Effect of mobile learning (application) on self-care behaviors and blood glucose of type 2 diabetic patients

Determining the impact of a self-care educational program designed based on the Peplau theory on adherence to treatment and self-care in elderly patients with diabetes

Objective

To examine the impact of a self-care program designed using Peplau's theory on adherence and self-care in elderly diabetic patients.

Methods

This semi-experimental study involved 102 elderly diabetic patients from a diabetes clinic in Hormoz, Iran, in 2023. Partici-pants were randomly allocated to either the control group (n=51) or the intervention group (n=51). Before and two weeks after the intervention, participants completed a demographic information questionnaire, the Modanloo Adherence to Treatment Questionnaire for Patients with Chronic Illness, and the Summary of Diabetes Self-Care Activities Scale. The intervention group received a self-care educational program based on Peplau's therapeutic communication theory, delivered in three phases: orientation, working, and termination. The program focused on key diabetes self-care factors including diet, medica-tion adherence, physical activity, blood sugar monitoring, and foot care. Educational sessions were conducted in small groups or individually in the clinic's education room. The control group received routine educational content provided by the diabetes clinic.

Results

The findings showed that the difference between the pre-post mean scores was significantly higher in the intervention group compared with the control group in the total self-care score, as well as in its dimensions: diet, blood sugar regulation, and foot care (p<0.001). On the other hand, in terms of adherence, no significant difference was observed in the mean difference between groups for the total score (p=0.307), although a statistical difference was found in the dimensions of willingness to participate in treatment (p=0.035) and ability to adapt (p<0.001).

Conclusion

The self-care educational program based on Peplau's theory improved the self-care and two dimensions of the adherence: willingness to participate in treatment and ability to adapt in diabetic patients.

A Feasibility Study of a Web Application Intervention for Persons With Uncontrolled Diabetes

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.

Factorial design study of self-management using Dnurse App in T2DM patients

Background

With the popularity of smart phones and the development of information technology, more and more patients are adopting diabetes APPs for self-management. However, at present, there are few research reports on the effect of those APPs coming from China.

Objective

The purpose of this study was to evaluate the effectiveness and applicability of an APP for blood glucose control that is widely popular among Chinese patients with type 2 diabetes mellitus (T2DM).

Methods

This is a 2-center, factorial design, with equal proportional distribution, and superiority trial conducted in outpatient endocrinology clinics at two tertiary hospitals in Chengdu, China. The trial enrolled smartphone-literature individuals aged at least 18 years old who have been diagnosed with T2DM based on glycosylated hemoglobin A1c (HbA1c) of at least 7.0%. The subjects were randomly divided into 4 groups, which were the usual care group (G1); the telephone follow-up group (G2); the APP group (G3); the APP & telephone follow-up group (G4). After 6 months of these interventions, the primary outcome was HbA1c, and the secondary outcomes were blood pressure (BP), body mass index (BMI), frequency of self-monitoring of blood glucose (SMBG), and satisfaction with the APP.

Results

273 patients with type 2 diabetes were included in the study, among which 226 (82.8%) were followed up at the 3rd month and 220 (80.6%) at the 6th month. There was no significant difference in HbA1c attainment rate among the four groups after intervention (P >.05), but the HbA1c attainment rate in the two APP groups was higher than that in the other groups. The systolic blood pressure (SBP) of the two APP groups was significantly lower than that of the other groups (P <.05). There was no significant difference in the compliance rate of SMBG among the four groups (P >.05). Each item of the participants' satisfaction evaluation of the APP scored more than 4.5 points.

Conclusions

The diabetes APP has a tendency to improve the HbA1c compliance rate of T2DM patients. The APP can help reduce patients' BP, and patients have a high satisfaction evaluation of the APP. Therefore, the study supports the use of the APP for self-management in people with type 2 diabetes.

Clinical Trial Registration

https://www.chictr.org.cn, identifier ChiCTR2100042297.

Comparison of the Effect of Healthy Lifestyle Education Through Peer Groups and mHealth Application on the Self-Efficacy of Patients With Diabetes Mellitus: A Randomized Clinical Trial

Background and Aims

Type 2 diabetes mellitus is a significant global public health issue. An unhealthy lifestyle can lead to this condition, but with the right education, we can prevent it. This study aimed to compare the effects of healthy lifestyle behaviors, education delivered through peer groups, and mHealth application on the self-efficacy of patients with diabetes mellitus.

Methods

This randomized clinical trial was carried out in 2022. Using purposive sampling, 135 patients with diabetes mellitus from two hospitals in Kermanshah, Iran, were recruited and assigned into three groups: peer education, virtual education through the mHealth application, and control. Peers with diabetes, whom the researcher trained, taught the patients of the peer education group four 35-min sessions in 2 days. With an application created for diabetes patients, the researchers taught the patients in the mHealth group in three 1-h sessions over 3 days. The individual characteristics and self-efficacy questionnaires were used to gather data.

