence of patient profiles and diabetes care practices in developing countries in seven cross-sectional waves (2005-2017). At each wave, each physician collected data from ten consecutive participants with type 2 diabetes during a 2 week period. The primary objective of this analysis was to evaluate trends of glycaemic control over time. RESULTS A total of 66,088 individuals with type 2 diabetes were recruited by 6099 physicians from 49 countries. The proportion of participants with HbA1c <53 mmol/mol (<7%) decreased from 36% in wave 1 (2005) to 30.1% in wave 7 (2017) (p < 0.0001). Compared with wave 1, the adjusted ORs of attaining HbA1c ≤64 mmol/mol (≤8%) decreased significantly in waves 2, 5, 6 and 7 (p < 0.05). Over 80% of participants received oral glucose-lowering drugs, with declining use of sulfonylureas. Insulin use increased from 32.8% (wave 1) to 41.2% (wave 7) (p < 0.0001). The corresponding time to insulin initiation (mean ± SD) changed from 8.4 ± 6.9 in wave 1 to 8.3 ± 6.6 years in wave 7, while daily insulin dosage ranged from 0.39 ± 0.21 U/kg (wave 1) to 0.33 ± 0.19 U/kg (wave 7) for basal regimen and 0.70 ± 0.34 U/kg (wave 1) to 0.77 ± 0.33 (wave 7) U/kg for basal-bolus regimen. An increasing proportion of participants had ≥2 HbA1c measurements within 12 months of enrolment (from 61.8% to 92.9%), and the proportion of participants receiving diabetes education (mainly delivered by physicians) also increased from 59.0% to 78.3%. CONCLUSIONS In developing countries, glycaemic control in individuals with type 2 diabetes remained suboptimal over a 12 year period, indicating a need for system changes and better organisation of care to improve self-management and attainment of treatment goals.
Collapse
Affiliation(s)
- Pablo Aschner
- Javeriana University School of Medicine, San Ignacio University Hospital, Carrera 7 # 40-62, Bogotá, 110231, Colombia.
| | - Juan J Gagliardino
- CENEXA, Center of Experimental and Applied Endocrinology (La Plata National University National Scientific and Technical Research Council), La Plata, Argentina
| | - Hasan Ilkova
- Division of Endocrinology Metabolism and Diabetes, Department of Internal Medicine, Cerrahpasa Medical Faculty, Istanbul University - Cerrahpasa, Istanbul, Turkey
| | - Fernando Lavalle
- Facultad de Medicina, Universidad Autónoma de Nuevo León, Monterrey, Mexico
| | - Ambady Ramachandran
- India Diabetes Research Foundation, Dr. A. Ramachandran's Diabetes Hospitals, Chennai, India
| | - Jean Claude Mbanya
- Biotechnology Center, Doctoral School of Life Sciences, Health and Environment, University of Yaounde I, Yaounde, Cameroon
- Department of Medicine and Specialities, Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaounde, Cameroon
| | | | | | - Juliana C N Chan
- Department of Medicine and Therapeutics, Hong Kong Institute of Diabetes and Obesity and Li Ka Shing Institute of Health Science, The Chinese University of Hong Kong, The Prince of Wales Hospital, Shatin, Hong Kong SAR, China
| |
Collapse
|
9
|
Abstract
People with diabetes have been experimenting with and modifying their own diabetes devices and technologies for many decades in order to achieve the best possible quality of life and improving their long-term outcomes, including do-it-yourself (DIY) closed loop systems. Thousands of individuals use DIY closed loop systems globally, which work similarly to commercial systems by automatically adjusting and controlling insulin dosing, but are different in terms of transparency, access, customization, and usability. Initial outcomes seen by the DIY artificial pancreas system community are positive, and randomized controlled trials are forthcoming on various elements of DIYAPS technology.
