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McClure RD, Talbo MK, Bonhoure A, Molveau J, South CA, Lebbar M, Wu Z. Exploring Technology's Influence on Health Behaviours and Well-being in Type 1 Diabetes: a Review. Curr Diab Rep 2024; 24:61-73. [PMID: 38294726 DOI: 10.1007/s11892-024-01534-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/01/2024]
Abstract
PURPOSE OF REVIEW Maintaining positive health behaviours promotes better health outcomes for people with type 1 diabetes (T1D). However, implementing these behaviours may also lead to additional management burdens and challenges. Diabetes technologies, including continuous glucose monitoring systems, automated insulin delivery systems, and digital platforms, are being rapidly developed and widely used to reduce these burdens. Our aim was to review recent evidence to explore the influence of these technologies on health behaviours and well-being among adults with T1D and discuss future directions. RECENT FINDINGS Current evidence, albeit limited, suggests that technologies applied in diabetes self-management education and support (DSME/S), nutrition, physical activity (PA), and psychosocial care areas improved glucose outcomes. They may also increase flexibility in insulin adjustment and eating behaviours, reduce carb counting burden, increase confidence in PA, and reduce mental burden. Technologies have the potential to promote health behaviours changes and well-being for people with T1D. More confirmative studies on their effectiveness and safety are needed to ensure optimal integration in standard care practices.
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Affiliation(s)
- Reid D McClure
- Faculty of Kinesiology, Sport and Recreation, University of Alberta, 3-100 University Hall, Edmonton, AB, T6G 2H9, Canada
- Alberta Diabetes Institute, Li Ka Shing Centre, University of Alberta, Edmonton, AB, T6G 2T9, Canada
| | - Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Anne Bonhoure
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Joséphine Molveau
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
- Univ. Lille, Univ. Artois, Univ. Littoral Côte d'Opale, ULR 7369 - URePSSS - Unité de Recherche Pluridisciplinaire Sport Santé Société, Lille, France
| | - Courtney A South
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada
- Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2405, Chemin de La Côte-Sainte-Catherine, Montreal, QC, H3T 1A8, Canada
| | - Zekai Wu
- Montreal Clinical Research Institute, 110 Pine Ave W, Montreal, QC, H2W 1R7, Canada.
- Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Décarie Boulevard, Montreal, QC, H4A 3J1, Canada.
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Cheng R, Taleb N, Wu Z, Bouchard D, Parent V, Lalanne-Mistrih ML, Boudreau V, Messier V, Lacombe MJ, Grou C, Brazeau AS, Rabasa-Lhoret R. Managing Impending Nonsevere Hypoglycemia With Oral Carbohydrates in Type 1 Diabetes: The REVERSIBLE Trial. Diabetes Care 2024; 47:476-482. [PMID: 38194601 DOI: 10.2337/dc23-1328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 12/20/2023] [Indexed: 01/11/2024]
Abstract
OBJECTIVE Current guidelines recommend initiating treatment for nonsevere (NS) hypoglycemia with 15 g carbohydrates (CHO) at 15-min intervals when blood glucose (BG) reaches <70 mg/dL (3.9 mmol/L). Despite this recommendation, NS hypoglycemia management remains challenging for individuals living with type 1 diabetes (T1D). We aimed to assess the efficacy of 15 g CHO at higher BG levels. RESEARCH DESIGN AND METHODS A total of 29 individuals with T1D participated in an open-label crossover study. After an inpatient subcutaneous insulin-induced decrease in BG in the fasting state, 16 g CHO was administered orally at a plasma glucose (PG) of <70 (3.9), ≤80 (4.5), or ≤90 mg/dL (5.0 mmol/L). The primary outcome was time spent in hypoglycemia (<70 mg/dL) after initial CHO intake. RESULTS When comparing the <70 (control) with the ≤80 and ≤90 mg/dL treatment groups, 100 vs. 86 (P = 0.1201) vs. 34% (P < 0.0001) of participants reached hypoglycemia, respectively. These hypoglycemic events lasted 26.0 ± 12.6 vs. 17.9 ± 14.7 (P = 0.026) vs. 7.1 ± 11.8 min (P = 0.002), with a PG nadir of 56.57 ± 9.91 vs. 63.60 ± 7.93 (P = 0.008) vs. 73.51 ± 9.37 mg/dL (P = 0.002), respectively. In the control group, 69% of participants required more than one treatment to reach or maintain normoglycemia (≥70 mg/dL), compared with 52% in the ≤80 mg/dL group and 31% in the ≤90 mg/dL group, with no significant rebound hyperglycemia (>180 mg/dL) within the first hour. CONCLUSIONS For some impending NS hypoglycemia episodes, individuals with TID could benefit from CHO intake at a higher BG level.
