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Impact of a Nurse Short Message Service Intervention for Patients With Diabetes
Abstract
The purpose of this study was to investigate the effect of a nurse short message service by cellular phone and the Internet on glycosylated hemoglobin (HbA1c) levels and adherence to diabetes control recommendations. The patients with diabetes were asked to input their blood glucose levels every day by cellular phone or the Internet. Optimal recommendations were sent weekly to each patient by short message service. After 12 weeks, the patients had a mean decrease of 1.1% in HbA1c level and an increase in diabetic medication taking, 30 minutes of physical exercise, and foot care adherence.
... Of the 337 studies, 13 (3.9%) [22,26,[40][41][42][43][44][45][46][47][48][49][50] used a digital health intervention to promote medication adherence to prescribed medications for diabetes and hypertension that was summarized (see Multimedia Appendix 1) and evaluated with the Chronic Care Model (see Table 2). ...
... The reviewed studies are presented in Multimedia Appendix 1 with the intent to categorize findings based on CCM components in order to assess findings about digital health interventions for medication adherence. Table 2 provides a summary of CCM components used in each study [22,26,[40][41][42][43][44][45][46][47][48][49][50]. ...
... The intervention group (50/98, 51%) had higher adherence (28%, 26%, and 27%) than the control group (48/98, 49%) (12%, 22%, and 20%) at baseline, 3 months, and 6 months, respectively; however, overall improvements in medication adherence self-report were not significant [45]. A quasi-experimental study conducted by Kim and colleagues [46] found that SMS text messaging from nurses by mobile phone or the Internet improved medication adherence in 45 patients with diabetes. Self-reported medication adherence was measured by the Summary of Diabetes Self-Care Activities (SDSCA) measure; diabetes medication-taking adherence increased 1.1 days per week at posttest as compared to pretest [46]. ...
Background:
Optimal management of chronic diseases, such as type 2 diabetes and hypertension, often include prescription medications. Medication adherence (MA) is one component of self-management. Optimization through digital health-eHealth and mHealth-could enhance patient awareness and/or communication between the patient and provider.
Objective:
Medication adherence is a major issue that affects 50%-60% of chronically ill adults. Digital health refers to eHealth and mHealth, collectively, and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence; communicate with patients and providers; and provide education to patients, families, and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension.
Methods:
An integrative review was conducted using databases within EBSCOhost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, had to contain digital health interventions to improve medication adherence to prescription medications in adults 18 years or older, and had to focus on diabetes or hypertension.
Results:
Of the 337 located studies, 13 (3.9%) used a digital health intervention for medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model.
Conclusions:
The 13 studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as interactive voice response (IVR), short message service (SMS) text messaging, telemonitoring, and interactive software technology. Among the 13 studies were digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and health care provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.
... Interventionist(s). Of those studies where the interventionist(s) was clearly identified, pharmacist(s) [28,33,34,51,60,61,63,70,75,76] and nurse(s) [29,36,38,42,48,53,62,66,71,72,78] were involved in delivering the intervention in ten and eleven studies, respectively (Table 1). Community health workers (n = 2) [41,52], peer supporters (n = 1) [65], bachelor level research assistants (n = 2) [31,69], masters level research coordinators (n = 2) [50,69], general practitioners/ clinicians/ physicians (n = 2) [30,45] were involved in the other interventions. ...
... In addition, the non-adherence factors addressed by the interventions had a similar trend. Five studies [50,53,56,67,69] addressed either three (n = 2) [56,67] or four (n = 3) [50,53,69] factors, while nine [31,36,44,49,51,52,61,63,70] and eight [32,54,57,72,[74][75][76][77] studies addressed either two or one factor, respectively. ...
... The interventionists involved in delivering these interventions varied. Pharmacists and nurses were involved in six [51,61,63,70,75,76] and three [36,53,72] interventions, respectively. A nurse was also involved in another, along with a dietician and another professional [54]. ...
Background:
Poor adherence to anti-diabetic medications contributes to suboptimal glycaemic control in patients with type 2 diabetes (T2D). A range of interventions have been developed to promote anti-diabetic medication adherence. However, there has been very little focus on the characteristics of these interventions and how effectively they address factors that predict non-adherence. In this systematic review we assessed the characteristics of interventions that aimed to promote adherence to anti-diabetic medications.
Method:
Using appropriate search terms in Medline, Embase, CINAHL, International Pharmaceutical Abstracts (IPA), PUBmed, and PsychINFO (years 2000-2013), we identified 52 studies which met the inclusion criteria.
Results:
Forty-nine studies consisted of patient-level interventions, two provider-level interventions, and one consisted of both. Interventions were classified as educational (n = 7), behavioural (n = 3), affective, economic (n = 3) or multifaceted (a combination of the above; n = 40). One study consisted of two interventions. The review found that multifaceted interventions, addressing several non-adherence factors, were comparatively more effective in improving medication adherence and glycaemic target in patients with T2D than single strategies. However, interventions with similar components and those addressing similar non-adherence factors demonstrated mixed results, making it difficult to conclude on effective intervention strategies to promote adherence. Educational strategies have remained the most popular intervention strategy, followed by behavioural, with affective components becoming more common in recent years. Most of the interventions addressed patient-related (n = 35), condition-related (n = 31), and therapy-related (n = 20) factors as defined by the World Health Organization, while fewer addressed health care system (n = 5) and socio-economic-related factors (n = 13).