Collapse
|
10
|
Hermanns N, Ehrmann D, Finke-Groene K, Kulzer B. Trends in diabetes self-management education: where are we coming from and where are we going? A narrative review. Diabet Med 2020; 37:436-447. [PMID: 32017188 DOI: 10.1111/dme.14256] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2020] [Indexed: 10/25/2022]
Abstract
AIMS To summarize the history, development and efficacy of diabetes self-management education on glycaemic control and mental health in adults and children or adolescents with type 1 diabetes and people with type 2 diabetes. A further aim was to review the status of implementation of diabetes self-management education into routine care and outline current gaps in implementation and research. METHODS We searched PubMed and Google scholar for German- and English-language articles regarding diabetes self-management education, glycaemic control and mental health, and restricted this search to meta-analyses. RESULTS Diabetes education has evolved from a compliance- and knowledge-oriented approach to an empowerment- and self-management-oriented approach. Diabetes self-management education seems to have a greater impact on glycaemic outcomes than on mental health outcomes, but the latter are rarely assessed. Technological development and digitalization can provide chances and challenges for diabetes self-management education. Digital solutions show promising results and great potential for improving the efficacy of diabetes self-management education further and providing ongoing support. The implementation of diabetes self-management education into routine clinical care frequently remains a challenge. CONCLUSION Diabetes self-management education has been acknowledged as an essential part of diabetes therapy; however, current gaps regarding the efficacy of diabetes self-management education on mental health, and the need for education on the use of diabetes technology, are future avenues for research.
Collapse
Affiliation(s)
- N Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - D Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - K Finke-Groene
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - B Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| |
Collapse
|
11
|
Desrochers HR, Schultz AT, Laffel LM. Use of Diabetes Technology in Children: Role of Structured Education for Young People with Diabetes and Families. Endocrinol Metab Clin North Am 2020; 49:19-35. [PMID: 31980118 PMCID: PMC7140592 DOI: 10.1016/j.ecl.2019.11.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The current era has witnessed an explosion of advanced diabetes technologies. Young people with diabetes and their families require detailed, structured diabetes education in order to optimize use of such devices. There is need for youth and their families to participate in the selection of particular devices for personal use and comprehensive education regarding the safe and effective use of such technologies. The education process should ensure that youth and their families receive realistic expectations of what the advanced technologies can and cannot do to avoid disappointment and the premature discontinuation of such systems.
Collapse
Affiliation(s)
- Hannah R Desrochers
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA
| | - Alan T Schultz
- Emergency Department, Montefiore Medical Center, 111 East 210th Street, The Bronx, NY 10467, USA
| | - Lori M Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, One Joslin Place, Boston, MA 02215, USA.
| |
Collapse
|
12
|
Liberman A, Barnard-Kelly K. Diabetes Technologies and the Human Factor. Diabetes Technol Ther 2020; 22:S130-S140. [PMID: 32069154 DOI: 10.1089/dia.2020.2510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alon Liberman
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Petah Tikva, Israel
| | | |
Collapse
|
13
|
|
14
|
Gucciardi E, Yang A, Cohen-Olivenstein K, Parmentier B, Wegener J, Pais V. Emerging practices supporting diabetes self-management among food insecure adults and families: A scoping review. PLoS One 2019; 14:e0223998. [PMID: 31693702 PMCID: PMC6834117 DOI: 10.1371/journal.pone.0223998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 10/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Food insecurity undermines a patient's ability to follow diabetes self-management recommendations. Care providers need strategies to direct their support of diabetes management among food insecure patients and families. OBJECTIVE To identify what emerging practices health care providers can relay to patients or operationalize to best support diabetes self-management among food insecure adults and families. ELIGIBILITY CRITERIA Food insecure populations with diabetes (type 1, type 2, prediabetes, gestational diabetes) and provided diabetes management practices specifically for food insecure populations. Only studies in English were considered. In total, 21 articles were reviewed. SOURCES OF EVIDENCE Seven databases: Cumulative Index of Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, Medline, ProQuest Nursing & Allied Health Database, PsychInfo, Scopus, and Web of Science. RESULTS Emerging practices identified through this review include screening for food insecurity as a first step, followed by tailoring nutrition counseling, preventing hypoglycemia through managing medications, referring patients to professional and community resources, building supportive care provider-patient relationships, developing constructive coping strategies, and decreasing tobacco smoking. CONCLUSION Emerging practices identified in our review include screening for food insecurity, nutrition counselling, tailoring management plans through medication adjustments, referring to local resources, improving care provider-patient relationship, promoting healthy coping strategies, and decreasing tobacco use. These strategies can help care providers better support food insecure populations with diabetes. However, some strategies require further evaluation to enhance understanding of their benefits, particularly in food insecure individuals with gestational and prediabetes, as no studies were identified in these populations. A major limitation of this review is the lack of global representation considering no studies outside of North America satisfied our inclusion criteria, due in part to the English language restriction.