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Affiliation(s)
- Ran Cheng
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Hôpital Maisonneuve-Rosemont, Montréal, Québec, Canada
- Endocrinology Division, Hôpital Santa-Cabrini, Montréal, Québec, Canada
| | - Nadine Taleb
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Zekai Wu
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Experimental Medicine Division, Faculty of Medicine, McGill University, Montréal, Québec, Canada
| | - Delphine Bouchard
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Valérie Parent
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | | | - Valérie Boudreau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Virginie Messier
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | | | - Caroline Grou
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
| | - Anne-Sophie Brazeau
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- School of Human Nutrition, McGill University, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Institut de recherches cliniques de Montréal, Montréal, Québec, Canada
- Department of Biomedical Sciences, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Endocrinology Division, Centre hospitalier de l'Université de Montréal, Montréal, Québec, Canada
- Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
- Montreal Diabetes Research Center, Montréal, Québec, Canada
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Wu Z, Talbo M, Lebbar M, Messier V, Courchesne A, Brazeau AS, Rabasa-Lhoret R. Characteristics associated with having a hemoglobin A1c ≤ 7 % (≤53 mmol/mol) among adults with type 1 diabetes using an automated insulin delivery system. Diabetes Res Clin Pract 2023; 206:111006. [PMID: 37952601 DOI: 10.1016/j.diabres.2023.111006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/16/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND We aim to investigate which characteristics are associated with having an HbA1c ≤ 7 % (≤53 mmol/mol) among adult automated insulin delivery (AID) users living with type 1 diabetes (T1D). METHODS Cross-sectional study using data from the T1D BETTER registry. INCLUSION CRITERIA aged ≥ 18 years old, using a commercial AID system, and with a reported HbA1c range value. Participants were divided into two groups (HbA1c ≤ 7 % group, N = 57; and HbA1c > 7 % group, N = 74). RESULTS A total of 131 participants were included: 61.8 % females, median age (Q1-Q3) was 43.0 (30.0, 55.0) years, and median duration of T1D was 24.0 (16.0, 36.0) years. Logistic regression analysis suggested that participants with a bachelor's degree or above were more likely (OR 3.04, 95 %CI 1.22, 7.58; P = 0.017) and with a longer duration of pump use were less likely (OR 0.90, 95 %CI 0.84, 0.98; P = 0.009) to report an HbA1c ≤ 7 % when using an AID, after adjusting for age, sex, body mass index, and annual household income. CONCLUSIONS Our study indicates that among AID users, in order to maximize benefits, additional support is needed for those who do not have a bachelor's degree and/or who have been using an insulin pump for a long time.
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Affiliation(s)
- Zekai Wu
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, H3A 0G4, Canada; Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada.
| | - Meryem Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada
| | - Virginie Messier
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Alec Courchesne
- Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada
| | - Remi Rabasa-Lhoret
- Department of Medicine, Division of Experimental Medicine, McGill University, Montreal, Quebec, H3A 0G4, Canada; Montreal Clinical Research Institute, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Nutrition, Faculty of Medicine, Universite de Montréal, 2900 Edouard Montpetit Blvd, Montreal, Quebec H3T 1J4, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, Quebec, H2X 0A9, Canada; Division of Endocrinology and Metabolism, Centre hospitalier de l'Université de montréal, 1051 Rue Sanguinet, Montréal, Quebec, H2X 3E4, Canada
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Lin YK, Newman S, Piette J. Response Consistency of Crowdsourced Web-Based Surveys on Type 1 Diabetes. J Med Internet Res 2023; 25:e43593. [PMID: 37594797 PMCID: PMC10474500 DOI: 10.2196/43593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/19/2023] Open
Abstract
Although Amazon Mechanical Turk facilitates the quick surveying of a large sample from various demographic and socioeconomic backgrounds, it may not be an optimal platform for obtaining reliable diabetes-related information from the online type 1 diabetes population.
