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Scott J, Agarwala A, Baker-Smith CM, Feinstein MJ, Jakubowski K, Kaar J, Parekh N, Patel KV, Stephens J. Cardiovascular Health in the Transition From Adolescence to Emerging Adulthood: A Scientific Statement From the American Heart Association. J Am Heart Assoc 2025; 14:e039239. [PMID: 40135400 DOI: 10.1161/jaha.124.039239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/27/2025]
Abstract
Cardiovascular disease remains a leading cause of death in the United States, with an alarming rise in the proportion of young adults experiencing cardiovascular events. Many adolescents enter adulthood with significant cardiovascular disease risk factors. This scientific statement addresses the critical need for cardiovascular health promotion during emerging adulthood, a transitional stage between the ages of 18 and 25 or 29 years of age. We discuss the significance of social determinants of health and the interplay between individual-level risk factors and developmental changes, including shifts in substance use, social connections, and emotional well-being. We conclude by outlining strategies for optimizing cardiovascular health promotion and disease prevention, underscoring the importance of primordial prevention, early intervention, and tailored approaches to address the unique needs of emerging adults. Addressing these multifaceted factors is crucial for mitigating the burden of cardiovascular disease risk factors among emerging adults and promoting long-term cardiovascular well-being.
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Hosoi Y, Kawakami M, Ito D, Kamimoto T, Kamimura H, Kawaguchi T, Terai S, Tsuji T. Mapping of rehabilitation interventions and assessment methods for patients with liver cirrhosis: a scoping review. BMC Gastroenterol 2025; 25:291. [PMID: 40269747 PMCID: PMC12020051 DOI: 10.1186/s12876-025-03881-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2025] [Accepted: 04/10/2025] [Indexed: 04/25/2025] Open
Abstract
BACKGROUND This scoping review aimed to delineate the detailed components of exercise therapy and the evaluation methods used for patients with liver cirrhosis. METHODS The methodology involved searching the original PubMed, Web of Science, and Scopus for studies published between January 1975 and March 2025. The search was completed on 13 March 2025. Studies describing exercise therapy for liver cirrhosis patients were selected. Relevant information matching the study objectives, such as intervention duration, content, intensity setting, evaluation criteria, and outcomes, was extracted and documented. RESULTS Of the 2314 articles identified, 18 fit the inclusion and exclusion criteria, with a total of 950 participants. The most prevalent form of exercise therapy was a combined aerobic exercise and strength training program (55.6%). Commonly used assessment criteria included the 6-minute walking distance for endurance evaluation (44.4%) and the Chronic Liver Disease Questionnaire for quality of life assessment (33.3%). Intervention durations ranged from 30 to 60 min per day, 2 to 7 days per week, and 8 to 12 weeks. Concerning intensity setting, subjective fatigue levels and heart rate were frequently used (38.9%), though detailed descriptions were limited. CONCLUSIONS For the establishment of effective exercise therapy for patients with liver cirrhosis, future research should concentrate on tailoring intensity settings according to individual patient needs. Additionally, standardized reporting of intervention details and assessment methods is crucial for improving the quality and comparability of studies in this field.
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Affiliation(s)
- Yuichiro Hosoi
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Michiyuki Kawakami
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Daisuke Ito
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Takayuki Kamimoto
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroteru Kamimura
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata city, 951-8510, Japan
| | - Takumi Kawaguchi
- Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, 67 Asahi-machi, Kurume city, 830-0011, Fukuoka, Japan
| | - Shuji Terai
- Division of Gastroenterology and Hepatology, Graduate School of Medical and Dental Sciences, Niigata University, 1-757, Asahimachi-dori, Chuo-ku, Niigata city, 951-8510, Japan
| | - Tetsuya Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
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Elbarbary NS, Mohamed MO, Fereig YA. Diabetes self-management smartphone application: Could it be an alternative for continuous glucose monitoring in low resource settings? Prim Care Diabetes 2025; 19:157-164. [PMID: 39915209 DOI: 10.1016/j.pcd.2025.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2024] [Revised: 01/25/2025] [Accepted: 02/01/2025] [Indexed: 03/04/2025]
Abstract
BACKGROUND The "Rightest" app connected to Rightest glucose meter via Bluetooth, helps to set blood glucose target and customize measurements. The app is provided with ketone alert when BG is ≥ 240 mg/dl. AIM OF THE WORK To assess the role of the rightest app in improving glycaemic control as well as quality of life in a 6- month interval of its usage. PATIENTS AND METHODS A clinical trial included 40 participants with type 1 diabetes, mean age 14.3 ± 1.42 years and diabetes duration of 4.5 ± 3.6 years regularly following up at Diabetes Unit. Rightest app was installed on the participants' smart phone on enrollment and 6 months later assessment of the glycemic control was done by HbA1c and time in range. Results collected from app Quality of life (PedsQL) and user experience (UEQ) Questionnaires were applied at the end of the study. RESULTS Using smartphone app yielded a significant reduction in mean BG level (-17.64 %, p = 0.012) that decreased HbA1c ( -10.63 %, p = 0.000). Increase of SMBG frequency was observed (p = 0.04). This is reflected on a 20 % increment time in range generated by app. (p-value = 0.002) and lower time above range (TAR > 180 mg/dl, -18.75 %, P = 0.001) in intervention group compared to control. However, the number of hypoglycemic events (p = 0.71) or DKA(p = 0.59) did not differ between groups. PedsQL questionnaire total score has improved (p-value = 0.010) in favor of intervention group with good experience with app indicated by UEQ. The pragmatic total score (1.425) of UEQ was above average while the hedonic total score was good (1.250) and overall score was good (1.338). The higher score of UEQ was inversely correlated with mean BG (r = -0.414, P = 0.008) and positively correlated to glycemic control (r = 0.644, p = 0.002). CONCLUSION Using mobile apps as an alternative for CGM in low resource settings can help improve glycemic control and quality of life for those who don't have access to diabetes technology services because of unavailability or unaffordability.
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Meenasantirak A, Siripitakchai C, Suriya N. A Feasibility Study of a Web Application Intervention for Persons With Uncontrolled Diabetes. Health Promot J Austr 2025; 36:e70020. [PMID: 39931764 DOI: 10.1002/hpja.70020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/15/2025] [Accepted: 01/28/2025] [Indexed: 05/08/2025] Open
Abstract
ISSUE ADDRESSED Type 2 diabetes (T2D) prevalence in Thailand is rapidly increasing, with significant challenges in achieving optimal glycemic control. There is a need for accessible interventions to help improve glycaemic control in people with type 2 diabetes in Thailand. This study evaluates a web application designed to enhance self-management in individuals with uncontrolled T2D. Pre- and post-intervention results indicate a statistically significant reduction in fasting blood glucose. Despite the inability to effectively utilise the web application for controlling blood sugar levels, the study suggests its suitability and potential for benefiting diabetes patient care. BACKGROUND Diabetes is a rapidly growing global health concern, with an estimated 537 million people affected worldwide in 2021, a number projected to rise to 783 million by 2045. In Thailand, diabetes cases have increased significantly, with over 3.3 million individuals affected in 2022. Effective diabetes management requires strict adherence to self-care behaviors, including diet, exercise, medication adherence, and glucose monitoring. However, many patients struggle with self-management, leading to severe complications. The integration of a web application in diabetes care has shown potential for enhancing patient engagement and glycemic control. This study explores the role of a web application in improving diabetes self-management and health outcomes. METHOD The quasi-experimental single-group research, assessing pre- and post-intervention outcomes, aims to investigate the feasibility of using a web application for diabetes patient care in controlling blood sugar levels. The study employs a web application focusing on dietary behaviour adjustment, physical activity and exercise among 80 diabetes patients selected through simple randomisation. Additionally, 10 nurses responsible for healthcare promotion at five hospitals oversee and empower patients' behaviours over two months. The research concentrates on exploring the feasibility of the web application and includes (I) the application's suitability and (II) the patient's blood sugar levels. The research collected quantitative and qualitative data from November 2022 to May 2023. Tools used for data collection include the feasibility assessment and application suitability. RESULTS The research findings indicate that the primary assessment regarding the feasibility of using the web application for diabetes patient care in controlling blood sugar levels shows overall high feasibility. The overall assessment also falls within a high range. Comparing the average levels of fasting blood sugar (FBS) before and after using the web application showed a statistically significant decrease (p-value = 0.023). When comparing the average FBS levels before and after using the web application among diabetes patients, the average FBS decreased significantly from 157.07 ± 47.248 mg/dL to 150.00 ± 43.325 mg/dL (p = 0.023). However, the HbA1c levels showed no statistically significant change (9.17% ± 1.76 to 9.12% ± 1.82, p = 0.38). SO WHAT?: These outcomes may positively contribute to early effective interventions and as well as appropriate responses to diabetes mellitus. Further supported for the health care professionals the use of a web application for diabetes patient care in patients with poorly controlled blood sugar. Specifically, for patients with smartphones, this intervention could help address their issues and provide tools for better self-regulation of their eating habits, physical activities and overall well-being. This can lead to better blood sugar control efficacy.
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Affiliation(s)
- Atchara Meenasantirak
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Nonthaburi, Thailand
| | | | - Natthawut Suriya
- Srimahasarakham Nursing College, Faculty of Nursing, Praboromarajchanok Institute, Nonthaburi, Thailand
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Ory MG, Han G, Nsobundu C, Carpenter K, Towne SD, Smith ML. Comparative effectiveness of diabetes self-management education and support intervention strategies among adults with type 2 diabetes in Texas. Front Public Health 2025; 13:1543298. [PMID: 40171438 PMCID: PMC11959030 DOI: 10.3389/fpubh.2025.1543298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2024] [Accepted: 02/21/2025] [Indexed: 04/03/2025] Open
Abstract
Background With approximately 1-in-10 Texas estimated to be living with Type 2 Diabetes Mellitus (T2DM), and the steadily rising healthcare costs associated with non-managed T2DM, efforts are needed to help patients manage their diabetes and avoid costly health consequences. While many diabetes self-management interventions and solutions exist to improve health among people living with T2DM, less is known about the relative effectiveness of these interventions based on their delivery format and when used in combination. The purpose of this study was to identify the effectiveness of three intervention modalities to reduce hemoglobin A1c (A1c) among Texans with T2DM living in rural and urban settings. Methods A three-arm randomized controlled trial (RCT) was conducted from November 2020 through March 2022. The three modalities included: (1) asynchronous virtual education and support program with one-on-one follow-up counseling [i.e., virtual Making Moves with Diabetes (vMMWD)]; (2) technology-based education and support (i.e., TBES); and (3) combined modality where participants sequentially received vMMWD and TBES (i.e., combined). Data were collected at baseline and again at 3- and 6-month follow-up. Using an intent-to-treat analysis, constrained longitudinal data analysis models were fitted to identify and compare changes in A1c over time. Results Findings demonstrate the positive effects of all three intervention modalities (i.e., vMMWD, TBES, and combined) to significantly reduce A1c among participants. Longitudinal analyses identified that initial reductions in A1c at 3-month follow-up were sustained at 6-month follow-up. Findings were consistent among rural- and urban-residing participants. Conclusion This RCT highlights the universal benefits of self-paced virtual diabetes self-management interventions to reduce A1c among Texans with unmanaged T2DM. Such low-cost interventions may be widely applicable for different settings and populations.
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Affiliation(s)
- Marcia G. Ory
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Gang Han
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, TX, United States
| | - Chinelo Nsobundu
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
| | - Keri Carpenter
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
| | - Samuel D. Towne
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Environmental and Occupational Health, School of Public Health, Texas A&M University, College Station, TX, United States
- School of Global Health Management and Informatics, University of Central Florida, Orlando, FL, United States
- Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, FL, United States
- Southwest Rural Health Research Center, Texas A&M University, College Station, TX, United States
| | - Matthew Lee Smith
- Center for Community Health and Aging, Texas A&M University, College Station, TX, United States
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX, United States
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Ferreira DD, Ferreira LG, Amorim KA, Delfino DCT, Ferreira ACBH, Souza LPCE. Assessing the Links Between Artificial Intelligence and Precision Nutrition. Curr Nutr Rep 2025; 14:47. [PMID: 40087237 DOI: 10.1007/s13668-025-00635-2] [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] [Accepted: 02/27/2025] [Indexed: 03/17/2025]
Abstract
PURPOSE OF REVIEW To conduct an overview of the potentialities of artificial intelligence in precision nutrition. RECENT FINDINGS A keyword co-occurrence analysis of 654 studies on artificial intelligence (AI) and precision nutrition (PN) highlighted the potential of AI techniques like Random Forest and Gradient Boosting in improving personalized dietary recommendations. These methods address gastrointestinal symptoms, weight management, and cardiometabolic markers, especially when incorporating data on gut microbiota. Despite its promise, challenges like data privacy, bias, and ethical concerns remain. AI must complement healthcare professionals, necessitating clear guidelines, robust governance, and ongoing research to ensure safe and effective applications. The integration of AI into PN enables highly personalized dietary recommendations by accounting for metabolic variability, genetics, and microbiome data. AI-driven strategies show potential in managing conditions like obesity and diabetes through accurate predictions of individual dietary responses. However, ethical, regulatory, and practical challenges must be addressed to ensure safe, equitable, and effective application of AI in nutrition.
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Affiliation(s)
- Danton Diego Ferreira
- Department of Automatic, Universidade Federal de Lavras, Lavras, Minas Gerais, Brazil.
| | - Lívia Garcia Ferreira
- Nutrition and Health Graduate Program, Universidade Federal de Lavras, Lavras, Minas Gerais, Brazil
| | - Katiúcia Alves Amorim
- Department of Food Science, Universidade Federal de Lavras, Lavras, Minas Gerais, Brazil
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Corsica JA, Kelly MC, Bradley LE, Konsor MM, Wilson EJ, Quinones IC, W Jeddi R, Markey MA. Mobile apps for diabetes self-management: An updated review of app features and effectiveness. J Behav Med 2025; 48:137-148. [PMID: 39489882 DOI: 10.1007/s10865-024-00525-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2024] [Accepted: 10/02/2024] [Indexed: 11/05/2024]
Abstract
Self-management of diabetes is extremely challenging and non-adherence is common. Health consequences are significant for those unable to adhere to the complex treatment regimen, which includes regular oral medication and/or insulin use, frequent blood sugar checks, strict dietary management, and regular physical activity. Mobile applications (apps) present a tremendous opportunity to help patients improve adherence to these behaviors. The availability of commercial diabetes self-management apps is increasing exponentially, making it difficult for patients and providers to stay informed about app options and benefits. Previous reviews have described commercial diabetes apps and their features and usability for patients with diabetes. A smaller number have reviewed the effectiveness of these apps in improving blood glucose as well as other aspects of diabetes management. The aim of this article is to update our 2016 review, summarize the results of new reviews, review outcomes of diabetes apps described in the literature, and offer recommendations for app features, effectiveness research, and marketing in apps for diabetes self-management. Although higher-quality research is needed, current reviews suggest that many diabetes apps are effective in lowering HbA1c. Recommendations for future research include reporting critical details such as patient demographics and intervention elements and designing studies to identify the most effective components of diabetes management apps. Furthermore, clearly labeling apps that have data supporting clinical efficacy in app stores would allow both providers and patients to easily identify apps that might be most beneficial. Future research should explore the use of apps for the prevention of diabetes in individuals diagnosed with prediabetes.
