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Among the intervention participants, 169 (92%) completed questions at follow-up about satisfaction and acceptability of the intervention (table 5). Participants reported high levels of satisfaction with SMS4BG, and all but two participants thought that text messaging was a good way to deliver this type of support. Ten participants reported technical issues while receiving the intervention, most commonly issues replying to the messages (n=4), issues accessing graphs (n=2), and mobile reception issues (n=2).
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.
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.
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.
Clinical psychologists have studied psychology at University, usually for at least seven years. They have specialised in learning about how the feelings, actions, beliefs, experiences and culture of people affect the way they live. They have learned how to listen to and understand people’s emotional and psychological problems and how to help people make changes in their lives.
New Zealand Europeans had a significantly higher incidence rate than Non-Europeans, which is consistent with other studies [21], [22]. There was a marked decrease in the proportion of Europeans in Auckland over the study period, so that the increase in type 1 diabetes incidence was not due to a shift in ethnic distribution. Furthermore, the incidence has been increasing in both Europeans and non-Europeans. A number of studies have shown that immigrant groups display higher rates of type 1 diabetes than in their countries of origin, particularly those that move into societies with a westernised lifestyle [23], [24]. For example, although type 1 diabetes in Polynesia is extremely rare, an abrupt increase in incidence occurs in Pacific Island peoples who migrate to New Zealand [25]. Our study provides evidence that the factors leading to an increase in incidence are operating across all ethnicities. Indeed, the incidence of type 1 diabetes has been remarkably similar over time for the indigenous Maori and the largely newly immigrant Pacific Island and Other ethnic groups.
We saw no significant interaction between the treatment group and any of the prespecified subgroups: type 1 versus type 2 diabetes (P=0.82), non-Māori/non-Pacific versus Māori/Pacific ethnicity (P=0.60), high urban versus high rural/remote region (P=0.38). Adjusted mean differences on change in HbA1c from baseline to nine months for patients with type 1 and type 2 diabetes were −5.75 mmol/mol (95% confidence interval −10.08 to −1.43, P=0.009) and −3.64 mmol/mol (−7.72 to 0.44, P=0.08), respectively. Adjusted mean differences for non-Māori/non-Pacific and Māori/Pacific people were −4.97 mmol/mol (−8.51 to −1.43, P=0.006) and −3.21 mmol/mol (−9.11 to 2.70, P=0.28), respectively. Adjusted mean differences for participants living in high urban and high rural/remote areas were −4.54 mmol/mol (−8.40 to −0.68, P=0.02) and −3.94 mmol/mol (−9.00 to 1.12, P=0.13), respectively (table 3).
Height and weight were recorded for 660 patients at their required first post-diagnostic clinic (on average 15 weeks from diagnosis) from 1994 onwards. Annual mean BMI SDS of newly diagnosed type 1 diabetes did not alter (average non-significant change smaller than ±0.02 SDS/year) over the period for the entire population, or for any gender, age, or ethnicity sub-group. There was no association between BMI SDS and age at diagnosis.
SMS4BG is an automated self management support programme delivered by SMS (short messaging service) to motivate and support people to engage in the behaviours needed for successful diabetes management. The programme was tailored by the needs and goals of the individual, and demographic factors. As well as core motivational and support messages (in Māori, Pacific, or non-Māori/Pacific cultural versions), participants could opt to receive additional modules including those for: insulin control, young adult support, smoking cessation, lifestyle behaviour (exercise, healthy eating, or stress/mood management), and foot care (further module details in supplementary table 1).
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).
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The reasons underpinning the considerable increase in incidence over the study period are unclear. This may reflect an actual change in the type 1 diabetes incidence in patients <15 yr. Alternatively, it may reflect an earlier age of onset without change in incidence over all ages, so that greater numbers of people are being diagnosed with type 1 diabetes in adolescence rather than in young adulthood. This would be consistent with the ‘accelerator hypothesis’, which suggests that an increasing rate of obesity is a primary driver for an earlier age of diabetes onset [6]. Studies have shown an association between higher BMI and younger age at diagnosis [9], [10], [11], indicating greater adiposity in childhood may hasten the onset of diabetes mellitus. The ‘accelerator hypothesis’ predicts an early onset rather than increased risk [11], and a Swedish study examining type 1 diabetes incidence on a nation-wide cohort 0–34 yr showed a shift in age of onset towards younger ages, rather than an increase in incidence per se across the whole population [20]. Although we cannot rule out a similar phenomenon in Auckland, we did not observe an increase in BMI SDS among children recently diagnosed with type 1 diabetes, or an association between BMI SDS and age at diagnosis. In fact, we observed an actual increase in age at diagnosis which is inconsistent with the ‘accelerator hypothesis’. Thus, our data suggest a true increase in the incidence of type 1 diabetes in the Auckland region, and not changes driven by increasing adiposity.
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.
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