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Affiliation(s)
- Yu Kuei Lin
- Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Sean Newman
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
| | - John Piette
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, United States
- VA Ann Arbor Healthcare System Center for Clinical Management Research, Ann Arbor, MI, United States
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Madar H, Lalanne-Mistrih ML, Lebbar M, Wu Z, Robitaille Y, Pelletier J, Grou C, Brazeau AS, Rabasa-Lhoret R. Cardiovascular Risk Factors and Adherence to Cardiovascular Protection Practice Guidelines in Adults With Type 1 Diabetes: A BETTER Registry Cross-sectional Analysis. Can J Diabetes 2023; 47:473-481.e1. [PMID: 37059389 DOI: 10.1016/j.jcjd.2023.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 02/12/2023] [Accepted: 04/05/2023] [Indexed: 04/16/2023]
Abstract
OBJECTIVES Cardiovascular disease (CVD) is a major cause of morbidity and mortality in people with type 1 diabetes (PWT1D). We assessed cardiovascular risk factors and pharmacologic treatment in a large Canadian cohort of PWT1D. METHODS This cross-sectional study used data from adult PWT1D in the BETTER registry (n=974). CVD risk factor status, diabetes complications, and treatments (used as proxy for blood pressure and dyslipidemia) were self-reported through online questionnaires. Objective data were available for a subgroup of PWT1D (23%, n=224). RESULTS Participants were adults (43.9±14.8 years) with a diabetes duration of 23.3±15.2 years; 34.8% reported glycated hemoglobin (A1C) levels of ≤7%, 67.2% reported a very high cardiovascular risk, and 27.2% reported at least 3 CVD risk factors. Most participants received care for CVD in accordance with the Diabetes Canada Clinical Practice Guidelines (DC-CPG), with a median recommended pharmacologic treatment score of 75.0%. However, 3 subgroups of participants with lower adherence (<70%) to DC-CPG were identified: 1) those with microvascular complications and receiving a statin (60.8%, 208 of 342) or renin-angiotensin axis nephroprotective therapy (52.6%, 180 of 342); 2) those aged ≥40 years and receiving statin therapy (67.1%, 369 of 550); and 3) those aged ≥30 years with a diabetes duration of ≥15 years and receiving statin therapy (58.9%, 344 of 584). Among a subgroup of participants with recent laboratory results, only 24.5% of PWT1D (26 of 106) achieved both A1C and low-density lipoprotein cholesterol targets. CONCLUSIONS Most PWT1D received recommended pharmacologic cardiovascular protection, but specific subgroups required special attention. Target achievement for key risk factors remains suboptimal.
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Affiliation(s)
- Houssein Madar
- Montreal Clinical Research Institute, Montréal, Québec, Canada
| | - Marie-Laure Lalanne-Mistrih
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, University Hospital, Abymes, Guadeloupe, France; UFR Medicine, French West Indies University, Abymes, Guadeloupe, France
| | - Maha Lebbar
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Zekai Wu
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, Québec, Canada
| | - Yves Robitaille
- Centre de Médecine Métabolique de Lanaudière, Terrebone, Québec, Canada
| | | | - Caroline Grou
- Montreal Clinical Research Institute, Montréal, Québec, Canada
| | - Anne-Sophie Brazeau
- Montreal Clinical Research Institute, Montréal, Québec, Canada; School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, Québec, Canada; Montréal Diabetes Research Center, Montréal, Québec, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Clinical Research Institute, Montréal, Québec, Canada; Department of Nutrition, Faculty of Medicine, Université de Montréal, Montréal, Québec, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, Montréal, Québec, Canada; Montréal Diabetes Research Center, Montréal, Québec, Canada; Centre Hospitalier de l'Université de Montréal Endocrinology Division and CHUM Research Center, Montréal, Québec, Canada.
