Only children aged <15 yr were included. Type 1 diabetes was diagnosed based on clinical features. All patients had elevated blood glucose at presentation: either a random measurement of ≥11.1 mmol/l and presence of classical symptoms, or fasting blood glucose ≥7.1 mmol/l. In addition, all patients met at least one of the following criteria: a) diabetic ketoacidosis; b) presence of at least two type 1 diabetes antibodies (to glutamic acid decarboxylase, islet antigen 2, islet cell, or insulin autoantibodies); or c) ongoing requirement for insulin therapy. Clinical and demographic data were prospectively recorded on all patients at each outpatient visit.
There are three forms of the disease. People with Type 1 Diabetes typically make none of their own insulin and therefore require insulin injections for survival. People with Type 2 Diabetes, the form that comprises the majority of all cases, usually produce their own insulin, but not enough or they are unable to use it properly. Then there is Gestational Diabetes; globally, 1 in 7 births is affected by gestational diabetes. While maternal blood glucose levels usually return to normal after the baby is born, there is an increased risk of both mother and child developing Type 2 Diabetes later in life.
Almost two-thirds of HPs responding had recommended a diabetes app to patients. Dieticians were more likely to recommend an app than others. Blood glucose and carbohydrate diaries were considered the most useful feature and HPs were most confident to recommend blood glucose diaries. HPs are the least confident recommending insulin dose calculation functions. Over one-third of HPs desire guidance with app recommendations.
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Among the intervention participants, 169 (92%) completed questions at follow-up about satisfaction and acceptability of the intervention (table 5). Participants reported high levels of satisfaction with SMS4BG, and all but two participants thought that text messaging was a good way to deliver this type of support. Ten participants reported technical issues while receiving the intervention, most commonly issues replying to the messages (n=4), issues accessing graphs (n=2), and mobile reception issues (n=2).
Similar to a national American mHealth survey, a large proportion of patients are not using health apps [26]. However, there was a higher rate (20%) of diabetes app use in this patient group compared to the 4% found in a survey of diabetes app use in the USA in 2015 [14] and 7% in Scotland in 2016 [23]. Our findings are consistent with previous surveys showing people using apps are more likely to be younger [26]. It has been suggested that people who are more in need of diabetes care are less likely to use apps [27]; however, we found no significant difference in HbA1c between app users and non-app users. The most favored feature being the blood glucose diary is not surprising given it is the most common feature included in the apps available [5,14]. However some responders are also using health apps that are not specific to diabetes, such as apps for dietary advice.
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).

Participants could choose to receive blood glucose monitoring reminders to which they could reply by sending in their result by text message. They could then view their results graphically over time on a password protected website. If they were identified as not having access to the internet at baseline they were mailed their graphs once a month. All messages were delivered in English although the Māori version included keywords in Te Reo Māori and the Pacific version had keywords in either Samoan or Tongan dependent on ethnicity. Examples of SMS4BG messages can be seen in the box. Participants were able to select the timing of messages and reminders, and identify the names of their support people and motivations for incorporation into the messages. The duration of the programme was also tailored to individual preferences. At three and six months, participants received a message asking if they would like to continue the programme for an additional three months, and had the opportunity to reselect their modules receiving up to a maximum nine months of messages. Participants could stop their messages by texting the word “STOP” or put messages on hold by texting “HOLIDAY.”
Mobile phone ownership rates are increasing. Similar to trends seen in the United States and Canada, where mobile phone ownership is 72% and 67%, respectively [20], 70% of New Zealanders own a mobile phone, making diabetes apps potentially available to most people [21]. Limited research exists into the use of diabetes apps in New Zealand. However with increasing rates of both diabetes prevalence and mobile phone ownership, access to safe apps is essential for both HPs as potential app prescribers and patients as app users [21,22]. In Scotland, a survey of people with diabetes found high mobile phone ownership (67%) with over half reporting an interest in using apps for self-management of diabetes, but app usage in only 7% of responders [23]. The objectives of this study were (1) To establish whether people with diabetes use apps to assist with diabetes self-management and which features are useful or desirable, and (2) To establish whether HPs treating people with diabetes recommend diabetes apps, which features were thought to be useful, and which features were they confident to recommend.