Conclusion:
There is a noticeable shift in the literature from using single to multifaceted intervention strategies addressing a range of factors impacting adherence to medications. However, research limitations, such as limited use of standardized methods and tools to measure adherence, lack of individually tailored adherence promoting strategies and variability in the interventions developed, reduce the ability to generalize the findings of the studies reviewed. Furthermore, this review highlights the need to develop multifaceted interventions which can be tailored to the individual patient's needs over the duration of their diabetes management.
... Two studies were cluster randomized trials [42,62], where either the participating general practices [62] or the clinicians [42] were randomized; four were controlled trials without randomization [27,35,48,55], and one followed time-series design where the subjects served as their own controls [52]. Other studies varied in their designs and were cross-sectional [24,41], quasi-experimental [33,37,43,54,75], and case series analyses [51]. The method of patient recruitment and research design were not clear in two studies [29,70]. ...
... In addition, a few comparable intervention strategies delivered different results; for example, continuous education and reinforcement text messages delivered to patients based on their blood glucose level, significantly improved medication adherence [33]; however, a similar intervention consisting of tailored feedback and reminders based on patient-specific data via messages on cellular phone failed to show an impact on adherence [35]. In both studies nurses delivered the interventions. ...
... A majority (94.2%) of the studies reported an impact on one or more non-clinical outcomes. Improvements were observed in adherence to exercise [25, 33, 44, 49-51, 53, 57], diet [26,39,44,50,51,57,71] blood glucose testing [26,49,51], foot care [33,44,49,51,57,71], QoL [27,73], self-efficacy [34,35,44,45], patient knowledge [30,32,34,41,42,49,57,58,60] and goal achievements [37,44]. ...
The global prevalence of diabetes is increasing. Medications are a recommended strategy to control hyperglycaemia. However, patient adherence can be variable, impacting health outcomes. A range of interventions for patients with type 2 diabetes have focused on improving treatment adherence. This review evaluates the impact of these interventions on adherence to anti-diabetic medications and focuses on the methods and tools used to measure adherence.
Medline, Embase, CINAHL, IPA, PUBmed, and PsychINFO were searched for relevant articles published in 2000-2013, using appropriate search terms.
Fifty two studies addressing adherence to anti-diabetic medications in patients with type 2 diabetes met the inclusion criteria and were reviewed. Each study was assessed for research design, method(s) used for measuring medication adherence, and impact of intervention on medication adherence and glycaemic control. Fourteen studies were published in 2000-2009 and 38 in 2010-2013. Twenty two interventions led to improvements in adherence to anti-diabetic medications, while only nine improved both medication adherence and glycaemic control. A single strategy could not be identified which would be guaranteed to improve anti-diabetic medication adherence consistently. Nonetheless, most interventions were successful in influencing one or more of the outcomes assessed, indicating the usefulness of these interventions under certain circumstances. Self-report, particularly the Summary of Diabetes Self-Care Activities questionnaire was the most commonly used tool to assess medication adherence, although other self-report tools were used in more recent studies. Overall, there was a slight increase in the number of studies that employed multiple methods to assess medication adherence in studies conducted after 2008.
The diversity of interventions and adherence measurements prevented a meta-analysis of the impact of interventions on adherence to therapy, highlighting the need for more consistency in methods in the area of adherence research. Whilst effective interventions were identified, it is not possible to conclude on an effective intervention that can be generalised to all patients with type 2 diabetes.
... Sample sizes ranged from 23 to 29,247, and intervention duration stretched from 2 weeks to 2 years. Eighteen of the studies were RCTs [15,[18][19][22][23][24][25][26][27][28][31][32][33][34][35][37][38][39], four were pre-post-test [16][17]21,40], two combined quasiexperimental with pre-and post-tests [29,41], two were cohorts [20,36], and one used a parallel group with repeated measure design [30]. Twenty-three of the studies used a control group for comparisons [15,[17][18][19][20][22][23][24][25][26][27][28][30][31][32][33][34][35][36][37][38][39][40]. ...
... All of the studies focused on adults with T2DM , but one study also included individuals diagnosed with Type 1 diabetes [24]. Thirteen of the 27 articles were conducted in international locations [15,[22][23][24][28][29][30][31][34][35][37][38]41]. Table 2 presents the medication adherence outcomes of studies meeting the inclusion criteria . ...
... No direct methods for measuring medication adherence were used. All forms of indirect methods were used, with 18 studies measuring medication adherence by self-report [15][16][17]21,[23][24][25][26][27][28][29][30][31][32]35,37,[39][40][41], two by pill count [22,33], three by electronic devices [18][19]38], and three by pharmacy claims data [20,34,36]. Of the 27 studies, 13 reported statistically significant differences in medication adherence in the intervention group compared with the control group [15,[17][18][19][20]22,24,28,[30][31]33,36,40]. ...