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Talbo MK, Lebbar M, Wu Z, Vanasse A, Lalanne-Mistrih ML, Brazeau AS, Rabasa-Lhoret R. Gender differences in reported frequency and consequences of hypoglycemia among adults living with type 1 diabetes: results from the BETTER registry. Diabetes Res Clin Pract 2023:110822. [PMID: 37423499 DOI: 10.1016/j.diabres.2023.110822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/05/2023] [Accepted: 07/07/2023] [Indexed: 07/11/2023]
Abstract
AIMS To evaluate the frequency and consequences of level 2 (L2H, glucose level <3.0 mmol/L with autonomous management) and level 3 hypoglycemia (L3H requiring external assistance to treat), in adults living with type 1 diabetes (T1D), while investigating the role of gender. METHODS Cross-sectional analysis of self-reported retrospective data from a Canadian registry of 900 adults living with T1D using logistic regression models adjusted for age, T1D management modalities, hypoglycemia history, and validated patient-reported outcomes scales. Changes in diabetes management, seeking healthcare resources, and impacts on daily well-being were explored. RESULTS Of the 900 adults (66% women, mean age 43.7 ± 14.8 years, mean T1D duration 25.5 ± 14.6 years), 87% used wearable diabetes technology. L3H in the past year was reported by 15% participants, similar between genders. Women reported more L2Hstudy analysis than men (median (Q1, Q3): 4 (2, 10) vs 3 (1,8), p=0.015), and were more likely to report persistent fatigue after both L2H and L3H (Odds ratio [95% confidence interval]: 1.95 [1.16, 3.28] and 1.86 [1.25, 2.75], respectively) and anxiety (1.70 [1.05, 2.75]) after a L3H. CONCLUSIONS The findings suggest taking a gender-based differential approach when addressing hypoglycemia and its various consequences for people living with T1D.
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Affiliation(s)
- Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada
| | - Maha Lebbar
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Département de nutrition, Faculté de médecine, Université de Montréal, 2405 Chem. de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1A8, Canada
| | - Zekai Wu
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada
| | - Andréane Vanasse
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada
| | - Marie-Laure Lalanne-Mistrih
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; University of French West Indies, Guadeloupe, France
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec, H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada.
| | - Remi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal, 110 Pine Ave W, Montréal, Québec, H2W 1R7, Canada; Département de nutrition, Faculté de médecine, Université de Montréal, 2405 Chem. de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1A8, Canada; Department of Medicine, Division of Experimental Medicine, McGill University, 1001 Decarie Boulevard, Montreal, Quebec, H4A 3J1, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada; Département de médecine, Service d'endocrinologie, Centre hospitalier de l'Université de Montréal, 1000, rue Saint-Denis, Montréal, Québec, H2X 0C1, Canada
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Xie LF, Housni A, Roy-Fleming A, Bandini A, Delormier T, Costa DD, Brazeau AS. Evaluation of Support, a self-guided online type 1 diabetes self-management education and support web application-a mixed methods study. Digit Health 2023; 9:20552076231204435. [PMID: 37780064 PMCID: PMC10540604 DOI: 10.1177/20552076231204435] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/03/2023] Open
Abstract
Background Type 1 diabetes requires making numerous daily decisions to maintain normoglycemia. Support is an evidence-based self-guided web application for type 1 diabetes diabetes self-management. Objective Evaluate users' satisfaction with Support and investigate changes in self-reported frequency of-, fear of- hypoglycemia, and diabetes-related self-efficacy. Methods Adults from a Quebec type 1 diabetes registry used Support. Data was collected through online surveys or extracted from the registry at 0, 6, and 12 months (number of episodes and fear of hypoglycemia). At 6 months, participants reported satisfaction with Support and diabetes-related self-efficacy. A sub-group of 16 users was interviewed about their experience. Transcripts were analyzed using inductive and deductive approaches. Results In total, 207 accounts were created (35% men, 96% White, mean age and diabetes duration: 49.3 ± 13.8 and 25.2 ± 14.7 years). At 6 months, the median [Q1; Q3] satisfaction was 40/49 [35; 45] with a mean decrease in hypoglycemia frequency of 0.43 episodes over 3 days (95% CI: -0.86; 0.00, p = 0.051) and of -1.98 score for fear (95% CI: -3.76; -0.20, p = 0.030). Half of the participants reported increased diabetes-related self-efficacy. Conclusions Participants reported a high level of satisfaction with Support. Its use has the potential to facilitate hypoglycemia management and increase diabetes-related self-efficacy. Trial registration This study is registered on ClinicalTrials.gov NCT04233138.