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Affiliation(s)
- Joyce A Corsica
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson, Suite 400, Chicago, IL, 60612, USA.
| | - Mackenzie C Kelly
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Lauren E Bradley
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Madeline M Konsor
- Department of Gastroenterology, Rush University Medical Center, 1725 W Harrison St, Suite 207, Chicago, IL, 60612, USA
| | - Elizabeth J Wilson
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Isabel C Quinones
- Department of Psychiatry & Behavioral Sciences, Rush University Medical Center, 1645 W. Jackson, Suite 400, Chicago, IL, 60612, USA
| | - Rebecca W Jeddi
- Department of Family and Preventive Medicine, Rush University Medical Center, 1700 W. Van Buren, Suite 470, Chicago, IL, 60612, USA
| | - Megan A Markey
- St Luke's Behavioral Health, 4400 W Broadway, Suite 300, Kansas City, MO, 64111, USA
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Backfish M, Kovalchick K, Albert R, Rosilio M, Chigutsa F, Liao B. Dose Accuracy and Reliability of a Connected Insulin Pen System. J Diabetes Sci Technol 2025:19322968241301760. [PMID: 39881439 PMCID: PMC11780621 DOI: 10.1177/19322968241301760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2025]
Abstract
For people with diabetes on insulin injection therapy, insulin pen dose accuracy and reliability are key features. Dose accuracy of the Tempo PenTM with attached Tempo Smart ButtonTM [Module] (the system) was tested for three doses under standard atmospheric conditions. Reliability and the ability of the Module to detect, store, and transmit dose-related data were also tested. The system met the International Organization for Standardization 11608-1:2014 requirements for dose accuracy at all doses. Mean (standard deviation) doses were 0.010 mL (0.002), 0.299 mL (0.002), and 0.597 mL (0.004) for the 0.010-mL, 0.300-mL, and 0.600-mL doses, respectively. The Module also met requirements for data transfer after every injection. The system accurately delivered doses and reliably captured and stored insulin dosing information.
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Affiliation(s)
| | | | | | | | | | - Birong Liao
- Eli Lilly and Company, Indianapolis, IN, USA
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Chiang YT, Yu HY, Tsay PK, Chen CW, Chang CW, Hsu CL, Lo FS, Moons P. Effectiveness of the User-Centered "Healthcare CEO" App for Patients With Type 1 Diabetes Transitioning From Adolescence to Early Adulthood: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2025; 14:e59871. [PMID: 39805107 PMCID: PMC11773287 DOI: 10.2196/59871] [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: 04/28/2024] [Revised: 11/06/2024] [Accepted: 11/25/2024] [Indexed: 01/16/2025] Open
Abstract
BACKGROUND Young patients aged 16 to 25 years with type 1 diabetes (T1D) often encounter challenges related to deteriorating disease control and accelerated complications. Mobile apps have shown promise in enhancing self-care among youth with diabetes. However, inconsistent findings suggest that further evidence is necessary to confirm the effectiveness of app-based interventions. OBJECTIVE This study aims to evaluate the effectiveness of the Healthcare CEO app in patients with T1D transitioning from adolescence to early adulthood. METHODS A 2 arms, double-blind, randomized controlled trial will be conducted over a 9-month period, with strategies designed to enhance treatment fidelity. The study expects to enroll 96 patients with T1D, aged 16 to 25 years. Participants will be randomly assigned to either the experimental or control group through central randomization. The intervention will be implemented using the Healthcare CEO app, which consists of 11 interfaces. The research will compare differences in disease control outcomes, confidence in self-management, self-care behaviors, emotional distress, quality of life, and specific diabetes-related knowledge between the 2 groups at baseline and 3, 6, and 9 months after intervention. Additionally, changes within the experimental group will be analyzed before and after the intervention. RESULTS The study was funded in August 2020. It was originally scheduled from August 2020 to July 2022 but was interrupted by the COVID-19 pandemic after enrolling 38 participants, with preliminary results anticipated for publication by November 2024. Recruitment resumed in August 2023, with findings expected to be finalized by July 2025. CONCLUSIONS The Healthcare CEO app is a comprehensive solution tailored specifically for individuals with T1D transitioning from adolescence to early adulthood. This innovative app has the potential to improve the quality of care for adolescents with T1D during this critical stage and may serve as valuable evidence in support of app-based intervention strategies. TRIAL REGISTRATION ClinicalTrials.gov NCT05022875; https://www.clinicaltrials.gov/study/NCT05022875. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/59871.
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Affiliation(s)
- Yueh-Tao Chiang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Hsing-Yi Yu
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Department of Nursing, New Taipei Municipal Tu-Cheng Hospital, New Taipei, Taiwan
| | - Pei-Kwei Tsay
- Department of Public Health and Center of Biostatistics, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei,, Taiwan
| | - Chi-Wen Chang
- School of Nursing, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chien-Lung Hsu
- Department of Information Management, Chang-Gung University, Taoyuan, Taiwan
- Graduate Institute of Management, Chang Gung University, Taoyuan, Taiwan
- Master of Science Degree Program in Innovation for Smart Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Fu-Sung Lo
- Division of Pediatric Endocrinology & Genetics, Department of Pediatrics, Chang-Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven-University of Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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AlOsaimi HM, Kanan M, AlOtaibi M, Alhejaili S, Alshammari B, Khalaf A, Hajea A, Saleh R, Jamal F, AbuShahin A, Alanazi B, Alshanbari R, Alsubaie A, Alasmari G, Alshahrani RS. Assessing intention to use mobile phone-based self-management support among adults with type 2 diabetes in Saudi Arabia: A cross-sectional study. Digit Health 2025; 11:20552076241308993. [PMID: 39801586 PMCID: PMC11719452 DOI: 10.1177/20552076241308993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 12/06/2024] [Indexed: 01/16/2025] Open
Abstract
Introduction The use of mobile phone technology for chronic illness self-management is growing, and it may help people with type 2 diabetes mellitus (T2DM). Innovative methods are needed to improve patient involvement and disease management in the Kingdom of Saudi Arabia due to the high incidence of T2DM. Objective The purpose of this study was to explore how the T2DM patients in KSA utilizes their mobile phones for self-management. Methods A cross-sectional study was conducted between April and June 2025 among T2DM patients who were attending endocrinologists for their diabetes management in the Northern Border region (Rafha and Arar) and the Central region (Riyadh) in KSA using a validated questionnaire. Results This study included a total of 267 participants with T2DM. Nearly all participants (99.3%) possess a cellphone, with 94.8% having daily internet access. The majority of the patients reported to have an intention to use mobile phones and the internet for managing diabetes, with 78.3% for dietary planning, 79.4% for physical activity planning, and 78.7% for text messages as reminders. Factors such as female (p = 0.008), younger age (p = 0.001), and duration of diabetes (p = <0.001) were significantly associated with the intention to use mobile apps for managing their diabetes. Conclusions This study demonstrates a significantly higher inclination of participants toward mobile phone technology for diabetes self-management vs. face-to-face consultations. These findings highlight the promising role of mobile phone technology for enhancing diabetes self-management among T2DM patients, thus highlighting the need for targeted interventions.
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Affiliation(s)
- Hind M AlOsaimi
- Department of Pharmacy Services Administration, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Mohammed Kanan
- Department of Pharmacy Administration, Rafha General Hospital, Rafha, Saudi Arabia
| | | | - Saba Alhejaili
- Department of Clinical Pharmacy, College of Pharmacy, University of Ha’il, Hail, Saudi Arabia
| | | | - Aleya Khalaf
- College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Amal Hajea
- College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Ryoof Saleh
- College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Futoon Jamal
- College of Pharmacy, Northern Border University, Rafha, Saudi Arabia
| | - Amnah AbuShahin
- College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Bandar Alanazi
- Department of Pharmacy, Al Dawaa Medical Services Company, Riyadh, Saudi Arabia
| | - Raghad Alshanbari
- Department of Pharmacy, Erfan and Bagedo General Hospital Jeddah, Jeddah, Saudi Arabia
| | - Ashwag Alsubaie
- Department of Pharmacy, Altaawin Medical Clinics, Alkharj, Saudi Arabia
| | - Ghadi Alasmari
- Department of Ambulatory Care Pharmacy, International Medical Center, Jeddah, Saudi Arabia
| | - Rana S Alshahrani
- Department Of Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia
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Bushey E, Wu Y, Wright A, Pescatello L. The Influence of Physical Activity and Diet Mobile Apps on Cardiovascular Disease Risk Factors: Meta-Review. J Med Internet Res 2024; 26:e51321. [PMID: 39382958 PMCID: PMC11499721 DOI: 10.2196/51321] [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: 07/27/2023] [Revised: 03/04/2024] [Accepted: 08/23/2024] [Indexed: 10/10/2024] Open
Abstract
BACKGROUND The literature on whether physical activity (PA) and PA and diet (PA+Diet) mobile apps improve cardiovascular disease (CVD) risk factors is promising. OBJECTIVE The aim of this meta-review is to provide an evidence synthesis of systematic reviews and meta-analyses examining the influence of PA and PA+Diet apps on the major CVD risk factors. METHODS We systematically searched 5 databases until January 12, 2022. Included systematic reviews and meta-analyses (1) reported the CVD risk factor outcomes of BMI, waist circumference, body weight, blood pressure (BP), hemoglobin A1c (HbA1c), fasting blood glucose, blood lipids, or PA; (2) enrolled healthy participants ≥18 years who may or may not have the metabolic syndrome, diabetes mellitus, or preexisting CVD risk factors; (3) reviewed PA or PA+Diet app interventions integrating behavioral change techniques (BCT) to deliver their information; and (4) had a nonapp control. RESULTS In total, 17 reviews (9 systematic reviews and 8 meta-analyses) published between 2012 and 2021 qualified. Participants were middle-aged, mostly women ranging in number from 10 to 62,219. Interventions lasted from 1 to 24 months, with the most common behavioral strategies being personalized feedback (n=8), self-monitoring (n=7), and goal setting (n=5). Of the PA app systematic reviews (N=4), the following CVD risk factors improved: body weight and BMI (n=2, 50%), BP (n=1, 25%), HbA1c (n=1, 25%), and blood lipids (n=1, 25%) decreased, while PA (n=4, 100%) increased. Of the PA+Diet app systematic reviews (N=5), the following CVD risk factors improved: body weight and BMI (n=3, 60%), BP (n=1, 20%), and HbA1c (n=3, 60%) decreased, while PA (n=3, 60%) increased. Of the PA app meta-analyses (N=1), the following CVD risk factors improved: body weight decreased (-0.73 kg, 95% CI -1.45 to -0.01; P=.05) and PA increased by 25 minutes/week (95% CI 0.58-1.68; P<.001), while BMI (-0.09 kg/m2, 95% CI -0.29 to 0.10; P=.35) and waist circumference (-1.92 cm, 95% CI -3.94 to 0.09; P=.06) tended to decrease. Of the PA+Diet app meta-analyses (n=4), the following CVD risk factors improved: body weight (n=4, 100%; from -1.79 kg 95% CI -3.17 to -0.41; P=.01 to -2.80 kg 95% CI -4.54 to -1.06, P=.002), BMI (n=1, 25%; -0.64 kg/m2, 95% CI -1.09 to -0.18; P=.01), waist circumference (n=1, 25%; -2.46 cm, 95% CI -4.56 to -0.36; P=.02), systolic/diastolic BP (n=1, 25%; -4.22/-2.87 mm Hg, 95% CI -6.54 to -1.91/ -4.44 to -1.29; P<.01), and HbA1c (n=1, 25%; -0.43%, 95% CI -0.68 to -0.19; P<.001) decreased. CONCLUSIONS PA and PA+Diet apps appear to be most consistent in improving PA and anthropometric measures with favorable but less consistent effects on other CVD risk factors. Future studies are needed that directly compare and better quantify the effects of PA and PA+Diet apps on CVD risk factors. TRIAL REGISTRATION PROSPERO CRD42023392359; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=392359.
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Affiliation(s)
- Erica Bushey
- University of Connecticut, Storrs, CT, United States
| | - Yin Wu
- University of Connecticut, Storrs, CT, United States
- Hartford Hospital, Hartford, CT, United States
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Tebianian MA, Jahromi SR. Advancing Diabetes Self-Management: A Novel Smartphone Application Featuring a Scoring Algorithm for Tailored User Engagement. Int J Prev Med 2024; 15:20. [PMID: 39170922 PMCID: PMC11338364 DOI: 10.4103/ijpvm.ijpvm_268_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 02/20/2024] [Indexed: 08/23/2024] Open
Abstract
Background We developed and evaluated an intelligent diabetes assistant application (Diabetter) for the self-management of diabetes. It suggested that increasing the patient's interest and participation in using smartphone apps is important for the effectiveness of diabetes management apps. Methods After evaluating all-encompassing features for diabetes management, we divided the selected factors into sub-factors for use in the application. Then, we created the first high-fidelity prototype using related programs and conducted early user testing to validate and improve Diabetter. To handle the user transaction time and keep them motivated, we designed and implemented a scoring system based on the nudge theory rules within the app. Results To evaluate Diabetter's impact on diabetes self-management, we measured HbA1c levels after a prolonged period. The Diabetter prototype was developed and modified in a revised version for better user interaction with the app. The scoring system increased the input of users' information, which resulted in more analysis and recommendations to users. Clinical studies showed that as a result of continuous input of information from users who had been using the application for a longer period of time, their HbA1c levels were within the healthy range. Conclusions The results demonstrate that the Diabetter application has been able to play an effective role in diabetes self-management by increasing users' app usage time. However, future study is needed to provide a better interpretation.