Results

The mean self-efficacy score did not significantly differ between the three groups before the training (p = 0.10). However, a significant difference was observed after the training (p < 0.001). The mean self-efficacy score of patients in the peer education group (100.36 ± 15.9 vs. 106.87 ± 9.08, p = 0.01) and the mHealth group (100.80 ± 24.72 vs. 116.91 ± 10.67, p = 0.02) had a significant increase after training, while there was no significant difference in the control group (106.87 ± 9.08 vs. 105.60 ± 10.84, p = 0.13). The mHealth application was more effective than peer group training on the self-efficacy of patients with diabetes (p < 0.001).

Conclusions

The self-efficacy of patients with diabetes mellitus can be increased by healthy lifestyle training through peer education and mHealth application. However, the mHealth application was more effective compared to peer group education. Future studies should examine how education applications affect patients with other chronic diseases' sense of self-efficacy.

The effect of self-care training based on e-learning and teach-back methods on the performance of patients with type 2 diabetes

Introduction

Due to the chronic nature of the diabetes, patients who suffer from this disease need education to take care of themselves and increase self-care. Therefore, the present study was conducted with the aim of comparing the effect of e-learning and teach-back methods on the performance of diabetic patients.

Methods

In this study, 144 patients with type 2 diabetes were selected based on purposive sampling. Considering the inclusion and exclusion criteria, the subjects were divided into two groups of intervention (n = 48) and control (n = 48) by simple randomization. The two intervention groups included the e-learning group whose subjects were trained by entering the training site for three months and the teach-back group whose subjects were trained during four 60-minute sessions for three months. The control group was followed up according to routine care. Before and one month after the intervention, data were collected using self-care questionnaires in the areas of knowledge and performance based on interviews and blood glucose tests and self-reporting. The data were analyzed using SPSS 21 and statistical tests of ANOVA, independent t and Pearson's correlation coefficient.

Results

The results showed that both e-learning (P = 0.001) and teach-back training (P = 0.008) methods were associated with a significant increase in self-care compared to before the intervention, but only in the teach-back group, this increase was significant compared to control group(P = 0.002) and the training methods showed no significant effect on blood sugar level and BMI of the patients (P > 0.05).

Conclusion

The results of the present study showed that both electronic and teach-back training methods have been effective on the level of self-care of diabetic patients. However, the teach-back method had a greater impact on the level of self-care.

Prognostic effectiveness of interactive vs. non-interactive mobile app interventions in type 2 diabetes: a systematic review and meta-analysis

BACKGROUND

Mobile app interventions are emerging as significant tools in managing the prognosis of type 2 diabetes, demonstrating progressively greater impacts. The effectiveness of these interventions needs further evidence-based support.

OBJECTIVE

This study conducted a systematic review and meta-analysis of randomized controlled trials to evaluate the effectiveness of mobile app interventions in improving prognosis for patients with type 2 diabetes.

METHODS

We searched PubMed, Cochrane, Embase, and Web of Science for relevant studies published from inception to 18 April 2024, adhering to the Cochrane Handbook guidelines. The quality of the included studies was assessed using the Cochrane risk of bias tool. Primary outcomes measured were changes in glycated hemoglobin (HbA1c) and diabetes self-management (DSM). Secondary outcomes included changes in diastolic blood pressure (DBP), systolic blood pressure (SBP), triglycerides(TG), total cholesterol(TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL), lipid profiles, fasting plasma glucose (FPG), body mass index (BMI), and Steps outcomes. Subgroup analyses were performed for the primary outcomes and for high-density lipoprotein (HDL), low-density lipoprotein (LDL), diastolic blood pressure (DBP), and systolic blood pressure (SBP). Interventions with or without interactions were also used as a basis for subgrouping.

RESULTS

A total of 15 eligible articles involving 17 studies with 2,028 subjects (1,123 in the intervention group and 1,020 in the control group) were included in the synthesis. Interactive mobile app interventions significantly reduced HbA1c levels (SMD - 0.24; 95% CI, -0.33 to -0.15; P < 0.00001) and significantly improved diabetes self-care (SMD 0.71; 95% CI, 0.21 to 1.21; P = 0.005). Secondary outcomes, including FPG, LDL, DBP, and SBP, showed varying degrees of improvement. Subgroup analyses indicated that the intervention effect was more pronounced and less heterogeneous in the short-term (≤ 3 months) for younger Asian individuals (< 55 years) who used an interactive mobile app.

CONCLUSION

Interactive mobile app interventions effectively improve HbA1c levels and diabetes self-care competencies in patients with type 2 diabetes. These interventions offer supportive evidence for their clinical use in managing and prognosticating type 2 diabetes.

SYSTEMATIC REVIEW REGISTRATION

CRD42024550643.

The effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study

Background

Mobile health presents a promising alternative in the digital era. Mobile health apps (mHealth), when combined with the concept of self-management, are considered one of the methods for incorporating technology-based interventions into the healthcare system.

Objective

This study aimed to determine the effect of mHealth (specifically, the Diabetic Care App) on foot care behavior, dietary behavior, foot condition, and fasting blood glucose levels among patients with uncontrolled diabetes mellitus.

Methods

A single randomized controlled trial was conducted at a government-run primary clinic in Northern Malaysia, involving 58 patients with uncontrolled diabetes who were assigned to two groups. The intervention group received the Diabetic Care App, attended a 2-hour face-to-face session, and was included in a WhatsApp group, while the control group received standard care. Relevant assessments were conducted for both groups in Week 1 and Week 5. The study was conducted from February 2020 to November 2020, and parametric and non-parametric statistics were used for data analysis.

Results

Pretest-posttest comparisons in both groups revealed significant findings for foot care behavior (p <0.01), dietary behavior (p <0.01), and foot condition (p <0.01), except for fasting blood glucose levels. In inter-group comparisons, a significant difference was observed only in foot care behavior (p <0.01) and dietary behavior (p <0.01).

Conclusion

The results indicate that technology-based interventions are beneficial for modifying behavior, specifically in terms of foot care and dietary behavior, in this study. The study highlights the applicability of mHealth for nurses in patient education and self-management of chronic conditions. Future research should explore app utilization among patients with chronic conditions.

Clinical trial registration number

NCT04260100 (registered at https://clinicaltrials.gov/ct2/show/NCT04260100).

The Impact of Mobile Health Use on the Self-care of Patients With Type 2 Diabetes: Protocol for a Randomized Controlled Trial

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 (HbA_1c), 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

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

Effectiveness of training in disease management for patients with type 2 diabetes mellitus: A systematic review

INTRODUCTION

Diabetes mellitus (DM) is included in the disease group described as the pandemic of the century. Although disease management is possible, it can significantly reduce the quality of life when glycaemic control is poor. The objective of this systematic review was to examine the effectiveness of different educational programmes on the management of the disease among type 2 DM patients.

METHODS

In the literature review, the flow chart of PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) was used. A literature search was conducted from 2010 to 2020 using the Ulakbim National Database, Google Scholar, Scopus, PubMed, Library, Science Direct, Web of Science, Medline, Ebscohost and Cochrane Library, and 18 English randomised controlled studies were included.

RESULTS

Within the scope of these studies, it was found that individualised and face-to-face training and long-term follow-up after the training were effective on metabolic control. Peer support was also determined as an important factor in the efficacy of the training. In line with the training, the self-management and quality-of-life scores of the individuals with diabetes were positively affected.

CONCLUSIONS

It can be suggested that planned and regular training has a positive effect on metabolic control variables, self-management behaviours and quality of life of individuals with diabetes. Regular training for individuals with diabetes and follow-up for more than 6 months are recommended since they have a positive effect on the disease. It is also recommended to integrate peer support into training programmes.

Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review

BACKGROUND

According to the World Health Organization, the worldwide prevalence of diabetes mellitus (DM) is increasing dramatically and DM comprises a large part of the global burden of disease. At the same time, the ongoing digitalization that is occurring in society today offers novel possibilities to deal with this challenge, such as the creation of mobile health (mHealth) apps. However, while a great variety of DM-specific mHealth apps exist, the evidence in terms of their clinical effectiveness is still limited.

OBJECTIVE

The objective of this review was to evaluate the clinical effectiveness of mHealth apps in DM management by analyzing health-related outcomes in patients diagnosed with type 1 DM (T1DM), type 2 DM (T2DM), and gestational DM.

METHODS

A scoping review was performed. A systematic literature search was conducted in MEDLINE (PubMed), Cochrane Library, EMBASE, CINAHL, and Web of Science Core Collection databases for studies published between January 2008 and October 2020. The studies were categorized by outcomes and type of DM. In addition, we carried out a meta-analysis to determine the impact of DM-specific mHealth apps on the management of glycated hemoglobin (HbA1c).

RESULTS

In total, 27 studies comprising 2887 patients were included. We analyzed 19 randomized controlled trials, 1 randomized crossover trial, 1 exploratory study, 1 observational study, and 5 pre-post design studies. Overall, there was a clear improvement in HbA1c values in patients diagnosed with T1DM and T2DM. In addition, positive tendencies toward improved self-care and self-efficacy as a result of mHealth app use were found. The meta-analysis revealed an effect size, compared with usual care, of a mean difference of -0.54% (95% CI -0.8 to -0.28) for T2DM and -0.63% (95% CI -0.93 to -0.32) for T1DM.

CONCLUSIONS

DM-specific mHealth apps improved the glycemic control by significantly reducing HbA1c values in patients with T1DM and T2DM patients. In general, mHealth apps effectively enhanced DM management. However, further research in terms of clinical effectiveness needs to be done in greater detail.