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Abstract
BACKGROUND The coronavirus pandemic of 2019 (COVID-19) forced worldwide recognition and implementation of telehealth as a means of providing continuity of care by varied health care institutions. Diabetes is a global health threat with rates that continue to accelerate, thereby causing an increased need for clinicians to provide diabetes care and education to keep up with demand. Utilizing technology to provide education via phone/smartphone, video/audio, web, text message, mobile apps, or a combination of these methods can help improve patient access and clinical outcomes, cut costs, and close gaps in care. METHODS While numerous publications have summarized the various tools and technologies available for capturing remote clinical data and their relevance to diabetes care and self-management, this review focuses on self-educational telehealth tools available for diabetes self-management, their advantages and disadvantages, and factors that need to be considered prior to implementation. Recent relevant studies indexed by PubMed were included. RESULTS The widespread use and popularity of phones/smartphones, tablets, computers, and the Internet by patients of all age groups, cultures, socioeconomic and geographic areas allow for increased outreach, flexibility, and engagement with diabetes education, either in combination or as an adjunct to traditional in-person visits. Demonstrated benefits of using health technologies for diabetes self-management education include improved lifestyle habits, reduced hemoglobin A1C levels, decreased health care costs, and better medication adherence. Potential drawbacks include lack of regulation, need for staff training on methodologies used, the requirement for patients to be tech savvy, privacy concerns, lag time with technology updates/glitches, and the need for more long-term research data on efficacy. CONCLUSIONS Telehealth technologies for diabetes self-education improve overall clinical outcomes and have come a long way. With increasing numbers of patients with diabetes, it is expected that more optimal and user-friendly methodologies will be developed to fully engage and help patients communicate with their physicians.
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Affiliation(s)
- Vidya Sharma
- Department of Nutrition & Dietetics, College for Health, Community and Policy, The University of Texas at San Antonio, San Antonio, TX, USA
| | | | - Ramaswamy Sharma
- Department of Cell Systems and Anatomy, Joe R. & Teresa Lozano Long School of Medicine, UT Health San Antonio, San Antonio, TX, USA
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Cranston I, Jamdade V, Liao B, Newson RS. Clinical, Economic, and Patient-Reported Benefits of Connected Insulin Pen Systems: A Systematic Literature Review. Adv Ther 2023; 40:2015-2037. [PMID: 36928495 PMCID: PMC10130105 DOI: 10.1007/s12325-023-02478-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/21/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION The objective of this systematic literature review was to evaluate the available literature concerning the clinical, economic, and patient-reported benefits of insulin pen platforms, including connected insulin pens/caps/sleeves and insulin platforms, as well as mobile apps capable of receiving near real-time insulin dosing information. METHODS Medline and Embase databases and the Cochrane Library were searched for published literature between January 2015 and May 2021, and manual searches for conference abstracts from 2018 to May 2021 were performed. These searches were supplemented by internet searches for relevant literature and clinical trials. Study selection involved the population, intervention, comparator, outcomes, time frame, and study design outline. Included studies investigated connected insulin systems or connected caps/sleeves enabling pens to be connected, or apps able to connect to these systems, in individuals of all ages with type 1 or type 2 diabetes mellitus. RESULTS Searches identified a total of 26 publications (mostly observational studies and conference abstracts) for inclusion, representing ten unique, predominantly small studies. Evidence in this field is still in its early stages, and only two randomized controlled trials met our inclusion criteria. Available results showed that connected insulin pens and their systems potentially helped reduce suboptimal insulin use and may therefore improve glycemic control. Satisfaction of people with diabetes with the technologies used was high, and economic benefits were noted. Features of effective connected insulin pen devices include simplicity of use and data upload/sharing, useful "point-of-care" alerts, and simple and understandable data presentation to facilitate more effective consultations. CONCLUSIONS Connected insulin pen systems could be increasingly considered as part of routine clinical care for insulin-treated persons with diabetes who must manage the complexity of their daily insulin routine. Future research focusing on the way data obtained from these devices can be most effectively used alongside other information is urgently needed.
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Affiliation(s)
- Iain Cranston
- Academic Department of Endocrinology and Diabetes, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | | | | | - Rachel S Newson
- Eli Lilly and Company, 60 Margaret Street, Sydney, NSW, 2000, Australia.
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Handa M, Afzal O, Beg S, SanapNasik S, Kaundal RK, Verma RK, Mishra A, Shukla R. Harnessing personalized tailored medicines to digital-based data-enriched edible pharmaceuticals. Drug Discov Today 2023; 28:103555. [PMID: 36931386 DOI: 10.1016/j.drudis.2023.103555] [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: 09/18/2022] [Revised: 02/26/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023]
Abstract
Tailoring drug products to personalized medicines poses challenges for conventional dosage forms. The prominent reason is the restricted availability of flexible dosage strengths in the market. Inappropriate dosage strengths lead to adverse drug reactions or compromised therapeutic effects. The situation worsens when the drug has a narrow therapeutic window. To overcome these challenges, data-enriched edible pharmaceuticals (DEEP) are novel concepts for designing solid oral products. DEEP have individualized doses and information embedded in quick response (QR) code form. When data are presented in a QR code, the information is printed with edible ink that contains the drug in tailored doses required for the patients.
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Affiliation(s)
- Mayank Handa
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, UP 226002, India
| | - Obaid Afzal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, AlKharj, Saudi Arabia
| | - Sarwar Beg
- School of Pharmacy and Biomedical Sciences, University of Central Lancashire, Preston PR1 2HE, UK.
| | - Sachin SanapNasik
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, UP 226002, India
| | - Ravinder K Kaundal
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research Raebareli (NIPER-R), Lucknow, UP 226002, India
| | - Rahul K Verma
- Institute of Nano Science and Technology (INST), SAS Nagar, Punjab 140306, India
| | - Awanish Mishra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER)-Guwahati, Changsari, Guwahati 781101, Assam, India
| | - Rahul Shukla
- Department of Pharmaceutics, National Institute of Pharmaceutical Education and Research-Raebareli, Lucknow, UP 226002, India.
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Seo J, Heidenreich S, Aldalooj E, Poon JL, Spaepen E, Eby EL, Newson RS. Patients' Preferences for Connected Insulin Pens: A Discrete Choice Experiment Among Patients with Type 1 and Type 2 Diabetes. THE PATIENT 2023; 16:127-138. [PMID: 36437389 PMCID: PMC9911509 DOI: 10.1007/s40271-022-00610-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND This study quantified how people with diabetes value the unique features of connected insulin pens and related mobile apps, and the underlying reasons for preferring connected versus non-connected insulin pens. METHODS A discrete choice experiment (DCE) was conducted in the USA and UK to elicit preferences of adults (≥ 18 years) with type 1 or 2 diabetes for attributes of insulin pens. Attributes included device type, dosing support, glucose monitoring, additional app features, and data sharing. Relative attribute importance (RAI) scores were calculated to capture the relative importance of an attribute. Predicted choice probabilities were obtained to compare different profiles for connected and non-connected insulin pens. RESULTS The DCE was completed by 540 participants (58.9% male; 90.7% Caucasian; mean age, 58.3 years; 69.4% type 2 diabetes). Participants most valued the possibility of using a connected insulin pen with dosing support and automated dose logging (RAI = 39.9%), followed by automatic transfer of glucose levels (RAI = 29.0%), additional features of tracking diet and physical activity (RAI = 14.6%), data sharing (RAI = 13.6%), and device type (RAI = 2.9%). All profiles of connected insulin pens were preferred over a non-connected pen (p < 0.001), and pen profiles with advanced features were preferred over those without (p < 0.001). Preferences differed by age but not diabetes type, country of residence, or insulin regimen. CONCLUSION People with diabetes in the USA and UK prefer connected over non-connected insulin pens due largely to the availability of automated logging of dose and glucose levels.
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Affiliation(s)
- Jaein Seo
- Patient-Centered Research, Evidera, Bethesda, MD, USA
| | | | | | - Jiat Ling Poon
- Value, Evidence, and Outcomes, Eli Lilly and Co, Indianapolis, IN, USA
| | | | - Elizabeth L Eby
- Value, Evidence, and Outcomes, Eli Lilly and Co, Indianapolis, IN, USA
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5
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Fu HNC, Wyman JF, Peden-McAlpine CJ, Draucker CB, Schleyer T, Adam TJ. App Design Features Important for Diabetes Self-management as Determined by the Self-Determination Theory on Motivation: Content Analysis of Survey Responses From Adults Requiring Insulin Therapy. JMIR Diabetes 2023; 8:e38592. [PMID: 36826987 PMCID: PMC10007004 DOI: 10.2196/38592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 11/11/2022] [Accepted: 12/01/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Using a diabetes app can improve glycemic control; however, the use of diabetes apps is low, possibly due to design issues that affect patient motivation. OBJECTIVE This study aimed to describes how adults with diabetes requiring insulin perceive diabetes apps based on 3 key psychological needs (competence, autonomy, and connectivity) described by the Self-Determination Theory (SDT) on motivation. METHODS This was a qualitative analysis of data collected during a crossover randomized laboratory trial (N=92) testing 2 diabetes apps. Data sources included (1) observations during app testing and (2) survey responses on desired app features. Guided by the SDT, coding categories included app functions that could address psychological needs for motivation in self-management: competence, autonomy, and connectivity. RESULTS Patients described design features that addressed needs for competence, autonomy, and connectivity. To promote competence, electronic data recording and analysis should help patients track and understand blood glucose (BG) results necessary for planning behavior changes. To promote autonomy, BG trend analysis should empower patients to set safe and practical personalized behavioral goals based on time and the day of the week. To promote connectivity, app email or messaging function could share data reports and communicate with others on self-management advice. Additional themes that emerged are the top general app designs to promote positive user experience: patient-friendly; automatic features of data upload; voice recognition to eliminate typing data; alert or reminder on self-management activities; and app interactivity of a sound, message, or emoji change in response to keeping or not keeping BG in the target range. CONCLUSIONS The application of the SDT was useful in identifying motivational app designs that address the psychological needs of competence, autonomy, and connectivity. User-centered design concepts, such as being patient-friendly, differ from the SDT because patients need a positive user experience (ie, a technology need). Patients want engaging diabetes apps that go beyond data input and output. Apps should be easy to use, provide personalized analysis reports, be interactive to affirm positive behaviors, facilitate data sharing, and support patient-clinician communication.