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Affiliation(s)
- Mohammad A. Tebianian
- Department of Computer Software Engineering, South Tehran Branch, Islamic Azad University, Tehran, Iran
| | - Soodeh Razeghi Jahromi
- Department of Clinical Nutrition, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Iran
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Pavan J, Noaro G, Facchinetti A, Salvagnin D, Sparacino G, Del Favero S. A strategy based on integer programming for optimal dosing and timing of preventive hypoglycemic treatments in type 1 diabetes management. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108179. [PMID: 38642427 DOI: 10.1016/j.cmpb.2024.108179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 03/29/2024] [Accepted: 04/13/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND AND OBJECTIVES One of the major problems related to type 1 diabetes (T1D) management is hypoglycemia, a condition characterized by low blood glucose levels and responsible for reduced quality of life and increased mortality. Fast-acting carbohydrates, also known as hypoglycemic treatments (HT), can counteract this event. In the literature, dosage and timing of HT are usually based on heuristic rules. In the present work, we propose an algorithm for mitigating hypoglycemia by suggesting preventive HT consumption, with dosages and timing determined by solving an optimization problem. METHODS By leveraging integer programming and linear inequality constraints, the algorithm can bind the amount of suggested carbohydrates to standardized quantities (i.e., those available in "off-the-shelf" HT) and the minimal distance between consecutive suggestions (to reduce the nuisance for patients). RESULTS The proposed method was tested in silico and compared with competitor algorithms using the UVa/Padova T1D simulator. At the cost of a slight increase of HT consumed per day, the proposed algorithm produces the lowest median and interquartile range of the time spent in hypoglycemia, with a statistically significant improvement over most competitor algorithms. Also, the average number of hypoglycemic events per day is reduced to 0 in median. CONCLUSIONS Thanks to its positive performances and reduced computational burden, the proposed algorithm could be a candidate tool for integration in a DSS aimed at improving T1D management.
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Affiliation(s)
- J Pavan
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - G Noaro
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - A Facchinetti
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - D Salvagnin
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - G Sparacino
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
| | - S Del Favero
- Department of Information Engineering, University of Padova, Via Gradenigo 6/A, Padova, 35131, Italy.
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Giebel GD, Speckemeier C, Schrader NF, Abels C, Plescher F, Hillerich V, Wiedemann D, Börchers K, Wasem J, Blase N, Neusser S. Quality assessment of mHealth apps: a scoping review. FRONTIERS IN HEALTH SERVICES 2024; 4:1372871. [PMID: 38751854 PMCID: PMC11094264 DOI: 10.3389/frhs.2024.1372871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 04/16/2024] [Indexed: 05/18/2024]
Abstract
Introduction The number of mHealth apps has increased rapidly during recent years. Literature suggests a number of problems and barriers to the adoption of mHealth apps, including issues such as validity, usability, as well as data privacy and security. Continuous quality assessment and assurance systems might help to overcome these barriers. Aim of this scoping review was to collate literature on quality assessment tools and quality assurance systems for mHealth apps, compile the components of the tools, and derive overarching quality dimensions, which are potentially relevant for the continuous quality assessment of mHealth apps. Methods Literature searches were performed in Medline, EMBASE and PsycInfo. Articles in English or German language were included if they contained information on development, application, or validation of generic concepts of quality assessment or quality assurance of mHealth apps. Screening and extraction were carried out by two researchers independently. Identified quality criteria and aspects were extracted and clustered into quality dimensions. Results A total of 70 publications met inclusion criteria. Included publications contain information on five quality assurance systems and further 24 quality assessment tools for mHealth apps. Of these 29 systems/tools, 8 were developed for the assessment of mHealth apps for specific diseases, 16 for assessing mHealth apps for all fields of health and another five are not restricted to health apps. Identified quality criteria and aspects were extracted and grouped into a total of 14 quality dimensions, namely "information and transparency", "validity and (added) value", "(medical) safety", "interoperability and compatibility", "actuality", "engagement", "data privacy and data security", "usability and design", "technology", "organizational aspects", "social aspects", "legal aspects", "equity and equality", and "cost(-effectiveness)". Discussion This scoping review provides a broad overview of existing quality assessment and assurance systems. Many of the tools included cover only a few dimensions and aspects and therefore do not allow for a comprehensive quality assessment or quality assurance. Our findings can contribute to the development of continuous quality assessment and assurance systems for mHealth apps. Systematic Review Registration https://www.researchprotocols.org/2022/7/e36974/, International Registered Report Identifier, IRRID (DERR1-10.2196/36974).
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Affiliation(s)
- Godwin Denk Giebel
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Christian Speckemeier
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nils Frederik Schrader
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Carina Abels
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Felix Plescher
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Vivienne Hillerich
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Desiree Wiedemann
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | | | - Jürgen Wasem
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Nikola Blase
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
| | - Silke Neusser
- Institute for Healthcare Management and Research, University of Duisburg-Essen, Essen, Germany
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Shao H, Liu C, Tang L, Wang B, Xie H, Zhang Y. Factors Influencing the Behavioral Intentions and Use Behaviors of Telemedicine in Patients With Diabetes: Web-Based Survey Study. JMIR Hum Factors 2023; 10:e46624. [PMID: 38153781 PMCID: PMC10784981 DOI: 10.2196/46624] [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: 02/18/2023] [Revised: 06/01/2023] [Accepted: 10/16/2023] [Indexed: 12/29/2023] Open
Abstract
BACKGROUND Telemedicine has great potential for diabetes management. The COVID-19 pandemic has boosted the development of telemedicine. However, the factors influencing the behavioral intentions to use and use behaviors of telemedicine in patients with diabetes in China are not clear. OBJECTIVE We aimed to understand the determinants of behavioral intention to use telemedicine based on an extended Unified Theory of Acceptance and Use of Technology model and to identify demographic factors associated with telemedicine use in patients with diabetes in China. METHODS Patients with diabetes who are aged ≥18 years were surveyed from February 1 to February 7, 2023. We distributed the survey link in 3 WeChat groups including a total of 988 patients with diabetes from the outpatient department or patients discharged from Changsha Central Hospital. Structural equation modeling was used to understand the determinants of behavioral intention. A multivariate logistic regression analysis was used to identify the demographic factors associated with telemedicine use. RESULTS In total, 514 questionnaires were collected. Of the respondents, 186 (36.2%) were diagnosed with COVID-19. The measurement model showed acceptable reliability, convergent validity, discriminant validity, and data fit indices. The model explained 63.8% of the variance in behavioral intention. Social influence, performance expectancy, and facilitating conditions positively influenced behavioral intention (β=.463, P<.001; β=.153, P=.02; and β=.257, P=.004, respectively). Perceived susceptibility, perceived severity, and effort expectancy had no significant impact on behavioral intention (all P>.05). The overall use of telemedicine was 20.6% (104/514). After adjusting for the behavioral intention score, the multivariate regression analysis showed that age, education, and family income were associated with telemedicine use. Telemedicine use was higher in the 40 to 59 years and 18 to 39 years age groups than in the ≥60 years age group (odds ratio [OR] 4.35, 95% CI 1.84-10.29, P=.001; OR 9.20, 95% CI 3.40-24.88, P<.001, respectively). Telemedicine use was higher in the senior high school and the university and more groups than in junior high school education and less group (OR 2.45, 95% CI 1.05-5.73, P=.04; OR 2.63, 95% CI 1.11-6.23, P=.03, respectively). Patients with a higher family income used telemedicine more often than the patients who had an annual family income ≤¥10,000 (CNY ¥1=US $0.1398; ¥10,000-¥50,000 group: OR 3.90, 95% CI 1.21-12.51, P=.02; ¥50,000-¥100,000 group: OR 3.91, 95% CI 1.19-12.79, P=.02; >¥100,000 group: OR 4.63, 95% CI 1.41-15.27, P=.01). CONCLUSIONS Social influence, performance expectancy, and facilitating conditions positively affected the behavioral intention of patients with diabetes to use telemedicine. Young patients, highly educated patients, and patients with high family income use telemedicine more often. Promoting behavioral intention and paying special attention to the needs of older adult patients, patients with low income, and patients with low levels of education are needed to encourage telemedicine use.
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Affiliation(s)
- Huige Shao
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Li Tang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Bian Wang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Hebin Xie
- Science and Education Department, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Yiyu Zhang
- Department of Endocrinology, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
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Jasmin M, Yusuf S, Syahrul S, Abrar EA. Validity and Reliability of a Vibration-Based Cell Phone in Detecting Peripheral Neuropathy among Patients with a Risk of Diabetic Foot Ulcer. INT J LOW EXTR WOUND 2023; 22:687-694. [PMID: 34382442 DOI: 10.1177/15347346211037411] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of this study was to determine the validity and reliability of a vibration-based cell phone in detecting peripheral neuropathy among individuals with a risk of diabetic foot ulcer (DFU). The current study consisted of 3 phases: a pilot study, concurrent validity study, and interreliability study. A 128 Hz tuning fork and vibration-based cell phone using the Vibrations-Test app was compared in the primary care setting. The pilot study confirmed that the vibration-based cell phone has an adequate reliability (r > 0.70, P < .001). The concurrent validity test involved 96 participants (aged 55.78 ± 8.32 years). The Pearson correlation test found the highest correlation in the fifth metatarsal heads (r = 0.741, right feet; 0.772, left feet; P < .001). In the 4 primary care settings, the interrater reliability between nurses of the vibration-based cell phone were k = 1.000, 1.000, 1.000, and 0.720. The concurrent validity test found moderate to strong correlation results and that the interrater reliability had a strong agreement that was almost perfect. Thus, vibration-based cell phone applications can be used as screening tools for detecting neuropathy among individuals with a risk of DFU.
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Affiliation(s)
- Muh Jasmin
- Nursing Study Program, College of Health Science Karya Kesehatan, Kendari, Indonesia
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Saldy Yusuf
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Syahrul Syahrul
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
| | - Eva Arna Abrar
- Faculty of Nursing, Hasanuddin University, Makassar, Indonesia
- Stikes Nani Hasanuddin, Makassar, Indonesia
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Velázquez López L, Achar de la Macorra R, Colin Ramirez E, Muñoz Torres AV, Pineda Del Aguila I, Medina Bravo PG, Klünder Klünder M, Medina Gómez OS, Escobedo de la Peña J. The diabetes education material on diabetes for website: Results of a validation process. J Healthc Qual Res 2023; 38:346-353. [PMID: 37567853 DOI: 10.1016/j.jhqr.2023.07.001] [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: 04/25/2022] [Revised: 06/27/2023] [Accepted: 07/14/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE To validate an educational material on diabetes through an expert consensus for its implementation into a web site. MATERIAL AND METHODS An observational study was carried out in a group of health professionals, for which an educational material was developed for patients with diabetes. Topics included nutrition, physical exercise, control indicators, complications, pharmacological treatment, among others. The language, text and figures were focused on easy comprehension, additionally, a section of didactic activities to be answered by the patient with diabetes at the end of each module was included. To evaluate the educational material by health professionals, an instrument was designed and validated. Once all the educational material was available, each of the modules was sent by e-mail to at least three clinical experts in the assigned topic, as well as the instrument for the evaluation of the module. RESULTS Thirty-seven experts were included in the study, 76% rated the educational modules evaluated as highly adequate, while only 24% rated them as adequate. The instrument used obtained a good level of internal consistency, with a Cronbach's alpha coefficient of 0.92. In the dimensions of the instrument, the lowest Cronbach's alpha score was that of "call-to-action", with a value of 0.71. CONCLUSION The diabetes educational material was rated as highly appropriate by the clinical experts. The developed instrument has an adequate content validity, as well as a good level of internal consistency.
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Affiliation(s)
- L Velázquez López
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, Ciudad de México, Mexico.
| | - R Achar de la Macorra
- Departamento de Salud, Universidad Iberoamericana, sede Santa Fe, Ciudad de México, Mexico
| | - E Colin Ramirez
- Centro de Investigación en Ciencias de la Salud (CICSA), FCS, Universidad Anáhuac, México Campus Norte, Huixquilucan Edo. de México 52786, Mexico
| | - A V Muñoz Torres
- Departmento de Salud Publica, Escuela de Medicina, Universidad Nacional Autónoma de México, 04510 Mexico City, Mexico
| | - I Pineda Del Aguila
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
| | - P G Medina Bravo
- Departamento de Endocrinología, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - M Klünder Klünder
- Departamento de Investigación, Hospital Infantil de México Federico Gómez, Mexico City, Mexico
| | - O S Medina Gómez
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
| | - J Escobedo de la Peña
- Unidad de Investigación en Epidemiología Clínica, Hospital Regional No 1, "Dr. Carlos Mac Gregor Sánchez Navarro" Instituto Mexicano del Seguro Social, 03100 Mexico City, Mexico
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Pienkowska A, Ang CS, Mammadova M, Mahadzir MDA, Car J. A Diabetes Education App for People Living With Type 2 Diabetes: Co-Design Study. JMIR Form Res 2023; 7:e45490. [PMID: 37721799 PMCID: PMC10546275 DOI: 10.2196/45490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/30/2023] [Accepted: 07/19/2023] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Type 2 diabetes (T2D) is a growing global health concern, including in Singapore. Diabetes education programs have been shown to be effective in improving health outcomes and diabetes self-management skills. Mobile health apps have emerged as useful tools for diabetes education; however, their use and acceptance by the target population remain inconsistent. Therefore, end-user participation in the design and development of a mobile health app is crucial for designing an acceptable app that can improve outcomes for populations with a chronic disease. OBJECTIVE The objective of this study was to apply an end-user participatory approach to co-design a diabetes education app prototype for people living with T2D by exploring their perceptions, acceptance, and usability of an app prototype, as well as their diabetes experience and perspectives on digital diabetes education. METHODS A total of 8 people with T2D, who were recruited from diabetes management Facebook groups, participated in 4 web-based surveys via Qualtrics and 2 structured interviews via Zoom (Zoom Video Communications, Inc) between August 20, 2021, and January 28, 2022. Descriptive statistics and thematic analyses of the discussion and iterative feedback on the app prototype were used to assess the participants' perceptions of living with T2D, attitudes toward digital diabetes education, and acceptance of the prototype. RESULTS Analyses of the surveys and interview data revealed 3 themes: challenges of living with T2D; validation, acceptability, and usability of the diabetes education app prototype; and perspectives on digital diabetes education. In the first theme, participants highlighted the importance of solitary accountability, translating knowledge into practice, and developing pragmatic self-consciousness. The second theme indicated that the diabetes education app prototype was acceptable, with information and appearance being key; revealed ambivalent and polarized opinions toward the chatbot; and confirmed potential impact of the app on diabetes self-management skills and practice. The third theme comprised the necessity of using a variety of information-seeking strategies and recommendations for desired content and app qualities, including accessibility, adaptability, autonomy, evidence-based design and content, gamification, guidance, integration, personalization, and up-to-date content. The findings were used to reiterate the app design. CONCLUSIONS Despite a small sample size, the study demonstrated the feasibility of engaging and empowering people living with T2D to consider digital therapeutics for diabetes self-management skills and practice. Participants gave rather positive feedback on the design and content of the app prototype, with some recommendations for improvements. The findings suggest that incorporating end-user feedback into app design can lead to the creation of feasible and acceptable tools for diabetes education, potentially improving outcomes for populations with a chronic disease. Further research is needed to test the impact of the refined diabetes education app prototype on diabetes self-management skills and practice and quality of life.
