Effectiveness of diabetes self-management education via a smartphone application in insulin treated type 2 diabetes patients - design of a randomised controlled trial ('TRIGGER study').

Health care providers aim to stimulate self-management in type 2 diabetes (T2DM) patients. However, they have a limited number of patient contacts to do this. With the growing number of T2DM patients, innovative and cost-effective interventions to promote self-management are needed. We aim to evaluate the effectiveness of diabetes self-management education via a smartphone app in T2DM patients on insulin therapy

Telemedicine and mHealth interventions for children and young people with type one diabetes (T1DM)

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The impact of mobile monitoring technologies on glycosylated hemoglobin in diabetes: a systematic review

Background: A new development in the field of telehealth is the use of mobile health technologies (mhealth) to help patients record and track medical information. Mhealth appears particularly advantageous for conditions that require intense and ongoing monitoring, such as diabetes, and where people are of working age and not disabled. This review aims to evaluate the evidence for the effectiveness of mhealth interventions in diabetes management on glycosylated hemoglobin. Method: A comprehensive search strategy was developed and applied to eight electronic databases to identify studies that investigated the clinical effectiveness of mobile-based applications that allowed patients to record and send their blood glucose readings to a central server. The eligibility of 8543 papers was assessed against the selection criteria, and 24 papers were reviewed. All studies reviewed were assessed for quality using a standardized quality assessment tool. Results: Results for patients with type 1 and type 2 diabetes were examined separately. Study variability and poor reporting made comparison difficult, and most studies had important methodological weaknesses. Evidence on the effectiveness of mhealth interventions for diabetes was inconsistent for both types of diabetes and remains weak

Mobile Health Biometrics to Enhance Exercise and Physical Activity Adherence in Type 2 Diabetes (MOTIVATE-T2D): protocol for a feasibility randomised controlled trial

Introduction Exercise and physical activity (PA) are fundamental to the treatment of type 2 diabetes. Current exercise and PA strategies for newly diagnosed individuals with type 2 diabetes are either clinically effective but unsuitable in routine practice (supervised exercise) or suitable in routine practice but clinically ineffective (PA advice). Mobile health (mHealth) technologies, offering biometric data to patients and healthcare professionals, may bridge the gap between supervised exercise and PA advice, enabling patients to engage in regular long-term physically active lifestyles. This feasibility randomised controlled trial (RCT) will evaluate the use of mHealth technology when incorporated into a structured home-based exercise and PA intervention, in those recently diagnosed with type 2 diabetes.Methods and analysis This feasibility multicentre, parallel group RCT will recruit 120 individuals with type 2 diabetes (diagnosis within 5–24 months, aged 40–75 years) in the UK (n=60) and Canada (n=60). Participants will undertake a 6-month structured exercise and PA intervention and be supported by an exercise specialist (active control). The intervention group will receive additional support from a smartwatch and phone app, providing real-time feedback and enabling improved communication between the exercise specialist and participant. Primary outcomes are recruitment rate, adherence to exercise and loss to follow-up. Secondary outcomes include a qualitative process evaluation and piloting of potential clinical outcome measures for a future RCT. Ethics and dissemination The trial was approved in the UK by the South East Scotland Research Ethics Committee 01 (20/SS/0101) and in Canada by the Clinical Research Ethics Board of the University of British Columbia (H20-01936), and is being conducted in accordance with the Declaration of Helsinki and Good Clinical Practice. Results will be published in peer-reviewed journals and presented at national and international scientific meetings.Trial registrationnumbers,ISRCTN14335124; ClinicalTrials.gov: NCT04653532

Investigating the use of mobile technology to promote active lifestyles and improved glycaemic control in individuals with type 2 diabetes

