Efficacy of the mHealth application in patients with type 2 diabetes transitioning from inpatient to outpatient care: A randomized controlled clinical trial

Introduction: No studies have assessed the efficacy of telemedicine using a platform for recording and adjusting insulin doses in patients with diabetes mellitus type 2 (DM2) transitioning from inpatient to outpatient care. This study aimed to assess, in a population of patients with DM2, discharged from a tertiary referral hospital, whether treatment based on the use of an mHealth application was associated with better glycemic control at the 3-month follow-up, than standard care. Methods: This open, randomized, controlled clinical trial included adult DM2 patients who were transitioning from inpatient to outpatient care. The efficacy and safety of patient management with and without mHealth was compared at the 3-month follow-up. The primary outcome was the change in the Glycosylated hemoglobin (HbA1c) levels. The secondary outcomes were the rates of hypoglycemic and hyperglycemic events and treatment satisfaction measured using the Insulin Treatment Satisfaction Questionnaire (ITSQ). Results: In total, 86 patients (41 using mHealth) were included in the clinical trial. HbA1c levels showed a significant decrease in both groups. The mean HbA1c level was significantly lower in the mHealth group. Patients using mHealth showed decreased incidence rate ratios of hypoglycemia 3.0 mmol/L [<54 mg/dl], hypoglycemia ranging from 3.0 to 3.8 mmol/L [54 to 70 mg/dl] and severe hypoglycemia. The level of satisfaction assessed using the ITSQ was higher in the mHealth group. Conclusion: Using mHealth in patients with DM2 transitioning from inpatient to outpatient care improves metabolic control and may reduce the hypoglycemia rates

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Depto. de Teorías y Análisis de la ComunicaciónFac. de Ciencias de la InformaciónFALSEsubmitte

Efficacy of the mHealth application in patients with type 2 diabetes transitioning from inpatient to outpatient care : a randomized controlled clinical trial

Ningún estudio ha evaluado la eficacia de la telemedicina utilizando una plataforma para registrar y ajustar las dosis de insulina en pacientes con diabetes mellitus tipo 2 (DM2) en transición de atención hospitalaria a ambulatoria . Este estudio tuvo como objetivo evaluar, en una población de pacientes con DM2, dados de alta de un hospital de referencia de tercer nivel, si el tratamiento basado en el uso de una aplicación mHealth se asoció con un mejor control glucémico a los 3 meses de seguimiento, que la atención estándar. Métodos Este ensayo clínico abierto, aleatorizado y controlado incluyó a pacientes adultos con DM2 que estaban pasando de la atención hospitalaria a la ambulatoria. Se comparó la eficacia y seguridad del manejo de pacientes con y sin mHealth en el seguimiento de 3 meses. El resultado primario fue el cambio en los niveles de hemoglobina glicosilada (HbA1c). Los resultados secundarios fueron las tasas de eventos hipoglucémicos e hiperglucémicos y la satisfacción con el tratamiento medida mediante el Cuestionario de Satisfacción con el Tratamiento con Insulina (ITSQ). Resultados En total, se incluyeron en el ensayo clínico 86 pacientes (41 con mHealth). Los niveles de HbA1c mostraron una disminución significativa en ambos grupos. El nivel medio de HbA1c fue significativamente más bajo en el grupo mHealth. Los pacientes que usaban mHealth mostraron índices de tasa de incidencia reducidos de hipoglucemia de 3,0 mmol/L [<54 mg/dl], hipoglucemia que oscilaba entre 3,0 y 3,8 mmol/L [54 a 70 mg/dl] e hipoglucemia grave. El nivel de satisfacción evaluado mediante el ITSQ fue mayor en el grupo mHealth. Conclusión El uso de mHealth en pacientes con DM2 en transición de atención hospitalaria a ambulatoria mejora el control metabólico y puede reducir las tasas de hipoglucemia.Q1No studies have assessed the efficacy of telemedicine using a platform for recording and adjusting insulin doses in patients with diabetes mellitus type 2 (DM2) transitioning from inpatient to outpatient care. This study aimed to assess, in a population of patients with DM2, discharged from a tertiary referral hospital, whether treatment based on the use of an mHealth application was associated with better glycemic control at the 3-month follow-up, than standard care. Methods This open, randomized, controlled clinical trial included adult DM2 patients who were transitioning from inpatient to outpatient care. The efficacy and safety of patient management with and without mHealth was compared at the 3-month follow-up. The primary outcome was the change in the Glycosylated hemoglobin (HbA1c) levels. The secondary outcomes were the rates of hypoglycemic and hyperglycemic events and treatment satisfaction measured using the Insulin Treatment Satisfaction Questionnaire (ITSQ). Results In total, 86 patients (41 using mHealth) were included in the clinical trial. HbA1c levels showed a significant decrease in both groups. The mean HbA1c level was significantly lower in the mHealth group. Patients using mHealth showed decreased incidence rate ratios of hypoglycemia 3.0 mmol/L [<54 mg/dl], hypoglycemia ranging from 3.0 to 3.8 mmol/L [54 to 70 mg/dl] and severe hypoglycemia. The level of satisfaction assessed using the ITSQ was higher in the mHealth group. Conclusion Using mHealth in patients with DM2 transitioning from inpatient to outpatient care improves metabolic control and may reduce the hypoglycemia rates.Revista Internacional - IndexadaS