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Affiliation(s)
- Anita Pienkowska
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Chin-Siang Ang
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Maleyka Mammadova
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Muhammad Daniel Azlan Mahadzir
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Josip Car
- Center for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
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Haghdoost A, Bakhshandeh S, Tohidi S, Ghorbani Z, Namdari M. Improvement of oral health knowledge and behavior of diabetic patients: an interventional study using the social media. BMC Oral Health 2023; 23:359. [PMID: 37270487 DOI: 10.1186/s12903-023-03007-w] [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: 12/17/2022] [Accepted: 05/03/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Diabetic patients are not often aware of relationship between diabetes mellitus (DM) and periodontal diseases, and the researchers recommend further knowledge enhancement of diabetic patients in this regard. This study aimed to enhance oral health knowledge of diabetic adults via an educational intervention. METHODS In this interventional study, three private offices of endocrinologists specialized in treatment of DM were selected for the recruitment of participants. In total, 120 diabetic adults (40 from each office) took part in an educational intervention in three groups (patients from each office made up one group): (I) physician-aid, (II) researcher-aid, and (III) social media. In group (I), participants received educational materials (brochure and CD) from their endocrinologist, in group (II) participants received educational materials from researcher. Group (III) joining an educational group in WhatsApp for 3 months. A self-reported standard questionnaire was filled out by the patients before, and after the intervention to assess oral health knowledge. Data were analyzed by SPSS version 21 using independent t-test, Mann-Whitney test, Chi-square test, and ANCOVA. RESULTS The mean oral health knowledge score increased in all three groups after the educational interventions (P < 0.001); the highest increase occurred in the social media group. Toothbrushing twice daily or more had the greatest improvement in the physician-aid group compared with the other two groups (P < 0.001). The greatest improvement in dental flossing once daily or more occurred in the social media group (P = 0.01). The mean level of the hemoglobin A1c (HbA1c) decreased in all three groups, but not significantly (P = 0.83). CONCLUSION The results showed that educational interventions enhance oral health knowledge, and improve the behavior of diabetic adults. The education via the social media can be an efficient method for knowledge enhancement of diabetic patients.
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Affiliation(s)
- Atousa Haghdoost
- Dental Research Center, Research Institute of Dental Sciences, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soheila Bakhshandeh
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Sajjad Tohidi
- Department of Endodontics, School of Dentistry, Qazvin University of Medical Science, Qazvin, Iran
| | - Zahra Ghorbani
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mahshid Namdari
- Department of Community Oral Health, School of Dentistry, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Diez Alvarez S, Fellas A, Santos D, Sculley D, Wynne K, Acharya S, Navathe P, Girones X, Coda A. The Clinical Impact of Flash Glucose Monitoring-a Digital Health App and Smartwatch Technology in Patients With Type 2 Diabetes: Scoping Review. JMIR Diabetes 2023; 8:e42389. [PMID: 36920464 PMCID: PMC10131890 DOI: 10.2196/42389] [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: 09/01/2022] [Revised: 12/29/2022] [Accepted: 01/19/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Type 2 diabetes has a growing prevalence and confers significant cost burden to the health care system, raising the urgent need for cost-effective and easily accessible solutions. The management of type 2 diabetes requires significant commitment from the patient, caregivers, and the treating team to optimize clinical outcomes and prevent complications. Technology and its implications for the management of type 2 diabetes is a nascent area of research. The impact of some of the more recent technological innovations in this space, such as continuous glucose monitoring, flash glucose monitoring, web-based applications, as well as smartphone- and smart watch-based interactive apps has received limited attention in the research literature. OBJECTIVE This scoping review aims to explore the literature available on type 2 diabetes, flash glucose monitoring, and digital health technology to improve diabetic clinical outcomes and inform future research in this area. METHODS A scoping review was undertaken by searching Ovid MEDLINE and CINAHL databases. A second search using all identified keywords and index terms was performed on Ovid MEDLINE (January 1966 to July 2021), EMBASE (January 1980 to July 2021), Cochrane Central Register of Controlled Trials (CENTRAL; the Cochrane Library, latest issue), CINAHL (from 1982), IEEE Xplore, ACM Digital Libraries, and Web of Science databases. RESULTS There were very few studies that have explored the use of mobile health and flash glucose monitoring in type 2 diabetes. These studies have explored somewhat disparate and limited areas of research, and there is a distinct lack of methodological rigor in this area of research. The 3 studies that met the inclusion criteria have addressed aspects of the proposed research question. CONCLUSIONS This scoping review has highlighted the lack of research in this area, raising the opportunity for further research in this area, focusing on the clinical impact and feasibility of the use of multiple technologies, including flash glucose monitoring in the management of patients with type 2 diabetes.
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Affiliation(s)
- Sergio Diez Alvarez
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Antoni Fellas
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
| | - Derek Santos
- School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom
| | - Dean Sculley
- School of Biomedical Sciences and Pharmacy, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
| | - Katie Wynne
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Shamasunder Acharya
- School of Medicine and Public Health, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, Australia
- Department of Diabetes and Endocrinology, Hunter New England Health, John Hunter Hospital, Newcastle, Australia
| | - Pooshan Navathe
- Central Queensland Hospital and Health Service, Brisbane, Australia
| | - Xavier Girones
- Department of Research, Universities de Catalunya, Generalitat de Catalunya, Barcelona, Cataluna, Spain
| | - Andrea Coda
- School of Health Sciences, College of Health, Medicine and Wellbeing, University of Newcastle, Ourimbah, Australia
- Equity in Health and Wellbeing Research Program, Hunter Medical Research Institute, Newcastle, Australia
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Wangler J, Jansky M. Attitudes and experiences of registered diabetes specialists in using health apps for managing type 2 diabetes: results from a mixed-methods study in Germany 2021/2022. Arch Public Health 2023; 81:36. [PMID: 36882859 PMCID: PMC9990333 DOI: 10.1186/s13690-023-01051-0] [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: 08/22/2022] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Hardly any area of application for health apps is seen to be as promising as health and lifestyle support in type 2 diabetes mellitus. Research has emphasised the benefits of such mHealth apps for disease prevention, monitoring, and management, but there is still a lack of empirical data on the role that health apps play in actual type 2 diabetes care. The aim of the present study was to gain an overview of the attitudes and experiences of physicians specialising in diabetes with regard to the benefits of health apps for type 2 diabetes prevention and management. METHODS An online survey was conducted amongst all 1746 physicians at practices specialised in diabetes in Germany between September 2021 and April 2022. A total of 538 (31%) of the physicians contacted participated in the survey. In addition, qualitative interviews were conducted with 16 randomly selected resident diabetes specialists. None of the interviewees took part in the quantitative survey. RESULTS Resident diabetes specialists saw a clear benefit in type 2 diabetes-related health apps, primarily citing improvements in empowerment (73%), motivation (75%), and compliance (71%). Respondents rated self-monitoring for risk factors (88%), lifestyle-supporting (86%), and everyday routine features (82%) as especially beneficial. Physicians mainly in urban practice environments were open to apps and their use in patient care despite their potential benefit. Respondents expressed reservations and doubts on app user-friendliness in some patient groups (66%), privacy in existing apps (57%), and the legal conditions of using apps in patient care (80%). Of those surveyed, 39% felt capable of advising patients on diabetes-related apps. Most of the physicians that had already used apps in patient care saw positive effects in increased compliance (74%), earlier detection of or reduction in complications (60%), weight reduction (48%), and decreased HbA1c levels (37%). CONCLUSIONS Resident diabetes specialists saw a real-life benefit with added value from health apps for managing type 2 diabetes. Despite the favourable role that health apps may play in disease prevention and management, many physicians expressed reservations regarding usability, transparency, security, and privacy in such apps. These concerns should be addressed more intensively towards bringing about ideal conditions for integrating health apps successfully in diabetes care. This includes uniform standards governing quality, privacy, and legal conditions as binding as possible with regard to apps and their use in a clinical setting.
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Affiliation(s)
- Julian Wangler
- Center for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany.
| | - Michael Jansky
- Center for General Medicine and Geriatrics, University Medical Center of the Johannes Gutenberg University Mainz, Am Pulverturm 13, 55131, Mainz, Germany
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Manzano-Monfort G, Paluzie G, Díaz-Gegúndez M, Chabrera C. Usability of a mobile application for health professionals in home care services: a user-centered approach. Sci Rep 2023; 13:2607. [PMID: 36788261 PMCID: PMC9929220 DOI: 10.1038/s41598-023-29640-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
The use of mobile devices by healthcare professionals has led to rapid growth in the development of mobile healthcare applications designed to improve healthcare services. This study was conducted to assess the acceptability and usability of a mobile application for health professionals in relation to their work in hospitalization at home. A mixed methods approach was used. Acceptance, included the satisfaction of the professionals, attitudes toward using the application, and intention or willingness to continue using the application. Usability tests were performed in laboratory analyzing five controlled clinical tasks, and the interaction of the participants with the mobile application was based on the six basic facial expressions published by the American Psychological Association. Perceived satisfaction was assessed using the computer system usability questionnaire. Thirty-two participants completed the task scenarios and questionnaire. More than 90 per cent of participants were able to complete the tasks with only some difficult with vital signs. Satisfaction had a score of 6.18/7 (SD: 0.76), and recommendation of the mobile application had a score of 6.21/7 (SD: 0.81). This study showed a significant usability and acceptability of this mobile application, in terms of effectiveness, efficiency, and satisfaction.
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Affiliation(s)
| | - Guillermo Paluzie
- Health Information Management Department, Corporació de Salut del Maresme i la Selva, Calella, Barcelona, Spain
| | - Mercedes Díaz-Gegúndez
- Home Care Services, Corporació de Salut del Maresme i la Selva, Calella, Barcelona, Spain
| | - Carolina Chabrera
- Tecnocampus, Universitat Pompeu Fabra, Barcelona, Spain
- Research Group on Chronic Care and Innovation in Health (GRACIS), Barcelona, Spain
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Guo H, Xiao Y, Liao C, Sun J, Xie Y, Zheng Y, Fan G. U-shaped association between online information exchange and app usage frequency: a large-scale survey of China 's online young and middle-aged people with pre diabetes and diabetes. Front Endocrinol (Lausanne) 2023; 14:1141645. [PMID: 37152927 PMCID: PMC10161200 DOI: 10.3389/fendo.2023.1141645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/20/2023] [Indexed: 05/09/2023] Open
Abstract
Background China has the world's largest diabetic population, and the cost of caring for all these people every day is substantial. Online information exchange and app usage frequency have been demonstrated to play a significant influence in the management of blood glucose and enhancement of diabetes-related quality of life. However, the association between online information exchange and app usage frequency among actual online populations remains unclear and deserves additional study. Therefore, we evaluated the factors affecting the frequency of app usage in the online glucose management population, with a particular emphasis on the connection between online information exchange and app use frequency, contributing to the expansion of the research of diabetes management models. Method This cross-sectional study was conducted by disseminating questionnaires in blood glucose management-related forums and WeChat groups and included 1586 online users concerned about blood glucose management. Information exchange and app usage frequency were considered as independent and dependent variables, respectively. We performed stratified and single factor analysis, multiple equation regression analysis, smooth curve fitting, and threshold effect and saturation effect analysis. R (version 4.1.3, http://www.Rproject.org) and EmpowerStats were used for data analysis. Result After adjusting for other covariates, information exchange was independently and positively associated with app use frequency (β = 8.6, 95% CI: 6.5 to 11.2, p < 0.001). Through interaction analysis, the most significant interaction factors influencing the relationship between information exchange and app usage frequency were identified as health insurance status, whether living with parents, glycated hemoglobin status in the previous month, and self-monitoring of blood glucose (SMBG). The association between information exchange and app usage frequency is U-shaped, with information exchange inflection points of 3.0 and 4.2. Information exchange and app usage frequency are negatively correlated when the average information exchange score is less than 3.0, and for every point increase in the average information exchange score, the likelihood of the app high usage frequency group compared to the app low usage frequency group decreases by 70%. The relationship between information exchange and app usage frequency is strongest when it is greater than or equal to 3.0 and less than or equal to 4.2. The probability of the app high usage frequency group occurring compared to the app low usage frequency group rises 17.3 times for every 1 point increase in the average information exchange score. The probability of the app high usage frequency group occurring in comparison to the app low usage frequency group increased by 1.8 times for every 1 point rise in information exchange when the average information exchange score was higher than 4.2. Conclusion Age, body mass index, married, living with parents, hemoglobin level, SMBG, and information exchange were positively connected with app usage frequency in our study of online blood glucose management population. The link between information exchange and app use frequency was significantly U-shaped. The app usage frequency changed the most with the rise in information exchange when the information exchange score was greater than or equal to 3.0 and less than or equal to 4.2. Therefore, we ought to offer effort to concentrate on and increase the health-related behaviors and activities of those in this score interval.
