The HPs’ survey was completed by 115 out of 286 HPs (40.2% response rate, 78 online, 37 paper). Table 6 shows the characteristics of responders. Almost all HPs (96.5%, 111/115) owned a mobile phone and of the 113 who answered, 60.2% (68/113) had recommended an app for diabetes management to a patient. Dieticians were most likely to have recommended an app (83%, 10/12), followed by nurses (66%, 42/64), (P=.006). There was no relationship between app recommendation and the number of years of treating diabetes (P=.48) or the responder’s age (P=.49).
With technology advancing rapidly, there is a call for mHealth to move towards more complex technology. However, this study has shown that text messaging—available on any mobile phone—although simple, is still potentially effective for improving glycaemic control. Equally, this study had very few technical difficulties, which probably contributed to the high satisfaction with the intervention. The individual tailoring of the intervention, and ability for participants to choose varying components and dosages, means that questions remain around the ideal duration for implementation as well as the components most important for effectiveness. Further research is needed to understand the components of this intervention that are most effective and the ideal intervention dosage to further refine this intervention and inform the development of future interventions. With participants highly satisfied with the intervention and largely happy with their intervention dosage, but great variance in the modules, durations, and dosages, SMS4BG may need to remain individually tailored in this way, resulting in a more complex intervention for delivery until further investigation on this can be made.
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.
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.
-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.
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.”
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).
This study shows the potential of SMS4BG to provide a low cost, scalable solution for increasing the reach of diabetes self management support. It showed that a text messaging programme can increase a patient’s feelings of support without the need for personal contact from a healthcare professional. Half of the intervention group reported sharing the messages with others. Traditional education for diabetes self management is delivered to individual patients, but there is benefit of support from other people being involved.45 This is particularly pertinent to ethnic populations such as Māori groups, in whom family have an important role in supporting diabetes self management.46
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.
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).
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…)
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