Marco referencial de la profesión de Enfermería

Título del libro "Marco Referencial de la Profesión de Enfermería" no la participación de los autores: Toxqui Tlachino, María Juana Gloria; Sánchez Arias, Andrea Guadalupe; Cárdenas Becerril, Lucila; Becerril Amero, Patricia; Gómez Martínez, Vicenta; Hernández Ortega, Yolanda; Soriano Reyes, Catalina; Martínez Garduño, María Dolores; Vianey, Méndez Salazar; Olivos Rubio, Micaela Rodríguez García, Claudia; Vargas Santillán, María de Lourdes; Chamorro Vázquez, Elia; con fecha de publicación año 2014 y apoyo de edicion de la Universidad Autónoma del Estado de Méxic

Marco Referencial de la Profesión de Enfermería.

Título del libro "Marco Referencial de la Profesión de Enfermería" no la participación de los autores: Toxqui Tlachino, María Juana Gloria; Sánchez Arias, Andrea Guadalupe; Cárdenas Becerril, Lucila; Becerril Amero, Patricia; Gómez Martínez, Vicenta; Hernández Ortega, Yolanda; Soriano Reyes, Catalina; Martínez Garduño, María Dolores; Vianey, Méndez Salazar; Olivos Rubio, Micaela Rodríguez García, Claudia; Vargas Santillán, María de Lourdes; Chamorro Vázquez, Elia; con fecha de publicación año 2014 y apoyo de edicion de la Universidad Autónoma del Estado de Méxic

High HPgV replication is associated with improved surrogate markers of HIV progression

<div><p>Background</p><p>Human Pegivirus (HPgV) may have a beneficial effect on HIV disease progression in co-infected patients; however, the virologic characteristics of this infection are not well defined. In this study, we determined HPgV viremia prevalence in Mexico and provide new insights to understand HPgV infection and HPgV/HIV co-infection.</p><p>Methods</p><p>We analyzed and quantified 7,890 serum samples for HPgV viremia by One-Step RT-Real-Time PCR, 6,484 from healthy blood donors and 1,406 from HIV-infected patients. Data on HIV progression were obtained from patients’ records. HPgV genotyping was performed in 445 samples by nested PCR of the 5’URT region. Finite Mixture Models were used to identify clustering patterns of HPgV viremia in blood donors and co-infected antiretroviral (ART)-naïve patients.</p><p>Results</p><p>HPgV was detected in 2.98% of blood donors and 33% of HIV patients, with a wide range of viral loads. The most prevalent genotypes were 3 (58.6%)and 2 (33.7%). HPgV viral loads from healthy blood donors and HPgV/HIV+ ART-naïve co-infected patients were clustered into two component distributions, low and high, with a cut-off point of 5.07log₁₀ and 5.06log₁₀, respectively. High HPgV viremia was associated with improved surrogate markers of HIV infection, independent of the estimated duration of HIV infection or HIV treatment.</p><p>Conclusions</p><p>HPgV prevalence in Mexico was similar to that reported for other countries. The prevalent genotypes could be related to Mexico’s geographic location and ethnicity, since genotype 2 is frequent in the United States and Europe and genotype 3 in Asia and Amerindian populations. HPgV viral load demonstrated two patterns of replication, low and high. The more pronounced beneficial response observed in co-infected patients with high HPgV viremia may explain discrepancies found between other studies. Mechanisms explaining high and low HPgV replication should be explored to determine whether the persistently elevated replication depends on host or viral factors.</p></div

Mean difference of HIV viral load in co-infected subjects according to time of HIV infection and HPgV viral load conditions.

<p>Mean difference of HIV viral load in co-infected subjects according to time of HIV infection and HPgV viral load conditions.</p

Effects of HPgV genotype (2 or 3) on surrogate markers of HIV progression.

<p>Each graph shows the differences between the means of: (A and B) HIV viral load/ml (log₁₀), (C and D) CD4⁺ cell counts (CD4⁺/mm³), and (E and F) CD4⁺/CD8⁺ ratio, in the ART-naïve population according to their HPgV condition (-negative, -low, or -high) and genotype 3 (A, C and E) and genotype 2 (B, D and F). Significant differences are considered at p<0.05.</p

Surrogate markers of HIV progression compared between genotypes 2 and 3, according to the low or high HPgV viral loads in HIV-positive ART-naïve patients.

<p>Surrogate markers of HIV progression compared between genotypes 2 and 3, according to the low or high HPgV viral loads in HIV-positive ART-naïve patients.</p

Mean difference of HIV viral load in co-infected subjects according to time of HIV infection and HPgV viral load conditions.

<p>Mean difference of HIV viral load in co-infected subjects according to time of HIV infection and HPgV viral load conditions.</p