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Zheng W, Chu J, Ren J, Dong J, Bambrick H, Wang N, Mengersen K, Guo X, Hu W. Age- and Gender-Specific Differences in the Seasonal Distribution of Diabetes Mortality in Shandong, China: A Spatial Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17024. [PMID: 36554905 PMCID: PMC9779441 DOI: 10.3390/ijerph192417024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 12/13/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Diabetes mortality in Shandong is higher than the national average in China. This study first explored diabetes mortality variation spatially at the county/district level among adults aged over 30 years in terms of age and gender, specifically by season. Daily diabetes mortality data were collected from 31 mortality surveillance points across Shandong Province in 2014. A geographic information system, spatial kriging interpolation and a spatial clustering method were used to examine the spatial patterns of diabetes mortality at the county/district level by season. Sensitivity analysis was conducted using diabetes mortality data from 10 mortality surveillance points from 2011 to 2020. As a result, the total diabetes mortality in eastern counties/districts was the highest (relative risk (RR) of cluster: 1.58, p = 0.00) across the whole province. For subgroups, women had higher mortality (16.84/100,000) than men (12.15/100,000), people aged over 75 years were the most vulnerable (93.91/100,000) and the highest-risk season was winter. However, the mortality differences between winter and summer were smaller in eastern and coastal regions than in other regions for all gender- and age-specific groups. The findings provide further evidence for early warning and precision preventative strategies for diabetes mortality in different regions of Shandong Province. Future research is required to identify the risk factors for diabetes and understand the differences in the social and environmental contexts.
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Affiliation(s)
- Wenxiu Zheng
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Jie Chu
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China
| | - Jie Ren
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China
| | - Jing Dong
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China
| | - Hilary Bambrick
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Ning Wang
- National Centre for Chronic and Noncommunicable Disease Control and Prevention, Chinese Centre for Disease Control and Prevention, Beijing 100050, China
| | - Kerrie Mengersen
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, QLD 4059, Australia
| | - Xiaolei Guo
- The Department for Chronic and Non-Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan 250014, China
| | - Wenbiao Hu
- Ecosystem Change and Population Health Research Group, School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD 4059, Australia
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25
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Hummel M, Bonn SE, Trolle Lagerros Y. The effect of the smartphone app DiaCert on health related quality of life in patients with type 2 diabetes: results from a randomized controlled trial. Diabetol Metab Syndr 2022; 14:192. [PMID: 36528609 PMCID: PMC9759853 DOI: 10.1186/s13098-022-00965-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Type 2 diabetes mellitus is associated with an increased risk of impaired quality of life. Improving health related quality of life (HRQoL) is therefore an important goal in the multimodal management of diabetes. The aim of this study was to evaluate whether the use of the smartphone app DiaCert, that encourage physical activity by promoting daily steps, also impacts HRQoL in patients with type 2 diabetes. METHODS In this randomized controlled trial, a total of 181 participants with type 2 diabetes were recruited from six health care centers in Stockholm, Sweden. At baseline, participants were randomized 1:1 to the use of the smartphone app DiaCert for a 3 month physical activity intervention in addition to routine care, or to a control group with routine care only. HRQoL was measured using the RAND-36 questionnaire at baseline and at follow-up after 3 months and 6 months. We analysed the HRQoL scores within the intervention and the control groups, respectively, using the Wilcoxon signed-rank test. Between group differences including intervention effect after the 3 month long intervention and after 6 months of follow-up, were assessed using generalized estimating equation models. RESULTS In total, 166 participants, 108 men and 58 women, with complete baseline data on RAND-36 were included in analysis. The mean age was 60.2 (SD 11.4) years and the mean Body Mass Index 30.3 (SD 5.4) kg/m2. The intervention effect, expressed in terms of the difference in change in HRQoL from baseline to follow-up after 3 months of intervention, showed improvement in the health concept role limitations due to physical health problems (- 16.9; 95% CI - 28.5 to - 5.4), role limitations due to emotional problems (- 13.9; 95% CI - 25.8 to - 2.1), and emotional well-being (- 5.7; 95% CI - 10.4 to - 1.0), in the intervention group compared to the control group. No intervention effect was seen at follow-up after 6 months. CONCLUSIONS Being randomized to use the smartphone app DiaCert promoting physical activity for 3 months, improved aspects of both physical and emotional HRQoL in patients with type 2 diabetes compared to routine care, but the effect did not last 3 months after the intervention ended. Trial Registration ClinicalTrials.gov Identifier: NCT03053336.
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Affiliation(s)
- Madeleine Hummel
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden.
| | - Stephanie Erika Bonn
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden
| | - Ylva Trolle Lagerros
- Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Eugeniahemmet T2:02, SE-171 76, Stockholm, Sweden
- Obesity Center, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
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26
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Crowdsourcing Operational and Design Flaws of Diabetes Mobile Apps. J Med Syst 2022; 46:101. [PMID: 36418791 DOI: 10.1007/s10916-022-01879-z] [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: 09/06/2020] [Accepted: 10/17/2022] [Indexed: 11/25/2022]
Abstract
Unfortunately, many of the diabetes mobile apps have operational and design flaws that are debarring users from maximizing from the self-management paradigm. We, therefore, aim to identify the markers of operational and design flaws of diabetes mobile apps to facilitate a better user-centred design. e crowdsourced negative user review comments (rating score: 1-3) of 47 diabetes mobile apps from the google play store. A total of 781 negative user comments (rating score 1-3) from the apps are coded to identify and categorize the themes relating to the operational and design flaws. The operational and design flaws account for 50.32% of the challenges faced by the unhappy diabetes mobile apps users. Among them, 44.73% have issues with app crashing, 17.3% are concerned about device compatibility that inhibits seamless operations, 9.67% are worried about the problem of data uploading. Poor design is a worry to 19.29% of the users who complain of the crowded user interface, poor data management, poor analytics, difficulty scheduling doctors' appointments, and transferring data. More patients with diabetes can be encouraged to continue using diabetes mobile apps for self-management of diabetes through improved design and a pace-wise software advancement to match the ever-growing enhancements in android operating systems and telecommunication devices. This will help to counter most of the challenges identified in this study.
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27
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Yoon S, Kwan YH, Phang JK, Tan WB, Low LL. Personal Goals, Barriers to Self-Management and Desired mHealth Application Features to Improve Self-Care in Multi-Ethnic Asian Patients with Type 2 Diabetes: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15415. [PMID: 36430134 PMCID: PMC9692780 DOI: 10.3390/ijerph192215415] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Revised: 11/02/2022] [Accepted: 11/17/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: The ubiquity of mobile phones suggests the potential of mobile health applications to reach patients with type 2 diabetes and engage them to improve self-care. This study aimed to explore personal goals, barriers to self-management and desired mobile health application features to improve self-care among multi-ethnic Asian patients with type 2 diabetes. (2) Methods: We conducted semi-structured interviews with patients with type 2 diabetes (n = 29). Patients were recruited from a multi-disciplinary center for diabetes and metabolism in Singapore, using a purposive sampling strategy. Various visual materials, collated from existing mobile health application features, were used to facilitate the discussion. Interviews were transcribed verbatim and thematically analyzed. (3) Results: A total of 29 patients participated in 11 focus group discussions or one-on-one interviews. Personal goals for self-management were centered around short-term outcome expectancy, such as better glucose control and a reduced number of medications. Self-management was hampered by competing priorities and limited healthy food options when at work, while a lack of tailored advice from healthcare providers further diminished competence. The desired mobile health app features to improve self-care behaviors included quantifiable goal-setting, personalized nudges based on tracked data, built-in resources from credible sources, in-app social support through virtual interaction with peers and healthcare providers, technology-driven novel data logging and user-defined nudges. (4) Conclusions: We identified a set of app features that may foster motivation to engage in lifestyle modification for patients with T2DM. The findings serve to inform the design of artificial intelligence-enabled mobile health application intervention aimed at improving diabetes self-care.
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Affiliation(s)
- Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Yu Heng Kwan
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Department of Pharmacy, National University of Singapore, Singapore 119077, Singapore
- Department of Internal Medicine, Singapore Health Services, Singapore 168753, Singapore
| | - Jie Kie Phang
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
| | - Wee Boon Tan
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
| | - Lian Leng Low
- Health Services and Systems Research, Duke-NUS Medical School, Singapore 169857, Singapore
- Centre for Population Health Research and Implementation, SingHealth Regional Health System, Singapore 828815, Singapore
- Population Health & Integrated Care Office (PHICO), Singapore General Hospital, Singapore 168753, Singapore
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Singapore 169856, Singapore
- Post-Acute and Continuing Care, Outram Community Hospital, Singapore 168582, Singapore
- Family Medicine Academic Clinical Program, SingHealth Duke-NUS, Singapore 168753, Singapore
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Graybeal AJ, Brandner CF, Tinsley GM. Visual body composition assessment methods: A 4-compartment model comparison of smartphone-based artificial intelligence for body composition estimation in healthy adults. Clin Nutr 2022; 41:2464-2472. [PMID: 36215866 DOI: 10.1016/j.clnu.2022.09.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 09/01/2022] [Accepted: 09/25/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND & AIMS Visual body composition (VBC) estimates produced from smartphone-based artificial intelligence represent a user-friendly and convenient way to automate body composition remotely and without the inherent geographical and monetary restrictions of other body composition methods. However, there are limited studies that have assessed the reliability and agreement of this method and thus, the aim of this study was to evaluate VBC estimates compared to a 4-compartment (4C) criterion model. METHODS A variety of body composition assessments were conducted across 184 healthy adult participants (114 F, 70 M) including dual-energy X-ray absorptiometry and bioimpedance spectroscopy for utilization in the 4C model and automated assessments produced from two smartphone applications (Amazon Halo®, HALO; and myBVI®) using either Apple® or Samsung® phones. Body composition components were compared to a 4C model using equivalence testing, root mean square error (RMSE), and Bland-Altman analysis. Separate analyses by sex and racial/ethnic groups were conducted. Precision metrics were conducted for 183 participants using intraclass correlation coefficients (ICC), root mean squared coefficients of variation (RMS-%CV) and precision error (PE). RESULTS Only %fat produced from HALO devices demonstrated equivalence with the 4C model although mean differences for HALO were <±1.0 kg for FM and FFM. RMSEs ranged from 3.9% to 6.2% for %fat and 3.1-5.2 kg for FM and FFM. Proportional bias was apparent for %fat across all VBC applications but varied for FM and FFM. Validity metrics by sex and specific racial/ethnic groups varied across applications. All VBC applications were reliable for %fat, fat mass (FM), and fat-free mass (FFM) with ICCs ≥0.99, RMS-%CV between 0.7% and 4.3%, and PEs between 0.3% and 0.6% for %fat and 0.2-0.5 kg for FM and FFM including assessments between smartphone types. CONCLUSIONS Smartphone-based VBC estimates produce reliable body composition estimates but their equivalence with a 4C model varies by the body composition component being estimated and the VBC being employed. VBC estimates produced by HALO appear to have the lowest error, but proportional bias and estimates by sex and race vary across applications.
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Affiliation(s)
- Austin J Graybeal
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS 39406, USA.
| | - Caleb F Brandner
- School of Kinesiology & Nutrition, College of Education and Human Sciences, University of Southern Mississippi, Hattiesburg, MS 39406, USA
| | - Grant M Tinsley
- Department of Kinesiology & Sport Management, Texas Tech University, Lubbock, TX 79409, USA
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Wangler J, Jansky M. Bedeutung und Einsatzpotenziale von Gesundheits-Apps in der diabetologischen Versorgung – Ergebnisse einer Befragungsstudie. DIABETOL STOFFWECHS 2022. [DOI: 10.1055/a-1859-6400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Zusammenfassung
Hintergrund Mit Blick auf Diabetes mellitus Typ 2 als lebensstilinduzierte Erkrankung wird ein großer potenzieller Nutzen in Gesundheits-Apps gesehen, die gesundheitsunterstützend bei Prävention und Monitoring oder auch der Therapie helfen sollen. Das Ziel der Studie ist es, den Anwendungshorizont, die Akzeptanz und Einstellungen sowie Erfahrungen von Ärzt*innen aus diabetologischen Schwerpunktpraxen hinsichtlich des Nutzungspotenzials von Gesundheits-Apps für Diagnostik, Therapie und Prävention bei Diabetes mellitus Typ 2 explorativ zu beleuchten.
Methodik Aufbauend auf mehreren Vorstudien wurden mittels schriftlicher Befragung zwischen März und Mai 2021 insgesamt 291 Ärzt*innen diabetologischer Schwerpunktpraxen in Rheinland-Pfalz, Hessen, Thüringen und dem Saarland anonymisiert befragt. Die Rücklaufquote beträgt 30% (N=88). Neben der deskriptiven Analyse wurde ein t-Test bei unabhängigen Stichproben durchgeführt.
Ergebnisse Die Befragten verbinden mit dem Einsatz von Apps eine wirksame Stärkung von Empowerment, Motivation und Compliance, aber auch durch Erinnerungs- und lebensstilunterstützenden Funktionen eine mögliche Effektivierung der Prävention und des Erkrankungsmanagements von Typ-2-Diabetes-Patient*innen. Gerade jüngere Ärzt*innen in städtischen Praxisumgebungen begegnen Gesundheits-Apps mit positiver Einstellung und greifen im Praxisalltag auf solche Tools zurück. Skepsis besteht auf Seiten der Befragten u.a. in Bezug auf die Anwendungsfreundlichkeit und Datensicherheit bestehender Apps sowie hinsichtlich rechtlicher Fragestellungen. Eine Mehrheit räumt ein, keinen ausreichenden Überblick über diabetologische Apps zu besitzen und traut sich eine Beratung von Patient*innen nur bedingt zu. Diejenigen Ärzt*innen, bei denen Apps schon in der Versorgung Einzug fanden, beobachten in großer Mehrzahl positive Effekte bei der Steigerung der Compliance, im schnelleren Aufdecken bzw. Verringern von Komplikationen, bei der Gewichtsreduktion sowie bei der Abnahme des HbA1c-Werts.
Diskussion Trotz der positiver Effekte, die Gesundheits-Apps für Prävention und Therapie haben können, bestehen bei vielen diabetologischen Ärzt*innen Vorbehalte hinsichtlich der Überschaubarkeit, Transparenz und Sicherheit von Apps. Diese Bedenken sollten verstärkt adressiert werden, um die richtigen Voraussetzungen für eine erfolgreiche Integration von Gesundheits-Apps in die diabetologische Versorgung zu schaffen (u.a. verbindliche Datenschutz- und Qualitätsstandards, klare Rechtslage in Bezug auf die Anwendung von Apps, Schulungen, Tools zur Übersicht und Einordnung).
