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Ehrmann D, Hermanns N, Finke-Gröne K, Roos T, Kober J, Schäfer V, Krichbaum M, Haak T, Ziegler R, Heinemann L, Rieger C, Bingol E, Kulzer B, Silbermann S. Efficacy of a Digital Diabetes Logbook for People With Type 1, Type 2, and Gestational Diabetes: Results From a Multicenter, Open-Label, Parallel-Group, Randomized Controlled Trial. J Diabetes Sci Technol 2024:19322968241239870. [PMID: 38529954 DOI: 10.1177/19322968241239870] [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] [Indexed: 03/27/2024]
Abstract
BACKGROUND In a randomized controlled trial, the efficacy of a digital diabetes diary regarding a reduction of diabetes distress was evaluated. METHODS A randomized controlled trial with a 12-week follow-up was conducted in 41 study sites across Germany. Key eligibility criteria were a diagnosis of type 1, type 2, or gestational diabetes and regular self-monitoring of blood glucose. Participants were randomly assigned (2:1 ratio) to either use the digital diabetes logbook (mySugr PRO), or to the control group without app use. The primary outcome was the reduction in diabetes distress at the 12-week follow-up. All analyses were based on the intention-to-treat population with all randomized participants. The trial was registered at the German Register for Clinical Studies (DRKS00022923). RESULTS Between February 11, 2021, and June 24, 2022, 424 participants (50% female, 50% male) were included, with 282 being randomized to the intervention group (66.5%) and 142 to the control group (33.5%). A total of 397 participants completed the trial (drop-out rate: 6.4%). The median reduction in diabetes distress was 2.41 (interquartile range [IQR]: -2.50 to 8.11) in the intervention group and 1.25 (IQR: -5.00 to 7.50) in the control group. The model-based adjusted between-group difference was significant (-2.20, IQR: -4.02 to -0.38, P = .0182) favoring the intervention group. There were 27 adverse events, 17 (6.0%) in the intervention group, and 10 (7.0%) in the control group. CONCLUSIONS The efficacy of the digital diabetes logbook was demonstrated regarding improvements in mental health in people with type 1, type 2, and gestational diabetes.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Katharina Finke-Gröne
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | | | | | - Michael Krichbaum
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents, Muenster, Germany
| | | | | | | | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
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Hermanns N, Ehrmann D, Finke-Groene K, Krichbaum M, Roos T, Haak T, Freckmann G, Kulzer B. Use of smartphone application versus written titration charts for basal insulin titration in adults with type 2 diabetes and suboptimal glycaemic control (My Dose Coach): multicentre, open-label, parallel, randomised controlled trial. Lancet Reg Health Eur 2023; 33:100702. [PMID: 37954005 PMCID: PMC10636267 DOI: 10.1016/j.lanepe.2023.100702] [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] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 07/07/2023] [Accepted: 07/12/2023] [Indexed: 11/14/2023]
Abstract
Background The majority of people with type 2 diabetes who require insulin therapy use only basal insulin in combination with other anti-diabetic agents. We tested whether using a smartphone application to titrate insulin could improve glycaemic control in people with type 2 diabetes who use basal insulin. Methods This was a 12-week, multicentre, open-label, parallel, randomised controlled trial conducted in 36 diabetes practices in Germany. Eligible participants had type 2 diabetes, a BMI ≥25.0 kg/m2, were on basal insulin therapy or were initiating basal insulin therapy, and had suboptimal glycaemic control (HbA1c >7.5%; 58.5 mmol/mol). Block randomisation with 1:1 allocation was performed centrally. Participants in the intervention group titrated their basal insulin dose using a smartphone application (My Dose Coach) for 12 weeks. Control group participants titrated their basal insulin dose according to a written titration chart. The primary outcome was the baseline-adjusted change in HbA1c at 12 weeks. The intention-to-treat analysis included all randomised participants. Results Between 13 July 2021 and 21 March 2022, 251 study participants were randomly assigned (control group: n = 123; intervention group: n = 128), and 236 completed the follow-up phase (control group: n = 119; intervention group: n = 117). Regarding the HbA1c a model-based adjusted between-group difference of -0.31% (95% CI: 0.01%-0.69%; p = 0.0388) in favour of the intervention group was observed. There were 30 adverse events reported: 16 in the control group, 14 in the intervention group. Of these, 15 adverse events were serious. No event was considered to be related to the investigational device. Interpretation Study results suggest that utilizing this digital health smartphone application for basal insulin titration may have resulted in a comparatively greater reduction in HbA1c levels among individuals with type 2 diabetes, as compared to basal insulin titration guided by a written titration schedule. No negative effect on safety outcomes was observed. Funding Sanofi-Aventis Deutschland GmbH.