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Affiliation(s)
- Helen N C Fu
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- Richard M Fairbanks School of Public Health, Indiana University, Indianapolis, IN, United States
| | - Jean F Wyman
- School of Nursing, University of Minnesota, Minneapolis, MN, United States
| | | | | | - Titus Schleyer
- Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, IN, United States
- School of Medicine, Indiana University, Indianapolis, IN, United States
| | - Terrence J Adam
- College of Pharmacy, Department of Pharmaceutical Care & Health Systems, University of Minnesota, Minneapolis, MN, United States
- Institute of Health Informatics, University of Minnesota, Minneapolis, MN, United States
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Ali Sherazi B, Laeer S, Krutisch S, Dabidian A, Schlottau S, Obarcanin E. Functions of mHealth Diabetes Apps That Enable the Provision of Pharmaceutical Care: Criteria Development and Evaluation of Popular Apps. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:64. [PMID: 36612402 PMCID: PMC9819585 DOI: 10.3390/ijerph20010064] [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: 11/28/2022] [Revised: 12/16/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
Personal digital health apps for managing diabetes should include functions that enable the provision of pharmaceutical care services and allow within-app communication with pharmacists and other healthcare providers, thereby improving patient outcomes. The primary aim of this study was to assess the functions of diabetes apps that were relevant to providing pharmaceutical care services (i.e., medication management, adherence, non-pharmacological management, interoperability, and communication). Sixteen criteria related to pharmaceutical care were developed and then used to assess ten popular diabetes apps. The highest numbers of pharmaceutical care criteria were met by the apps Diabetes:M and mySugr (11 criteria); Contour™Diabetes, Dario Health, and OneTouch Reveal® (ten); and DiabetesConnect and ESYSTA (nine); followed by Glucose Buddy (eight), meala (seven), and lumind (three). The most prevalent functions were related to promoting adherence and non-pharmacological management, but most criteria relevant to medication management were lacking. Five apps allowed within-app communication between patients and healthcare professionals (HCPs); however, no app included communication with pharmacists. High-quality diabetes apps are powerful tools to support pharmaceutical care and remotely monitor diabetes patients. Improvements are needed as they often lack many medication management functions, including within-app communication with HCPs (especially pharmacists). To maximize diabetes app use and improve outcomes, app developers should consider including pharmacists alongside other healthcare providers when customizing app designs.
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Affiliation(s)
- Bushra Ali Sherazi
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
- Institute of Pharmacy, Faculty of Pharmaceutical and Allied Health Sciences, Lahore College for Women University, Lahore 54000, Pakistan
| | - Stephanie Laeer
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | | | - Armin Dabidian
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Sabina Schlottau
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
| | - Emina Obarcanin
- Institute of Clinical Pharmacy and Pharmacotherapy, Heinrich Heine University, Universitätsstraße 1, 40225 Düsseldorf, Germany
- Department of Pharmacy, National University Singapore, 18 Science Drive 4, Singapore 117559, Singapore
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Ahn DT. Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy. J Diabetes Sci Technol 2022; 16:605-609. [PMID: 34933594 PMCID: PMC9294589 DOI: 10.1177/19322968211062624] [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: 12/24/2022]
Abstract
Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)-mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.
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Affiliation(s)
- David T Ahn
- Mary & Dick Allen Diabetes
Center, Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
- David Ahn, MD, Mary & Dick
Allen Diabetes Center, Hoag Memorial Hospital Presbyterian, 520
Superior Avenue, Suite 150, Newport Beach, CA 92663, USA.
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8
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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: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [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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Buendia R, Havsol J, Lundberg V, Sooben K, Jornten-Karlsson M, Nyman E, Khan FM, Dennis G. Analysis of Use and Outcomes of the Balance Digital Disease Management Tool for Patients with Type 2 Diabetes. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:1372-1375. [PMID: 34891540 DOI: 10.1109/embc46164.2021.9630389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Management of type 2 diabetes mellitus (T2DM) is a serious medical need for millions of patients and clinicians worldwide. Numerous smartphone apps for T2DM management are available. Due to their global accessibility, computing power and cellular connectivity, the pervasiveness of mobile phones now provide an opportunity for non-invasive Digital Therapeutics that have the potential to manage disease by modifying patient behavior as new modality for disease management and intervention. However, this novel approach has yet to be tested in large clinical studies. The BALANCE clinical study was designed to evaluate mobile phone App usage in a large multi-center clinical trial and its impact on T2DM outcomes. It included a digital aid for the management of, blood glucose, diet, physical activity, and medication adherence. Overall, patient use of the BALANCE-App was low (21% of significant patients users), and it diminished over time. BALANCE showed no effect on HbA1c or weight, what is consistent with other smartphone apps for T2DM which were tested on large clinical trials. Nevertheless, post-hoc subgroup analysis showed women using the App significantly achieved a significant reduction in HbA1c and weight.Clinical relevance Suitability of Digital Therapeutics, at least in the form of smartphone apps, for T2DM is under question. The low use indicates need for a strong focus in patient acceptability and patient engagement in the design process.
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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: 0.7] [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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11
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Tsunemi A, Sato J, Sugimoto S, Iwagaki Y, Enomoto M, Someya Y, Kiya M, Matsuhashi E, Wakabayashi Y, Funayama T, Mita T, Uchida T, Miyatsuka T, Azuma K, Shimizu T, Kanazawa A, Satoh H, Watada H. A Pilot Study of Intervention With a Mobile Application Visualizing the Macronutrient Content for Type 2 Diabetes at a Japanese Center. J Clin Med Res 2021; 13:425-433. [PMID: 34527098 PMCID: PMC8425790 DOI: 10.14740/jocmr4558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Estimating the nutritional content of food is essential for self-management in people with type 2 diabetes mellitus, but it is a difficult skill to learn. The aim of this study was to investigate how diabetes management was impacted by the ability of patients to search for items they ate from a database of 26,300 different foods, and to visualize nutritional intake using the Japanese mobile application (app) “Calomeal.” Methods This was a single-arm, single-center, pilot study. Eighteen outpatients with type 2 diabetes mellitus used the “Calomeal” app for 3 months. The primary endpoint was change in hemoglobin A1c (HbA1c). Secondary endpoints were changes in body weight (BW), lipid parameters, and quality of life scores. Results The baseline characteristics of the study subjects were as follows: age: 53.4 ± 7.8 years; male/female ratio: 11/7; HbA1c: 7.9 (7.58 - 8.23)%; and body mass index (BMI): 25.17 (21.63 - 28.59) kg/m2. Significant reductions in HbA1c and BMI were observed over 3 months (HbA1c: 7.9 (7.58 - 8.23)% to 7.6 (7.3 - 8.23)%, P = 0.0410; BMI: 25.17 (21.63 - 28.59) to 24.54 (21.57 - 27.81) kg/m2, P = 0.0057). Reductions in HbA1c and BMI both correlated with decreased carbohydrate intake estimated by the mobile app. Conclusions Japanese patients who used their smartphones to visualize their nutritional intake using the “Calomeal” app demonstrated improved short-term glycemic control and BMI. Although the validity of the results should be tested in future randomized controlled trials, this approach may be a clinical option for improving self-management in Japanese patients with type 2 diabetes mellitus.
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Affiliation(s)
- Asako Tsunemi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Sakae Sugimoto
- Department of Nutrition, Juntendo University Hospital, Tokyo, Japan
| | - Yuko Iwagaki
- Department of Nutrition, Juntendo University Hospital, Tokyo, Japan
| | - Mari Enomoto
- Department of Nutrition, Juntendo University Hospital, Tokyo, Japan
| | - Yuki Someya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Mai Kiya
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Eiko Matsuhashi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuka Wakabayashi
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takashi Funayama
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toyoyoshi Uchida
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takeshi Miyatsuka
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kosuke Azuma
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tomoaki Shimizu
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akio Kanazawa
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroaki Satoh
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Therapeutic Innovations in Diabetes, Juntendo University Graduate School of Medicine, Tokyo, Japan.,Center for Identification of Diabetic Therapeutic Targets, Juntendo University Graduate School of Medicine, Tokyo, Japan
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12
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He Q, Zhao X, Wang Y, Xie Q, Cheng L. Effectiveness of smartphone application-based self-management interventions in patients with type 2 diabetes: A systematic review and meta-analysis of randomized controlled trials. J Adv Nurs 2021; 78:348-362. [PMID: 34324218 DOI: 10.1111/jan.14993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/24/2021] [Accepted: 07/11/2021] [Indexed: 01/09/2023]
Abstract
AIMS To synthesize evidences on smartphone application-based intervention and determine its effectiveness on glycaemic control, self-management behaviours, psychological well-being, quality of life and cardiometabolic risk factors. DESIGN A systematic review and meta-analysis of randomized controlled trials (RCTs). DATA SOURCES Major English and Chinese electronic databases were searched from January 2008 to January 2021, including PubMed, Web of Science, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang and Sinomed. REVIEW METHODS RCTs were screened and selected if they used smartphone applications to support patients in the self-management of diabetes. Data extraction and methodological assessment were performed by two reviewers independently. Meta-analysis was performed to pool the intervention effect on outcomes of interest using RevMan 5.3. RESULTS Across 19 included trials involving 2585 participants, smartphone application-based interventions were associated with a clinically and statistically significant reduction of glycated haemoglobin (HbA1c). Beneficial effects were also observed in participants' behavioural performance, especially in medication adherence. Intervention effects on psychological status, quality of life and cardiometabolic risk factors were nonsignificant. Subgroup analysis showed interactive approach with medium frequency or flexible facilitator-patient interaction induced a larger effect on HbA1c reduction. Besides, patients with baseline HbA1c ≥9% benefited more than those with HbA1c <9% from the use of smartphone applications. CONCLUSIONS Smartphone application-based diabetes self-management intervention could optimize patients' glycaemic control and enhance participants' self-management performance. Further endeavour is required to examine the long-term effects and cost-effectiveness of smartphone application-based intervention before promoting the adoption and dissemination of such intervention. IMPACT This review supports the potential of smartphone application-based intervention as effective approach to optimize glycaemic control and promote self-management engagement among patients with type 2 diabetes. Suggestions for future research and practice are provided and discussed.