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Affiliation(s)
- Julian Wangler
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Germany
| | - Michael Jansky
- Zentrum für Allgemeinmedizin und Geriatrie, Universitätsmedizin Mainz, Mainz, Germany
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Ossai CI, Wickramasinghe N. Automatic user sentiments extraction from diabetes mobile apps - An evaluation of reviews with machine learning. Inform Health Soc Care 2022:1-20. [PMID: 35930432 DOI: 10.1080/17538157.2022.2097083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Using diabetes mobile apps for self-management of diabetes is one of the emerging strategies for controlling blood sugar levels and maintaining the wellness of patients with diabetes. This study aims to develop a strategy for thematically extracting user comments from diabetes mobile apps to understand the concern of patients with diabetes. Hence, 2678 user comments obtained from the Google Play Store are thematically analyzed with Non-negative Matrix Factorization (NMF) to identify the themes for describing positive, neutral, and negative sentiments. These themes are used as the ground truth for developing a 10-fold cross-validation ensemble Multilayer Artificial Neural Network (ANN) model following the Bag of Word (BOW) analysis of lemmatized user comments. The result shows that a total of 41.24% of positive sentimental users identified the diabetes mobile apps as Effective for Blood Sugar Monitoring (EBSM), 32.36% with neutral sentiments are mostly impressed by the Information Quality (IQ), whereas 40.81% of unhappy users are worried about the Poor Information Quality (PIQ). The prediction accuracy of the ANN model is 89%-97%, which is 5%-48% better than other predominant algorithms. It can be concluded from this study that diabetes mobile apps with a simple user interface, effective data storage and security, medication adherence, and doctor appointment scheduling are preferred by patients with diabetes.
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Affiliation(s)
- Chinedu I Ossai
- Department of Health Science and Biostatistics, Swinburne University of Technology; Swinburne University, Melbourne, Australia
| | - Nilmini Wickramasinghe
- Department of Health Science and Biostatistics, Swinburne University of Technology; Swinburne University, Melbourne, Australia
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Gosak L, Pajnkihar M, Stiglic G. The Impact of Mobile Health Use on the Self-care of Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2022; 11:e31652. [PMID: 35713944 PMCID: PMC9250066 DOI: 10.2196/31652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 03/04/2022] [Accepted: 03/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Chronic diseases are a substantial public health issue worldwide and affect an individual’s quality of life. Due to the alarming rise in type 2 diabetes, health care that was primarily focused on diagnosis and treatment of the disease is increasingly focused on prevention and self-care. Patients who adhere to a constant and strict treatment regimen (physical activity, diet, medication) and regularly monitor their health are more likely to maintain self-care and health, prevent the exacerbation of the disease, and avoid the complications of diabetes (retinopathy, diabetic feet, etc). In recent years, many innovative devices that have become increasingly present in inpatient health care, such as mobile apps, are available to help patients maintain consistency in monitoring their health status. Mobile apps make it easier for individuals to monitor their self-care and illness and follow instructions regarding disease control. Objective This study aims to determine the impact of mobile app use on self-care in patients with type 2 diabetes. We will evaluate and test the usefulness of the forDiabetes app as a tool to improve the self-care of individuals with type 2 diabetes. Methods We will perform a double-blind randomized controlled trial. The study will include individuals aged over 18 years diagnosed with or have regulated type 2 diabetes who are treated in family medicine practices. Additionally, the individuals included in the study should not have any acute complications due to the consequences of type 2 diabetes. They will use an Android or iOS mobile phone and a blood glucose meter during the investigation. With the help of simple randomization, individuals will be divided into the intervention and control groups. Individuals in the intervention group will use the forDiabetes mobile app to monitor their self-care for type 2 diabetes. Individuals in the control group will not receive a particular intervention. Data will be collected using the Self-care of Diabetes Inventory questionnaire and Brief Illness Perception Questionnaire. Blood sugar, blood pressure, glycated hemoglobin (HbA1c), and weight measurements will be monitored using calibrated instruments during the study by the nurses employed at the family medicine practice. Data will be collected at the beginning of the study and after a patient visits the family medicine practice. Results In the first half of 2020, we have prepared a translation of the mobile app that will be used by the participants of the intervention group, as well as more detailed instructions for using the app. We have also prepared a translation of the questionnaires in Slovene. The research results will be published in 2023. Conclusions This research contributes to greater visibility and usability of mobile apps for the self-care of patients with type 2 diabetes and raises awareness of the possible use of innovative methods. Trial Registration Clinicaltrials.gov NCT04999189; https://clinicaltrials.gov/ct2/show/NCT04999189 International Registered Report Identifier (IRRID) PRR1-10.2196/31652
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Affiliation(s)
- Lucija Gosak
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Majda Pajnkihar
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
| | - Gregor Stiglic
- Faculty of Health Sciences, University of Maribor, Maribor, Slovenia
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Stephen DA, Nordin A, Nilsson J, Persenius M. Using mHealth applications for self-care - An integrative review on perceptions among adults with type 1 diabetes. BMC Endocr Disord 2022; 22:138. [PMID: 35614419 PMCID: PMC9131554 DOI: 10.1186/s12902-022-01039-x] [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] [Received: 12/29/2021] [Accepted: 05/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individually designed interventions delivered through mobile health applications (mHealth apps) may be able to effectively support diabetes self-care. Our aim was to review and synthesize available evidence in the literature regarding perception of adults with type 1 diabetes on the features of mHealth apps that help promote diabetes self-care, as well as facilitators and barriers to their use. An additional aim was to review literature on changes in patient reported outcome measures (PROMs) in the same population while using mHealth apps for diabetes self-care. METHODS Quantitative and qualitative studies focusing on adults aged 18 years and over with type 1 diabetes in any context were included. A systematic literature search using selected databases was conducted. Data was synthesised using narrative synthesis. RESULTS We found that features of mHealth apps designed to help promote and maintain diabetes self-care could be categorized into self-care data monitoring, app display, feedback & reminders, data entry, data sharing, and additional features. Factors affecting the use of mHealth apps reported in the literature were personal factors, app design or usability factors, privacy and safety factors, or socioeconomic factors. Quality of life and diabetes distress were the most commonly reported PROMs in the included studies. CONCLUSION We are unable to reach a conclusive result due to the heterogeneity of the included studies as well as the limited number of studies reporting on these areas among adults with type 1 diabetes. We therefore recommend further large-scale studies looking into these areas that can ultimately improve mHealth app use in type 1 diabetes self-care. SYSTEMATIC REVIEW REGISTRATION Prospero CRD42020157620 .
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Affiliation(s)
- Divya Anna Stephen
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden.
| | - Anna Nordin
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
- Department of Health, Learning and Technology, Nursing and Medical Technology, Luleå University of Technology, Luleå, Sweden
| | - Jan Nilsson
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
- Faculty of Health and Social Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - Mona Persenius
- Department of Health Sciences, Faculty for Health, Science And Technology, Karlstad University, Karlstad, Sweden
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Safiee L, Rough DJ, Whitford H. Barriers and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-Management (GDM): A Systematic Literature Review of Perceptions of Healthcare Professionals and Women with GDM (Preprint). J Med Internet Res 2022; 24:e39689. [PMID: 36301613 PMCID: PMC9650580 DOI: 10.2196/39689] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/16/2022] [Accepted: 09/28/2022] [Indexed: 11/30/2022] Open
Abstract
Background Gestational diabetes mellitus (GDM) is one of the most common medical complications during pregnancy. eHealth technologies are proving to be successful in supporting the self-management of medical conditions. Digital technologies have the potential to improve GDM self-management. Objective The primary objective of this systematic literature review was to identify the views of health professionals (HPs) and women with GDM regarding the use of eHealth for GDM self-management. The secondary objective was to investigate the usability and user satisfaction levels when using these technologies. Methods Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach, the search included primary papers in English on the evaluation of technology to support self-management of GDM from January 2008 to September 2021 using MEDLINE, CINAHL, Embase, ACM, and IEEE databases. The lists of references from previous systematic literature reviews, which were related to technology and GDM, were also examined for primary studies. Papers with qualitative, quantitative, and mixed methodologies were included and evaluated. The selected papers were assessed for quality using the Cochrane Collaboration tool, National Institute for Health and Care Excellence clinical guidelines, Critical Appraisal Skills Programme Qualitative Checklist, and McGill University Mixed Methods Appraisal Tool. NVivo (QSR International) was used to extract qualitative data, which were subjected to thematic analysis. Narrative synthesis was used to analyze the quantitative data. Results A total of 26 papers were included in the review. Of these, 19% (5/26) of studies used quantitative research methodologies, 19% (5/26) used qualitative methods, and 62% (16/26) used mixed methods. In all, 4 themes were identified from the qualitative data: the benefits of using technology, engagement with people via technology, the usability of technology, and discouragement factors for the use of technology. The thematic analysis revealed a vast scope of challenges and facilitators in the use of GDM self-management systems. The challenges included usability aspects of the system, technical problems, data privacy, lack of emotional support, the accuracy of reported data, and adoption of the system by HPs. Convenience, improved GDM self-management, peer support, increased motivation, increased independence, and consistent monitoring were facilitators to use these technologies. Quantitative data showed that there is potential for improving the usability of the GDM self-management systems. It also showed that convenience, usefulness, increasing motivation for GDM self-management, helping with GDM self-management, and being monitored by HPs were facilitators to use the GDM self-management systems. Conclusions This novel systematic literature review shows that HPs and women with GDM encountered some challenges in using GDM self-management systems. The usability of GDM systems was the primary challenge derived from qualitative and quantitative results, with convenience, consistent monitoring, and optimization of GDM self-management emerging as important facilitators.
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Affiliation(s)
- Ladan Safiee
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Daniel John Rough
- School of Science and Engineering, University of Dundee, Dundee, United Kingdom
| | - Heather Whitford
- School of Health Sciences, University of Dundee, Dundee, United Kingdom
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Tews D, Gouveri E, Simon J, Marck C. A Smartphone-Based Application to Assist Insulin Titration in Patients Undergoing Basal Insulin-Supported Oral Antidiabetic Treatment. J Diabetes Sci Technol 2022:19322968221090521. [PMID: 35491554 DOI: 10.1177/19322968221090521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION INSULIA is an insulin-titration app developed for patients with type 2 diabetes treated with basal insulin as part of a basal insulin-supported oral therapy (BOT). The app uses patient-logged fasting blood glucose (FBG) values and a titration plan defined by the treating physician to provide basal insulin dosing recommendations. Physicians use the web portal to monitor their patients' therapy progress and, if necessary, adjust therapy. The aim of this study was to assess the app, specifically its features, handling and impact on diabetes treatment and self-management in Germany. METHODS This German retrospective pilot study included physicians (diabetologists, general practitioners, and internists) and patients with type 2 diabetes who either receive or start BOT using the app. Both groups completed group-specific questionnaires between December 2018 and June 2019. RESULTS Overall, 10 physicians and 34 patients with type 2 diabetes completed their respective questionnaires. Physicians perceived their app-using patients to be more involved and more confident in managing their insulin therapy than patients not using the app. The majority of patients considered the app as a tool that assists with safer insulin treatment. The physicians perceived that due to the app use, FBG and HbA1c target values were achieved more often than patients not using the app and the number and severity of hypoglycemic episodes was reduced. CONCLUSION The titration app seems to have a positive impact on BOT patients' FBG and HbA1c target achievement and was highly appreciated by both physicians and patients alike.
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Affiliation(s)
| | | | - Jörg Simon
- MVZ im Altstadt-Carree Fulda GmbH, Fulda, Germany
| | - Cornelia Marck
- Centrum für Diabetologie und Allgemeinmedizin, Pohlheim, Germany
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Schretzlmaier P, Hecker A, Ammenwerth E. Suitability of the Unified Theory of Acceptance and Use of Technology 2 Model for Predicting mHealth Acceptance Using Diabetes as an Example: Qualitative Methods Triangulation Study. JMIR Hum Factors 2022; 9:e34918. [PMID: 35262493 PMCID: PMC8943545 DOI: 10.2196/34918] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 01/27/2022] [Accepted: 02/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background In recent years, the use of mobile health (mHealth) apps to manage chronic diseases has increased significantly. Although mHealth apps have many benefits, their acceptance is still low in certain areas and groups. Most mHealth acceptance studies are based on technology acceptance models. In particular, the Unified Theory of Acceptance and Use of Technology 2 (UTAUT2) model was developed to predict technology acceptance in a consumer context. However, to date, only a few studies have used the UTAUT2 model to predict mHealth acceptance and confirm its suitability for the health sector. Thus, it is unclear whether the UTAUT2 model is suitable for predicting mHealth acceptance and whether essential variables for a health-related context are missing. Objective This study aims to validate the suitability of UTAUT2 for predicting mHealth acceptance. Methods In this study, diabetes was used as an example as mHealth apps are a significant element of diabetes self-management. In addition, diabetes is one of the most common chronic diseases affecting young and older people worldwide. An explorative literature review and guided interviews with 11 mHealth or technology acceptance experts and 8 mHealth users in Austria and Germany were triangulated to identify all relevant constructs for predicting mHealth acceptance. The interview participants were recruited by purposive sampling until theoretical saturation was reached. Data were analyzed using structured content analysis based on inductive and deductive approaches. Results This study was able to confirm the relevance of all exogenous UTAUT2 constructs. However, it revealed two additional constructs that may also need to be considered to better predict mHealth acceptance: trust and perceived disease threat. Conclusions This study showed that the UTAUT2 model is suitable for predicting mHealth acceptance. However, the model should be extended to include 2 additional constructs for use in the mHealth context.