The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research.The purpose of this thesis was to examine the potential of using mobile technology to promote active lifestyles and improved glycaemic control in individuals with Type 2 diabetes. Chapter 1 introduced the research area, thesis rationale, and the design and structure of the thesis. Five studies were undertaken as part of this thesis. This first (Chapter 2) was a systematic and integrated literature review examining the effectiveness, acceptability and feasibility of using mobile technology to promote active living in adults with Type 2 Diabetes. The second (Chapter 3) presented the challenges and solutions of combining glucose and activity data sets measured continuously using mobile technology. The third (Chapter 4) examined the physical activity, sedentary behaviour and glucose patterns of adults with Type 2 diabetes in a free-living setting using mobile technology. The fourth (Chapter 5) examined the individual glycaemic response in adults with Type 2 Diabetes to interrupting prolonged sedentary behaviour in a controlled setting. Study five (Chapter 6) explored the experiences of, and attitudes towards, using mobile technologies to promote active living in adults with Type 2 diabetes. The final chapter (Chapter 7) discussed the findings of these studies in the wider context of the thesis and how the findings can be used to positively impact diabetes care and future research

Exploring the potential of using mobile applications in diabetes management

Background Diabetes mellitus is a common chronic disease and a leading cause of morbidity, complications and mortality worldwide. The number of people living with diabetes is projected to rise sharply over the forthcoming decades. Diabetes care is complex and can overburden clinicians and nurses. There is a need for innovative, flexible and cost-effective technologies to enable successful diabetes management. This thesis explores the opportunities and challenges of the mobile application (app) technology as a potential tool to support diabetes care and management. Purpose The purpose was to develop and evaluate a mobile app that supports healthcare professionals (HCPs) in clinical decision-making. Methods A mixed-methods approach was used following the user-centred design (UCD) framework for the design and implementation of all studies. Quantitative and qualitative systematic reviews of studies reporting the use of mobile apps to support diabetes management were undertaken to identify, appraise and summarise available research evidence. An interview study was carried out with diabetes specialist nurses (DSNs), to explore their experiences and views, and to identify user requirements for apps. Lastly, a guidelines-based mobile clinical decision-support app was developed and tested with junior doctors and DSNs in a controlled environment to evaluate its usability and impact on adherence to clinical guidelines, and to explore how participants experienced the app and their suggestions for improvements. Results Both reviews found that the existing evidence base for mobile apps is weak and inadequate to draw conclusions about the impact of their use as interventions in diabetes management. The interview study identified that nurses lack experience in using apps in clinical practice, even though they believed it could facilitate and support their work. ‘Diabetes & CKD’, a simple mobile decision-support app, has been designed and built for the study to assist HCPs in management of patients with diabetes and kidney disease and was tested by 39 junior doctors and 3 DSNs. It had no impact on the accuracy of decisions. Feedback from participants after the pilot session and usability testing indicated a wish to integrate such apps into their clinical practice with a strong willingness to use them in the future. Conclusions Application of UCD methods was efficient as the app was well-accepted by both DSNs and junior doctors. Despite the positive views and the strong willingness to use such apps, they are not widely used. There is a need to regulate the use of medical apps in clinical practice. Further research with rigorous methodology is required upon which policymakers and practitioners can base their decision-making

An adaptive real-time intelligent system to enhance self-care of chronic disease (ARISES)

Diabetes mellitus is an increasingly prevalent chronic metabolic condition characterised by impaired glucose homeostasis and raised blood glucose levels (hyperglycaemia). Broadly categorised as either type 1 (T1DM) or type 2 diabetes (T2DM), people with diabetes are largely responsible for self-managing their blood glucose levels. Despite the development of diabetes technologies such as real time continuous glucose monitoring (RT-CGM), many individuals are frequently exposed to iatrogenic low blood glucose levels (hypoglycaemia). Severe hypoglycaemia is associated with an increased risk of recurrent hypoglycaemia, impaired symptomatic awareness of hypoglycaemia, and potentially death if left untreated. This thesis affirmed the existing clinical impact of severe hypoglycaemia and its recurrent risk in a six-month analysis of severe hypoglycaemia attended by the London Ambulance Service NHS Trust (LAS). Fewer incidents of severe hypoglycaemia observed in a date matched repeat analysis during the 2020 COVID-19 lockdown suggested improved self-management possibly motivated by a proximal fear of hospitalisation and improved structure at home. Finally, a 12-week randomised control trial demonstrating a significant difference in time spent in hypoglycaemia <3mmol/L, is the first study to prove the immediate provision of RT-CGM significantly reduces the risk of recurrent hypoglycaemia. Moreover, it highlighted the impact of socioeconomic disparity as a barrier to effective hypoglycaemia risk modification. This guided the design of an adaptive real time intelligent system to enhance self-care of chronic disease (ARISES) aimed to deliver therapeutic and lifestyle decision support for people with T1DM. The ARISES graphic user interface (GUI) design was a collaborative process conceived in a series of focus group meetings including people with T1DM. Finally, a 12-week observational study using RT-CGM, a physiological sensor wristband, and a mobile diary app, allowed for a sub-analysis identifying measurable physiological parameters associated with current and impending hypoglycaemia in people with T1DM.Open Acces