Collapse
Affiliation(s)
- Enza Gucciardi
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Adalia Yang
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | | | | | - Jessica Wegener
- School of Nutrition, Ryerson University, Toronto, Ontario, Canada
| | - Vanita Pais
- Division of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| |
Collapse
|
15
|
Rojano B, West E, Goodman E, Weiss JJ, de la Hoz RE, Crane M, Crowley L, Harrison D, Markowitz S, Wisnivesky JP. Self-management behaviors in World Trade Center rescue and recovery workers with asthma. J Asthma 2019; 56:411-421. [PMID: 29985718 PMCID: PMC7553201 DOI: 10.1080/02770903.2018.1462377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 03/23/2018] [Accepted: 04/03/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Asthma is a major source of morbidity among World Trade Center (WTC) rescue and recovery workers. While physical and mental health comorbidities have been associated with poor asthma control, the potential role and determinants of adherence to self-management behaviors (SMB) among WTC rescue and recovery workers is unknown. OBJECTIVES To identify modifiable determinants of adherence to asthma self-management behaviors in WTC rescue and recovery worker that could be potential targets for future interventions. METHODS We enrolled a cohort of 381 WTC rescue and recovery workers with asthma. Sociodemographic data and asthma history were collected during in-person interviews. Based on the framework of the Model of Self-regulation, we measured beliefs about asthma and controller medications. Outcomes included medication adherence, inhaler technique, use of action plans, and trigger avoidance. RESULTS Medication adherence, adequate inhaler technique, use of action plans, and trigger avoidance were reported by 44%, 78%, 83%, and 47% of participants, respectively. Adjusted analyses showed that WTC rescue and recovery workers who believe that they had asthma all the time (odds ratio [OR]: 2.37; 95% confidence interval [CI]: 1.38-4.08), that WTC-related asthma is more severe (OR: 1.73; 95% CI: 1.02-2.93), that medications are important (OR: 12.76; 95% CI: 5.51-29.53), and that present health depends on medications (OR: 2.39; 95% CI: 1.39-4.13) were more likely to be adherent to their asthma medications. Illness beliefs were also associated with higher adherence to other SMB. CONCLUSIONS Low adherence to SMB likely contributes to uncontrolled asthma in WTC rescue and recovery workers. Specific modifiable beliefs about asthma chronicity, the importance of controller medications, and the severity of WTC-related asthma are independent predictors of SMB in this population. Cognitive behavioral interventions targeting these beliefs may improve asthma self-management and outcomes in WTC rescue and recovery workers. Key message: This study identified modifiable beliefs associated with low adherence to self-management behaviors among World Trade Center rescue and recovery rescue and recovery workers with asthma which could be the target for future interventions. CAPSULE SUMMARY Improving World Trade Center-related asthma outcomes will require multifactorial approaches such as supporting adherence to controller medications and other self-management behaviors. This study identified several modifiable beliefs that may be the target of future efforts to support self-management in this patient population.
Collapse
Affiliation(s)
- Belen Rojano
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Erin West
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Emily Goodman
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jeffrey J. Weiss
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rafael E. de la Hoz
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael Crane
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laura Crowley
- Division of Occupational and Environmental Medicine, Department of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Denise Harrison
- Department of Medicine, New York University School of Medicine, Bellevue Hospital Center, New York, NY, USA
| | - Steven Markowitz
- Barry Commoner Center for Health and the Environment, Queens College, City University of New York, Queens, NY, USA
| | - Juan P. Wisnivesky
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| |
Collapse
|
16
|
Jimenez G, Lum E, Car J. Examining Diabetes Management Apps Recommended From a Google Search: Content Analysis. JMIR Mhealth Uhealth 2019; 7:e11848. [PMID: 30303485 PMCID: PMC6352016 DOI: 10.2196/11848] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 09/20/2018] [Accepted: 09/29/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The availability of smartphone health apps empowers people to manage their own health. Currently, there are over 300,000 health apps available in the market targeting a variety of user needs from weight loss to management of chronic conditions, with diabetes being the most commonly targeted condition. To date, health apps largely fall outside government regulation, and there are no official guidelines to help clinicians and patients in app selection. Patients commonly resort to the internet for suggestions on which diabetes app to use. OBJECTIVE The objective of this study was to investigate apps identified through a Google search and characterize these apps in terms of features that support diabetes management. METHODS We performed a Google search for the "best diabetes apps 2017" and explored the first 4 search results. We identified and compiled a list of the apps recommended in the returned search results, which were Web articles. Information about each app was extracted from the papers and corresponding app store descriptions. We examined the apps for the following diabetes management features: medication management, blood glucose self-management, physical activity, diet and nutrition, and weight management. RESULTS Overall, 26 apps were recommended in 4 papers. One app was listed in all 4 papers, and 3 apps appeared on 3 of the 4 lists. Apart from one paper, there were no explicit criteria to justify or explain the selection of apps. We found a wide variation in the type and the number of diabetes management features in the recommended apps. Five apps required payment to be used. Two-thirds of the apps had blood glucose management features, and less than half had medication management features. The most prevalent app features were nutrition or diet-related (19/24, 79%) and physical activity tracking (14/24, 58%). CONCLUSIONS The ambiguity of app selection and the wide variability in key features of the apps recommended for diabetes management may pose difficulties for patients when selecting the most appropriate app. It is critical to involve patients, clinicians, relevant professional bodies, and policy makers to define the key features an app should have for it to be classified as a "diabetes management" app. The lessons learned here may be extrapolated for the development and recommendation of apps for the management of other chronic conditions.