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Affiliation(s)
- Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
| | - Katharina Finke-Groene
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Michael Krichbaum
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Timm Roos
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
| | - Thomas Haak
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
| | - Guido Freckmann
- IfDT - Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH, Helmholtzstr. 20, Ulm 89081, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, Bad Mergentheim 97980, Germany
- Diabetes Centre Bad Mergentheim, Theodor-Klotzbuecher-Str. 12, Bad Mergentheim 97980, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, Bamberg 96047, Germany
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Hermanns N, Ehrmann D, Finke-Gröne K, Roos T, Freckmann G, Kulzer B. Evaluation of a Digital Health Tool for Titration of Basal Insulin in People With Type 2 Diabetes: Rationale and Design of a Randomized Controlled Trial. J Diabetes Sci Technol 2023:19322968221148756. [PMID: 36602040 DOI: 10.1177/19322968221148756] [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] [Indexed: 01/06/2023]
Abstract
BACKGROUND Optimal insulin titration is essential in helping people with type 2 diabetes mellitus (T2DM) to achieve adequate glycemic control. Barriers of people with diabetes to implementation of titration include lack of self-efficiency and self-management skills, increased diabetes-related distress, low treatment satisfaction, poor well-being, as well as concerns about hypoglycemia and insulin overdose. My Dose Coach is a digital health tool for optimizing titration of basal insulin that combines a smartphone app for patients with T2DM and a Web portal for health care professionals. METHODS/DESIGN This is a prospective, open-label, multicenter, randomized controlled parallel study conducted in approximately 50 centers in Germany that are specialized in the treatment of diabetes. Patients in the intervention group will use the titration app and will be registered on the Web portal by their treating physician. Control group patients will continue their current basal insulin titration without using the app. The primary outcome is the mean change in HbA1c levels at the 12-week follow-up. The secondary outcome measures include patient-reported outcomes such as diabetes-related distress, self-management, empowerment, self-efficacy, treatment satisfaction, and psychological well-being as well as fasting blood glucose values. CONCLUSION This digital health tool has been previously implemented in several independent pilot studies. The findings from this multicenter randomized controlled trial can provide further evidence supporting the effectiveness of this tool in patients with T2DM and serve as a basis for its clinical integration. TRIAL REGISTRATION German Register for Clinical Studies-DRKS-ID: DRKS00024861.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | | | - Timm Roos
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | - Guido Freckmann
- Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Institut für Diabetes-Technologie, Ulm, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- Diabetes Center Mergentheim, Bad Mergentheim, Germany
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Bergis D, Roos T, Ehrmann D, Schmitt A, Schipfer M, Haak T, Kulzer B, Hermanns N. Perceived Benefits and Barriers Regarding CSII Treatment: Development and Psychometric Evaluation of the Insulin Pump Attitudes Questionnaire (IPA-Questionnaire). Exp Clin Endocrinol Diabetes 2019; 129:566-573. [PMID: 31426110 DOI: 10.1055/a-0899-4980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Continuous subcutaneous insulin infusion is the most advanced and demanding form of insulin therapy. Various positive and negative expectations, attitudes and experiences can occur, influencing adherence to and efficacy of continuous subcutaneous insulin infusion therapy. A new questionnaire was developed to systematically assess perceived benefits, perceived barriers and handling of continuous subcutaneous insulin infusion therapy. METHODS The Insulin Pump Attitude Questionnaire was tested in two samples (n=265/452) comprising pump users and non-pump users. Reliability was assessed using Cronbach's Alpha estimation. Exploratory and confirmatory factor analyses were conducted to establish the factorial structure. Correlations with other questionnaires as well as group differences between pump users and non-pump users were used to assess validity. RESULTS Exploratory factor analysis revealed 26 items comprising six subscales: "Glycaemic Control", "Flexibility", "Impaired Body Image", "Technology Dependency", "Ease Of Use" and "Functionality". Confirmatory factor analysis confirmed this factor structure. The IPA sum score correlated significantly with diabetes distress (r=-0.30), self-efficacy (r=0.22), diabetes empowerment (r=0.36), psychological well-being (r=0.16) and treatment dissatisfaction (r=-0.24), supporting criterion validity with small to medium effect sizes. Furthermore, the IPA was able to differentiate between pump users and non-pump users with higher scores for pump users regarding "Glycaemic Control", "Flexibility", "Ease of use" and "Functionality" and lower scores for pump users regarding "Impaired Body Image" and "Technology Dependency". CONCLUSIONS The Insulin Pump Attitude Questionnaire is a reliable and valid new instrument to assess attitudes towards continuous subcutaneous insulin infusion. With six scales, the Insulin Pump Attitude Questionnaire provides a comprehensive analysis of possible benefits, barriers, and handling problems of continuous subcutaneous insulin infusion therapy. In clinical practice, the Insulin Pump Attitude Questionnaire might be used to address the different attitudes in pump users but also in people considering continuous subcutaneous insulin infusion therapy.
