The main treatment effect on the primary outcome is presented in table 2. The reduction in HbA1c from baseline to nine month follow-up was significantly greater in the intervention group than in the control group (mean −8.85 mmol/mol (standard deviation 14.84) v −3.96 mmol/mol (17.02), adjusted mean difference −4.23 (95% confidence interval −7.30 to −1.15), P=0.007). The adjusted mean difference on change in HbA1c at three and six months were −4.76 (−8.10 to −1.43), P=0.005) and −2.36 (−5.75 to 1.04), P=0.17), respectively (table 2).
Strengths of the intervention were that it was theoretically based, the information reinforced messages from standard care, and it was system initiated, personally tailored, and used simple technology. These strengths result in high relevance to diverse individuals, increasing the intervention’s reach and acceptability. Unlike SMS4BG, previous diabetes SMS programmes have largely focused on specific groups—for example, limiting their generalisability. Furthermore, the SMS4BG intervention was tailored and personalised to the individual. Although this specificity results in a more complex intervention in relation to its delivery, it appears to be a worthwhile endeavour with high satisfaction and the majority of participants happy with their message dosage.
-Keep your cholesterol levels in normal range. The liver makes cholesterol and it is also found in the foods we eat such as eggs, meats and dairy products. High cholesterol levels can clog your arteries and put you at risk of developing heart disease and stroke. If you have high cholesterol, you can help lower it by losing weight, exercising and eating a healthful diet.
The World Health Organisation (WHO) has mandated November 14 as World Diabetes Day, an international event to raise awareness about diabetes. Close to 350 million people in the world have diabetes and WHO reports that a person dies from this disease every 6 seconds – that’s 5 million deaths. Currently 1 in 11 adults have diabetes worldwide and this is predicted to increase to 1 adult in 10 (652 million) by 2040. Sobering statistics indeed.
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Increase your physical activity. Exercise is a very important tool to help lower your blood glucose. Prior to starting any exercise program, you will need to consult with your doctor. Make exercise routine with activities you enjoy. In addition to helping manage your blood glucose, exercise helps lower blood pressure and improves balance, flexibility and muscle strength. Exercise may even help to reduce anxiety and depression. Go out and play!
Additional data on all patients were collected from the hospital management system, including age, and the most recent values within the previous 12 months from date of survey for blood pressure (BP), glycated hemoglobin (HbA1c), urinary microalbumin to Creatinine ratio (ACR), low density lipoprotein cholesterol (LDL), and total cholesterol to HDL ratio (C:HDL). Prescription of lipid lowering drugs, anti-hypertensive drugs, insulin, or other hypoglycemic medication were also extracted from the medication list from the last visit within the sample period. Type of diabetes was self-reported in the survey (type 1 [T1DM], type 2 [T2DM], other or unknown) and in four participants who had selected ‘other’ or ‘unknown’ diabetes type was determined by examination of the clinical records. For categorization of participants by app use, 4 responders who did not indicate if they had a mobile phone or not were included in the non-app group.
The 60.2% of HPs in our survey who had recommended a diabetes app is significantly higher than previously documented amongst physicians across a range of specialties [28], although it is similar to HPs’ recommendation for any type of health app [19]. We did not observe any effect of HPs’ age on app recommendation, although it is previously well established that younger HPs are more likely to adopt mHealth for diabetes [28].
This study shows app usage is relatively low among people with diabetes, while 60.2% of HPs have recommended an app to patients. There is, however, interest amongst people with diabetes and HPs to use diabetes apps, with strong interest in an insulin dose calculator. Apps with this feature have the potential to improve diabetes control. However, the critical problem of app safety remains a barrier to the prescription and use of insulin dose calculators. Further work is needed to ensure apps are safe and provided in a regulated environment. An app assessment process would provide HPs with confidence in the apps they recommend and would ultimately ensure app quality and safety for app users. At present, however, app users and HPs must remain cautious with diabetes apps, especially those in the insulin dose calculator category.
To assess whether changes in incidence were more marked in certain age groups (as observed overseas [3], [4]), patients were also categorised into three bands according to age at diagnosis: 0–4 yr (children less than 5 yr), 5–9 yr (equal or greater than 5 yr but less than 10 yr), and 10–14 yr (equal or greater than 10 yr but less than 15 yr). These age bands also match national census classifications. The incidence of type 1 diabetes was assessed as the number of new diagnoses per 100,000 age-matched inhabitants on a given year, based on the 5-yearly national census data from Statistics New Zealand [12] and interpolated estimates of the population for the intervening years. Incidence was modelled using the Poisson distribution. Point estimates were calculated with exact Poisson confidence limits, and change in incidence over time were analysed using Poisson regression. Changes in patient numbers, age at diagnosis, and anthropometric data over time were assessed by linear regression. Poisson modelling was undertaken using StatsDirect v2.7.8 (StatsDirect Ltd, UK); other analyses were undertaken using JMP v. 5.1 (SAS Inc, USA).
Results The reduction in HbA1c at nine months was significantly greater in the intervention group (mean −8.85 mmol/mol (standard deviation 14.84)) than in the control group (−3.96 mmol/mol (17.02); adjusted mean difference −4.23 (95% confidence interval −7.30 to −1.15), P=0.007). Of 21 secondary outcomes, only four showed statistically significant improvements in favour of the intervention group at nine months. Significant improvements were seen for foot care behaviour (adjusted mean difference 0.85 (95% confidence interval 0.40 to 1.29), P<0.001), overall diabetes support (0.26 (0.03 to 0.50), P=0.03), health status on the EQ-5D visual analogue scale (4.38 (0.44 to 8.33), P=0.03), and perceptions of illness identity (−0.54 (−1.04 to −0.03), P=0.04). High levels of satisfaction with SMS4BG were found, with 161 (95%) of 169 participants reporting it to be useful, and 164 (97%) willing to recommend the programme to other people with diabetes.
Nearly half of American adults have diabetes or prediabetes; more than 30 million adults and children have diabetes; and every 21 seconds, another individual is diagnosed with diabetes in the U.S. Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes. In addition, the ADA supports people living with diabetes, those at risk of developing diabetes, and the health care professionals who serve them through information and programs that can improve health outcomes and quality of life. For more information, please call the ADA at 1-800-DIABETES (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)
The look of the Dario appealed straight away to me. Small and compact. Easy for me to carry with my phone which goes everywhere with me. Love the fantastic app on my phone. Clear, informative and easy to use. Love it! I can look back at previous readings to see any patterns. Sara and Assaf have been brilliant at helping out with any issues I have come across, which I thank them hugely for. The Dario Lounge is a great community for all users, who all share advice.
-Keep your cholesterol levels in normal range. The liver makes cholesterol and it is also found in the foods we eat such as eggs, meats and dairy products. High cholesterol levels can clog your arteries and put you at risk of developing heart disease and stroke. If you have high cholesterol, you can help lower it by losing weight, exercising and eating a healthful diet.
Contributors: RW obtained funding for this trial. All coauthors had input into the study protocol. RD, RW, RMu, and MS contributed to the development of the intervention content. RD managed the day-to-day running of the trial and delivery of the intervention. RD and RW collected the data. YJ and RD did the data analyses. All coauthors were involved in the interpretation of the results. RD wrote the article with input from all coauthors. All authors, external and internal, had full access to all of the data (including statistical reports and tables) in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis. All authors approved the final version of this manuscript. RD is guarantor. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.
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