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.
Cost effectiveness as well as healthcare use was assessed during the study period compared with the nine months before randomisation (presented separately). We measured patient engagement and satisfaction with the intervention using semistructured interviews and data from the content management system. The secondary outcomes health related quality of life and perceived social support were not included in the initial trial registration but added before commencing the trial.
In a perfect world, the answer to the question “should someone with diabetes take steroids?” would be a simple “no”. Of course, not only do we not live in a perfect world, there are also few simple answers for diabetics. Steroids can play havoc with blood sugar levels, but they can also be the best choice in treating some very serious conditions. So, perhaps the better answer would be “maybe” with the added caveat of making sure you are aware of the consequences and prepared to be proactive in managing them. (more…)
In contrast with the extensive app problems presented in the literature, over half of the responders with an app reported no problems [5,11-13,15]. This discrepancy may be due to false self-report or responders may have tried multiple apps before finding the one they like. Our study is unable to add significantly to literature about insulin dose calculation problems , as only 7 responders reported using their app for insulin calculation. However it is notable that this feature is desired by users and reinforces the importance of having a regulated environment to ensure safety.
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.
We thank the participants who took part in this study as well as the staff at the primary care practices and diabetes clinics across New Zealand who referred their patients to the study; the National Institute for Health Innovation’s IT team for their work on the text message delivery system, and all those involved in the study design and set up; Coral Skipper, Louise Elia, Erana Poulsen, and Hamish Johnstone (Māori Advisory Group members); Aumea Herman (Pacific adviser); Joanna Naylor and Michelle Garrett (content development advisers); Richard Edlin (health economist); Mahalah Ensor (assistance with recruitment); Hannah Bartley, Rachel Sullivan, Anne Duncan, and Gillian Lockhart (research assistants); Michelle Jenkins and John Faatui (data management support); and Karen Carter and Angela Wadham (project management support).
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.
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.
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…)
Some of the most vocal diabetes stories come from blogs and other social media platforms which create a broad online community of people who have diabetes or whose loved ones are living with the disease. “By means of this blog,” noted Hausner, “we hope to add our voice to this dialogue and further engage with those who may be well aware of the effects diabetes can have on their lives.”
The flexibility of mobile phones and their adoption into everyday life mean that they are an ideal tool in supporting people with diabetes whose condition needs constant management. Mobile phones, which have been used effectively to support diabetes management,13141516 offer an ideal avenue for providing care at the patient’s desired intensity. Additionally, they can provide effective methods of support to patients in rural and remote locations where access to healthcare providers can be limited.1718 Although there is growing support for the use of mobile health (mHealth) in diabetes, there is increasing evidence of a digital divide, with lower use of some technologies in specific population groups.1920 These groups include people who have low health literacy,21 have low income,222324 and are members of ethnic minorities.2526 Contributing factors include low technology literacy, mismatch between individual needs and the available tools, lack of local information, cost, literacy and language barriers, and lack of cultural appropriateness.27 For mHealth tools to be used to manage poor diabetes control, they need to be designed to the needs and preferences of those people who need the greatest support by considering these factors.
Main outcome measures Primary outcome measure was change in glycaemic control (HbA1c) from baseline to nine months. Secondary outcomes included change in HbA1c at three and six months, and self efficacy, diabetes self care behaviours, diabetes distress, perceptions and beliefs about diabetes, health related quality of life, perceived support for diabetes management, and intervention engagement and satisfaction at nine months. Regression models adjusted for baseline outcome, health district category, diabetes type, and ethnicity.
In relation to perceptions and beliefs about diabetes, a significant reduction in illness identity (how much patients experience diabetes related symptoms) on the BIPQ was observed in favour of the intervention (adjusted mean difference −0.54 (95% confidence interval −1.04 to −0.03), P=0.04). However, we saw no significant group differences for perceptions of consequences, timeline, control, concern, emotions, and illness comprehensibility. A significant improvement in health status on the EQ-5D VAS was observed in favour of the intervention (4.38 (0.44 to 8.33), P=0.03) but no significant differences were observed between groups for the quality of life index score. Finally, the measure of perceived support for diabetes management showed a significant improvement between the groups in how supported the participants felt in relation to their diabetes management overall (0.26 (0.03 to 0.50), P=0.03) but no significant group differences on appraisal, emotional, and informational support.
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 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
The message delivery was managed by our content management system, with messages sent and received through a gateway company to allow for participants to be registered with any mobile network. Sending and receiving messages was free for participants. The system maintained logs of all outgoing and incoming messages. Further details of the intervention can be seen in the published pilot study,28 and protocol.30
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.
This study shows app usage is relatively low among people with diabetes, while 60.2% of HPs have recommended an app to patients. There is, however, interest amongst people with diabetes and HPs to use diabetes apps, with strong interest in an insulin dose calculator. Apps with this feature have the potential to improve diabetes control. However, the critical problem of app safety remains a barrier to the prescription and use of insulin dose calculators. Further work is needed to ensure apps are safe and provided in a regulated environment. An app assessment process would provide HPs with confidence in the apps they recommend and would ultimately ensure app quality and safety for app users. At present, however, app users and HPs must remain cautious with diabetes apps, especially those in the insulin dose calculator category.
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.
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.