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Affiliation(s)
- Qianyu He
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Xiaoyan Zhao
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Yarui Wang
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Qinqin Xie
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Li Cheng
- School of Nursing, Sun Yat-sen University, Guangzhou, Guangdong, China
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13
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Maharaj A, Lim D, Murphy R, Serlachius A. Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study. JMIR Form Res 2021; 5:e25151. [PMID: 34132640 PMCID: PMC8277312 DOI: 10.2196/25151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. OBJECTIVE We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. METHODS Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. RESULTS In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. CONCLUSIONS Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671.
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Affiliation(s)
- Alita Maharaj
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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14
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Mumford B, Oldham V, Lee D, Jones J, Das G. The effectiveness of running virtual clinics as part of insulin pump services for patients with type 1 diabetes. ENDOCRINE AND METABOLIC SCIENCE 2021. [DOI: 10.1016/j.endmts.2021.100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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15
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What’s the Name of the Game? The Impact of eHealth on Productive Interactions in Chronic Care Management. SUSTAINABILITY 2021. [DOI: 10.3390/su13095221] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Chronic care management is dependent on productive interactions between patients and healthcare professionals. Digital health technologies (eHealth) open up new possibilities for improving the quality of care, but there is a limited understanding of what productive interactions entail. This study explores characteristics of productive interactions to support self-care and healthcare in the context of eHealth use in diabetes care. We collected qualitative data based on interviews with nurses and responses to open-ended survey questions from patients, prior to and post using an eHealth service for self-monitoring and digital communication. We found that eHealth’s influence on productive interactions was characterized by unconstrained access, health parameter surveillance, and data-driven feedback, with implications for self-care and healthcare. Our findings indicate that eHealth perforates the boundaries that define interactions under traditional, non-digital care. This was manifested in expressions of uncertainty and in blurred boundaries between self-care and healthcare. We conclude that the attainment of a sustainable eHealth ecosystem will require healthcare to acknowledge eHealth as a disruptive change that may require re-organization to optimally support the productive use of eHealth services for both patients and staff, which includes agreement on new routines, as well as social interaction rules.
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16
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Franc S, Hanaire H, Benhamou PY, Schaepelynck P, Catargi B, Farret A, Fontaine P, Guerci B, Reznik Y, Jeandidier N, Penfornis A, Borot S, Chaillous L, Serusclat P, Kherbachi Y, d'Orsay G, Detournay B, Simon P, Charpentier G. DIABEO System Combining a Mobile App Software With and Without Telemonitoring Versus Standard Care: A Randomized Controlled Trial in Diabetes Patients Poorly Controlled with a Basal-Bolus Insulin Regimen. Diabetes Technol Ther 2020; 22:904-911. [PMID: 32407148 PMCID: PMC7757616 DOI: 10.1089/dia.2020.0021] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: The DIABEO® system (DS) is a telemedicine solution that combines a mobile app for patients with a web portal for health care providers. DS allows real-time monitoring of basal-bolus insulin therapy as well as therapeutic decision-making, integrating both basal and bolus dose calculation. Real-life studies have shown a very low rate of use of mobile health applications by patients. Therefore, we conducted a large randomized controlled trial study to investigate the efficacy of DS in conditions close to real life (TELESAGE study). Methods: TELESAGE was a multicenter, randomized, open study with three parallel arms: arm 1 (standard care), arm 2 (DIABEO alone), and arm 3 (DIABEO+telemonitoring by trained nurses). The primary outcome assessed the reduction in HbA1c levels after a 12-month follow-up. Results: Six hundred sixty-five patients were included in the study. Participants who used DIABEO once or more times a day (DIABEO users) showed a significant and meaningful reduction of HbA1c versus standard care after a 12-month follow-up: mean difference -0.41% for arm 2-arm 1 (P = 0.001) and -0.51% for arm 3-arm 1 (P ≤ 0.001). DIABEO users included 25.1% of participants in arm 2 and 37.6% in arm 3. In the intention-to-treat population, HbA1c changes and incidence of hypoglycemia were comparable between arms. Conclusions: A clinical and statistically significant reduction in HbA1c levels was found in those patients who used DIABEO at least once a day.
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Affiliation(s)
- Sylvia Franc
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), Evry, France
- Address correspondence to: Sylvia Franc, MD, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), 116 Bd Jean Jaures, Evry 91100, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Bogdan Catargi
- Department of Endocrinology and Diabetes, University Hospital, Bordeaux, France
| | - Anne Farret
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Montpellier, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Yves Reznik
- Department of Endocrinology, University of Caen Côte de Nacre Regional Hospital Center, Caen, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition, CHU of Strasbourg, Strasbourg, France
| | - Alfred Penfornis
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
- Professor at the University Paris-Sud, University Paris-Sud, Orsay, France
| | - Sophie Borot
- Centre Hospitalier Universitaire Jean Minjoz, Service d'Endocrinologie-Métabolisme et Diabétologie-Nutrition, Besançon, France
| | | | - Pierre Serusclat
- Endocrinology, Diabetology and Nutrition, Clinique Portes du Sud, Venissieux, France
| | | | | | | | - Pierre Simon
- National Association of Telemedicine, Evry, France
| | - Guillaume Charpentier
- Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, and Centre d'étude et de Recherche pour l'Intensification du Traitement du Diabète (CERITD), Evry, France
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17
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Uncertain Multiplicative Language Decision Method Based on Group Compromise Framework for Evaluation of Mobile Medical APPs in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17082858. [PMID: 32326244 PMCID: PMC7216081 DOI: 10.3390/ijerph17082858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 02/07/2023]
Abstract
The mobile medical application (M-medical APP) can optimize medical service process and reduce health management costs for users, which has become an important complementary form of traditional medical services. To assist users including patients choose the ideal M-medical APP, we proposed a novel multiple attribute group decision making algorithm based on group compromise framework, which need not determine the weight of decision-maker. The algorithm utilized an uncertain multiplicative linguistic variable to measure the individual original preference to express the real evaluation information as much as possible. The attribute weight was calculated by maximizing the differences among alternatives. It determined the individual alternatives ranking according to the net flow of each alternative. By solved the 0–1 optimal model with the objective of minimizing the differences between individual ranking, the ultimate group compromise ranking was obtained. Then we took 10 well-known M-medical APPs in Chinese as an example, we summarized service categories provided for users and constructed the assessment system consisting of 8 indexes considering the service quality users are concerned with. Finally, the effectiveness and superiority of the proposed method and the consistency of ranking results were verified, through comparing the group ranking results of 3 similar algorithms. The experiments show that group compromise ranking is sensitive to attribute weight.
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18
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Ceriello A, deValk HW, Guerci B, Haak T, Owens D, Canobbio M, Fritzen K, Stautner C, Schnell O. The burden of type 2 diabetes in Europe: Current and future aspects of insulin treatment from patient and healthcare spending perspectives. Diabetes Res Clin Pract 2020; 161:108053. [PMID: 32035117 DOI: 10.1016/j.diabres.2020.108053] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 02/04/2020] [Indexed: 02/08/2023]
Abstract
Due to the progressive nature of type 2 diabetes (T2DM), initiation of insulin therapy is very likely in the disease continuum. This article aims at highlighting the current situation with regard to insulin therapy in people with T2DM in Europe and at presenting the associated unmet need. Challenges for both people with T2DM and healthcare professionals include clinical inertia also derived from fear of hypoglycaemia, weight gain and injections as well as increased need for a comprehensive diabetes management. We compare national and international guidelines and recommendations for the initiation and intensification of insulin therapy with the real-world situation in six European countries, demonstrating that glycaemic targets are only met in a minority of people with T2DM on insulin therapy. Furthermore, this work evaluates currently recorded numbers of people with T2DM treated with insulin in Europe, the proportion not achieving the stated glycaemic targets and thus in need to enhance insulin therapy e.g. by a change in means of insulin delivery including, but not limited to, insulin pens, wearable mealtime insulin delivery patches, patch pumps, and conventional insulin pumps with continuous subcutaneous insulin infusion.