Aim:
Medication adherence is associated with improved outcomes in diabetes. Interventions have been established to help improve medication adherence; however, the most effective interventions in patients with Type 2 diabetes remain unclear. The goal of this study was to distinguish whether interventions were effective and identify areas for future research.
Methods:
Medline was searched for articles published between January 2000 and May 2013, and a reproducible strategy was used. Study eligibility criteria included interventions measuring medication adherence in adults with Type 2 diabetes.
Results:
Twenty seven studies met the inclusion criteria and 13 showed a statistically significant change in medication adherence.
Conclusion:
Heterogeneity of the study designs and measures of adherence made it difficult to identify effective interventions that improved medication adherence. Additionally, medication adherence may not be solely responsible for achieving glycemic control. Researchers must emphasize tailored interventions that optimize management and improve outcomes, and examine the need for clear indicators of medication adherence.
... Interventions related to treatment and management focused on investigating patient adherence to treatment (eg, visiting a doctor as planned) [1][2][3][4][5][6], adherence to medication [7][8][9][10][11][12][13], and disease management (particularly for diabetes [14][15][16][17][18][19][20][21][22][23] and asthma [24][25][26]), including coordinated health care interventions between health care providers and patients using communication technologies (mobile phone-based apps and SMS) for patients self-care of chronic diseases. The literature contains 28 cases with sample sizes ranging from 25 to 424. ...
... The literature contains 28 cases with sample sizes ranging from 25 to 424. The interventions are described in Multimedia Appendix 1. Interventions in both developed countries (United States [1,16,17,[22][23][24][27][28][29][30][31], Ireland [2,11], United Kingdom [5,25,26], Denmark [6], Spain [9], France [10], the Netherlands [12,13], South Korea [14,18,32], Austria [19], and Canada [20,33]), and developing ones (Peru [7,8], Kenya [3,34], Cameroon [35], and Brazil [36]) have explored the use of mobile phone-based software, voice and SMS, and personal digital assistants (PDAs). In these interventions, the technology was used to send automated reminders to patients, either by voice or text messages. ...
... In these interventions mobile phone-based apps and SMS were found to be acceptable to patients [11,16], practical and acceptable [1], feasible [10,16,17,24], effective [9,14], and cost-effective [5,19,38]. Patients had positive perceptions [6,8,15,[19][20][21]25], positive impact on some clinical outcomes (eg, medication taking) [17,18,23,26,27], and were highly satisfied [32]. These apps and SMS improved patient adherence to medication [12,18,31,34], and to health behavior (taking vitamin C for preventive reasons) over a 1-month intervention [33]; and they also assisted in preserving higher rates of adherence over time [31]. ...
Background:
A growing body of research has employed mobile technologies and geographic information systems (GIS) for enhancing health care and health information systems, but there is yet a lack of studies of how these two types of systems are integrated together into the information infrastructure of an organization so as to provide a basis for data analysis and decision support. Integration of data and technical systems across the organization is necessary for efficient large-scale implementation.
Objective:
The aim of this paper is to identify how mobile technologies and GIS applications have been used, independently as well as in combination, for improving health care.
Methods:
The electronic databases PubMed, BioMed Central, Wiley Online Library, Scopus, Science Direct, and Web of Science were searched to retrieve English language articles published in international academic journals after 2005. Only articles addressing the use of mobile or GIS technologies and that met a prespecified keyword strategy were selected for review.
Results:
A total of 271 articles were selected, among which 220 concerned mobile technologies and 51 GIS. Most articles concern developed countries (198/271, 73.1%), and in particular the United States (81/271, 29.9%), United Kingdom (31/271, 11.4%), and Canada (14/271, 5.2%). Applications of mobile technologies can be categorized by six themes: treatment and disease management, data collection and disease surveillance, health support systems, health promotion and disease prevention, communication between patients and health care providers or among providers, and medical education. GIS applications can be categorized by four themes: disease surveillance, health support systems, health promotion and disease prevention, and communication to or between health care providers. Mobile applications typically focus on using text messaging (short message service, SMS) for communication between patients and health care providers, most prominently reminders and advice to patients. These applications generally have modest benefits and may be appropriate for implementation. Integration of health data using GIS technology also exhibit modest benefits such as improved understanding of the interplay of psychological, social, environmental, area-level, and sociodemographic influences on physical activity. The studies evaluated showed promising results in helping patients treating different illnesses and managing their condition effectively. However, most studies use small sample sizes and short intervention periods, which means limited clinical or statistical significance.
Conclusions:
A vast majority of the papers report positive results, including retention rate, benefits for patients, and economic gains for the health care provider. However, implementation issues are little discussed, which means the reasons for the scarcity of large-scale implementations, which might be expected given the overwhelmingly positive results, are yet unclear. There is also little combination between GIS and mobile technologies. In order for health care processes to be effective they must integrate different kinds of existing technologies and data. Further research and development is necessary to provide integration and better understand implementation issues.
