SMS4BG was delivered in the English language (with the exception of some Māori, Samoan, and Tongan words). With high rates of diabetes in ethnic minority groups, delivery of this type of intervention in languages native to these groups could provide greater benefit. It is likely that some people were not referred to the study, or were unable to take part, due to the criteria that they must be able to read English. SMS health programmes have been translated into other languages such as Te Reo;44 thus, further research needs to look at whether such translations would be of benefit in SMS4BG.
Clinical psychologists have studied psychology at University, usually for at least seven years. They have specialised in learning about how the feelings, actions, beliefs, experiences and culture of people affect the way they live. They have learned how to listen to and understand people’s emotional and psychological problems and how to help people make changes in their lives.
The American Diabetes Association launched its first official blog today to help put a face on a disease that kills more people each year than breast cancer and AIDS combined.  The blog, called Diabetes Stops Here: Living with Diabetes; Inspired to Stop It, aims to document the Stop Diabetes® movement by reaching and engaging the 23.6 million Americans living with diabetes as well as the 57 million who are at risk for developing type 2 diabetes. 
Funding: The development of SMS4BG was funded by Waitemata District Health Board. The randomised controlled trial was funded by the Health Research Council of New Zealand in partnership with the Waitemata District Health Board and Auckland District Health Board (through the Research Partnerships for New Zealand Health Delivery initiative), and the New Zealand Ministry of Health. The funders were not involved in any way in the preparation of the manuscript or analysis of the study results. No payment has been received for writing this publication.
We saw no significant interaction between the treatment group and any of the prespecified subgroups: type 1 versus type 2 diabetes (P=0.82), non-Māori/non-Pacific versus Māori/Pacific ethnicity (P=0.60), high urban versus high rural/remote region (P=0.38). Adjusted mean differences on change in HbA1c from baseline to nine months for patients with type 1 and type 2 diabetes were −5.75 mmol/mol (95% confidence interval −10.08 to −1.43, P=0.009) and −3.64 mmol/mol (−7.72 to 0.44, P=0.08), respectively. Adjusted mean differences for non-Māori/non-Pacific and Māori/Pacific people were −4.97 mmol/mol (−8.51 to −1.43, P=0.006) and −3.21 mmol/mol (−9.11 to 2.70, P=0.28), respectively. Adjusted mean differences for participants living in high urban and high rural/remote areas were −4.54 mmol/mol (−8.40 to −0.68, P=0.02) and −3.94 mmol/mol (−9.00 to 1.12, P=0.13), respectively (table 3).
The reasons underpinning the considerable increase in incidence over the study period are unclear. This may reflect an actual change in the type 1 diabetes incidence in patients <15 yr. Alternatively, it may reflect an earlier age of onset without change in incidence over all ages, so that greater numbers of people are being diagnosed with type 1 diabetes in adolescence rather than in young adulthood. This would be consistent with the ‘accelerator hypothesis’, which suggests that an increasing rate of obesity is a primary driver for an earlier age of diabetes onset [6]. Studies have shown an association between higher BMI and younger age at diagnosis [9], [10], [11], indicating greater adiposity in childhood may hasten the onset of diabetes mellitus. The ‘accelerator hypothesis’ predicts an early onset rather than increased risk [11], and a Swedish study examining type 1 diabetes incidence on a nation-wide cohort 0–34 yr showed a shift in age of onset towards younger ages, rather than an increase in incidence per se across the whole population [20]. Although we cannot rule out a similar phenomenon in Auckland, we did not observe an increase in BMI SDS among children recently diagnosed with type 1 diabetes, or an association between BMI SDS and age at diagnosis. In fact, we observed an actual increase in age at diagnosis which is inconsistent with the ‘accelerator hypothesis’. Thus, our data suggest a true increase in the incidence of type 1 diabetes in the Auckland region, and not changes driven by increasing adiposity.
This patient sample came from patients in secondary care diabetes clinics, and therefore, app use may be different amongst patients managed in primary care. Similarly, findings may not generalize to patients with poorer glycemic control as responders had statistically significantly lower HbA1c than non-responders. This was a cross-sectional survey that is useful to assess app use at one point in time, but it is likely that people vary their app use and recommendations over time. It was therefore not possible to assess whether the introduction of an app has significant effect on clinical outcomes. Our study did not address the difference in needs in app features between responders on insulin and those not on insulin. Overall the response rates for both surveys were low and responses were limited by self-report and therefore liable to responder bias.
The American Diabetes Association launched its first official blog today to help put a face on a disease that kills more people each year than breast cancer and AIDS combined.  The blog, called Diabetes Stops Here: Living with Diabetes; Inspired to Stop It, aims to document the Stop Diabetes® movement by reaching and engaging the 23.6 million Americans living with diabetes as well as the 57 million who are at risk for developing type 2 diabetes. 

We’ll also teach you what to do with everything you’re learning. Using the latest research and stories from people with diabetes, we’ll help you make small changes through short videos and simple action items. Soon, you’ll be seeing results, feeling better and having more energy. Many people with diabetes say that they’re healthier NOW than they were before they were diagnosed– you can be one of them!
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