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Affiliation(s)
| | - Harold W deValk
- Department of Internal Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Bruno Guerci
- Endocrinology, Diabetology & Nutrition Clinical Unit, Brabois Hospital & Center of Clinical Investigation ILCV, Centre Hospitalier Universitaire of Nancy, University of Lorraine Vandoeuvre-lès-Nancy, France
| | - Thomas Haak
- Diabetes Klinik Bad Mergentheim, Bad Mergentheim, Germany
| | - David Owens
- Diabetes Research Unit Cymru, Swansea University, Swansea, Wales, UK
| | | | | | | | - Oliver Schnell
- Sciarc GmbH, Baierbrunn, Germany; Forschergruppe Diabetes e.V., Muenchen-Neuherberg, Germany.
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19
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Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes digital app technology: benefits, challenges, and recommendations. A consensus report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetologia 2020; 63:229-241. [PMID: 31802144 DOI: 10.1007/s00125-019-05034-1] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Digital health technology, especially digital and health applications ('apps'), have been developing rapidly to help people manage their diabetes. Numerous health-related apps provided on smartphones and other wireless devices are available to support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. However, regulations and guidelines have not caught up with the burgeoning field to standardise how mobile health apps are reviewed and monitored for patient safety and clinical validity. The available evidence on the safety and effectiveness of mobile health apps, especially for diabetes, remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore conducted a joint review of the current landscape of available diabetes digital health technology (only stand-alone diabetes apps, as opposed to those that are integral to a regulated medical device, such as insulin pumps, continuous glucose monitoring systems, and automated insulin delivery systems) and practices of regulatory authorities and organisations. We found that, across the USA and Europe, mobile apps intended to manage health and wellness are largely unregulated unless they meet the definition of medical devices for therapeutic and/or diagnostic purposes. International organisations, including the International Medical Device Regulators Forum and WHO, have made strides in classifying different types of digital health technology and integrating digital health technology into the field of medical devices. As the diabetes digital health field continues to develop and become more fully integrated into everyday life, we wish to ensure that it is based on the best evidence for safety and efficacy. As a result, we bring to light several issues that the diabetes community, including regulatory authorities, policymakers, professional organisations, researchers, people with diabetes and healthcare professionals, needs to address to ensure that diabetes health technology can meet its full potential. These issues range from inadequate evidence on app accuracy and clinical validity to lack of training provision, poor interoperability and standardisation, and insufficient data security. We conclude with a series of recommended actions to resolve some of these shortcomings.
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Affiliation(s)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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20
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Crossen SS, Marcin JP, Qi L, Sauers-Ford HS, Reggiardo AM, Chen ST, Tran VA, Glaser NS. Home Visits for Children and Adolescents with Uncontrolled Type 1 Diabetes. Diabetes Technol Ther 2020; 22:34-41. [PMID: 31448952 PMCID: PMC6945797 DOI: 10.1089/dia.2019.0214] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background: Home-based video visits were provided over one year as a supplement to in-person care for pediatric type 1 diabetes (T1D) patients with suboptimal glycemic control. We hypothesized that the intervention would be feasible and satisfactory for the target population and would significantly improve hemoglobin A1c (HbA1c) levels and completion of recommended quarterly diabetes clinic visits. Methods: This was a nonrandomized clinical trial. Fifty-seven patients aged 3-17 years with known T1D and HbA1c ≥8% (64 mmol/mol) were recruited to receive the intervention. The study population was 49% adolescent (13-17 years old) and 58% publicly insured patients. Video visits were scheduled every 4, 6, or 8 weeks depending on the HbA1c level. HbA1c levels as well as frequencies of clinic visits and of diabetes-related emergency department (ED) and hospital encounters were compared before and after the study. Results: Thirty participants completed 12 months of video visits. The study cohort demonstrated significant improvement in mean HbA1c in both intention-to-treat (N = 57) analysis (10.8% [95 mmol/mol] to 10.0% [86 mmol/mol], P = 0.01) and per-protocol (N = 30) analysis (10.8% [95 mmol/mol] to 9.6% [81 mmol/mol], P = 0.004). Completion of ≥4 annual diabetes clinic visits improved significantly from 21% at baseline to 83% during the study period for the entire cohort, P < 0.0001. The frequency of diabetes-related ED and hospital encounters did not change significantly. Conclusions: Home-based video visits are a feasible supplement to in-person care for children and adolescents with T1D and suboptimal glycemic control and can successfully improve HbA1c levels and adherence to recommended frequency of care in this high-risk clinical population.
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Affiliation(s)
- Stephanie S. Crossen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
- Address correspondence to: Stephanie S. Crossen, MD, MPH, Department of Pediatrics, UC Davis Health, 2516 Stockton Boulevard, Sacramento, CA 95817
| | - James P. Marcin
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, Davis, California
| | - Hadley S. Sauers-Ford
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Allison M. Reggiardo
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Shelby T. Chen
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Victoria A. Tran
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
| | - Nicole S. Glaser
- Department of Pediatrics, University of California, Davis Health System, Sacramento, California
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21
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Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes Digital App Technology: Benefits, Challenges, and Recommendations. A Consensus Report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetes Care 2020; 43:250-260. [PMID: 31806649 DOI: 10.2337/dci19-0062] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Digital health technology, especially digital and health applications ("apps"), have been developing rapidly to help people manage their diabetes. Numerous health-related apps provided on smartphones and other wireless devices are available to support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. However, regulations and guidelines have not caught up with the burgeoning field to standardize how mobile health apps are reviewed and monitored for patient safety and clinical validity. The available evidence on the safety and effectiveness of mobile health apps, especially for diabetes, remains limited. The European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) have therefore conducted a joint review of the current landscape of available diabetes digital health technology (only stand-alone diabetes apps, as opposed to those that are integral to a regulated medical device, such as insulin pumps, continuous glucose monitoring systems, and automated insulin delivery systems) and practices of regulatory authorities and organizations. We found that, across the U.S. and Europe, mobile apps intended to manage health and wellness are largely unregulated unless they meet the definition of medical devices for therapeutic and/or diagnostic purposes. International organizations, including the International Medical Device Regulators Forum and the World Health Organization, have made strides in classifying different types of digital health technology and integrating digital health technology into the field of medical devices. As the diabetes digital health field continues to develop and become more fully integrated into everyday life, we wish to ensure that it is based on the best evidence for safety and efficacy. As a result, we bring to light several issues that the diabetes community, including regulatory authorities, policy makers, professional organizations, researchers, people with diabetes, and health care professionals, needs to address to ensure that diabetes health technology can meet its full potential. These issues range from inadequate evidence on app accuracy and clinical validity to lack of training provision, poor interoperability and standardization, and insufficient data security. We conclude with a series of recommended actions to resolve some of these shortcomings.
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Affiliation(s)
| | - John R Petrie
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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22
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How Do Smart Device Apps for Diabetes Self-Management Correspond with Theoretical Indicators of Empowerment? An Analysis of App Features. Int J Technol Assess Health Care 2019; 35:150-159. [PMID: 31017563 DOI: 10.1017/s0266462319000163] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Smart device apps for diabetes have the potential to support patients in their daily disease management. However, uncertainty exists regarding their suitability for empowering patients to improve self-management behaviors. This paper addresses a general research gap regarding theoretically based examinations of empowerment in diabetes research, by examining how diabetes app features correspond with conceptual indicators of empowerment. METHODS We examined features of 121 apps for diabetes self-management available in Singapore, with the second highest proportion of diabetes among developed nations, for psychological empowerment (feeling of empowerment) and for behavioral empowerment (social support). RESULTS Diabetes apps studied offered a narrow range of features, with limited feature-sets corresponding to indicators of empowerment. Customization as a strategy to improve perceived relevance of diabetes self-management as an indicator of psychological empowerment was especially limited. Moreover, there was a lack of features supporting patients' communication with healthcare professionals and within their private social networks. CONCLUSIONS Mobile apps for diabetes self-management failed to provide relevant features for empowering patients. Specific practical recommendations target improved adoption, sustained usage, and effectiveness of diabetes self-management apps.
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Bienfait F, Petit M, Pardenaud R, Guineberteau C, Pignon A. Applying M-Health to Palliative Care: A Systematic Review on the Use of M-Health in Monitoring Patients With Chronic Diseases and its Transposition in Palliative Care. Am J Hosp Palliat Care 2019; 37:549-564. [PMID: 31773969 DOI: 10.1177/1049909119885655] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The major growth of mobile technologies in the recent years has led to the development of medical-monitoring applications, particularly on smartphones. AIM The aim of this study was to review the use of m-health in the monitoring of patients with chronic pathologies in order to consider what could be adapted for palliative care patients at home. DESIGN A systematic review of the English and French literature was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. DATE SOURCES The review screened the following databases: PUBMED, SCOPUS, COCHRANE, SCIENCE DIRECT, SUDOC, and EM-Premium, screening studies published between 2008 and 2018. The selection of articles was done by the main investigator. All studies concerning the use of m-Health apps for patients with chronic diseases were included. RESULTS From the 337 selected publications, 8 systematic reviews and 14 original studies were included. The main uses of m-Health apps were biological and clinical monitoring (particularly concerning the symptoms) in 75% of the applications, disease self-management in 64% of the applications, and therapeutic patient education in 50% of the applications, with remote monitoring. CONCLUSIONS The development of an m-Health application could become a complementary monitoring tool during palliative care. However, it seems important to question the impact of technique in the professional-patient relationship and avoid the pitfalls of standardizing palliative care and reducing the patient to a "sick" health technician. A future step would then be to define which health-care professional would be in charge of this "m-monitoring."
