Using Smartphone Technology to Enhance Self-Management Support in Adults with Type 2 Diabetes in Primary Care

Background: Self-care is a crucial component in the management of Type 2 Diabetes Mellitus (T2DM). The literature shows that frequent feedback on blood sugar recordings together with reminders can lead to improvements in patient’s glucose control and diabetic self-care. The Chronic Care Model developed by Wagner emphasizes the importance of patient participation in the management of their chronic diseases. Purpose: To explore the possibility of using smartphone technology to help adults with T2DM better manage this chronic disease in a primary care clinic in New England. Methods: A smartphone application (App) OnTrack Diabetes (OnTrack) and text messaging were used to enhance communication between the patient and the provider. After receiving facility and IRB waivers, participants were recruited and trained on the downloaded App. Data was generated through text messages, the App and DNP student journaling, which was evaluated for patient and provider satisfaction with the App. Results: This project lasted about five months with five out of the seven participants recruited actually completing the project. Many (60%) of the participants found the App useful, 80% followed through with the instructions in the text messages and 60% intend to continue to use the App. Three out of five providers liked the App and intend to continue to use it. Most (80%) of the participants noticed a decrease in blood sugar, hemoglobin A1C and weight. Conclusion: This project confirms that an App and text messaging may be a useful tool for primary care providers to enhance self management in patients with T2DM and that frequent communication with the patient in between face to face office visits keeps them engaged and more compliant with diabetes management

Integrating Technology to Support and Maintain Glycemic Control in People With Diabetes

Presented to the Faculty of the University of Alaska Anchorage in Partial Fulfillment of the Requirements for the Degree of MASTER OF SCIENCEType II diabetes is a chronic disease state that leads to increased morbidity and mortality and impacts the lives of millions of Americans. This quality improvement project explored the use of a free smartphone application, Glucose Buddy, in aiding people with Type II diabetes to achieve and maintain glycemic control. The project was conducted through the involvement of patients at the Creekside Family Health Clinic in Ketchikan, Alaska over a three month time period. Pre-intervention hemoglobin A1c (HA1c) was compared with post-intervention HA1c. The project, due to the small sample size and high withdraw rate, was not statistically significant. However, there was clinical significance as it showed a decrease in HA1c levels in 60% of the participants.Abstract / Introduction / Literature Review and Synthesis / Problem Statement / Research Question / Methodology / Results / Limitations / Conclusions / Outcomes / Impact on Practice / Dissemination / References / Appendix A / Appendix B / Appendix C / Appendix

Prescribable mHealth apps identified from an overview of systematic reviews

AbstractMobile health apps aimed towards patients are an emerging field of mHealth. Their potential for improving self-management of chronic conditions is significant. Here, we propose a concept of “prescribable” mHealth apps, defined as apps that are currently available, proven effective, and preferably stand-alone, i.e., that do not require dedicated central servers and continuous monitoring by medical professionals. Our objectives were to conduct an overview of systematic reviews to identify such apps, assess the evidence of their effectiveness, and to determine the gaps and limitations in mHealth app research. We searched four databases from 2008 onwards and the Journal of Medical Internet Research for systematic reviews of randomized controlled trials (RCTs) of stand-alone health apps. We identified 6 systematic reviews including 23 RCTs evaluating 22 available apps that mostly addressed diabetes, mental health and obesity. Most trials were pilots with small sample size and of short duration. Risk of bias of the included reviews and trials was high. Eleven of the 23 trials showed a meaningful effect on health or surrogate outcomes attributable to apps. In conclusion, we identified only a small number of currently available stand-alone apps that have been evaluated in RCTs. The overall low quality of the evidence of effectiveness greatly limits the prescribability of health apps. mHealth apps need to be evaluated by more robust RCTs that report between-group differences before becoming prescribable. Systematic reviews should incorporate sensitivity analysis of trials with high risk of bias to better summarize the evidence, and should adhere to the relevant reporting guideline.</jats:p

A case study in open source innovation: developing the Tidepool Platform for interoperability in type 1 diabetes management.

OBJECTIVE:Develop a device-agnostic cloud platform to host diabetes device data and catalyze an ecosystem of software innovation for type 1 diabetes (T1D) management. MATERIALS AND METHODS:An interdisciplinary team decided to establish a nonprofit company, Tidepool, and build open-source software. RESULTS:Through a user-centered design process, the authors created a software platform, the Tidepool Platform, to upload and host T1D device data in an integrated, device-agnostic fashion, as well as an application ("app"), Blip, to visualize the data. Tidepool's software utilizes the principles of modular components, modern web design including REST APIs and JavaScript, cloud computing, agile development methodology, and robust privacy and security. DISCUSSION:By consolidating the currently scattered and siloed T1D device data ecosystem into one open platform, Tidepool can improve access to the data and enable new possibilities and efficiencies in T1D clinical care and research. The Tidepool Platform decouples diabetes apps from diabetes devices, allowing software developers to build innovative apps without requiring them to design a unique back-end (e.g., database and security) or unique ways of ingesting device data. It allows people with T1D to choose to use any preferred app regardless of which device(s) they use. CONCLUSION:The authors believe that the Tidepool Platform can solve two current problems in the T1D device landscape: 1) limited access to T1D device data and 2) poor interoperability of data from different devices. If proven effective, Tidepool's open source, cloud model for health data interoperability is applicable to other healthcare use cases

Empower You: an Adult Type 2 Diabetes Mellitus Management Program with Utilization of a Mobile Phone Application

In 2018, 34.2 million Americans had diabetes and there continues to be 1.5 million Americans diagnosed with diabetes every year (ADA, 2018). Due to this increasing prevalence, self-management of type 2 diabetes mellitus (T2DM) is essential to disease management. The PICOT question for this project was: In adults with T2DM with a hemoglobin A1C (HbA1C) greater than 8% in a diabetes specialty clinic (P), what is the effect of a multimodal smartphone application (I) compared to prior nonuse of the application (C) on average blood glucose readings (O) over an 8-week period (T)? The project was completed in a large, metropolitan area located in southcentral Wisconsin. There was a total of 11 participants, comprised mostly of males with a range from 46-76 years of age. The Johns Hopkins Nursing Evidence-Based Practice (JHNEBP) Model was utilized to guide the development and implementation of this project. The project used a within-group design that evaluated the effect of a multimodal smartphone application on average blood glucose levels. Data were collected through patient-owned glucometers that were connected via Bluetooth to the mySugr© application. Pre-intervention and post-intervention blood glucose level data were analyzed using a paired sample t-test. Secondary outcomes included time in range (TIR), estimated HbA1C, and DES-SF scores. Statistically significant differences were found for average blood glucose levels (p = .008), TIR (p = .0025), estimated HbA1C (p = .00048), and DES-SF scores (p =.007). Findings from this project demonstrated that the use of a multimodal smartphone application can lower average blood glucose levels