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Affiliation(s)
- Patrik Schretzlmaier
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
| | - Achim Hecker
- Institute for Management and Economics in Healthcare, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria.,DBU Digital Business University of Applied Sciences, Berlin, Germany
| | - Elske Ammenwerth
- Institute of Medical Informatics, UMIT - Private University for Health Sciences, Medical Informatics and Technology, Hall in Tirol, Austria
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Burda V, Mráz M, Schneider J, Novák D. Managing Diabetes Using Mobiab: Long Term Case Study of the Impact of a Mobile App on Self-Management (Preprint). JMIR Diabetes 2022; 7:e36675. [PMID: 35442201 PMCID: PMC9069284 DOI: 10.2196/36675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/20/2022] [Accepted: 03/17/2022] [Indexed: 11/26/2022] Open
Abstract
Background This paper describes the development of a mobile app for diabetes mellitus (DM) control and self-management and presents the results of long-term usage of this system in the Czech Republic. DM is a chronic disease affecting large numbers of people worldwide, and this number is continuously increasing. There is massive potential to increase adherence to self-management of DM with the use of smartphones and digital therapeutics interventions. Objective This study aims to describe the process of development of a mobile app, called Mobiab, for DM management and to investigate how individual features are used and how the whole system benefits its long-term users. Using at least 1 year of daily records from users, we analyzed the impact of the app on self-management of DM. Methods We have developed a mobile app that serves as an alternative form to the classic paper-based protocol or diary. The development was based on cooperation with both clinicians and people with DM. The app consists of independent individual modules. Therefore, the user has the possibility to use only selected features that they find useful. Mobiab was available free of charge on Google Play Store from mid-2014 until 2019. No targeted recruitment was performed to attract users. Results More than 500 users from the Czech Republic downloaded and signed up for the mobile app. Approximately 80% of the users used Mobiab for less than 1 week. The rest of the users used it for a longer time and 8 of the users produced data that were suitable for long-term analysis. Additionally, one of the 8 users provided their medical records, which were compared with the gathered data, and the improvements in their glucose levels and overall metabolic stability were consistent with the way in which the mobile app was used. Conclusions The results of this study showed that the usability of a DM-centered self-management smartphone mobile app and server-based systems could be satisfactory and promising. Nonetheless, some better ways of motivating people with diabetes toward participation in self-management are needed. Further studies involving a larger number of participants are warranted to assess the effect on long-term diabetes management.
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Affiliation(s)
- Václav Burda
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Miloš Mráz
- Department of Diabetes, Diabetes Centre, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Jakub Schneider
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
| | - Daniel Novák
- Department of Cybernetics, Faculty of Electrical Engineering, Czech Technical University in Prague, Prague, Czech Republic
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Keller R, Hartmann S, Teepe GW, Lohse KM, Alattas A, Tudor Car L, Müller-Riemenschneider F, von Wangenheim F, Mair JL, Kowatsch T. Digital Behavior Change Interventions for the Prevention and Management of Type 2 Diabetes: Systematic Market Analysis. J Med Internet Res 2022; 24:e33348. [PMID: 34994693 PMCID: PMC8783286 DOI: 10.2196/33348] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/22/2021] [Accepted: 11/15/2021] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Advancements in technology offer new opportunities for the prevention and management of type 2 diabetes. Venture capital companies have been investing in digital diabetes companies that offer digital behavior change interventions (DBCIs). However, little is known about the scientific evidence underpinning such interventions or the degree to which these interventions leverage novel technology-driven automated developments such as conversational agents (CAs) or just-in-time adaptive intervention (JITAI) approaches. OBJECTIVE Our objectives were to identify the top-funded companies offering DBCIs for type 2 diabetes management and prevention, review the level of scientific evidence underpinning the DBCIs, identify which DBCIs are recognized as evidence-based programs by quality assurance authorities, and examine the degree to which these DBCIs include novel automated approaches such as CAs and JITAI mechanisms. METHODS A systematic search was conducted using 2 venture capital databases (Crunchbase Pro and Pitchbook) to identify the top-funded companies offering interventions for type 2 diabetes prevention and management. Scientific publications relating to the identified DBCIs were identified via PubMed, Google Scholar, and the DBCIs' websites, and data regarding intervention effectiveness were extracted. The Diabetes Prevention Recognition Program (DPRP) of the Center for Disease Control and Prevention in the United States was used to identify the recognition status. The DBCIs' publications, websites, and mobile apps were reviewed with regard to the intervention characteristics. RESULTS The 16 top-funded companies offering DBCIs for type 2 diabetes received a total funding of US $2.4 billion as of June 15, 2021. Only 4 out of the 50 identified publications associated with these DBCIs were fully powered randomized controlled trials (RCTs). Further, 1 of those 4 RCTs showed a significant difference in glycated hemoglobin A1c (HbA1c) outcomes between the intervention and control groups. However, all the studies reported HbA1c improvements ranging from 0.2% to 1.9% over the course of 12 months. In addition, 6 interventions were fully recognized by the DPRP to deliver evidence-based programs, and 2 interventions had a pending recognition status. Health professionals were included in the majority of DBCIs (13/16, 81%,), whereas only 10% (1/10) of accessible apps involved a CA as part of the intervention delivery. Self-reports represented most of the data sources (74/119, 62%) that could be used to tailor JITAIs. CONCLUSIONS Our findings suggest that the level of funding received by companies offering DBCIs for type 2 diabetes prevention and management does not coincide with the level of evidence on the intervention effectiveness. There is considerable variation in the level of evidence underpinning the different DBCIs and an overall need for more rigorous effectiveness trials and transparent reporting by quality assurance authorities. Currently, very few DBCIs use automated approaches such as CAs and JITAIs, limiting the scalability and reach of these solutions.
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Affiliation(s)
- Roman Keller
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Sven Hartmann
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
| | - Gisbert Wilhelm Teepe
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Kim-Morgaine Lohse
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Aishah Alattas
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
| | - Lorainne Tudor Car
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Florian von Wangenheim
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
| | - Jacqueline Louise Mair
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Tobias Kowatsch
- Future Health Technologies Programme, Campus for Research Excellence and Technological Enterprise, Singapore-ETH Centre, Singapore, Singapore
- Centre for Digital Health Interventions, Institute of Technology Management, University of St Gallen, St Gallen, Switzerland
- Centre for Digital Health Interventions, Department of Management, Technology, and Economics, ETH Zurich, Zurich, Switzerland
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Więckowska-Rusek K, Danel J, Deja G. The usefulness of the nutrition apps in self-control of diabetes mellitus - the review of literature and own experience. Pediatr Endocrinol Diabetes Metab 2022; 28:75-80. [PMID: 35307999 PMCID: PMC10226352 DOI: 10.5114/pedm.2022.113631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 12/05/2021] [Indexed: 06/07/2023]
Abstract
Intensive technology development as well as the COVID-19 pandemic has contributed to the increased interest in the telemedicine and mHealth sector. Increasing availability and use of mobile devices as well as the constantly growing number of nutritional mobile applications, resulted in creating new tools for food and meals nutrients calculation which can be used by patients with diabetes. Variety of mobile applications and multiple functions included in them enable finding applications focused on individual patients' needs. The scientific data coming from research conducted so far suggest that the regular use of mobile nutritional applications contributes to improving metabolic control of diabetes and the reduction of the value of glycated hemoglobin in patients with diabetes. Innovative solutions bring hope also for a significant improvement in the quality of life of patients. The aim of this article was to summarize the EBM knowledge about the use of mHealth in self-control and diet of patients with diabetes, especially type 1 and to present and assess the nutrition mobile applications available in polish language according to their functionality in diabetic self-control.
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Affiliation(s)
- Katarzyna Więckowska-Rusek
- Students’ Scientific Association in Department of Children’s Diabetology, Medical University of Silesia, Poland
| | - Justyna Danel
- Students’ Scientific Association in Department of Children’s Diabetology, Medical University of Silesia, Poland
| | - Grażyna Deja
- Department of Children’s Diabetology, Medical University of Silesia, Poland
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Shahriar H, Sneha S, Abaye Y, Hashmi T, Wilson S, Usen U. A review of diabetes management tools and applications. COMPUTATIONAL INTELLIGENCE IN HEALTHCARE APPLICATIONS 2022:87-99. [DOI: 10.1016/b978-0-323-99031-8.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
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Bonet Olivencia S, Rao AH, Smith A, Sasangohar F. Eliciting Requirements for a Diabetes Self-Management Application for Underserved Populations: A Multi-Stakeholder Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:127. [PMID: 35010385 PMCID: PMC8751044 DOI: 10.3390/ijerph19010127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/16/2021] [Accepted: 12/17/2021] [Indexed: 06/14/2023]
Abstract
Medically underserved communities have limited access to effective disease management resources in the U.S. Mobile health applications (mHealth apps) offer patients a cost-effective way to monitor and self-manage their condition and to communicate with providers; however, current diabetes self-management apps have rarely included end-users from underserved communities in the design process. This research documents key stakeholder-driven design requirements for a diabetes self-management app for medically underserved patients. Semi-structured survey interviews were carried out on 97 patients with diabetes and 11 healthcare providers from medically underserved counties in South Texas, to elicit perspectives and preferences regarding a diabetes self-management app, and their beliefs regarding such an app's usage and utility. Patients emphasized the need for accessible educational content and for quick access to guidance on regulating blood sugar, diet, and exercise and physical activity using multimedia rather than textual forms. Healthcare providers indicated that glucose monitoring, educational content, and the graphical visualization of diabetes data were among the top-rated app features. These findings suggest that specific design requirements for the underserved can improve the adoption, usability, and sustainability of such interventions. Designers should consider health literacy and numeracy, linguistic barriers, data visualization, data entry complexity, and information exchange capabilities.
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Affiliation(s)
- Samuel Bonet Olivencia
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Arjun H. Rao
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Alec Smith
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
| | - Farzan Sasangohar
- Department of Industrial & Systems Engineering, Texas A&M University, College Station, TX 77843, USA; (S.B.O.); (A.H.R.); (A.S.)
- Center for Outcomes Research, Houston Methodist, Houston, TX 77030, USA
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Yan K, Balijepalli C, Druyts E. The Impact of Digital Therapeutics on Current Health Technology Assessment Frameworks. Front Digit Health 2021; 3:667016. [PMID: 34713140 PMCID: PMC8521991 DOI: 10.3389/fdgth.2021.667016] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 05/17/2021] [Indexed: 11/26/2022] Open
Abstract
Historically healthcare has been delivered offline (e.g., physician consultations, mental health counseling services). It is widely understood that healthcare lags behind other industries (e.g., financial, transportation) whom have already incorporated digital technologies in their workflow. However, this is changing with the recent emergence of digital therapeutics (DTx) helping to bring healthcare services online. To promote adoption, healthcare providers need to be educated regarding the digital therapy to allow for proper prescribing. But of equal importance is affordability and many countries rely on reimbursement support from the government and insurance agencies. Here we briefly explore how national reimbursement agencies or non-profits across six countries (Canada, United States of America, United Kingdom, Germany, France, Australia) handle DTx submissions and describe the potential impact of digital therapeutics on current health technology assessment (HTA) frameworks. A targeted review to identify HTA submissions and guidelines from national reimbursement agencies or non-profits was conducted. We reviewed guidelines from the Institute for Clinical and Economic Review (ICER) in the USA, the Canadian Agency for Drugs and Technologies in Health (CADTH) in Canada, the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK), the Institute for Quality and Efficiency in Health Care (IQWIG) in Germany, Haute Autorité de Santé (HAS) in France, and the Pharmaceutical Benefits Advisory Committee (PBAC) in Australia. Our review identified one set of guidelines developed by NICE in the UK. The guidelines by NICE outlined an evidence standards framework for digital health technologies (DHT). Depending on the organizational impact, financial commitment, and economic risk for the payer, different economic analyses are required. Economic analyses levels are separated into 3 categories, basic, low financial commitment, and high financial commitment. All economic analyses levels require a budget impact analysis. A cost-utility analysis is recommended for DHTs categorized in the high financial commitment category. Whereas, for DHTs that are in the low financial commitment category, a cost-consequence analysis is typically recommended. No HTA guidelines for DTx submissions were identified for the remaining countries (Canada, USA, Germany, France, and Australia)
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Affiliation(s)
- Kevin Yan
- Pharmalytics Group, Vancouver, BC, Canada.,Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
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42
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Shetty VB, Soon WHK, Roberts AG, Fried L, Roby HC, Smith GJ, Fournier PA, Jones TW, Davis EA. A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study. JMIR Diabetes 2021; 6:e29739. [PMID: 34647896 PMCID: PMC8554675 DOI: 10.2196/29739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 08/19/2021] [Accepted: 09/09/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. OBJECTIVE Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. METHODS A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. RESULTS The main themes arising from the interview analysis were "increased knowledge," "increased confidence to exercise," and "suitability" for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). CONCLUSIONS The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373.
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Affiliation(s)
- Vinutha B Shetty
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Wayne H K Soon
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Alison G Roberts
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Leanne Fried
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Heather C Roby
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Grant J Smith
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia
| | - Paul A Fournier
- Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Exercise and Health, School of Human Sciences, The University of Western Australia, Perth, Australia
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Australia.,Telethon Kids Institute, Children's Diabetes Centre, The University of Western Australia, Perth, Australia.,Division of Pediatrics, The University of Western Australia, Perth, Australia
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Development features and study characteristics of mobile health apps in the management of chronic conditions: a systematic review of randomised trials. NPJ Digit Med 2021; 4:144. [PMID: 34611287 PMCID: PMC8492762 DOI: 10.1038/s41746-021-00517-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/13/2021] [Indexed: 11/21/2022] Open
Abstract
COVID-19 pandemic challenges have accelerated the reliance on digital health fuelling the expanded incorporation of mobile apps into healthcare services, particularly for the management of long-term conditions such as chronic diseases (CDs). However, the impact of health apps on outcomes for CD remains unclear, potentially owing to both the poor adoption of formal development standards in the design process and the methodological quality of studies. A systematic search of randomised trials was performed on Medline, ScienceDirect, the Cochrane Library and Scopus to provide a comprehensive outlook and review the impact of health apps on CD. We identified 69 studies on diabetes (n = 29), cardiovascular diseases (n = 13), chronic respiratory diseases (n = 13), cancer (n = 10) or their combinations (n = 4). The apps rarely adopted developmental factors in the design stage, with only around one-third of studies reporting user or healthcare professional engagement. Apps differed significantly in content, with a median of eight behaviour change techniques adopted, most frequently pertaining to the ‘Feedback and monitoring’ (91%) and ‘Shaping knowledge’ (72%) categories. As for the study methodologies, all studies adopted a traditional randomised control trial (RCT) design, with relatively short follow-ups and limited sample sizes. Findings were not significant for the majority of studies across all CD, with most RCTs revealing a high risk of bias. To support the adoption of apps for CD management, this review reinforces the need for more robust development and appropriate study characteristics to sustain evidence generation and elucidate whether study results reflect the true benefits of apps or a biased estimate due to unsuitable designs.