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Affiliation(s)
- Li Feng Xie
- McGill University, School of Human Nutrition, Montreal, Canada
| | - Asmaa Housni
- McGill University, School of Human Nutrition, Montreal, Canada
| | | | - Aude Bandini
- Université de Montréal, Department of Philosophy, Montreal, Canada
| | | | - Deborah Da Costa
- McGill University, Department of Medicine, Montreal, Canada
- Research Institute of the McGill University Health Centre, Montreal, Canada
| | - Anne-Sophie Brazeau
- McGill University, School of Human Nutrition, Montreal, Canada
- Montreal Diabetes Research Center, Montreal, Canada
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Moyen A, Rappaport AI, Fleurent-Grégoire C, Tessier AJ, Brazeau AS, Chevalier S. Relative Validation of an Artificial Intelligence–Enhanced, Image-Assisted Mobile App for Dietary Assessment in Adults: Randomized Crossover Study. J Med Internet Res 2022; 24:e40449. [DOI: 10.2196/40449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/09/2022] [Accepted: 10/23/2022] [Indexed: 11/23/2022] Open
Abstract
Background
Thorough dietary assessment is essential to obtain accurate food and nutrient intake data yet challenging because of the limitations of current methods. Image-based methods may decrease energy underreporting and increase the validity of self-reported dietary intake. Keenoa is an image-assisted food diary that integrates artificial intelligence food recognition. We hypothesized that Keenoa is as valid for dietary assessment as the automated self-administered 24-hour recall (ASA24)–Canada and better appreciated by users.
Objective
We aimed to evaluate the relative validity of Keenoa against a 24-hour validated web-based food recall platform (ASA24) in both healthy individuals and those living with diabetes. Secondary objectives were to compare the proportion of under- and overreporters between tools and to assess the user’s appreciation of the tools.
Methods
We used a randomized crossover design, and participants completed 4 days of Keenoa food tracking and 4 days of ASA24 food recalls. The System Usability Scale was used to assess perceived ease of use. Differences in reported intakes were analyzed using 2-tailed paired t tests or Wilcoxon signed-rank test and deattenuated correlations by Spearman coefficient. Agreement and bias were determined using the Bland-Altman test. Weighted Cohen κ was used for cross-classification analysis. Energy underreporting was defined as a ratio of reported energy intake to estimated resting energy expenditure <0.9.
Results
A total of 136 participants were included (mean 46.1, SD 14.6 years; 49/136, 36% men; 31/136, 22.8% with diabetes). The average reported energy intakes (kcal/d) were 2171 (SD 553) in men with Keenoa and 2118 (SD 566) in men with ASA24 (P=.38) and, in women, 1804 (SD 404) with Keenoa and 1784 (SD 389) with ASA24 (P=.61). The overall mean difference (kcal/d) was −32 (95% CI −97 to 33), with limits of agreement of −789 to 725, indicating acceptable agreement between tools without bias. Mean reported macronutrient, calcium, potassium, and folate intakes did not significantly differ between tools. Reported fiber and iron intakes were higher, and sodium intake lower, with Keenoa than ASA24. Intakes in all macronutrients (r=0.48-0.73) and micronutrients analyzed (r=0.40-0.74) were correlated (all P<.05) between tools. Weighted Cohen κ scores ranged from 0.30 to 0.52 (all P<.001). The underreporting rate was 8.8% (12/136) with both tools. Mean System Usability Scale scores were higher for Keenoa than ASA24 (77/100, 77% vs 53/100, 53%; P<.001); 74.8% (101/135) of participants preferred Keenoa.