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Affiliation(s)
- Florent Bienfait
- CHU d'Angers, Unité Laroque Médecine Soins Palliatifs, Angers, France
| | - Marie Petit
- CHU d'Angers, Unité Laroque Médecine Soins Palliatifs, Angers, France
| | - Romain Pardenaud
- CHU d'Angers, Unité Laroque Médecine Soins Palliatifs, Angers, France.,CHU d'Angers, Equipe Mobile d'Accompagnement, et de Soins de Support et Palliatifs, Angers, France
| | - Clément Guineberteau
- Faculté de Santé d'Angers, Département de Médecine Générale, Universite d'Angers, Angers, France
| | - Aude Pignon
- CHU d'Angers, Unité Laroque Médecine Soins Palliatifs, Angers, France
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24
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Abstract
PURPOSE OF REVIEW To review the current state of diabetes technology adoption and describe impact on outcomes in the context of age, gender, and ethnicity. We will discuss barriers and propose solutions that may help facilitate the adoption. RECENT FINDINGS We are witnessing rapid evolution and increase in adoption of diabetes technology in all its forms, including insulin delivery and glucose monitoring devices, mobile medical applications, and telemedicine. This technology has a great potential to improve diabetes-related outcomes, including acute and chronic complications as well as quality of life for people living with diabetes. However, currently available outcome data are showing modest efficacy and evidence for disparities when it comes to age, gender, and ethnicity. Despite multiple barriers, the adoption of technology is steadily increasing. It is clear that disparities exist in terms of access to and use of technology, but they may be at least in part driven by unmet needs of end users and as such are not unsurmountable. While more research is needed to identify the specific causes for the disparities, future development of diabetes technology that is based on adaptation of behavioral theories has a potential to address the gaps. The disparities can be lessened by understanding the needs of end users and with improvement in personalization of technology, allowing the right device to be used by the right patient. Targeted interventions to increase awareness and education and help navigate the processes involved in currently available technology may help diminish the gaps in health equity.
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Affiliation(s)
- Leslie Eiland
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Thiyagarajan Thangavelu
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Andjela Drincic
- Department of Internal medicine, Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA.
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25
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Joubert M, Benhamou PY, Schaepelynck P, Hanaire H, Catargi B, Farret A, Fontaine P, Guerci B, Reznik Y, Jeandidier N, Penfornis A, Borot S, Chaillous L, Franc S, Serusclat P, Kherbachi Y, Bavière E, Detournay B, Simon P, Charpentier G. Remote Monitoring of Diabetes: A Cloud-Connected Digital System for Individuals With Diabetes and Their Health Care Providers. J Diabetes Sci Technol 2019; 13:1161-1168. [PMID: 30862245 PMCID: PMC6835183 DOI: 10.1177/1932296819834054] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Benefits of telemedicine have been proven in the field of diabetes. Among a number of technical solutions, Diabeo® has been studied in both type 1 and type 2 diabetes with intensive insulin therapy. This digital therapeutic system contains a self-monitoring glucose logbook and offers automated insulin dose recommendations thanks to a fully customizable algorithm. In addition, the cloud-based dedicated software also has features to facilitate remote monitoring, including a platform for diabetes nurses who perform coaching and treatment adjustment. A detailed description of this telemedicine system is provided, as well as results of completed clinical studies. In particular, TeleDiab 1's positive results on HbA1c in type 1 diabetes are detailed. We conclude with a discussion of the role of this telemedicine system within the landscape of mobile apps for diabetes.
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Affiliation(s)
- Michael Joubert
- Diabetes Care Unit, Caen University Hospital, Caen, France
- Michael Joubert, MD, PhD, Diabetes Care Unit, Caen University Hospital, CHU Côte de Nacre, 14033 Caen Cedex 09, France.
| | | | - Pauline Schaepelynck
- Department of Nutrition-Endocrinology-Metabolic Disorders, Marseille University Hospital, Sainte Marguerite Hospital, Marseille, France
| | - Hélène Hanaire
- Department of Diabetology, Metabolic Diseases and Nutrition, CHU Toulouse, University of Toulouse, Toulouse, France
| | - Bogdan Catargi
- Department of Endocrinology and Diabetes, University Hospital, Bordeaux, France
| | - Anne Farret
- Department of Endocrinology, Diabetes and Nutrition, University Hospital, Montpellier, France
| | - Pierre Fontaine
- Department of Diabetology, University Hospital, Lille, France
| | - Bruno Guerci
- Endocrinology-Diabetes Care Unit, University of Lorraine, Vandoeuvre Lès Nancy, France
| | - Yves Reznik
- Diabetes Care Unit, Caen University Hospital, Caen, France
| | - Nathalie Jeandidier
- Department of Endocrinology, Diabetes and Nutrition. CHU of Strasbourg, Strasbourg, France
| | - Alfred Penfornis
- University Paris-Sud, Orsay, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - Sophie Borot
- Centre Hospitalier Universitaire Jean Minjoz, Service d’Endocrinologie-Métabolisme et Diabétologie-Nutrition, Besançon, France
| | - Lucy Chaillous
- Department of Endocrinology, Diabetology and Nutrition, Institut du Thorax, Nantes University Hospital, France
| | - Sylvia Franc
- CERITD (Centre d’étude et de Recherche pour l’Intensification du Traitement du Diabète), Evry, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
| | - Pierre Serusclat
- Endocrinology, Diabetology and Nutrition, Clinique Portes du Sud, Venissieux, France
| | | | | | | | - Pierre Simon
- National Association of Telemedicine, Paris, France
| | - Guillaume Charpentier
- CERITD (Centre d’étude et de Recherche pour l’Intensification du Traitement du Diabète), Evry, Department of Diabetes, Sud-Francilien Hospital, Corbeil-Essonnes, France
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26
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Baptista S, Trawley S, Pouwer F, Oldenburg B, Wadley G, Speight J. What Do Adults with Type 2 Diabetes Want from the "Perfect" App? Results from the Second Diabetes MILES: Australia (MILES-2) Study. Diabetes Technol Ther 2019; 21:393-399. [PMID: 31166804 DOI: 10.1089/dia.2019.0086] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background: We investigated what Australian adults with type 2 diabetes (T2D) want from the "perfect" diabetes self-management application. Methods: Adults with T2D completed a national online survey including an open-ended question: "If you were describing the perfect app to help you manage your diabetes, what would it do?" Qualitative responses were subjected to thematic analysis. Results: Of the 339 participants who provided usable responses, 153 (45%) were women, the mean age was 58 ± 10 years, and 139 participants (41%) managed their diabetes with insulin. Two primary themes emerged. First, participants expressed a desire for assistance with practical aspects of diabetes self-management to improve, and reduce the cognitive burden of, self-management; this included tracking and visualizing multiple sources of data, using data to inform automated, personalized coaching, reminders, and alarms, and automating upload and linking of data through connected devices. Second, they desired assistance with psychological and emotional aspects of diabetes self-management; this included ongoing encouragement and motivation, help with stress management or negative emotions, and complementing existing health care by facilitating interconnectivity with health professionals. Conclusions: Our findings suggest that the clear desire of people with type 2 diabetes is for the "perfect app" to reduce not only the practical, but also the cognitive and emotional burden of diabetes self-management. They provide further evidence that understanding the desires of people living with diabetes needs to be the first step in app development to ensure that apps provide features, support, and benefits that people with diabetes value.
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Affiliation(s)
- Shaira Baptista
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
| | - Steven Trawley
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- 3 Cairnmillar Institute, Hawthorn East, VIC, Australia
| | - Frans Pouwer
- 4 School of Psychology, Deakin University, Geelong, VIC, Australia
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark
- 6 STENO Diabetes Center Odense, Odense, Denmark
| | - Brian Oldenburg
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Greg Wadley
- 7 School of Computing and Information Systems, The University of Melbourne, Melbourne, VIC, Australia
| | - Jane Speight
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
- 2 The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC, Australia
- 4 School of Psychology, Deakin University, Geelong, VIC, Australia
- 5 Department of Psychology, University of Southern Denmark, Odense, Denmark
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27
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Shan R, Sarkar S, Martin SS. Digital health technology and mobile devices for the management of diabetes mellitus: state of the art. Diabetologia 2019; 62:877-887. [PMID: 30963188 DOI: 10.1007/s00125-019-4864-7] [Citation(s) in RCA: 143] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/13/2019] [Indexed: 11/29/2022]
Abstract
Diabetes mellitus is a disease that can be difficult to manage and requires high levels of health literacy and numeracy, self-monitoring and frequent contact with clinicians. If not optimally controlled, diabetes can lead to kidney failure, blindness and cardiovascular complications, which, in turn, contribute to increasing healthcare costs. Although not yet widely used, mobile health (mHealth) tools have enhanced diabetes management and prevention and are likely to play an increasing role with the growth of smartphone ownership and medical device innovations. Recent mHealth interventions targeting type 1 and type 2 diabetes are diverse in their goals and components, and include insulin management applications, wearable blood glucose meters, automated text messages, health diaries and virtual health coaching. In this paper, we review the modalities and components of various impactful interventions for insulin management, diabetes education, self-management and prevention. More work is needed to investigate how individual demographic, socioeconomic, behavioural and clinical characteristics contribute to patient engagement and the efficacy of mHealth tools for diabetes.
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Affiliation(s)
- Rongzi Shan
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Sudipa Sarkar
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Endocrinology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth S Martin
- Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
- Johns Hopkins Hospital, 600 N. Wolfe St, Carnegie 591, Baltimore, MD, 21287, USA.
