Nearly half of American adults have diabetes or prediabetes; more than 30 million adults and children have diabetes; and every 21 seconds, another individual is diagnosed with diabetes in the U.S. Founded in 1940, the American Diabetes Association (ADA) is the nation’s leading voluntary health organization whose mission is to prevent and cure diabetes, and to improve the lives of all people affected by diabetes. The ADA drives discovery by funding research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and works to safeguard policies and programs that protect people with diabetes. In addition, the ADA supports people living with diabetes, those at risk of developing diabetes, and the health care professionals who serve them through information and programs that can improve health outcomes and quality of life. For more information, please call the ADA at 1-800-DIABETES (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn)
Results The reduction in HbA1c at nine months was significantly greater in the intervention group (mean −8.85 mmol/mol (standard deviation 14.84)) than in the control group (−3.96 mmol/mol (17.02); adjusted mean difference −4.23 (95% confidence interval −7.30 to −1.15), P=0.007). Of 21 secondary outcomes, only four showed statistically significant improvements in favour of the intervention group at nine months. Significant improvements were seen for foot care behaviour (adjusted mean difference 0.85 (95% confidence interval 0.40 to 1.29), P<0.001), overall diabetes support (0.26 (0.03 to 0.50), P=0.03), health status on the EQ-5D visual analogue scale (4.38 (0.44 to 8.33), P=0.03), and perceptions of illness identity (−0.54 (−1.04 to −0.03), P=0.04). High levels of satisfaction with SMS4BG were found, with 161 (95%) of 169 participants reporting it to be useful, and 164 (97%) willing to recommend the programme to other people with diabetes.
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.

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 [11]. 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 [15]. HPs are also concerned about app safety [19] and are advised to take care when advising apps to patients [15]. In the United Kingdom, The Royal College of Physicians Health Informatics Unit (London) has developed a checklist for assessing app quality [19]. However, the multitude of factors HPs must consider while recommending apps, including patient familiarity with technology, app features, ease of use, and FDA approval [19] may be burdensome and not practical in day to day clinical care.
I am passionate about diabetes education, so when you purchase from the Diabetes Depot, you also have at your disposal the resources of a pharmacist, a Certified Diabetes Educator and a fellow pumper. I am a member of a Peterborough Family Health Team, where I have the opportunity to help clients manage their diabetes. I have given many lectures on the management and prevention of diabetes complications to both patient groups and health care professionals throughout Canada, and am the proud recipient of numerous awards for this work. I hope my effort to provide lower-cost insulin pump supplies to Canadians will help you, and I again invite you to contact me with your specific diabetes questions.
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).
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.

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
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.
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.

The majority of responders were not using diabetes apps (80.4%, 152/189), although 60.5% (89/147) reported they would be interested in trying one. Of the 118 people who answered the question, the reasons for not using an app was not knowing they existed (66.9%, 79/118), feeling confident without one (16.9%, 20/118), discontinued use after having used an app previously 16.9% (20/118).
Owing to time restrictions, longer term follow-up of participants was not feasible within the current study, although it is hoped that a two year follow-up of the present study’s participants is possible. The significant group difference seen at three months, dropping slightly at six months, but reaching significance again at nine months, could be an indication of sustained change. Another limitation of the study design was that secondary outcome assessors were not blinded to treatment allocation, which could have introduced bias in follow-up data collection of secondary variables.
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.

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