MOBILE SMARTPHONE INTERVENTION FOR MANAGING GLYCAEMIA CONTROL IN THE PATIENTS WITH DIABETES MELLITUS: A SYSTEMATIC REVIEW

Background: Diabetes mellitus (DM) is a chronic disease that is a global public health problem that has a social impact, economic impact, and quality of life for patients, which leads to increased morbidity and mortality. Uncontrolled blood sugar levels and long-term DM, affecting the pathophysiology of disorders including diabetic retinopathy, heart disease, kidney failure, hyperglycemia and hypoglycemia are needed interventions that can help regulate glycemic (blood sugar levels and HbA1c) (Sami & Ansari, 2015). Objective: This study aimed to identify efficacy mobile smartphone application for managing glycaemia control in the patients with diabetes mellitus. Design: This study design is a systematic review to search and review article from database and the theory underlying this study or guidance in this systematic literature review using Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Data Sources: Database search for article are from Scopus, Proquest, Pubmed, Science Direct, and Springer Link is limited to the publication of the last five years from 2015 to 2020 and full text article in English. Review Methods: This review methods in a systematic review based on Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA). Results: In this review literature, thirteen articles were found that fit the specified inclusion and exclusion criteria. The results of this review literature found that mobile smartphone impelmentation led to a decrease in HbA1c and fasting blood glucose in the patients with diabetes mellitus. Conclusion: The findings from this study help validate the efficacy of the mobile diabetes intervention for managing glycaemia control in the patients with diabetes mellitus. Keywords: Diabetes Mellitus, Glycaemia Control, Health Education, M-Health

Enhancing diabetes self-management through mobile phone application

Mary Adu adopted a systematic health behavioural framework and user engagement process to develop and explore the efficacy of a novel mobile-phone app for diabetes self-management. Reported benefits of the app provide empirical evidence of support for its multi-feature functionality and comprehensive interventional role in diabetes self-management education and support

The Use of Data Collected from mHealth apps to inform Evidence-based Quality Improvement: An Integrative Review:Using data from mHealth apps to inform Evidence-based Quality Improvement

© 2019 Sigma Theta Tau International Background: The global acceptance and use of technology in health care has resulted in an abundance of mobile health (mHealth) applications (apps) available for use in the delivery and improvement of care. With so many apps available to patients and clinicians, it is important to understand how data from apps are being used to inform quality improvement in practice. Aim: The aim of this integrative review is to establish current knowledge of how mHealth apps are used to produce data to inform quality improvement in health care. Methods: Scopus, Web of Science, CINAHL, and Medline Plus Full Text databases were searched for peer-reviewed papers written in English. The inclusion criteria comprised of full-text, empirical research studies relating to mobile health application use (not development) in clinical care. Results: Nineteen studies met inclusion criteria. The functions of the apps outlined in the studies can be summarized into four different categories: communication, illness management, clinical management, and education/information. The types of data collected by the apps included numerical, textual, photographic, and graphical with several apps able to collect a variety of data types. Analysis of the studies showed that although data collection is rarely outlined as the explicit purpose of mHealth apps, data collected through such technology are and can be used to inform practice change both in real time and retrospectively. Linking Evidence to Action: This review highlights while this is an emerging area, data obtained from mHealth apps can and are being used to inform quality improvement in health care. Further research is required in this area to adequately understand how data from mHealth apps can be used to produce quality improvement, specifically in relation to nursing. This review also highlights a need for the development of apps that aim to capture data to inform quality improvement, particularly from the patient perspective