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Rozga M, Jones K, Robinson J, Yahiro A. Nutrition and physical activity interventions for the general population with and without cardiometabolic risk: a scoping review. Public Health Nutr 2021; 24:4718-4736. [PMID: 34030758 PMCID: PMC10195388 DOI: 10.1017/s1368980021002184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 03/24/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The objective of this scoping review was to examine the research question: In the adults with or without cardiometabolic risk, what is the availability of literature examining interventions to improve or maintain nutrition and physical activity-related outcomes? Sub-topics included: (1) behaviour counseling or coaching from a dietitian/nutritionist or exercise practitioner, (2) mobile applications to improve nutrition and physical activity and (3) nutritional ergogenic aids. DESIGN The current study is a scoping review. A literature search of the Medline Complete, CINAHL Complete, Cochrane Database of Systematic Reviews and other databases was conducted to identify articles published in the English language from January 2005 until May 2020. Data were synthesised using bubble charts and heat maps. SETTING Out-patient, community and workplace. PARTICIPANTS Adults with or without cardiometabolic risk factors living in economically developed countries. RESULTS Searches resulted in 19 474 unique articles and 170 articles were included in this scoping review, including one guideline, thirty systematic reviews (SR), 134 randomised controlled trials and five non-randomised trials. Mobile applications (n 37) as well as ergogenic aids (n 87) have been addressed in several recent studies, including SR. While primary research has examined the effect of individual-level nutrition and physical activity counseling or coaching from a dietitian/nutritionist and/or exercise practitioner (n 48), interventions provided by these practitioners have not been recently synthesised in SR. CONCLUSION SR of behaviour counseling or coaching provided by a dietitian/nutritionist and/or exercise practitioner are needed and can inform practice for practitioners working with individuals who are healthy or have cardiometabolic risk.
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Affiliation(s)
- Mary Rozga
- Evidence Analysis Center, Academy of Nutrition and Dietetics, 120 South Riverside Plaza, Suite 2190, Chicago, IL60606-6995, USA
| | - Kelly Jones
- Kelly Jones Nutrition, LLC, Newtown, PA, USA
| | - Justin Robinson
- Adjunct Faculty, Point Loma Nazarene University, San Diego, CA, USA
| | - Amy Yahiro
- North American Spine Society, Burr Ridge, IL, USA
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45
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Represas-Carrera FJ, Martínez-Ques ÁA, Clavería A. Effectiveness of mobile applications in diabetic patients' healthy lifestyles: A review of systematic reviews. Prim Care Diabetes 2021; 15:751-760. [PMID: 34275771 DOI: 10.1016/j.pcd.2021.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE (1) Examine the mobile applications that address lifestyles to improve the metabolic control of adult patients with diabetes mellitus. (2) Describe the characteristics of the used mobile applications, identify the healthy lifestyles they target, and describe any of their adverse effects. METHODS Review systematic reviews. We included studies that used any mobile application to help patients improve diabetes mellitus self-management by focusing on healthy lifestyles. Studies needed to include a control group receiving regular care with no mobile devices. In May 2018, Medline, Embase, Cochrane, LILACS, PsychINFO, Cinahl and Science Direct were searched, updated in June 2021. The methodological quality of the studies was assessed by the Amstar-2 tool. RESULTS First 804 articles were analyzed to select 17 systematic reviews, of which the methodological quality of seven was high or moderate. Interventions lasted 1-12 months. Twenty-three different mobile applications were identified that were all related to eating and physical activity. Significant changes were noted in HbA1c values. No clear improvement was observed for weight/BMI, lipid profile, quality of life or blood pressure. No adverse effects were found. CONCLUSIONS Managing the lifestyle of patients with diabetes using mobile applications improves short-term glycemic control, but the long-term results are not conclusive. The identified mobile applications focus on food and physical activity. Most are free. No adverse effects caused by using them were identified. PROSPERO REGISTER CRD42019133685.
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Affiliation(s)
- Francisco Jesús Represas-Carrera
- Vigo Health Area, Galician Health Service (SERGAS), Galicia South Health Research Institute, Vigo, Spain. Spanish Primary Care Research Network (REDIAPP), Barcelona, Spain.
| | - Ángel Alfredo Martínez-Ques
- Ourense Health Area, Galician Health Service (SERGAS), Galicia South Health Research Institute, Ourense, Spain
| | - Ana Clavería
- Vigo Health Area, Galician Health Service (SERGAS), Galicia South Health Research Institute, Vigo, Spain. Spanish Primary Care Research Network (REDIAPP), Barcelona, Spain
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Rufo DD, Debelee TG, Ibenthal A, Negera WG. Diagnosis of Diabetes Mellitus Using Gradient Boosting Machine (LightGBM). Diagnostics (Basel) 2021; 11:1714. [PMID: 34574055 PMCID: PMC8467876 DOI: 10.3390/diagnostics11091714] [Citation(s) in RCA: 74] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/06/2021] [Accepted: 09/17/2021] [Indexed: 12/01/2022] Open
Abstract
Diabetes mellitus (DM) is a severe chronic disease that affects human health and has a high prevalence worldwide. Research has shown that half of the diabetic people throughout the world are unaware that they have DM and its complications are increasing, which presents new research challenges and opportunities. In this paper, we propose a preemptive diagnosis method for diabetes mellitus (DM) to assist or complement the early recognition of the disease in countries with low medical expert densities. Diabetes data are collected from the Zewditu Memorial Hospital (ZMHDD) in Addis Ababa, Ethiopia. Light Gradient Boosting Machine (LightGBM) is one of the most recent successful research findings for the gradient boosting framework that uses tree-based learning algorithms. It has low computational complexity and, therefore, is suited for applications in limited capacity regions such as Ethiopia. Thus, in this study, we apply the principle of LightGBM to develop an accurate model for the diagnosis of diabetes. The experimental results show that the prepared diabetes dataset is informative to predict the condition of diabetes mellitus. With accuracy, AUC, sensitivity, and specificity of 98.1%, 98.1%, 99.9%, and 96.3%, respectively, the LightGBM model outperformed KNN, SVM, NB, Bagging, RF, and XGBoost in the case of the ZMHDD dataset.
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Affiliation(s)
- Derara Duba Rufo
- College of Engineering and Technology, Dilla University, Dilla 419, Ethiopia;
| | - Taye Girma Debelee
- College of Electrical and Mechanical Engineering, Addis Ababa Science and Technology University, Addis Ababa 120611, Ethiopia;
- Ethiopian Artificial Intelligence Center, Addis Ababa 40782, Ethiopia;
| | - Achim Ibenthal
- Faculty of Engineering and Health, HAWK Universityof Applied Sciences and Arts, 37085 Göttingen, Germany
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Hilmarsdóttir E, Sigurðardóttir ÁK, Arnardóttir RH. A Digital Lifestyle Program in Outpatient Treatment of Type 2 Diabetes: A Randomized Controlled Study. J Diabetes Sci Technol 2021; 15:1134-1141. [PMID: 32680441 PMCID: PMC8442170 DOI: 10.1177/1932296820942286] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Lifestyle is important in type 2 diabetes mellitus (T2DM). This study's aim was to investigate whether a healthy-lifestyle-supporting smartphone application could affect treatment outcomes at an endocrinology outpatient clinic. METHODS Consecutively invited patients were randomly assigned to an intervention or control group after age and gender stratification. In addition to standard care, intervention group participants used a smartphone application to access a lifestyle program (SidekickHealth) through which they received personalized recommendations and education about healthy lifestyles. Tests at baseline and every other month for six months included body weight and blood tests for glycated hemoglobin (HbA1c) and blood lipids, as well as questionnaires about distress related to diabetes, health-related quality of life, depression, and anxiety. Statistics included comparisons both within and between groups. RESULTS A total of 37 patients (23 women) were included, whereof 30 finished, 15 in each group (19% dropout); the average age was 51.2 ± 10.6 (25-70) years. No significant differences emerged between groups, but within the intervention group, there was a significant decrease in HbA1c from 61 ± 21.4 to 52.7 ± 15.2 mmol/mol, in disease-specific distress from 19.5 ± 16.5 to 11.7 ± 13.4, and in anxiety symptoms from 5.4 ± 4.0 to 4.1 ± 3.8. No significant changes occurred within the control group. The application usage was most frequent during the first months and differed interpersonally. CONCLUSIONS Our results indicate that the SidekickHealth digital lifestyle program could potentially enhance outpatient treatment in T2DM, in terms of both glycemic control and psychological well-being but larger confirmative studies are needed.
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Affiliation(s)
- Eva Hilmarsdóttir
- School of Health Sciences, University of
Akureyri, Iceland
- Endocrinology Clinic, Akureyri Hospital,
Iceland
| | - Árún K. Sigurðardóttir
- School of Health Sciences, University of
Akureyri, Iceland
- Department of Education and Science,
Akureyri Hospital, Iceland
- Árún K. Sigurðardóttir, PhD, School of
Health Sciences, University of Akureyri, Norðurslóð 2, Akureyri, 600, Iceland.
| | - Ragnheiður Harpa Arnardóttir
- School of Health Sciences, University of
Akureyri, Iceland
- Department of Rehabilitation, Akureyri
Hospital, Iceland
- Department of Medical Science,
Respiratory, Allergy and sleep Research, Uppsala University, Academic Hospital,
Sweden
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48
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Jia W, Zhang P, Zhu D, Duolikun N, Li H, Bao Y, Li X. Evaluation of an mHealth-enabled hierarchical diabetes management intervention in primary care in China (ROADMAP): A cluster randomized trial. PLoS Med 2021; 18:e1003754. [PMID: 34547030 PMCID: PMC8454951 DOI: 10.1371/journal.pmed.1003754] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 08/04/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Glycemic control remains suboptimal in developing countries due to critical system deficiencies. An innovative mobile health (mHealth)-enabled hierarchical diabetes management intervention was introduced and evaluated in China with the purpose of achieving better control of type 2 diabetes in primary care. METHODS AND FINDINGS A community-based cluster randomized controlled trial was conducted among registered patients with type 2 diabetes in primary care from June 2017 to July 2019. A total of 19,601 participants were recruited from 864 communities (clusters) across 25 provinces in China, and 19,546 completed baseline assessment. Moreover, 576 communities (13,037 participants) were centrally randomized to the intervention and 288 communities (6,509 participants) to usual care. The intervention was centered on a tiered care team-delivered mHealth-mediated service package, initiated by monthly blood glucose monitoring at each structured clinic visit. Capacity building and quarterly performance review strategies upheld the quality of delivered primary care. The primary outcome was control of glycated hemoglobin (HbA1c; <7.0%), assessed at baseline and 12 months. The secondary outcomes include the individual/combined control rates of blood glucose, blood pressure (BP), and low-density lipoprotein cholesterol (LDL-C); changes in levels of HbA1c, BP, LDL-C, fasting blood glucose (FBG), and body weight; and episodes of hypoglycemia. Data were analyzed using intention-to-treat (ITT) generalized estimating equation (GEE) models, accounting for clustering and baseline values of the analyzed outcomes. After 1-year follow-up, 17,554 participants (89.8%) completed the end-of-study (EOS) assessment, with 45.1% of them from economically developed areas, 49.9% from urban areas, 60.5 (standard deviation [SD] 8.4) years of age, 41.2% male, 6.0 years of median diabetes duration, HbA1c level of 7.87% (SD 1.92%), and 37.3% with HbA1c <7.0% at baseline. Compared with usual care, the intervention led to an absolute improvement in the HbA1c control rate of 7.0% (95% confidence interval [CI] 4.0% to 10.0%) and a relative improvement of 18.6% (relative risk [RR] 1.186, 95% CI 1.105 to 1.267) and an absolute improvement in the composite ABC control (HbA1c <7.0%, BP <140/80 mm Hg, and LDL-C <2.6 mmol/L) rate of 1.9% (95% CI 0.5 to 3.5) and a relative improvement of 21.8% (RR 1.218, 95% CI 1.062 to 1.395). No difference was found on hypoglycemia episode and weight gain between groups. Study limitations include noncentralized laboratory tests except for HbA1c, and caution should be exercised when extrapolating the findings to patients not registered in primary care system. CONCLUSIONS The mHealth-enabled hierarchical diabetes management intervention effectively improved diabetes control in primary care and has the potential to be transferred to other chronic conditions management in similar contexts. TRIAL REGISTRATION Chinese Clinical Trial Registry (ChiCTR) IOC-17011325.
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Affiliation(s)
- Weiping Jia
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Endocrinology, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
- Chinese Diabetes Society, Beijing, China
- * E-mail:
| | - Puhong Zhang
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Dalong Zhu
- Chinese Diabetes Society, Beijing, China
- Department of Endocrinology, Drum Tower Hospital affiliated to Nanjing University Medical School, Nanjing, China
| | - Nadila Duolikun
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
| | - Hong Li
- Department of Endocrinology, Sir Run Run Shaw Hospital affiliated to School of Medicine, Zhejiang University, Hangzhou, China
| | - Yuqian Bao
- Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Endocrinology, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai, China
| | - Xian Li
- The George Institute for Global Health at Peking University Health Science Center, Beijing, China
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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Ossai CI, Wickramasinghe N. Text Mining and Grounded Theory for Appraising the Self-Management Indicators of Diabetes Mobile Apps. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Islam SMS, Mishra V, Siddiqui MU, Moses JC, Adibi S, Nguyen L, Wickramasinghe N. Smartphone Apps for Diabetes Medication Adherence: A Systematic Review (Preprint). JMIR Diabetes 2021; 7:e33264. [PMID: 35727613 PMCID: PMC9257622 DOI: 10.2196/33264] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 02/24/2022] [Accepted: 04/08/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Sheikh Mohammed Shariful Islam
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Faculty of Health, Deakin University, Melbourne, Australia
| | - Vinaytosh Mishra
- College of Healthcare Management and Economics, Gulf Medical University, Ajman, United Arab Emirates
| | - Muhammad Umer Siddiqui
- Department of Internal Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
| | | | - Sasan Adibi
- School of Information Technology, Deakin University, Burwood, Australia
| | - Lemai Nguyen
- School of Information Technology, Deakin University, Burwood, Australia
| | - Nilmini Wickramasinghe
- Iverson Health Innovation Research Institute, Swinburne University of Technology, Melbourne, Australia
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