... 24 Eight studies utilized registered nurses (RN), nurse practitioners (NP), or certified diabetes educators (CDE) to provide the intervention. 23,24,33,36,[38][39][40][41][42] Two studies provided automatic feedback as the main intervention, generated from computer algorithms, without provider input. 37,43 Elements of Structured SMBG Table 2 summarizes elements of structured SMBG incorporated in each study, mean baseline A1C and IE. ...
... Education for both participants and providers is necessary in interventions evaluating SMBG data, and 11 studies described an initial education intervention for the study participants. 23,24,33,35,36,[38][39][40][41][42][43][44] Education ranged from a half-day educational program based on the American Diabetes Association (ADA) guidelines 44 to ongoing access to online educational content through an Internet portal, 23,24,33,44 personal health records, 40 text messaging, 34,38,43 or a home telehealth system. 36,39,41,42 Some studies only referenced education to implement the telehealth RPM intervention technology. ...
... Education for both participants and providers is necessary in interventions evaluating SMBG data, and 11 studies described an initial education intervention for the study participants. 23,24,33,35,36,[38][39][40][41][42][43][44] Education ranged from a half-day educational program based on the American Diabetes Association (ADA) guidelines 44 to ongoing access to online educational content through an Internet portal, 23,24,33,44 personal health records, 40 text messaging, 34,38,43 or a home telehealth system. 36,39,41,42 Some studies only referenced education to implement the telehealth RPM intervention technology. ...
Aims
The aim was to summarize research on telehealth remote patient monitoring interventions that incorporate key elements of structured self-monitoring of blood glucose (SMBG) identified as essential for improving A1C.
Methods
A systematic review was conducted using the Medline, Cumulative Index to Nursing and Allied Health Literature, EMBASE, and OVID Medline databases with search terms “Telemedicine” AND “Monitoring, Physiologic” AND “Diabetes Mellitus, Type 2.” Study selection criteria included original randomized clinical trials evaluating the impact of telehealth remote patient monitoring on A1C among adults with type 2 diabetes and incorporated 1 or more essential elements of SMBG identified by the International Diabetes Federation (patient education, provider education, structured SMBG profile, SMBG goals, feedback, data used to modify treatment, interactive communication or shared decision making).
Results
Fifteen studies were included, with interventions ranging from 3 to 12 months (mean 8 months) with sample sizes from 30 to 1665. Key SMBG elements were grouped into 3 categories: education, SMBG protocols, and feedback. Research incorporating 5 of the 7 elements consistently achieved significant A1C improvements between study groups. Interventions using more SMBG elements are associated with an improvement in A1C. Studies with the largest A1C decrease incorporated 6 of the 7 elements and computer decision support. Two studies with 5 of the 7 elements and active medication management achieved significant A1C decreases.
Conclusion
Telehealth remote patient monitoring interventions in type 2 diabetes have not included all structured monitoring elements recommended by the IDF. Incorporating more elements of structured SMBG is associated with improved A1C.
... The study results regarding adherence to exercise program in two aural and pamphlet training groups by independent t-test showed significant statistical differences between adherence to exercise programs before and after the intervention. In line with the results of the current study, Kim et al. (2006) showed that after 12 weeks of intervention via short message service, there was a statistical significant difference (P = 0.036) between the pre-intervention and post-intervention values in the group of diabetic patients (25). Also, in the study of Chan et al. (2005), a statistically significant difference (P < 0.01) was found between two internet intervention and control groups after the intervention regarding the amount of physical activity (1).The present study results regarding adherence to drug regimens also showed that there was no statistically significant difference between adherence to drug regimens in both groups before and after the intervention. ...
... The study results regarding adherence to exercise program in two aural and pamphlet training groups by independent t-test showed significant statistical differences between adherence to exercise programs before and after the intervention. In line with the results of the current study, Kim et al. (2006) showed that after 12 weeks of intervention via short message service, there was a statistical significant difference (P = 0.036) between the pre-intervention and post-intervention values in the group of diabetic patients (25). Also, in the study of Chan et al. (2005), a statistically significant difference (P < 0.01) was found between two internet intervention and control groups after the intervention regarding the amount of physical activity (1).The present study results regarding adherence to drug regimens also showed that there was no statistically significant difference between adherence to drug regimens in both groups before and after the intervention. ...
... Kim & Jeong telefonla takip ettikleri ve sesli mesajla 3 ay izledikleri diyabetli bireylerin kontrol grubuna göre AKŞ ve TKŞ düzeylerinde azalma olmakla birlikte, aralarında istatistiksel olarak anlamlı bir fark olmadığını (30), Menenghini çalışmasında diyabetli bireylerin telefon-SMS uyarılarının HbA1c düzeyinde düşmeye yol açmasının yanısıra bu yöntemin zamandan tasarruf sağlaması, maliyeti azaltması ve güvenilir olmasının önemini de vurgulamıştır (31). Yapılan pek çok çalışmada telefon-SMS uyaranlarının HbA1c düzeyinde anlamlı ölçüde azalma sağladığı gösterilmiş olup (12,13,27,28,32,33,34,35,36,37), bulgumuz önceki çalışma sonuçlarını doğrulamaktadır. Bununla birlikte NICHE çalışmasında 12 haftalık izlem sonunda gruplar arasında HbA1c düzeylerinde anlamlı bir fark olmadığını bildirilmiştir (38). ...