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28
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Ashok Kumar M, Shanmugasundaram P. A validation study of questionnaire towards mobile based health applications in uncontrolled diabetic population of India (South). Diabetes Metab Syndr 2019; 13:2106-2110. [PMID: 31235144 DOI: 10.1016/j.dsx.2019.04.037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mobile applications have the potential to provide needed support for older adults with diabetes. The field of medical application is currently one of the most dynamic in application development and medicine. OBJECTIVE This study was designed to develop and validate a questionnaire to assess knowledge, attitude and practice of uncontrolled diabetic patients towards mobile based health applications. METHODS A Cross Sectional study was designed and enrolled 78 adult uncontrolled diabetic (≥18 years old DM type 2)patients and clinically validated questionnaire was examined for internal consistency, reproducibility, convergent and discriminant validity using Cronbach's alpha, intra class correlation and CITC scores respectively. RESULTS Cronbach's alpha coefficient was 0.97 for Assessment of Knowledge, 0.93 for Assessment of Attitude, and 0.90 for Assessment of Practice in uncontrolled diabetic population. CONCLUSION The final version of questionnaire was found to be statistically internally consistent, reproducible and reliable and could be used to assess the awareness and attitude of patients towards self-management of diabetes mellitus.
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Affiliation(s)
- M Ashok Kumar
- Vels Institute of Science Technology and Advanced Studies, Pallavaram, 600117, Chennai, India
| | - P Shanmugasundaram
- Vels Institute of Science Technology and Advanced Studies, Pallavaram, 600117, Chennai, India.
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29
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Echarri A, Vera I, Ollero V, Arajol C, Riestra S, Robledo P, Calvo M, Gallego F, Ceballos D, Castro B, Aguas M, García-López S, Marín-Jiménez I, Chaparro M, Mesonero P, Guerra I, Guardiola J, Nos P, Muñiz J. The Harvey-Bradshaw Index Adapted to a Mobile Application Compared with In-Clinic Assessment: The MediCrohn Study. Telemed J E Health 2019; 26:80-88. [PMID: 30848700 PMCID: PMC6948001 DOI: 10.1089/tmj.2018.0264] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objectives: Mobile apps are useful tools in e-health and self-management strategies in disease monitoring. We evaluated the Harvey–Bradshaw index (HBI) mobile app self-administered by the patient to see if its results agreed with HBI in-clinic assessed by a physician. Methods: Patients were enrolled in a 4-month prospective study with clinical assessments at months 1 and 4. Patients completed mobile app HBI and within 48 h, HBI was performed by a physician (gold standard). HBI scores characterized Crohn's disease (CD) as remission <5 or active ≥5. We determined agreement per item and total HBI score and intraclass correlation coefficients (ICCs). Bland–Altman plot was performed. HBI changes in disease activity from month 1 to month 4 were determined. Results: A total of 219 patients were enrolled. All scheduled assessments (385 pairs of the HBI questionnaire) showed a high percentage of agreement for remission/activity (92.4%, κ = 0.796), positive predictive value (PPV) for remission of 98.2%, and negative predictive value of 76.7%. High agreement was also found at month 1 (93.15%, κ = 0.82) and month 4 (91.5%, κ = 0.75). Bland–Altman plot was more uniform when the HBI mean values were <5 (remission). ICC values were 0.82, 0.897, and 0.879 in all scheduled assessments, 1 and 4 months, respectively. Conclusions: We found a high percentage of agreement between patients' self-administered mobile app HBI and in-clinic physician assessment to detect CD activity with a remarkably high PPV for remission. The mobile app HBI might allow a strict control of inflammation by remote monitoring and flexible follow-up of CD patients. Reduction of sanitary costs could be possible.
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Affiliation(s)
- Ana Echarri
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Isabel Vera
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Virginia Ollero
- Gastroenterology Department, University Hospital, Ferrol, Spain
| | - Claudia Arajol
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Sabino Riestra
- Gastroenterology Department, Central University Hospital, Oviedo, Spain
| | - Pilar Robledo
- Gastroenterology Department, San Pedro de Alacantara University Hospital, Cáceres, Spain
| | - Marta Calvo
- Gastroenterology Department, Puerta de Hierro University Hospital, Madrid, Spain
| | - Franscisco Gallego
- Gastroenterology Department, Poniente University Hospital, Almeria, Spain
| | - Daniel Ceballos
- Gastroenterology Department, Dr. Negrín University Hospital, Las Palmas de Gran Canaria, Spain
| | - Beatriz Castro
- Gastroenterology Department, Marqués de Valdecilla University Hospital, Santander, Spain
| | - Mariam Aguas
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | | | | | - María Chaparro
- Gastroenterology Department, Instituto de Investigación Sanitaria Princesa and CIBERehd, La Princesa University Hospital, Madrid, Spain
| | - Paco Mesonero
- Gastroenterology Department, Ramón y Cajal University Hospital, Madrid, Spain
| | - Iván Guerra
- Gastroenterology Department, Fuenlabrada University Hospital, Madrid, Spain
| | - Jordi Guardiola
- Gastroenterology Department, Bellvitge University Hospital; IDIBELL Barcelona University, Barcelona, Spain
| | - Pilar Nos
- Gastroenterology Department, La Fe University Hospital, Valencia, Spain
| | - Javier Muñiz
- Instituto Universitario de Ciencias de La Salud e INIBIC, La Coruña University, La Coruña, Spain
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30
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Zhang Y, Li X, Luo S, Liu C, Xie Y, Guo J, Liu F, Zhou Z. Use, Perspectives, and Attitudes Regarding Diabetes Management Mobile Apps Among Diabetes Patients and Diabetologists in China: National Web-Based Survey. JMIR Mhealth Uhealth 2019; 7:e12658. [PMID: 30735147 PMCID: PMC6384538 DOI: 10.2196/12658] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/01/2019] [Accepted: 01/20/2019] [Indexed: 12/19/2022] Open
Abstract
Background The diabetes disease burden in China is heavy, and mobile apps have a great potential for diabetes management. However, there is a lack of investigation of diabetes app use among Chinese diabetes patients and diabetologists. The perspectives and attitudes of diabetes patients and diabetologists regarding diabetes apps are also unclear. Objective Our objectives were to investigate diabetes patients’ and diabetologists’ use, attitudes, and perspectives, as well as patients’ needs, with respect to diabetes apps to provide information regarding the optimal design of diabetes apps and the best strategies to promote their use. Methods Diabetes patients and diabetologists across China were surveyed on the WeChat (Tencent Corp) network using Sojump (Changsha ran Xing InfoTech Ltd) from January 23, 2018, to July 30, 2018. In total, 2 survey links were initially sent to doctors from 46 Latent Autoimmune Diabetes of Adults Study collaborative hospitals in China in 25 major cities and were spread on their WeChat contacts network. We also published the patient survey link on 3 WeChat public accounts and requested diabetes patients to fill out questionnaires. A multivariate regression analysis was used to identify associations of demographic and basic disease information with app usage among adult patients. Results Overall, 1276 individuals from 30 provincial regions responded to the patient survey; among them, the overall app awareness rate was 29.94% (382/1276) and usage was 15.44% (197/1276). The usage was higher among patients with type 1 diabetes (T1DM) than among patients with type 2 diabetes (T2DM; 108/473, 22.8% vs 79/733, 10.8%; P<.001). The multivariate regression analysis showed that diabetes type, age, education, family income, and location were associated with app use in adult patients (P<.05). The need for and selection of diabetes apps differed slightly between patients with T1DM and patients with T2DM. The reasons why patients discontinued the use of an app included limited time (59/197, 29.9%), complicated operations (50/197, 25.4%), ineffectiveness for glycemic control (48/197, 24.4%), and cost (38/197, 19.3%). Of the 608 responders to the diabetologist survey, 40.5% (246/608) recommended diabetes apps to patients and 25.2% (153/608) used diabetes apps to manage patients. The greatest obstacles to the diabetologists’ use of apps to manage diabetes patients include limited time (280/608, 46.1%), legal issues (129/608, 21.2%), patients’ distrust (108/608, 17.8%), and billing issues (66/608, 10.9%). Conclusions The awareness and use of diabetes apps in Chinese people with diabetes and the proportion of diabetologists using diabetes apps to manage patients are low. Designing apps targeting different patient needs and conducting high-quality randomized controlled trials will improve the effectiveness of the apps, provide evidence for patients to choose suitable apps, and be conducive to the promotion of app use.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yuting Xie
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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31
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Abstract
PURPOSE OF REVIEW To perform a comprehensive literature review and critical assessment of peer-reviewed manuscripts addressing the efficacy, safety, or usability of insulin calculator apps. RECENT FINDINGS Managing diabetes with insulin can be complex, and literacy and numeracy skills pose barriers to manual insulin dose calculations. App-based insulin calculators are promising tools to help people with diabetes administer insulin safely and have potential to improve glycemic control. While a large number of apps which assist with insulin dosing are available, there is limited data evaluating their efficacy, safety, and usability. Recently, a need for regulatory oversight has been recognized, but few apps meet federal standards. Thus, choosing an appropriate app is challenging for both patients and providers. An electronic literature review was performed to identify insulin calculator apps with either evidence for efficacy, safety or usability published in peer-reviewed literature or with FDA/CE approval. Twenty apps were identified intended for use by patients with diabetes on insulin. Of these, nine included insulin calculators. Summaries of each app, including pros and cons, are provided. Insulin-calculator apps have the potential to improve self-management of diabetes. While current literature demonstrates improvements in quality of life and glycemic control after use of these programs, larger trials are needed to collect outcome and safety data. Also, further human factor analysis is needed to assure these apps will be adopted appropriately by people with diabetes. App features including efficacy and safety data need to be easily available for consumer review and decision making. Higher standards need to be set for app developers to ensure safety and efficacy.