Conclusions
The Keenoa app showed moderate to strong relative validity against ASA24 for energy, macronutrient, and most micronutrient intakes analyzed in healthy adults and those with diabetes. Keenoa is a new, alternative tool that may facilitate the work of dietitians and nutrition researchers. The perceived ease of use may improve food-tracking adherence over longer periods.
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Rajan R, Athale U, Ewusie JE, McAssey K, Thabane L, Samaan MC. An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study. Front Pediatr 2022; 10:1038345. [PMID: 36467474 PMCID: PMC9716184 DOI: 10.3389/fped.2022.1038345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background The COVID-19 pandemic led to substantial shifts in pediatric diabetes care delivery to virtual and hybrid models. It is unclear if these changes in care delivery impacted short-term patient outcomes. Objectives We aimed to explore glycemic control and other diabetes-related outcomes in children living with Type 1 Diabetes Mellitus (T1DM) during the first year of the COVID-19 pandemic at a tertiary pediatric academic center in Canada. Subjects Patients <18 years of age with a confirmed diagnosis of T1DM for at least one year were included. Methods This was a retrospective chart review. We compared data from two years pre-pandemic (March 15, 2018-March 14, 2020) to the first year of the pandemic (March 15, 2020-March 14, 2021). The data assessed included glycemic control [Hemoglobin A1c (HbA1c)], diabetic ketoacidosis (DKA), hospital attendance and hospitalizations, hypoglycemia, and hyperglycemia. The generalized estimating equation (GEE) analysis was used to model potential factors affecting the HbA1c and diabetes-related morbidities. Multiple imputations were conducted as a sensitivity analysis. Results There were 346 eligible patients included in the study. The HbA1c remained stable during the pandemic compared to the pre-pandemic phase (MD-0.14, 95% CI, -0.28, 0.01; p = 0.058). The pandemic saw an increase in the number of newly diagnosed patients (X2 = 16.52, p < 0.001) and a higher number of newly diagnosed patients presenting in DKA (X2 = 12.94, p < 0.001). In patients with established diabetes, there was an increase in hyperglycemia (OR1.38, 95% CI, 1.12,1.71; p = 0.003) and reduced DKA (OR 0.30, 95% CI, 0.12,0.73; p = 0.009) during the pandemic compared to the pre-pandemic phase. Stable rates of hospitalization (OR0.57, 95% CI, 0.31,1.04, p = 0.068) and hypoglycemia (OR1.11, 95% CI, 0.83,1.49; p = 0.484) were noted. These results were retained in the sensitivity analysis. Conclusions Glycemic control in children with T1DM remained stable during the first year of the pandemic. There were more newly diagnosed patients during the pandemic compared to the pre-pandemic phase, and more of these new patients presented in DKA. The latter presentation was reduced in those with established diabetes during the same period.Further studies are needed to assess the ongoing impact of the COVID-19 pandemic on T1DM care pathways and outcomes to allow children, families, and diabetes teams to personalize choices of care models.