... Literatürde diyabetli bireylerin kolesterol düzeylerinde değişim için üç aylık sürenin yeterli olmadığı (23,32,34,39), 1443 kişi ile yapılan IDEATel çalışmasında da HbA1c düzeyi ve kendi kendine yeterlilikleri açısından gruplar arasında anlamlı fark belirlenirken, lipid değerleri açısından anlamlı fark olmadığı bildirilmektedir (40). Çalışmamızda kontrol ve Not: x p-Pearson korelasyon katsayısı; y p-Spearman Sıra korelasyon katsayısı; AD -Anlamlı Değil, *p<0.05, ...
... This web-based program, which provided ongoing tracking and documentation of patients' needs and care, decreased HbA1c levels significantly [38]. Seven studies combined web-based diabetes management program with SMS and were associated with significantly decreased HbA1c levels for the intervention group after implementation [39][40][41][42][43][44][45]. In six of those studies using quasi-experimental pretest/ posttest method conducted by the same research group, the nurse researcher reviewed uploaded patient data on the website, integrated patient clinical information into the patients' EHRs, provided education for self-management and sent weekly medication adjustment advice to the patient via SMS and internet [39][40][41][42][43][44]. ...
... Seven studies combined web-based diabetes management program with SMS and were associated with significantly decreased HbA1c levels for the intervention group after implementation [39][40][41][42][43][44][45]. In six of those studies using quasi-experimental pretest/ posttest method conducted by the same research group, the nurse researcher reviewed uploaded patient data on the website, integrated patient clinical information into the patients' EHRs, provided education for self-management and sent weekly medication adjustment advice to the patient via SMS and internet [39][40][41][42][43][44]. ...
Successful diabetes disease management involves routine medical care with individualized patient goals, self-management education and on-going support to reduce complications. Without interventions that facilitate patient scheduling, improve attendance to provider appointments and provide patient information to provider and care team, preventive services cannot begin. This review examines interventions based upon three focus areas: 1) scheduling the patient with their provider; 2) getting the patient to their appointment, and; 3) having patient information integral to their diabetes care available to the provider. This study identifies interventions that improve appointment management and preparation as well as patient clinical and behavioral outcomes.
A systematic review of the literature was performed using MEDLINE, CINAHL and the Cochrane library. Only articles in English and peer-reviewed articles were chosen. A total of 77 articles were identified that matched the three focus areas of the literature review: 1) on the schedule, 2) to the visit, and 3) patient information. These focus areas were utilized to analyze the literature to determine intervention trends and identify those with improved diabetes clinical and behavioral outcomes.
The articles included in this review were published between 1987 and 2013, with 46 of them published after 2006. Forty-two studies considered only Type 2 diabetes, 4 studies considered only Type 1 diabetes, 15 studies considered both Type 1 and Type 2 diabetes, and 16 studies did not mention the diabetes type. Thirty-five of the 77 studies in the review were randomized controlled studies. Interventions that facilitated scheduling patients involved phone reminders, letter reminders, scheduling when necessary while monitoring patients, and open access scheduling. Interventions used to improve attendance were letter reminders, phone reminders, short message service (SMS) reminders, and financial incentives. Interventions that enabled routine exchange of patient information included web-based programs, phone calls, SMS, mail reminders, decision support systems linked to evidence-based treatment guidelines, registries integrated with electronic medical records, and patient health records.
The literature review showed that simple phone and letter reminders for scheduling or prompting of the date and time of an appointment to more complex web-based multidisciplinary programs with patient self-management can have a positive impact on clinical and behavioral outcomes for diabetes patients. Multifaceted interventions aimed at appointment management and preparation during various phases of the medical outpatient care process improves diabetes disease management.
... Concerning medication self care activities, the present study clarified that all of the study subjects in both groups had adequate self care activities preand post intervention. This was contradicted with Kim et al., 2006 who found inadequate medication self care activities pre-intervention and web-based education for diabetic patients improved medication self care activities post-intervention. Also the present findings were in accordance with Toumas, et al., 2009 who found that during comparing the effectiveness of small-group training in correct inhaler technique with self-directed Internet-based training, there was a significant improvement in the number of participants demonstrating correct technique in both groups post intervention, with no significant statitically difference between the groups. ...
... While post intervention, the results showed that the majority of counseling group had adequate foot care compared to less than half of web-based group with statistically significant difference between them. The findings of the current study were in the same line with Kim et al., 2006 who found inadequate foot self care activities pre-intervention and web-based education for diabetic patients improved foot self care activities post-intervention. The present results showed that the majority of two groups had low self efficacy and high mean of blood sugar level pre intervention with statistically significant relation between self efficacy and mean of blood sugar level. ...
