Improving insulin sensitivity, liver steatosis and fibrosis in type 2 diabetes by a food-based digital education-assisted lifestyle intervention program: a feasibility study

Current Situation and Prospects of Digital Therapeutics in the Field of Liver Diseases in China

Digital therapeutics have developed rapidly in recent years, providing a new method for disease management. The burden of liver diseases in China is heavy, and there are obvious problems in disease management. This paper expounds on the definition and classification of digital therapeutics, introduces their application in liver disease treatment and management in detail, and analyzes their development prospects in the field of liver diseases and future challenges.Graphical abstract available for this article.

[Impact of educational intervention in a population with type 2 diabetes mellitus]

Introduction

The complications associated with the chronic pathophysiological process of type 2 diabetes mellitus (T2DM) have a significant impact on the affected population. The Diabetes Knowledge Questionnaire (DKQ-24) determines the level of knowledge about diabetes, providing health professionals with information to carry out useful educational interventions and prevent both acute and chronic complications of the disease

Objective

To assess the long-term effect of implementing a hospital-based therapeutic diabetes education model (self-care and knowledge) on patients with type 2 diabetes mellitus (T2DM) in a population from southern Colombia.

Materials and methods

Longitudinal study, prospective type, conducted on 60 hospitalized T2DM patients. The DKQ-24 was used for pre-assessment, and after 90 days, it was administered again, along with the collection of biometric variables. The intervention consisted of 5 sessions of therapeutic diabetes education in hospital settings.

Results

The average results according to the DKQ-2 questionnaire pre-intervention (10.13±3.28) and post-intervention (20.13±2.77) showed significant differences (p<0.000). The biometric profile indicated significant differences (p<0.000) during pre and post-intervention, except for systolic blood pressure (p=0.275). The Cronbach's alpha for the DKQ 24 had an adequate value of 0.86. The intraclass correlation coefficient (ICC) for average measures was 0.860, considered "good" (p<0.000).

Conclusions

The diabetes educational intervention demonstrated significant changes in basic knowledge levels regarding the disease, glycemic control, and complication prevention, improving the patient's biometric profile and highlighting its importance.

Navigating Diabetes: Enhancing Self-Management through Education among Diabetic People at the Early Stages of the Disease-A Systematic Review

Diabetes self-management education helps to improve health outcomes and qualities of life for diabetic patients. This systematic review examines the effectiveness of several types of diabetes self-management education for patients at the early stages of type 2 diabetes mellitus (T2DM). A review of studies that have researched the use and impacts of health education on diabetic patients with T2DM was conducted using the electronic databases PubMed, Elsevier, JSTORE, Walters Kluwer, and the Cochrane Library between January 2017 and November 2022. We found 789 studies, and after selecting the PRISMA flowchart, we selected 19 studies, including those of 2512 adult patients diagnosed with T2DM. Biomedical results presented the pooled effect of a glycated hemoglobin (HbA1c) of -0.64% and a fasting blood glucose (FBG) of -0.32. Emotional and social results and behavioral effects were evaluated in 10 and nine studies, respectively. The education and support of diabetic patients at the early stages of the disease impact various aspects, including the biomedical profile, lifestyle, emotional and social well-being, and anthropometric parameters. Among the factors that have been identified to enhance the effectiveness of educational interventions are the following: conducting individualized sessions (or at least in small groups of patients), extending the duration of interventions by at least 12 months, adopting a combined approach that includes both face-to-face and online components, and ensuring the involvement of a multidisciplinary healthcare team.

The Key Digital Tool Features of Complex Telehealth Interventions Used for Type 2 Diabetes Self-Management and Monitoring With Health Professional Involvement: Scoping Review

BACKGROUND

Therapeutic education and patient self-management are crucial in diabetes prevention and treatment. Improving diabetes self-management requires multidisciplinary team intervention, nutrition education that facilitates self-management, informed decision-making, and the organization and delivery of appropriate health care services. The emergence of telehealth services has provided the public with various tools for educating themselves and for evaluating, monitoring, and improving their health and nutrition-related behaviors. Combining health technologies with clinical expertise, social support, and health professional involvement could help persons living with diabetes improve their disease self-management skills and prevent its long-term consequences.

OBJECTIVE

This scoping review's primary objective was to identify the key digital tool features of complex telehealth interventions used for type 2 diabetes or prediabetes self-management and monitoring with health professional involvement that help improve health outcomes. A secondary objective was to identify how these key features are developed and combined.

METHODS

A 5-step scoping review methodology was used to map relevant literature published between January 1, 2010 and March 31, 2022. Electronic searches were performed in the MEDLINE, CINAHL, and Embase databases. The searches were limited to scientific publications in English and French that either described the conceptual development of a complex telehealth intervention that combined self-management and monitoring with health professional involvement or evaluated its effects on the therapeutic management of patients with type 2 diabetes or prediabetes. Three reviewers independently identified the articles and extracted the data.

RESULTS

The results of 42 studies on complex telehealth interventions combining diabetes self-management and monitoring with the involvement of at least 1 health professional were synthesized. The health professionals participating in these studies were physicians, dietitians, nurses, and psychologists. The digital tools involved were smartphone apps or web-based interfaces that could be used with medical devices. We classified the features of these technologies into eight categories, depending on the intervention objective: (1) monitoring of glycemia levels, (2) physical activity monitoring, (3) medication monitoring, (4) diet monitoring, (5) therapeutic education, (6) health professional support, (7) other health data monitoring, and (8) health care management. The patient-logged data revealed behavior patterns that should be modified to improve health outcomes. These technologies, used with health professional involvement, patient self-management, and therapeutic education, translate into better control of glycemia levels and the adoption of healthier lifestyles. Likewise, they seem to improve monitoring by health professionals and foster multidisciplinary collaboration through data sharing and the development of more concise automatically generated reports.

CONCLUSIONS

This scoping review synthesizes multiple studies that describe the development and evaluation of complex telehealth interventions used in combination with health professional support. It suggests that combining different digital tools that incorporate diabetes self-management and monitoring features with a health professional's advice and interaction results in more effective interventions and outcomes.

A Review of the Epidemiology, Pathophysiology, and Efficacy of Anti-diabetic Drugs Used in the Treatment of Nonalcoholic Fatty Liver Disease

In recent years, epidemiological studies have consistently demonstrated that the coexistence of nonalcoholic fatty liver disease (NAFLD) and type 2 diabetes mellitus (T2DM) is strongly associated with increased mortality and morbidity related to hepatic- and extrahepatic causes. Indeed, compared with the general population, patients with T2DM are more likely to be diagnosed with more severe forms of NAFLD (i.e., nonalcoholic steatohepatitis (NASH) with liver fibrosis). There is an ongoing debate whether NALFD is a consequence of diabetes or whether NAFLD is simply a component and manifestation of the metabolic syndrome, since liver fat (steatosis) and even more advanced stages of liver fibrosis can occur in the absence of diabetes. Nevertheless, insulin resistance is a key component of the mechanism of NAFLD development; furthermore, therapies that lower blood glucose concentrations also appear to be effective in the treatment of NAFLD. Here, we will discuss the pathophysiological and epidemiological associations between NAFLD and T2DM. We will also review currently available anti-diabetic agents with their regard to their efficacy of NAFLD/NASH treatment.