-Keep your blood pressure under control. The same lifestyle changes that control blood glucose levels (dietary modifications and exercise) may also help you keep your blood pressure at safe levels. The American Diabetes Association recommends that people with diabetes keep their blood pressure below 140/80, but check with your health care professional about what target is best for you.
Almost two-thirds of HPs responding had recommended a diabetes app to patients. Dieticians were more likely to recommend an app than others. Blood glucose and carbohydrate diaries were considered the most useful feature and HPs were most confident to recommend blood glucose diaries. HPs are the least confident recommending insulin dose calculation functions. Over one-third of HPs desire guidance with app recommendations.
It’s heart-wrenching to watch all that people go through as natural disasters play out on our television screens. Tucked away, along with sympathy for those in the midst of a hurricane, earthquake, flood or other catastrophic events, is the very understandable thought, “I’m so glad that’s not happening to me!”. The truth is, however, that we are all susceptible to major life-changing events, and they can happen with very little notice. Those with a chronic medical condition, like diabetes, are especially vulnerable and should take seriously the advice to be prepared.    (more…)
Patients were involved in all stages of the study, including the initial conceptualisation and formative work leading to the development of SMS4BG (for more information, see the development paper28). Patient feedback informed the intervention modality, purpose, and structure, and patients reviewed intervention content before it was finalised. Patient feedback on the acceptability of SMS4BG through the pilot study28 led to improvements to the intervention including additional modules, the option for feedback graphs to be posted, additional tailoring variables, and a longer duration of intervention. Patient feedback also informed the design of this trial—specifically its duration, the inclusion criteria, and recruitment methods. Additionally, patients contributed to workshops of key stakeholders held to discuss interpretation, dissemination of the findings, and potential implementation. We have thanked all participants for their involvement and they will be given access to all published results when these are made publicly available.
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.
We recognize that the Stop Diabetes movement is built on relationships and understanding what it means to live with diabetes, from frustrations and fears to friendships and triumphs. We hope this blog will act as window for you into the role of the Association in this movement. Let us know how we’re doing – email us at diabetesstopshere@diabetes.org.

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.
Conclusion A tailored, text message based, self management support programme resulted in modest improvements in glycaemic control in adults with poorly controlled diabetes. Although the clinical significance of these results is unclear, the findings support further investigation into the use of SMS4BG and other text message based support for this patient population.
Type 2 Diabetes is one of the major consequences of the obesity epidemic and according to Diabetes New Zealand is New Zealand’s fastest-growing health crisis. In terms of diabetes diagnosis, Type 2 currently accounts for around 90% of all cases. Also of concern to health professionals is that there are large numbers of people with silent, undiagnosed Type 2 Diabetes which may be damaging their bodies. An estimated 258,000 New Zealanders are estimated to have some form of diabetes, with than number doubling over the past decade.
In the U.S., there are nearly 26 million people living with diabetes, and more seniors have diabetes than any other age group. Currently, one in four Americans (10.9 million, or 26.9 percent) over the age of 60 is living with diabetes. With age comes an increased risk for specific complications that require diligence and care to properly mitigate them.

Lack of insulin results in ketoacidosis. Ketones are acids that develop in the blood and appear in the urine. Ketones could poison the body and this is a warning sign that the diabetes is out of control. Symptoms of diabetes involve nausea, shortness of breath, vomiting, fruity flavor in breath, dry mouth, and high glucose levels. Complications associated with diabetes are retinopathy, neuropathy, nephropathy, heart disease and gangrene. Hypoglycemia or low blood sugar is yet another problem associated with diabetes mellitus. Symptoms include hunger, tremor, seizure, sweating, dizziness, jerks, tingling sensation and pale skin color. Improper management of diabetes causes low blood sugar, which in turn causes hypoglycemic coma. It is a life threatening condition.
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