Collapse
Affiliation(s)
- Geronimo Jimenez
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Elaine Lum
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
- School of Clinical Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Australia
| | - Josip Car
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Global eHealth Unit, Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| |
Collapse
|
17
|
Havas K, Douglas C, Bonner A. Meeting patients where they are: improving outcomes in early chronic kidney disease with tailored self-management support (the CKD-SMS study). BMC Nephrol 2018; 19:279. [PMID: 30342487 PMCID: PMC6195997 DOI: 10.1186/s12882-018-1075-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 10/05/2018] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND To achieve optimal health outcomes, people with chronic kidney disease must make changes in their everyday lives to self-manage their condition. This can be challenging, and there is a need for self-management support interventions which assist people to become successful self-managers. While interventions have been developed, the literature in this area is sparse and limited by lack of both individualisation and sound theoretical basis. The aim of this study was to implement and evaluate the Chronic Kidney Disease-Self-Management Support intervention: a theory-based, person-centred self-management intervention for people with chronic kidney disease stages 1-4. METHODS A single-sample, pre-post study of an individualised, 12-week intervention based upon principles of social-cognitive theory and person-centred care was conducted with patients attending outpatient renal clinics in Queensland, Australia (N = 66). Data were collected at T0 (pre-intervention) and T1 (post-intervention). Primary outcomes were self-efficacy and self-management behaviour. RESULTS There were significant, small-to-medium improvements in primary outcomes (self-efficacy: mean difference + 0.8, 95% CI 0.3-1.2, d = 0.4; self-management behaviour: mean difference + 6.2, 95% CI 4.5-7.9, d = 0.8). There were further significant improvements in secondary outcomes (blood pressure, disease-specific knowledge, physical activity, fruit and vegetable consumption, alcohol consumption, health-related quality of life, psychological distress, and communication with healthcare providers), with effect sizes ranging from negligible to large (all ps < .05). CONCLUSIONS Social-cognitive theory shows promise as a framework for providing effective person-centred self-management support to patients within this population, and longer-term evaluation is needed. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12618000066280 . Retrospectively registered 17/01/2018.
