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.
The 60.2% of HPs in our survey who had recommended a diabetes app is significantly higher than previously documented amongst physicians across a range of specialties [28], although it is similar to HPs’ recommendation for any type of health app [19]. We did not observe any effect of HPs’ age on app recommendation, although it is previously well established that younger HPs are more likely to adopt mHealth for diabetes [28].
It is well documented that any reduction in HbA1c is likely to be associated with a decrease in the risk of diabetic complications.38 Reductions in HbA1c are much more clinically important at higher levels, given that the association between vascular complications and HbA1c is non-linear and that similar reductions at lower HbA1c levels have much less effect.383940 In a less ethnically diverse population of people with type 2 diabetes who had levels of HbA1c higher than 6.5% (53 mmol/mol), a decrease of 1% (11 mmol/mol) has been found to result in reduced microvascular complications by 37%, myocardial infarction by 14%, and risk of death by 21%.38 A total of 75% of participants in the intervention group experienced a decrease in HbA1c at nine months, with a mean reduction in HbA1c of 8.9 mmol/mol (0.8%) from baseline, and a significant group difference of 4.2 mmol/mol (0.4%) in favour of the intervention. Therefore, the results in this study have potential to be clinically relevant in reducing the risk of vascular complications and death, although further investigation is needed.

A total of 793 individuals were referred to the study and assessed for eligibility between June 2015 and November 2016. Of these, 366 were randomised to the intervention and control groups (n=183 each; fig 1). The final nine month follow-up assessments were completed in August 2017, with loss to follow-up (that is, no follow-up data on any outcome) low in both groups (overall 7/366=2%). A total of 12 participants (six per group) were excluded from the primary outcome analysis because of no follow-up HbA1c results after randomisation. Baseline characteristics of participants are presented in table 1, and no adverse events were recorded from the study or protocol deviations.


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 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
We summarised the primary and secondary outcomes using descriptive statistics at each scheduled visit. A random effects mixed model was used to evaluate the effect of intervention on HbA1c at three, six, and nine months’ follow-up, adjusting for baseline HbA1c and stratification factors and accounting for repeated measures over time. Model adjusted mean differences in HbA1c between the two groups were estimated at each visit, by including an interaction term between treatment and month. Missing data on the primary outcome were taken into account in modelling based on the missing at random assumption. Both 95% confidence intervals and P values were reported. Treatment effects sizes were also compared between important subgroups considered in stratification, including diabetes type (1 and 2), ethnicity (Māori/Pacific and non-Māori/non-Pacific), and region (urban and rural). For other secondary outcomes measured at nine months, we used generalised linear regression models with same covariate adjustment using a link function appropriate to the distribution of outcomes. Model adjusted estimates on the treatment difference between the two groups at nine months were reported, together with 95% confidence intervals and P values. No imputation was considered on secondary outcomes.

Strengths of the intervention were that it was theoretically based, the information reinforced messages from standard care, and it was system initiated, personally tailored, and used simple technology. These strengths result in high relevance to diverse individuals, increasing the intervention’s reach and acceptability. Unlike SMS4BG, previous diabetes SMS programmes have largely focused on specific groups—for example, limiting their generalisability. Furthermore, the SMS4BG intervention was tailored and personalised to the individual. Although this specificity results in a more complex intervention in relation to its delivery, it appears to be a worthwhile endeavour with high satisfaction and the majority of participants happy with their message dosage.


Diabetes Depot carries a full line insulin pump supplies, including all major insulin infusions sets, insulin reservoirs and cartridges available in Canada, all at significant discounts below the manufacturer's list price. Our product line of diabetic supplies, required daily by people living with diabetes, include blood glucose meters, glucose test strips, lancets, insulin pen needles, insulin products, Dex-4 glucose tablets and Emla anesthetic cream. We also carry accessories such as pump clips, pump cases & pouches, prep pads, battery caps, diabetic socks, and helpful books on diabetes… everything an insulin pump user would require. Plus, because the Diabetes Depot is located within Stutt's Pharmacy, we also offer a complete prescription service.

It’s heart-wrenching to watch all that people go through as natural disasters play out on our television screens. Tucked away, along with sympathy for those in the midst of a hurricane, earthquake, flood or other catastrophic events, is the very understandable thought, “I’m so glad that’s not happening to me!”. The truth is, however, that we are all susceptible to major life-changing events, and they can happen with very little notice. Those with a chronic medical condition, like diabetes, are especially vulnerable and should take seriously the advice to be prepared.    (more…)

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…)


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.
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.
Understanding how food affects blood sugar level and constantly monitoring it is a way of life for those with diabetes. This largely involves the balance between the amount of insulin currently in the body at any given time and how the foods we eat change that it. At center stage for this daily drama are carbohydrates. Knowing the difference between how the various types of carbohydrates are processed by the body is key to maintaining blood sugar levels. (more…)
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