The Endocrinology Service at Starship Children's Health provides specialist care for all children diagnosed with type 1 diabetes in the Auckland region (New Zealand). Its Paediatric Diabetes Service provides centralised medical care for all diabetic children up to 15 yr who reside in the Auckland region, drawing from the regional population of approximately 1.5 million [12]. All children or adolescents diagnosed with type 1 diabetes who attended the Paediatric Service between 1 January 1990 and 31 December 2009 were eligible for this study. Subjects were captured from a comprehensive database (Starbase) that gathers data on all children with type 1 diabetes in the Auckland region. This information was cross-referenced with hospital admission data and subsequent clinical follow up, leading to a case ascertainment >95% for children with type 1 diabetes [13].

A total of 884 new patients aged <15 yr were diagnosed with type 1 diabetes over the 20-year period covered by this study. There was an increase in the mean age at diagnosis from 7.6 yr in 1990/1 to 8.9 yr in 2008/9 (0.07/yr, r2 = 0.31, p = 0.009). This was observed in both males (0.07/yr, r2 = 0.22, p = 0.04) and females (0.06/yr, r2 = 0.13, p = 0.12).
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.
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.
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The SMS4BG (self management support for blood glucose) intervention was developed to address the need for innovative solutions to support self management in adults with poorly controlled diabetes.28 The individually tailored intervention provides information and support designed to motivate a person to engage in the behaviours required to manage their diabetes effectively for long term health improvement. The development of SMS4BG followed the mHealth Development and Evaluation Framework29 (including extensive formative work and end user engagement to ensure that it met the needs of the population it was designed to reach) is evidence based and theoretically grounded. A previous pilot study found SMS4BG to be acceptable and perceived it as useful.28 This study aimed to determine the effectiveness of the mHealth diabetes self management support programme—SMS4BG in adults with poorly controlled type 1 or type 2 diabetes, in addition to their usual diabetes care.
Like my customers, I use an insulin pump to control my diabetes because it allows me to be spontaneous and flexible in managing my diabetes while reducing hypoglycemia. Reaching target blood glucose levels is not always easy, but being a Pharmacist, as well as a Certified Diabetes Educator and Certified Pump Trainer, I know the importance of managing my blood glucose to reduce long-term complications. You are welcome to contact me about any aspect of insulin pump therapy or with any questions about specific insulin pump supplies.
Your health professional at the Centre may suggest that they make a referral for you, if there are problems affecting your diabetes management or your overall health and management. Alternatively you can ask your family doctor or nurse to refer you. If you are uncertain about whether it would be helpful to see us, you are most welcome to phone us directly to discuss this. Phone 3640 860 ext 89113.
The main effect of the intervention on secondary outcomes are presented in table 4. No significant differences were observed between the two groups for self efficacy (SEDM). A significant improvement in foot care behaviour was seen in the intervention group compared with the control group (adjusted mean difference 0.85 (95% confidence interval 0.40 to 1.29), P<0.001) but no significant group differences were observed for diet (general or specific), exercise, blood glucose testing, and smoking behaviours (SDSCA). No significant group differences were observed for diabetes distress (DDS2).
Overall, all five potential app features were considered useful, with more than 60% of responders selecting that these features were useful, very useful, or extremely useful on the scale of scale 1 (not at all useful) to 5 (extremely useful). Equally, the mean usefulness score was higher than 3 for all 5 features. Blood glucose and carbohydrate intake diaries were rated as being the most useful app feature (Figure 1), with the highest mean score of 3.64 (SD 0.948) for usefulness (Table 7).
The average reduction of 4.2 mmol/mol (0.4%) in HbA1c seen in this study did not reach the level chosen to signify clinical significance in the initial power calculation (5.5 mmol/mol (0.5%) reduction in HbA1c). Therefore, this study is unable to conclude that the effects of the SMS4BG intervention are clinically significant. Although further investigation is needed, we believe the results have the potential to still be clinically relevant in practice, particularly among individuals with high levels of HbA1c, such as the participants with poorly controlled diabetes in this study. The unadjusted group difference on change in HbA1c from baseline was −5.89, −3.05 and −5.24 mmol/mol at three, six, and nine months, respectively. The main analysis, with adjustment for baseline value and stratification factors, showed a smaller treatment effect, although both results were significant at three and nine months. Similar results were found across major subgroups of interest despite the fact that these analyses were not specifically powered. These consistent findings led us to believe that the intervention shows promising effects on treating people with poorly controlled diabetes and warrants further investigation.
One of the most important aspects of diabetes management is to maintain a healthy body weight. Being overweight not only increases your risk of heart disease, stroke and some cancers, it also makes your diabetes harder to manage. Small changes in your diet such as reducing your portion sizes and swapping to low-fat dairy products can help you to achieve a healthy body weight and manage your diabetes.
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
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.
Of mobile phone owners, those using diabetes apps were more likely to have T1DM (30/96) than T2DM (n=7/61); (P=.006). App users were younger with a mean age of 39.0 years (SD 11.1) compared to non-app users having a mean of 52.5 years (SD 15.6), (P<.001). There were no other significant differences in clinical variables between app and non-app users.
ED is a failure to obtain/maintain penile erection sufficient for intercourse is more prevalent in men with diabetes and increases with age.  It is important to distinguish erectile failure from premature ejaculation, decreased libido and other problems as these have different causes and treatment. ED in diabetes is largely due to failure of vascular smooth muscle relaxation secondary to endothelial dysfunction and/or autonomic neuropathy.