Collapse
Affiliation(s)
- Kathryn Havas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology, Victoria Park Rd, Kelvin Grove, Brisbane, QLD 4059 Australia
- NHMRC Chronic Kidney Disease Centre for Research Excellence, University of Queensland, St Lucia, Australia
- Visiting Research Fellow, Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
18
|
Warshaw HS. Is it time to remodel diabetes self-management education and support? Am J Manag Care 2018; 24:SP449-SP451. [PMID: 30550249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
|
19
|
Schrauben SJ, Hsu JY, Rosas SE, Jaar BG, Zhang X, Deo R, Saab G, Chen J, Lederer S, Kanthety R, Hamm LL, Ricardo AC, Lash JP, Feldman HI, Anderson AH. CKD Self-management: Phenotypes and Associations With Clinical Outcomes. Am J Kidney Dis 2018; 72:360-370. [PMID: 29580660 PMCID: PMC6109611 DOI: 10.1053/j.ajkd.2018.01.047] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/12/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND To slow chronic kidney disease (CKD) progression and its complications, patients need to engage in self-management behaviors. The objective of this study was to classify CKD self-management behaviors into phenotypes and assess the association of these phenotypes with clinical outcomes. STUDY DESIGN Prospective cohort study. SETTING & PARTICIPANTS Adults with mild to moderate CKD enrolled in the Chronic Renal Insufficiency Cohort (CRIC) Study. 3,939 participants in the CRIC Study recruited between 2003 and 2008 served as the derivation cohort and 1,560 participants recruited between 2013 and 2015 served as the validation cohort. PREDICTORS CKD self-management behavior phenotypes. OUTCOMES CKD progression, atherosclerotic events, heart failure events, death from any cause. MEASUREMENTS Latent class analysis stratified by diabetes was used to identify CKD self-management phenotypes based on measures of body mass index, diet, physical activity, blood pressure, smoking status, and hemoglobin A1c concentration (if diabetic); Cox proportional hazards models. RESULTS 3 identified phenotypes varied according to the extent of implementation of recommended CKD self-management behaviors: phenotype I characterized study participants with the most recommended behaviors; phenotype II, participants with a mixture of recommended and not recommended behaviors; and phenotype III, participants with minimal recommended behaviors. In multivariable-adjusted models for those with and without diabetes, phenotype III was strongly associated with CKD progression (HRs of 1.82 and 1.49), death (HRs of 1.95 and 4.14), and atherosclerotic events (HRs of 2.54 and 1.90; each P < 0.05). Phenotype II was associated with atherosclerotic events and death among those with and without diabetes. LIMITATIONS No consensus definition of CKD self-management; limited to baseline behavior data. CONCLUSIONS There are potentially 3 CKD self-management behavior phenotypes that distinguish risk for clinical outcomes. These phenotypes may inform the development of studies and guidelines regarding optimal self-management.
Collapse
Affiliation(s)
- Sarah J Schrauben
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, PA.
| | - Jesse Y Hsu
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Sylvia E Rosas
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Bernard G Jaar
- Division of Nephrology, Johns Hopkins University, Baltimore, MD; Welch Center for Prevention, Epidemiology & Clinical Research, Johns Hopkins University, Baltimore, MD
| | - Xiaoming Zhang
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Rajat Deo
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA; Division of Cardiology, University of Pennsylvania, Philadelphia, PA
| | - Georges Saab
- Division of Nephrology, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH
| | - Jing Chen
- Department of Medicine, Tulane University, New Orleans, LA
| | - Swati Lederer
- Department of Medicine, University of Texas Southwestern, Dallas, TX
| | | | - L Lee Hamm
- Department of Medicine, Tulane University, New Orleans, LA
| | - Ana C Ricardo
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - James P Lash
- Department of Medicine, University of Illinois at Chicago, Chicago, IL
| | - Harold I Feldman
- Division of Renal, Electrolyte, and Hypertension, University of Pennsylvania, Philadelphia, PA; Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - Amanda H Anderson
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| |
Collapse
|
20
|
Klonoff DC, Kerr D, Wong JC, Pavlovic Y, Koliwad S, Hu J, Salber P, Aguilera A, Long W, Hamilton G, Chen KY, Adi S. Digital Diabetes Congress 2017. J Diabetes Sci Technol 2017; 11:1045-1052. [PMID: 28786320 PMCID: PMC5951004 DOI: 10.1177/1932296817723037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of developing mobile applications for diabetes is generally to: (1) provide enhanced access to timely information for patients, health care professionals, and researchers; (2) facilitate remote monitoring and diagnosis of patients, often based on information delivered by wearable devices; (3) provide decision support to assist patients in selecting treatment; or (4) deliver timely recommendations for treatment to increase adherence to prescribed therapy. There is a perception that mobile applications can provide meaningful clinical benefits, however, there is only sparse convincing evidence to support this belief at the present time. Compounding this problem is the short life span of digital software, such that if a traditional type of randomized controlled trial is conducted on a product, by the time the study has been designed, approved by an IRB, conducted, and analyzed, the product might have significantly changed to a next generation system. Because of great interest in establishing what are the potential benefits, metrics of success, and appropriate components of mobile applications for diabetes, Diabetes Technology Society and William Sansum Diabetes Center launched the Digital Diabetes Congress, March 7-8, 2017, in San Francisco. This report contains summaries of the meeting's 12 sessions. Each summary was written by the session's moderator who helped develop the session prior to the event and keep it on track during the event. This meeting report presents a summary of how 57 panelists, speakers, and moderators, who are leaders in digital health, see the current and future landscape of digital health tools applied to diabetes.