Background: Diabetes mellitus is one of the most common non-communicable diseases globally, and its related complications result in increasing disability, reduced life expectancy and enormous health costs. Diabetes management education is a critical element of care for all people with diabetes and it is necessary to improve patient outcomes through traditional diabetes patient education strategy and/or through internet based education that has the opportunity to expand the to the massive individuals with diabetes Objectives: The aim of this study was to compare the efficiency of Web-Based education versus counseling on diabetic patients' outcomes including patients' diabetic knowledge, level of self-efficacy, self-care activities and blood glucose level. The design of this study was a quasi-experimental research design.. Setting: The study was conducted at the outpatient clinic for diabetes in Ain Shams University hospitals, Cairo, Egypt. The Subjects: Purposive sample of patients were included in the study. Patients for this study were adult and diagnosed with type 2 diabetes. Patients divided randomly into two equal groups (45 patients each) to constitute the web-based group and counseling group. Instruments: Patient's assessment and clinical data sheet, Diabetes Management Self-efficacy Sale (DMSES), diabetic patients' knowledge questionnaire sheet and a Summary of Diabetes Self –Care Activities Scale (SDSCA) were used. Results: The majority of counseling and web-based group had unsatisfactory knowledge, low level of self efficacy, inadequate self care activities and abnormal glucose level with no statistically significant difference between them pre-intervention. While, post-intervention, The majority of counseling and web-based group had satisfactory knowledge, high level of self efficacy, adequate self care activities and normal glucose level with. Alao, Counseling group had more satisfactory knowledge, high level of self efficacy, adequate self care activities and normal blood glucose level than web-based group with no statistically significant difference in all items except for self care activities Conclusion: It was concluded that, both of counseling and web-based diabetic patients' education improve patient outcome however counseling was more effective than web-based education strategy with no statistically significant difference between them in all items except for self care activities. This study recommended further research into the full use of the available technology is imperative for improving the quality of nursing intervention. [Fathia A. Mersal; Naglaa E. Mahday and Nahed A. Mersal. Efficiency of Web-Based Education versus Counseling on Diabetic Patients' Outcomes. Life Sci J 2012;9(3):912-926]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 131
... A short message service by cellular phone study in type 2 diabetic patients resulted in a decrease of HbA1c of 1.31% points at nine months and 1.32% points at twelve months [18]. An SMS intervention study by a nurse showed that the HbA1c levels decreased 1.1 percentage points after 12 weeks [2]. At the end of Internet diabetic patient management study using a Short Messaging Service A1C levels were significantly (0.72%) decreased in the intervention group [19]. ...
... Each year, 7 million people are diagnosed with the disease, and every 10s, a person dies from diabetes-related causes [1]. Diabetes is a chronic disease requiring lifelong medical and nursing intervention and lifestyle adjustment [2]. The National Survey of Risk Factors for Non-Communicable of Iran, which was conducted in 2005, demonstrated that the prevalence of diabetes mellitus in Iranian citizens aged 25–64 years was 7.7% (2 million individuals) [3], among whom half are undiagnosed [4]. ...
Background
To investigate and to compare the effectiveness of a nurse short message service (SMS) by cellular phone and telephone follow-up by nurse on Glycosylated hemoglobin (HbA1c) levels in people with type 2 diabetes.
Methods
Semi experimental study consisted of 77 patients with type 2 diabetes that randomly assigned to two groups: telephone follow-up (n = 39) and short message service (n = 38). Telephone interventions were applied by researcher for 3 months. SMS group that received message daily for 12 weeks. Data gathering instrument include data sheet to record HbA1c and questionnaire that consisted of demographic characteristics. Data gathering was performed at two points: initial the study and after 12 weeks. Data analyzed using descriptive and inferential statistics methods with SPSS version 11.5.
Results
Demographic variables were compared and all of them were homogenous. Results of this study showed that both interventions had significant mean changes in HbA1c; for the telephone group (p = 0.001), with a mean change of −0.93% and for the SMS group (p = 0.001), with a mean change of −1.01%.
Conclusion
Finding of this research showed that intervention using SMS via cellular phone and nurse-led-telephone follow up improved HbA1c for three months in type 2 diabetic patients and it can consider as alternative methods for diabetes control.
... With few exceptions [23] research has demonstrated improvements in diabetes outcomes and chronic illness selfmanagement behaviors [32,[39][40][41] when behavioral support is available through a variety of technologies (e.g., cell phone and automated text messaging [39,[42][43][44][45], hand-held devices [46] and e-communication with healthcare providers [47,48]). E-health interventions have helped improve dietary practices [23,49], physical activity [28,50,51], medication taking [32,49,52], clinical outcomes [32,39,40,53,54], and psychosocial variables [55]. ...
... With few exceptions [23] research has demonstrated improvements in diabetes outcomes and chronic illness selfmanagement behaviors [32,[39][40][41] when behavioral support is available through a variety of technologies (e.g., cell phone and automated text messaging [39,[42][43][44][45], hand-held devices [46] and e-communication with healthcare providers [47,48]). E-health interventions have helped improve dietary practices [23,49], physical activity [28,50,51], medication taking [32,49,52], clinical outcomes [32,39,40,53,54], and psychosocial variables [55]. ...