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Affiliation(s)
- Dominik Bergis
- Division of Endocrinology & Diabetes, Department of Internal Medicine 1, Goethe University Hospital, Frankfurt am Main, Germany
| | - Timm Roos
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
| | - Dominic Ehrmann
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Andreas Schmitt
- Diabetes Akademie Bad Mergentheim, e.V., Bad Mergentheim, Germany
| | - Melanie Schipfer
- Profusa, Inc., 345 Allerton Ave, South San Francisco, CA 94080, USA
| | - Thomas Haak
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
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Hermanns N, Ehrmann D, Schipfer M, Kröger J, Haak T, Kulzer B. The impact of a structured education and treatment programme (FLASH) for people with diabetes using a flash sensor-based glucose monitoring system: Results of a randomized controlled trial. Diabetes Res Clin Pract 2019; 150:111-121. [PMID: 30844467 DOI: 10.1016/j.diabres.2019.03.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [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: 11/30/2018] [Revised: 01/31/2019] [Accepted: 03/01/2019] [Indexed: 10/27/2022]
Abstract
AIMS Flash sensor-based glucose monitoring (FSGM) provides people with diabetes considerably more information on their glycaemic control. We have developed and evaluated a structured education and treatment programme, termed FLASH, to assist FSGM users to understand and use the available glycaemic information for optimization of their diabetes treatment. METHODS We report on a multi-centre, randomized, parallel trial with a six-month follow-up involving 216 eligible participants (16-75 years old) on intensive insulin therapy. The primary outcome was HbA1c change from baseline to six months. Secondary outcomes were measures of glucose control as assessed by FSGM, as well as changes in behavioural and psychosocial measures. RESULTS At six months, the between-group difference in HbA1c reduction was significant, favouring FLASH education compared to the control group receiving no FLASH education (-0.28%, 95% CI -0.16% to -0.40% vs.-0.11%, 95% CI 0.00% to -0.22%; with a between-group difference of -0.17%, 95% CI -0.01% to -0.33%; p = 0.033). Participation in FLASH education also resulted in significant improvements in time spent in the target glucose range, in diabetes-related distress scores and in satisfaction with the glucose monitoring method. FLASH education also resulted in significant improvements in the use of glycaemic information provided by FSGM and in reduced self-monitoring of blood glucose (SMBG) fingerstick testing. CONCLUSION FLASH is an effective programme to improve glycaemic control and lower diabetes-related distress in users of FSGM. The study was registered in ClinicalTrials: NCT03175315.
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Affiliation(s)
- Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany; Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany.
| | - Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany
| | - Melanie Schipfer
- Profusa, Inc., 345 Allerton Ave, South San Francisco, CA 94080, USA
| | - Jens Kröger
- Centre of Diabetology Hamburg Bergedorf, Hamburg, Germany
| | - Thomas Haak
- Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Johann-Hammer-Str. 24, 97980 Bad Mergentheim, Germany; Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany; Diabetes Clinic Mergentheim, Theodor-Klotzbuecher-Str. 12, 97980 Bad Mergentheim, Germany
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