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Affiliation(s)
- Raeesha Rajan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Uma Athale
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Hematology Oncology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Joycelyne Efua Ewusie
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen McAssey
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
- The Research Institute Biostatistics Unit,St Joseph’s Healthcare Hamilton, Hamilton, ON, Canada
- Department of Anesthesia, McMaster University, Hamilton, ON, Canada
- Centre for Evaluation of Medicines, Hamilton, ON, Canada
| | - M. Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
- Division of Pediatric Endocrinology, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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Iceta S, Sohier L, Bégin C, Brazeau AS, Rabasa-Lhoret R, Gagnon C. Impact of glycemic variability on cognitive impairment, disordered eating behaviors and self-management skills in patients with type 1 diabetes: study protocol for a cross-sectional online study, the Sugar Swing study. BMC Endocr Disord 2022; 22:283. [PMID: 36401237 PMCID: PMC9673316 DOI: 10.1186/s12902-022-01191-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND People living with type 1 diabetes (PWT1D) are at increased risk for impairments in brain function, which may impact on daily life. Cognitive impairments in PWT1D might contribute to increasing eating disorders, reducing self-management skills, and deteriorating glycemic control. Glycemic variability may be a key determinant of disordered eating behaviors, as well as of cognitive impairments. The main objective of this study is to better understand the impact of glycemic variability in disordered eating behaviors and cognitive impairment, and its consequences on self-management skills in PWT1D. METHOD We aim to recruit 150 PWT1D with 50% of men and women in this cross-sectional study. Participants will record their glycemic variability over a 10-day period using a continuous glucose monitoring system (CGMS) and track their dietary intakes using image-assisted food tracking mobile application (2 days). Over four online visits, eating behaviors, diabetes self-management's skills, anxiety disorders, depression disorder, diabetes literacy and numeracy skills, cognitive flexibility, attention deficit, level of interoception, and impulsivity behaviors will be assessed using self-reported questionnaires. Cognitive functions (i.e., attention, executive functions, impulsivity, inhibition and temporal discounting), will be measured. Finally, medical, biological and sociodemographic data will be collected. To further our understanding of the PWT1D experience and factors impacting glycemic self-management, 50 PWT1D will also participate in the qualitative phase of the protocol which consist of individual in-depth face-to-face (virtual) interviews, led by a trained investigator using a semi-structured interview. DISCUSSION This study will contribute to highlighting the consequences of blood sugar fluctuations (i.e., "sugar swings"), in daily life, especially how they disrupt eating behaviors and brain functioning. A better understanding of the mechanisms involved could eventually allow for early detection and management of these problems. Our study will also seek to understand the patients' point of view, which will allow the design of appropriate and meaningful recommendations. TRIAL REGISTRATION ClinicalTrials.gov, NCT05487534. Registered 4 August 2022.
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Affiliation(s)
- Sylvain Iceta
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada.
- Department of Psychiatry and Neurosciences, Laval University, Québec, QC, Canada.
| | - Léonie Sohier
- Research Center of the Quebec Heart and Lung Institute, Québec, QC, Canada
- School of Psychology, Laval University, Québec, QC, Canada
| | - Catherine Bégin
- School of Psychology, Laval University, Québec, QC, Canada
- Centre d'expertise, Poids, Image Et Alimentation (CEPIA), Québec, QC, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Montreal, QC, Canada
- Montreal Institute for Clinical Research, Montreal, QC, Canada
| | - Rémi Rabasa-Lhoret
- Montreal Institute for Clinical Research, Montreal, QC, Canada
- Department of Nutrition, Montreal University, Montreal, QC, Canada
| | - Claudia Gagnon
- CHU de Québec-Université Laval Research Centre, Québec, QC, Canada
- Department of Medicine, Laval University, Québec, QC, Canada
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Xie LF, Housni A, Nakhla M, Cianci R, Leroux C, Da Costa D, Brazeau AS. Adaptation of an adult web application for type 1 diabetes self-management to youth: use of the Behaviour Change Wheel to tailor the needs of healthcare transition- A qualitative study (Preprint). JMIR Diabetes 2022; 8:e42564. [PMID: 37121571 PMCID: PMC10173038 DOI: 10.2196/42564] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 11/24/2022] [Accepted: 01/23/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Youth (aged 14-24 years) living with type 1 diabetes (T1D) encounter increased challenges in their diabetes self-management (DSM), especially during the transition to adult care. Although DSM education and support are imperative, there is insufficient information on how web-based digital tools tailored to their demands can be developed. OBJECTIVE On the basis of the Behavior Change Wheel, this study aims to identify, among youth living with T1D, the needs and factors influencing their DSM in the context of health care transition and to inform the adaptation (content and features) of an adult self-guided web application (Support). METHODS Internet-based semistructured individual interviews based on a phenomenological study design were conducted with 21 youths, and transcripts were analyzed using an inductive approach with concept mapping. RESULTS Factors influencing T1D self-management were categorized into barriers and facilitators and then as external or internal. Features influencing the accessibility to information, increasing the sense of support, and use of the tool were positively accepted. Features unrelated to their expectations of digital tool use or difficulty navigating were viewed negatively. Participants expressed an interest in reliable, practical, and novel educational content. Although youth considered the information provided by medical professionals to be important, peer exchange was deemed necessary to obtain a practical perspective and real-life examples. CONCLUSIONS Compared with the adult population, in addition to tailored content and a simplified information search process, when building a DSM education and support digital tool for youth, features should be selected to encourage supervised peer exchange.