Health information technology has great potential to promote efficiency in patient care and increase patient-provider communication, and patient engagement in their treatment. This paper explored qualitatively what patients with type 2 diabetes want from electronic resources that are designed to support their diabetes self-management. Data were collected via interviews and focus groups from managed care patients who had completed participation in either a web-based (MyPath) or in-person group-based (¡Viva Bien!) longitudinal diabetes self-management study. Content analysis identified common themes that highlighted participant interest in virtual and electronic programs to support diabetes self-management goals, and their desired content and features. Eighteen ¡Viva Bien! participants completed telephone interviews and 30 MyPath participants attended seven focus groups in 2010-2011. All participants expressed a preference for face-to-face contact; however, most participants were also interested in using technology as a tool to support daily diabetes self-management decisions and to receive tailored information. Choice of technology, personalized instruction on how to use program features, and the ability to exchange information with their healthcare team were desired by all participants. Participants were divided on whether virtual social support networks should be closed to friends and family, should include other program members (peers), or should be open to anyone with diabetes. Participants aged 65 and older stressed the desire for technical support. What patients wanted from technology is real-time assistance with daily behavioral decision-making, ability to share information with their healthcare team, connections with others for support, and choice.
... It is expensive to manage diabetes and its consequences, especially in developing countries [1]. Numerous studies have demonstrated that controlling blood glucose levels can lower chances of developing complications [2]. Although many patients with diabetes have poor glycemic control, it is possible to improve patients' knowledge, practice, and self-efficacy to obtain better glycemic control [3]. ...
Background: With blood glucose self-monitoring, patients may assess how well their glucose level is controlled, and change their treatment plan as advised by their physicians. The development and increasing availability of different devices that are readily accessible play a significant role in glycemic control and prevention of complications through early recognition with proper practice. Methods: This observational cross-sectional study includes patients with diabetes attending Khartoum North Diabetes and Endocrinology Hospital and was carried out in April–July 2021 using convenient sampling via questionnaires obtained and filled by data collectors through interviews. Data analysis was done using SPSS software. Results: Out of 125 patients, 82 had prior basic knowledge about glucose self-monitoring devices. Twenty-four patients were using it regularly, and only seven were using it daily. Fifty-one patients had never used any device before. Fifty-five patients owned a device, and the rest borrowed or used devices available at healthcare centers or clinics, pharmacies, relatives’ or neighbors’ devices. Factors hindering the use of devices included financial difficulties and lack of education. Most frequent users had a stable occupation. Just below half of the patients using devices had good practice techniques with significant association with higher level of education. The rest had poor practice technique that was associated with lower level of education. Conclusion: Utilization of glucose self-monitoring devices is prevalent among patients with diabetes. However, many challenges require attention to facilitate ongoing self-use with proper practice in line with education and access.
... Prior research on reminders has primarily focused on using a short message service (SMS) to remind users to comply with a planned goal-based activity (e.g., an exercise, food, or medication schedule). Research has shown that people receiving short messages outperform those who do not receive such messages in terms of engaging in physical activity, taking medication, and adhering to healthy dietary choices (Haapala et al., 2009;Kim et al., 2006;Prestwich et al., 2010). Our study on motivational messages differs from studies on reminder-based text messages (e.g., Calzolari & Nardotto, 2017). ...
We investigate how two digitally delivered nudges, namely light social support (nonverbal cues such as kudos or likes) and motivational messaging, affect employees’ self-reported physical activity in an online, corporate wellness program. Within this unique field setting, using data from several years, we found evidence that both types of nudges provide benefits beyond the effect of cash incentives. However, the effects vary by individual, depending on whether the employee is actively engaging in physical activity, and by time, depending on how long the employee has been in the wellness program. We found light social support to be less effective over time, while motivational messages were found to be more effective with the duration in the program and generally more effective for physically inactive users. Our findings have implications for the design of wellness systems, suggesting different approaches depending on an employee’s current activity level and tenure in the program
... Type 2 diabetes mellitus (T2DM) is a chronic disease that requires lifelong treatment and lifestyle changes, and throughout the past few decades, the prevalence of T2DM has been rising steadily [1]. In 2019, around 463 million people were estimated to be living with diabetes, representing 9.3% of the adult population (20-79 years of age) globally [2]. ...
... These techniques will offer ease delivery of health care according to patients' needs and improve the Economical, Clinical, and Humanistic outcomes (ECHO). Evidence shows that SMS reminder has a more significant impact over improvement in medication adherence [12,13]. These text messages have distinct benefits in terms of reducing interferences into the patient's life and their relative easiness and low cost compared to voice communication [14]. ...