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Affiliation(s)
- Leslie Eiland
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
| | - Meghan McLarney
- Nebraska Medicine - Diabetes Center, University of Nebraska Medical Center, 984120 Nebraska Medical Center, Omaha, NE, 68198-4120, USA
| | - Thiyagarajan Thangavelu
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, NE, USA
| | - Andjela Drincic
- Division of Diabetes, Endocrinology & Metabolism, University of Nebraska Medical Center, Omaha, NE, USA.
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32
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Zhang Y, Li X, Luo S, Liu C, Liu F, Zhou Z. Exploration of Users' Perspectives and Needs and Design of a Type 1 Diabetes Management Mobile App: Mixed-Methods Study. JMIR Mhealth Uhealth 2018; 6:e11400. [PMID: 30249580 PMCID: PMC6231832 DOI: 10.2196/11400] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 08/13/2018] [Accepted: 09/04/2018] [Indexed: 12/17/2022] Open
Abstract
Background With the popularity of mobile phones, mobile apps have great potential for the management of diabetes, but the effectiveness of current diabetes apps for type 1 diabetes mellitus (T1DM) is poor. No study has explored the reasons for this deficiency from the users’ perspective. Objective The aims of this study were to explore the perspectives and needs of T1DM patients and diabetes experts concerning a diabetes app and to design a new T1DM management mobile app. Methods A mixed-methods design combining quantitative surveys and qualitative interviews was used to explore users’ needs and perspectives. Experts were surveyed at 2 diabetes conferences using paper questionnaires. T1DM patients were surveyed using Sojump (Changsha ran Xing InfoTech Ltd) on a network. We conducted semistructured, in-depth interviews with adult T1DM patients or parents of child patients who had ever used diabetes apps. The interviews were audio-recorded, transcribed, and coded for theme identification. Results The expert response rate was 63.5% (127/200). The respondents thought that the reasons for app invalidity were that patients did not continue using the app (76.4%, 97/127), little guidance was received from health care professionals (HCPs; 73.2%, 93/127), diabetes education knowledge was unsystematic (52.8%, 67/127), and the app functions were incomplete (44.1%, 56/127). A total of 245 T1DM patient questionnaires were collected, of which 21.2% (52/245) of the respondents had used diabetes apps. The reasons for their reluctance to use an app were limited time (39%, 20/52), complicated operations (25%, 13/52), uselessness (25%, 13/52), and cost (25%, 13/52). Both the experts and patients thought that the most important functions of the app were patient-doctor communication and the availability of a diabetes diary. Two themes that were useful for app design were identified from the interviews: (1) problems with patients’ diabetes self-management and (2) problems with current apps. In addition, needs and suggestions for a diabetes app were obtained. Patient-doctor communication, diabetes diary, diabetes education, and peer support were all considered important by the patients, which informed the development of a prototype multifunctional app. Conclusions Patient-doctor communication is the most important function of a diabetes app. Apps should be integrated with HCPs rather than stand-alone. We advocate that doctors follow up with their patients using a diabetes app. Our user-centered method explored comprehensively and deeply why the effectiveness of current diabetes apps for T1DM was poor and what T1DM patients needed for a diabetes app and provided meaningful guidance for app design.
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Affiliation(s)
- Yiyu Zhang
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Xia Li
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Shuoming Luo
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Chaoyuan Liu
- Department of Oncology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Fang Liu
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhiguang Zhou
- Department of Metabolism and Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, China.,Key Laboratory of Diabetes Immunology, Ministry of Education, Changsha, China.,National Clinical Research Center for Metabolic Diseases, Changsha, China
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33
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SUITABILITY OF CURRENT EVALUATION FRAMEWORKS FOR USE IN THE HEALTH TECHNOLOGY ASSESSMENT OF MOBILE MEDICAL APPLICATIONS: A SYSTEMATIC REVIEW. Int J Technol Assess Health Care 2018; 34:464-475. [PMID: 30201060 DOI: 10.1017/s026646231800051x] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To identify and appraise existing evaluation frameworks for mobile medical applications (MMA) and determine their suitability for use in health technology assessment (HTA) of these technologies. METHODS Systematic searches were conducted of seven bibliographic databases to identify literature published between 2008 and 2016 on MMA evaluation frameworks. Frameworks were eligible if they were used to evaluate at least one of the HTA domains of effectiveness, safety, and/or cost and cost-effectiveness of an MMA. After inclusion, the frameworks were reviewed to determine the number and extent to which other elements of an HTA were addressed by the framework. RESULTS A total of forty-five frameworks were identified that assessed MMAs. All frameworks assessed whether the app was effective. Of the thirty-four frameworks that examined safety, only seven overtly evaluated potential harms from the MMA (e.g., the impact of inaccurate information). Only one framework explicitly considered a comparator. Technology specific domains were sporadically addressed. CONCLUSION None of the evaluation frameworks could be used, unaltered, to guide the HTA of MMAs. To use these frameworks in HTA they would need to identify relevant comparators, improve assessments of harms and consider the ongoing effect of software updates on the safety and effectiveness of MMAs. Attention should also be paid to ethical issues, such as data privacy, and technology specific characteristics. IMPLICATIONS Existing MMA evaluation frameworks are not suitable for use in HTA. Further research is needed before an MMA evaluation framework can be developed that will adequately inform policy makers.
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Hou C, Xu Q, Diao S, Hewitt J, Li J, Carter B. Mobile phone applications and self-management of diabetes: A systematic review with meta-analysis, meta-regression of 21 randomized trials and GRADE. Diabetes Obes Metab 2018; 20:2009-2013. [PMID: 29582538 DOI: 10.1111/dom.13307] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/10/2018] [Accepted: 03/23/2018] [Indexed: 01/09/2023]
Abstract
We conducted a systematic review with meta-analysis of randomized controlled trials that evaluated the effect of diabetes mobile phone applications. A total of 1550 participants from 21 studies were included. For type 1 diabetes, a significant 0.49% reduction in HbA1c was seen (95% CI, 0.04-0.94; I2 = 84%), with unexplained heterogeneity and a low GRADE of evidence. For type 2 diabetes, using diabetes apps was associated with a mean reduction of 0.57% (95% CI, 0.32-0.82; I2 = 77%). The results had severe heterogeneity that was explained by the frequency of HCP feedback. In studies with no HCP feedback, low frequency and high frequency HCP feedback, the mean reduction is 0.24% (95% CI, 0.02-0.49; I2 = 0%), 0.33% (95% CI, 0.07-0.59; I2 = 47%) and 1.12% (95% CI, 0.91-1.32; I2 = 0%), respectively, with a high GRADE of evidence. There is evidence that diabetes apps improve glycaemic control in type 1 diabetes patients. A reduction of 0.57% in HbA1c was found in type 2 diabetes patients. However, HCP functionality is important to achieve clinical effectiveness. Future studies are needed to explore the cost-effectiveness of diabetes apps and the optimal intensity of HCP feedback.
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Affiliation(s)
- Can Hou
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Qian Xu
- Department of Pathophysiology, West China School of Basic and Forensic Medicine, Sichuan University, Chengdu, China
| | - Sha Diao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Jonathan Hewitt
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Jiayuan Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Ben Carter
- Division of Population Medicine, Cardiff University, Cardiff, UK
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Cochrane Skin Group, School of Medicine, Nottingham University, Nottingham, UK
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Offringa R, Sheng T, Parks L, Clements M, Kerr D, Greenfield MS. Digital Diabetes Management Application Improves Glycemic Outcomes in People With Type 1 and Type 2 Diabetes. J Diabetes Sci Technol 2018; 12:701-708. [PMID: 29277103 PMCID: PMC6154224 DOI: 10.1177/1932296817747291] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Diabetes is a chronic condition that requires constant self-management. As a consequence, several software platforms have been developed to facilitate the tracking of diabetes data to improve diabetes management. Our aim was to determine the real-world glycemic benefits of a mobile diabetes management platform used by individuals with type 1 and type 2 diabetes. METHODS Mobile platform-using (n = 899) and control (n = 900) participants meeting specific minimum data criteria were randomly selected from a database of diabetes users. All results were modeled using different mixed effect generalized linear models, assigning random intercepts for each user, and adjusting the distribution assumption for each outcome. RESULTS Users of the mobile platform increased their frequency of blood glucose monitoring (+8.8 tests per month, 95% CI [3.4, 14.1], P < .001) and had fewer hyperglycemic events and lower average glucose levels compared to the control group. In addition, a mobile user could expect a 3.5% drop in average BG (-6.4 mg/dL, 95% CI [-2.0, -10.7], P < .001) and a 10.7% decrease in hyperglycemia ( P < .001) after 2 months. CONCLUSION Users of the mobile platform tested their BG more often and demonstrated greater improvement in blood glucose compared to users who did not use the mobile platform. This supports previous studies indicating that digital technologies can enhance diabetes care in a real-world setting.
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Affiliation(s)
| | - Tong Sheng
- Glooko Inc., Mountain View, CA,
USA
- Tong Sheng, PhD, Glooko Inc, 303 Bryant St,
Mountain View, CA 94041, USA.
| | | | - Mark Clements
- Glooko Inc., Mountain View, CA,
USA
- Children’s Mercy Hospital, Kansas City,
MO, USA
| | - David Kerr
- Glooko Inc., Mountain View, CA,
USA
- William Sansum Diabetes Center, Santa
Barbara, CA, USA
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Abstract
To date, the use of technology for the management of diabetes represents a promising area of innovation that can dramatically change diabetics' lives. In the past decade, the use of diabetes devices has widely grown and looks to have partially improved diabetes management. The combination of cloud technology with real-expert intervention saves time and improves efficiency, as well as empowering the patient. The application of mathematical models applied to diabetes therapy could lead to significant improvement in life quality and challenge the burden of hypoglycaemia. Events where an individual needs support are instantly achieved, triggering outreach alerts via cloud and wireless connectivity, thereby improving patient compliance and reducing disease costs.