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Affiliation(s)
- Li Feng Xie
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Asmaa Housni
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Meranda Nakhla
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Division of Endocrinology, Montreal Children's Hospital, Montreal, QC, Canada
| | - Rosemarie Cianci
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Catherine Leroux
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
| | - Deborah Da Costa
- The Research Institute of the McGill University Health Centre, Montreal, QC, Canada
- Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, Sainte-Anne-de-Bellevue, QC, Canada
- Montreal Diabetes Research Center, Montreal, QC, Canada
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12
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Talbo MK, Rabasa-Lhoret R, Yale JF, Peters TM, Brazeau AS. Are nocturnal hypoglycemia prevention strategies influenced by diabetes technology usage? A BETTER registry analysis. Diabetes Res Clin Pract 2022; 191:110080. [PMID: 36099973 DOI: 10.1016/j.diabres.2022.110080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/02/2022] [Accepted: 09/06/2022] [Indexed: 12/24/2022]
Abstract
AIM To assess the association of nocturnal hypoglycemia prevention strategies (NH-PS) and diabetes technology usage (insulin pump and/or continuous glucose monitors [CGM]) in people with type 1 diabetes (PWT1D). METHODS Logistic regression models were used to describe associations between self-reported NH-PS and diabetes technology (pump with intermittently-scanned or real-time CGM (isCGM or rtCGM), or automated insulin delivery (AID)), hypoglycemia history, and fear of hypoglycemia (FOH). RESULTS Among 831 adults (65 % female, aged 44 ± 15 years, T1D duration 26 ± 15 years), 32 % reported HbA1c ≤ 7.0 %, 88 % used ≥ 1 diabetes technology, 66 % reported ≥ 1 symptomatic NH in the past month, and 64 % used ≥ 2 NH-PS. Compared to multiple daily injections (MDI) + capillary blood glucose (CBG), bedtime snack consumption was less likely among pump + isCGM (OR [95 %CI]: 0.55 [0.31, 0.98]), pump + rtCGM (0.40 [0.20, 0.81]), and AID (0.34 [0.17, 0.66]) users, while evening insulin basal reduction was associated with CSII + CBG (3.15 [1.25, 7.99]), pump + isCGM 4.00 [1.99, 8.01]), and pump + rtCGM 2.89 [1.28, 6.50] use. Elevated FOH was associated with snack consumption (1.37 [1.00, 1.89]), evening bolus insulin avoidance (1.77 [1.11, 2.83]), limiting exercise (2.50 [1.30, 4.82]), and limiting alcohol consumption (2.33 [1.15, 4.70]) as NH-PS. CONCLUSION Technology use and elevated FOH might influence PWT1D' choice of NH-PS.
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Affiliation(s)
- Meryem K Talbo
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada
| | - Rémi Rabasa-Lhoret
- Institut de Recherches Cliniques de Montréal Université de Montréal, 110 Pine Ave W, Montréal, Québec H2W 1R7, Canada; Division of Endocrinology and Metabolism, Centre hospitalier de l'Université de Montréal, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada
| | - Jean-François Yale
- Division of Endocrinology and Metabolism, McGill University Health Center, McGill University, Montreal, Quebec, Canada
| | - Tricia M Peters
- Lady Davis Institute of Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; The Jewish General Hospital, Division of Endocrinology, Department of Medicine, McGill University, Montreal, QC, Canada
| | - Anne-Sophie Brazeau
- School of Human Nutrition, McGill University, 21111 Lakeshore Dr, Sainte-Anne-de-Bellevue, Quebec H9X 3V9, Canada; Montreal Diabetes Research Center, 900 Saint-Denis, Montreal, QC H2X 0A9, Canada.
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