Collapse
Affiliation(s)
- David C. Klonoff
- Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCP (Edin), Fellow AIMBE, Mills-Peninsula Medical Center, 100 S San Mateo Dr, Rm 5147, San Mateo, CA 94401, USA.
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
| | - Jenise C. Wong
- University of California, San Francisco, San Francisco, CA, USA
| | | | - Suneil Koliwad
- University of California, San Francisco, San Francisco, CA, USA
| | | | | | | | | | | | - Kong Y. Chen
- National Institutes of Health, Bethesda, MD, USA
| | - Saleh Adi
- University of California, San Francisco, San Francisco, CA, USA
| |
Collapse
|
21
|
Abstract
BACKGROUND Since the introduction of mobile phones, technology has been increasingly used to enable diabetes self-management education and support. This timely systematic review summarizes how currently available technology impacts outcomes for people living with diabetes. METHODS A systematic review of high quality review articles and meta analyses focused on utilizing technology in diabetes self-management education and support services was conducted. Articles were included if published between January 2013 and January 2017. RESULTS Twenty-five studies were included for analysis. The majority evaluated the use of mobile phones and secure messaging. Most studies described healthy eating, being active and metabolic monitoring as the predominant self-care behaviors evaluated. Eighteen of 25 reviews reported significant reduction in A1c as an outcome measure. Four key elements emerged as essential for improved A1c: (1) communication, (2) patient-generated health data, (3) education, and (4) feedback. CONCLUSION Technology-enabled diabetes self-management solutions significantly improve A1c. The most effective interventions incorporated all the components of a technology-enabled self-management feedback loop that connected people with diabetes and their health care team using 2-way communication, analyzed patient-generated health data, tailored education, and individualized feedback. The evidence from this systematic review indicates that organizations, policy makers and payers should consider integrating these solutions in the design of diabetes self-management education and support services for population health and value-based care models. With the widespread adoption of mobile phones, digital health solutions that incorporate evidence-based, behaviorally designed interventions can improve the reach and access to diabetes self-management education and ongoing support.
Collapse
Affiliation(s)
- Deborah A. Greenwood
- American Association of Diabetes Educators, Chicago, IL, USA
- Deborah Greenwood Consulting, Granite Bay, CA, USA
- Deborah A. Greenwood, PhD, RN, BC-ADM, CDE, FAADE, American Association of Diabetes Educators, 200 W Madison St, Ste 800, Chicago, IL 60606, USA.
| | - Perry M. Gee
- Dignity Health, Nursing Research and Analytics, Phoenix, AZ, USA
- University of Utah, Salt Lake City, UT, USA
| | | | - Malinda Peeples
- American Association of Diabetes Educators, Chicago, IL, USA
- WellDoc, Columbia, MD, USA
| |
Collapse
|
22
|
Affiliation(s)
- David Kerr
- William Sansum Diabetes Center , Santa Barbara, California
| | - Ceara Axelrod
- William Sansum Diabetes Center , Santa Barbara, California
| | - Charis Hoppe
- William Sansum Diabetes Center , Santa Barbara, California
| |
Collapse
|
23
|
Affiliation(s)
- Jessica R Castle
- Division of Endocrinology, Harold Schnitzer Diabetes Health Center, Oregon Health & Science University , Portland, Oregon
| |
Collapse
|
24
|
Affiliation(s)
- Farhad Fatehi
- 1 Centre for Online Health, The University of Queensland , Brisbane, Australia
- 2 Australian eHealth Research Centre , Commonwealth Scientific and Industrial Research Organisation, Brisbane, Australia
- 3 School of Allied Medical Sciences, Tehran University of Medical Sciences , Tehran, Iran
| | - Leonard C Gray
- 1 Centre for Online Health, The University of Queensland , Brisbane, Australia
- 4 Centre for Research in Geriatric Medicine, The University of Queensland , Brisbane, Australia
| | - Anthony W Russell
- 5 Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Australia
- 6 School of Medicine, The University of Queensland , Brisbane, Australia
| |
Collapse
|