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Affiliation(s)
- A R Maurizi
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
| | - V Piemonte
- Faculty of Bioengineering, Campus Bio-Medico University of Rome, Rome, Italy
| | - P Pozzilli
- Unit of Endocrinology and Diabetes, Department of Medicine, Campus Bio-Medico University of Rome, Rome, Italy
- Centre of Immunobiology, Blizard Instiute, Barts and the London School of Medicine, Queen Mary, University of London, London, UK
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Abstract
Bolus advisors that are designed to improve the accuracy of individual bolus doses relative to a meal's carb content and the current glucose have not substantially changed since they were introduced 15 years ago despite an obvious need for enhancement and innovation. Although some glycemic benefits have been demonstrated, bolus advisors largely ignore the large amounts of clinical data they gather that could have a significant impact on glucose outcomes. Concerns have also been raised regarding the aggressive nature of largely unpublished or poorly explained bolus advisor algorithms. Hypoglycemia and hyperglycemia remain significant risks due to inaccurate bolus advisor settings and the absence of tracking or an inappropriate handling of bolus on board. This review covers common sources for bolus advisor error such as the selection of physiologically inappropriate bolus advisor settings, the use of short duration of insulin action times, poor algorithm logic that tends to cover all carb intake fully, and an excessive reliance on simplistic dosing algorithms. As well as discussing these areas, we provide 21 ways to improve current bolus calculators.
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Affiliation(s)
- John Walsh
- Advanced Metabolic Care and Research, Escondido, CA, USA
- John Walsh, PA, CDTC, Advanced Metabolic Care and Research, 625 W Citracado Pkwy, Ste 108, Escondido, CA 92025, USA.
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Cahn A, Akirov A, Raz I. Digital health technology and diabetes management. J Diabetes 2018; 10:10-17. [PMID: 28872765 DOI: 10.1111/1753-0407.12606] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 08/27/2017] [Accepted: 08/30/2017] [Indexed: 01/22/2023] Open
Abstract
Diabetes care is largely dependent on patient self-management and empowerment, given that patients with diabetes must make numerous daily decisions as to what to eat, when to exercise, and determine their insulin dose and timing if required. In addition, patients and providers are generating vast amounts of data from many sources, including electronic medical records, insulin pumps, sensors, glucometers, and other wearables, as well as evolving genomic, proteomic, metabolomics, and microbiomic data. Multiple digital tools and apps have been developed to assist patients to choose wisely, and to enhance their compliance by using motivational tools and incorporating incentives from social media and gaming techniques. Healthcare teams (HCTs) and health administrators benefit from digital developments that sift through the enormous amounts of patient-generated data. Data are acquired, integrated, analyzed, and presented in a self-explanatory manner, highlighting important trends and items that require attention. The use of decision support systems may propose data-driven actions that, for the most, require final approval by the patient or physician before execution and, once implemented, may improve patient outcomes. The digital diabetes clinic aims to incorporate all digital patient data and provide individually tailored virtual or face-to-face visits to those persons who need them most. Digital diabetes care has demonstrated only modest HbA1c reduction in multiple studies and borderline cost-effectiveness, although patient satisfaction appears to be increased. Better understanding of the barriers to digital diabetes care and identification of unmet needs may yield improved utilization of this evolving technology in a safe, effective, and cost-saving manner.
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Affiliation(s)
- Avivit Cahn
- The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
- Endocrinology and Metabolism Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
| | - Amit Akirov
- Institute of Endocrinology, Rabin Medical Center - Beilinson Hospital, Petach-Tikva, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itamar Raz
- The Diabetes Unit, Hadassah Hebrew University Hospital, Jerusalem, Israel
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39
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Affiliation(s)
- David C. Klonoff
- Medical Director, Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA, USA
- David C. Klonoff, MD, FACP, FRCPE, Diabetes Research Institute, Mills-Peninsula Medical Center, San Mateo, CA 94404, USA.
| | - David Kerr
- Director of Research and Innovation at William Sansum Diabetes Center, Santa Barbara, CA, USA
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40
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Awareness and Use of mHealth Apps: A Study from England. PHARMACY 2017; 5:pharmacy5020033. [PMID: 28970445 PMCID: PMC5597158 DOI: 10.3390/pharmacy5020033] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 06/07/2017] [Accepted: 06/07/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose: Mobile health (mHealth) solutions have become an inevitable element of the healthcare landscape. The recommendation and use of mHealth is important, but it is often underutilised. This study was conducted in England. It aimed to determine the use and recommendation of mHealth apps by pharmacists, the public’s perceptions of mHealth apps in general, and the awareness and use of health apps by diabetic patients in particular. Methods: The study used a mixed research approach, utilising a sequence of survey-based questionnaires with pharmacists and the general public, followed by semi-structured interviews with diabetic patients. Results: Pharmacists’ questionnaires revealed that 56% of the respondents were aware of health apps, 60% of which recommended them to patients. Over 76% of the individuals owned a smartphone. The types of applications that saw the most use from the general public were health and lifestyle apps (24%), social apps (19%), followed by news (18%). Although eight out of nine diabetic patients owned a smartphone, only three used diabetes apps. Diabetic patients also suggested an interest in using diabetes apps to aid in optimising care via the utilisation of visual aids, reminders, recording patient data, social coaching, and remote collaboration with healthcare professionals (HCPs), but time was seen as the biggest obstacle to using a diabetes mHealth application. Conclusion: Despite the growing number of mHealth apps, the level of awareness and usability of such apps by patients and pharmacists was still relatively low. Nevertheless, the majority who used health apps found them to be beneficial, and the public agreed that it helped them to live a healthier lifestyle. Therefore, health apps have great potential in health promotion. Pharmacists are ideally placed to promote them and make patients more aware of them. To increase the use of these apps, it is necessary to first increase awareness and knowledge of these apps, both to the public and to healthcare professionals.
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Bousquet J, Chavannes NH, Guldemond N, Haahtela T, Hellings PW, Sheikh A. Realising the potential of mHealth to improve asthma and allergy care: how to shape the future. Eur Respir J 2017; 49:49/5/1700447. [PMID: 28461306 DOI: 10.1183/13993003.00447-2017] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 03/05/2017] [Indexed: 12/19/2022]
Affiliation(s)
- Jean Bousquet
- MACVIA-France (Contre les Maladies Chroniques pour un Vieillissement Actif en France) European Innovation Partnership on Active and Healthy Ageing Reference Site, Montpellier, France .,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, France.,Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France
| | - Niels H Chavannes
- Dept of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Nick Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, Helsinki, Finland
| | - Peter W Hellings
- Laboratory of Clinical Immunology, Dept of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Centre of Medical Informatics, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Izahar S, Lean QY, Hameed MA, Murugiah MK, Patel RP, Al-Worafi YM, Wong TW, Ming LC. Content Analysis of Mobile Health Applications on Diabetes Mellitus. Front Endocrinol (Lausanne) 2017; 8:318. [PMID: 29230195 PMCID: PMC5711785 DOI: 10.3389/fendo.2017.00318] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022] Open
Abstract
Diabetes self-management offers an opportunity to patients to be actively involved in managing their conditions and modifying lifestyle behaviors to attain positive health outcomes. With the unprecedented growth of mobile technology, smartphone plays a role in supporting diabetes self-management. Nonetheless, selecting appropriate mobile applications (apps) is challenging for patients. Thus, this study aimed to evaluate and compare the contents and features of mobile medical apps for diabetes self-management. Of 346 commercial apps, 16 (16%) and 19 (7.72%) of the diabetes apps found in Apple and Google Play stores, respectively, were included based on the selection criteria and individually scored for the availability of 8 main features of diabetes self-management. The apps supported self-management by offering features such as free installation, less than 50 MB space used, offline use, automated data entry, data export and sharing, educational tool, and advice. Of the 8 evaluated features, only 11 (31.4%) apps had a score of 5 whereas 7 (20%) apps scored the lowest, with a score of 3. The majority of apps were free, required no Internet connectivity to use and were less than 50 MB in size. Our findings showed that the design of diabetes mobile apps focused on reporting and setting reminders, rather than providing personalized education or therapeutic support. In the future, the design of apps could be improved to integrate patients' needs, usability for disease management, and lifestyle modifications.
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Affiliation(s)
- Syarafina Izahar
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Qi Ying Lean
- Faculty of Pharmacy, Universiti Teknologi MARA, Bertam, Malaysia
- Vector borne Diseases Research Group, Pharmaceutical and Life Sciences CoRe, Universiti Teknologi MARA, Shah Alam, Malaysia
- *Correspondence: Qi Ying Lean, ; Long Chiau Ming,
| | | | - Muthu Kumar Murugiah
- Pharmaceutical Services Division, Penang State Health Department, Georgetown, Malaysia
| | - Rahul P. Patel
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | | | - Tin Wui Wong
- Non-Destructive Biomedical and Pharmaceutical Research Centre, iPROMISE, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Long Chiau Ming
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
- School of Pharmacy, KPJ Healthcare University College, Nilai, Malaysia
- *Correspondence: Qi Ying Lean, ; Long Chiau Ming,
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43
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Affiliation(s)
- David C Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, CA, USA
| | - David Kerr
- William Sansum Diabetes Center, Santa Barbara, CA, USA
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