However, there are concerns about the appropriateness and safety of apps for diabetes self-management [5,11-13,15]. In 2013 only 1 of 600 diabetes apps reviewed in the USA had received FDA clearance . Similarly a review, specifically of insulin dose calculator apps, determined that only one of 46 calculators was clinically safe. The most common issue was that calculators accepted implausible values for blood glucose readings (eg, negative values), yet would still provide an advised insulin dose . HPs are also concerned about app safety  and are advised to take care when advising apps to patients . In the United Kingdom, The Royal College of Physicians Health Informatics Unit (London) has developed a checklist for assessing app quality . However, the multitude of factors HPs must consider while recommending apps, including patient familiarity with technology, app features, ease of use, and FDA approval  may be burdensome and not practical in day to day clinical care.
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.
Today’s first post is titled “Why ‘Stop Diabetes’?” can be found at www.diabetesstopshere.org. This initial post seeks to explain why the Stop Diabetes movement was created and its goal for engaging the public. “The goal of the Stop Diabetes movement is to grow to epic proportions, to be bigger than the disease itself,” the blog explains. “In short, it’s the answer to why the Association does the work that it does.”
A nine month, two arm, parallel, randomised controlled trial was conducted in adults with poorly controlled diabetes between June 2015 and August 2017. The study received ethical approval from the Health and Disability Ethics Committee (14/STH/162), and the protocol was published30 and registered with the Australian New Zealand Clinical Trials Registry (ACTRN12614001232628). Trial development and reporting was guided by the CONSORT31 and CONSORT EHEALTH32 statements.
The growing prevalence of diabetes is considered to be one of the biggest global health issues.1 People of ethnic minorities, including Pacific and Māori (New Zealand indigenous population) groups, are particularly vulnerable to the development of diabetes, experience poorer control, and increased rates of complications.23456 In New Zealand, 29% of patients with diabetes were found to have HbA1c levels indicative of poor control (≥65 mmol/mol or 8%), putting them at risk for the development of debilitating and costly complications.7 Diabetes complications can be prevented or delayed with good blood glucose control, which is not only advantageous for a person’s quality of life but also will substantially reduce healthcare costs associated with treating or managing the complications.89101112
The biggest study limitation was the difficulty with recruitment, which resulted in a sample size smaller than initially planned. One reason for the low recruitment was the required time needed by clinicians to identify and refer patients to the study, which was not always available. Furthermore, many referred patients who did not meet the HbA1c inclusion criteria were still referred because clinicians had thought these individuals would benefit from the programme. This limitation highlights the difference between research and implementation where strict criteria can be relaxed. Alternative methods of recruitment could be explored, such as through laboratory test facilities to ensure access to the intervention regardless of clinician availability.
Sexual problems are common in the general population but people with diabetes are at an increased risk. The biological effects of diabetes can affect both men and women although the correlation between diabetes and sexual function in women is poorly understood. It is important to ask both male and female patients if they are experiencing any issues regarding their sexual functioning.
Statistical analyses were performed by SAS version 9.4 (SAS Institute). All statistical tests were two sided at a 5% significance level. Analyses were performed on the principle of intention to treat, including all randomised participants who provided at least one valid measure on the primary outcome after randomisation. Demographics and baseline characteristics of all participants were first summarised by treatment group with descriptive statistics. No formal statistical tests were conducted at baseline, because any baseline imbalance observed between two groups could have occurred by chance with randomisation.
Another goal of this blog is to give you a behind-the-scenes look at what the Association does on a daily basis to fulfill its mission: To prevent and cure diabetes and improve the lives of all people living with diabetes. Our staff’s dedication – combined the stories that provide them with inspiration through the day – is a critical part of the Stop Diabetes movement.
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.
There are over 30 million people in the U.S. who have diabetes, even if nearly a quarter of them have not been diagnosed. 13 million individuals in the U.S. have been diagnosed with urinary incontinence, and it is believed that the percentage of undiagnosed incontinence is likely to be significant. Diabetes is a disease, while incontinence is a symptom related to lifestyle choices, physical issues or an underlying medical condition. Urinary incontinence is often linked to diabetes because diabetes is one of the more common medical conditions that contribute to incontinence. (more…)
Strengths of the current study included its sample size, diverse population, very low loss to follow-up, pragmatic design, absence of protocol violations, and objectively measured primary outcome. Although the initial sample size target was not reached, the final sample of 366 participants is larger than previous randomised controlled trials in this area. This study contributes valuable evidence to the literature on the use of text messages in diabetes particularly for individuals with poor control. Considering poorer outcomes are experienced by ethnic minority groups, a strength of this study was its high proportion of participants representing these groups.
To assess whether changes in incidence were more marked in certain age groups (as observed overseas , ), 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  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).
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.
Wednesday Walks are a joint venture between Korowhai Aroha Health Centre and Diabetes NZ Rotorua Branch. Join Mary every Wednesday morning for some gentle exercise in good company. The idea is to have fun and encourage each other to exercise. Our Wednesday Walks set out from the Waka on the Lakefront at 9am sharp. The walk lasts for up to an hour. You can go at your own pace and there is no minimum level of fitness required. Wear a hat and bring walking shoes, water & extra carbohydrate foods if you are prone to low blood sugar levels. Bring your partner, friend, kids or mokopuna.