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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.

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).


Owing to individual tailoring, participants in the intervention group received varying numbers of messages. Half the participants (92/183) received messages for three months, an additional 18% (33/183) chose to continue the messages for six months, and the remaining 32% (58/183) chose to continue the messages to the maximum nine months. Only three participants chose to stop their messages early. A total number of 76 523 messages were sent by the system to participants (median number of messages per participant 242 (interquartile range 122-511; range 14-2050)), and 16 251 messages of blood glucose results were sent into the system by participants receiving the reminders (68 (1-169; 0-917)).
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.
Diabetes is a metabolic disorder, which is accompanied by high blood glucose levels. It is a result of improper functioning of the pancreas, which secretes the insulin hormone. Lack of insulin, result in ketoacidosis. Makhana or Fox nut is a sweet and sour seed, which is also known as Euryale ferox. These seeds contain starch and ten percent of protein. There is no supporting literature for its positive association with diabetes. Therapeutic effects of fox nut involve its strengthening of kidney. It also helps to relieve the dampness, associated with leucorrhoea. It also regulates hypertension or high blood pressure. It is also beneficial for individuals with impotence and arthritis. Fox nuts are effective for individuals with high risk of premature ageing. It is also known as gorgon nut, is also helpful.
In Type 1 Diabetes, symptoms are often sudden and can be life-threatening; therefore it is usually diagnosed quite quickly. In Type 2 Diabetes, many people have no symptoms at all, while other signs can go unnoticed, being seen as part of ‘getting older’. Therefore, by the time symptoms are noticed, complications of diabetes may already be present.
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