Aims: This study aimed to assess the effect of discharge counseling with SMS reminders on medication adherence in chronic disorders. Study Design: Prospective randomized open-label trial Place and Duration of Study: The study was conducted at the dispensing department of a secondary care referral charity hospital located in a small village. The study was conducted for a period of six months from October 2018 to April 2019. Methodology: Upon consent, a total of 364 patients were enrolled in this study and randomized into two groups viz., intervention group (n=182) and control group (n=182) respectively, with and without discharge counseling and SMS reminder on medication usage by the clinical pharmacist. The level of medication adherence was measured using a pill count and visual analog scale (VAS) methods at two follow-up visits includes baseline and final follow-up visit (gap of two months). A two-sample Wilcoxon rank‑sum (Mann–Whitney) was used to compare the statistical mean difference of medication adherence levels between two groups at each follow‑up visit. Results: The mean age of intervention and control groups were 57.1±8.55 and 58.5±8.53; most of the subjects were >60 years of age and were typically suffering from hypertension (30.2%) and diabetes (34.8%). Initially, at baseline, the values of medication adherence level (pill-count method) were closer in both intervention (82.4±7.3) and control group (81.35±6.4), whereas at follow up visits, the levels of the intervention group (93.2±6.0, 95.6±2.25) were significantly increased (p<0.0001) as compared to the control group (81.2±8.5, 80.6±8.1). Conclusion: Thus, the statistical significance infers that the clinical pharmacist-mediated discharge counseling with SMS reminders would increase medication adherence levels in chronic disorders.
... The health belief model (HBM) provides an appropriate framework for educational interventions in different fields, including diabetes control. To date, this model has been used as a framework for designing and implementing educational interventions in various areas of health care (15,16). However, few studies have investigated the effects of using virtual education on diabetic patients in Iran, and it remains unclear which e-learning method is more effective in the training of diabetic patients. ...
Background: Various teaching methods could be used to reduce complications in diabetic patients. Objectives: The present study aimed to assess the effect of nutrition training based on the health belief model (HBM) and electronic methods on the awareness of patients with type II diabetes in Kermanshah, Iran in 2012. Methods: This quasi-experimental study was conducted at a diabetes clinic in Kermanshah City. In total, 60 patients were selected via convenience sampling and divided into three groups of 20, including SMS, blog, and collaborative blog. Data were collected before, immediately after, and three months after the educational intervention using a standard questionnaire. Data analysis was performed in SPSS version 16 using the Kruskal-Wallis test, Friedman’s test, and analysis of variance (ANOVA) at the significance level of 0.05. Results: The mean score of awareness was considered significant (P < 0.01). In addition, significant differences were observed in the perceived sensitivity and barriers, cue to action, and self-efficacy in the blog group (P < 0.05) before and three months after the intervention. In the collaborative blog group, a significant difference was denoted in the perceived severity and cue to action before and three months after the intervention (P < 0.05). Cue to action also differed significantly in the SMS group, and the self-efficacy score significantly changed only in the blog group after the intervention (P = 0.006). Conclusions: According to the results, using blogs, group/collaborative blogs, and SMS could effectively increase the awareness of the diabetic patients. Therefore, virtual training could enhance the structures of the HBM, with the exception of the perceived sensitivity domain.
... When mobile phones were first employed in POC settings in the early 2000s, users could only take advantage of their data transmission capabilities. They were, thus, initially used to replace personal digital assistants (PDAs) and facilitate communication between medical staff [11]. Mobile phone cameras began to be exploited shortly after, and one of their earliest uses was to capture screenshots from ultrasound images for sharing among professionals [12]. ...
Smartphones are becoming increasingly versatile thanks to the wide variety of sensor and actuator systems packed in them. Mobile devices today go well beyond their original purpose as communication devices, and this enables important new applications, ranging from augmented reality to the Internet of Things. Personalized diagnostics is one of the areas where mobile devices can have the greatest impact. Hitherto, the camera and communication abilities of these devices have been barely exploited for point of care (POC) purposes. This short review covers the recent evolution of mobile devices in the area of POC diagnostics and puts forward some ideas that may facilitate the development of more advanced applications and devices in the area of personalized diagnostics. With this purpose, the potential exploitation of wireless power and actuation of sensors and biosensors using near field communication (NFC), the use of the screen as a light source for actuation and spectroscopic analysis, using the haptic module to enhance mass transport in micro volumes, and the use of magnetic sensors are discussed.
... The intervention program significantly improved medication adherence of the elderly with T2DM. The result of this study was comparable with the results of several studies [11][12][13][14][15] . Furthermore, this finding is supported by a previous study that showed patients adherence to medication improved health inclusive treatment with oral monotherapy [16] . ...
Background: Health complications with type 2 diabetes mellitus (T2DM) increases as the patient's age increases. This study aimed to investigate if the pharmacist counseling program has an impact on patient medication adherence and satisfaction of elderly diabetic patients. Moreover, it was aimed to investigate the impact of patients' adherence to HbA1c. Methods: This is a comparative study that was carried out in the diabetic clinic in a governmental hospital at King Saud Hospital, Unaizah city, in Saudi Arabia, over a period of eight months starting from June 2015. 102 patients were included in this study. In order to evaluate adherence and satisfaction, we used Morisky Medication Adherence Scale-8 (MMAS-8) and Diabetes Medication Satisfaction (DiabMedSat) questionnaires, respectively. Results: The mean total score of pre-MMAS-8 was 4.15±0.85. The mean total score of post-MMAS-8 was 5.67±0.51. The level of adherence after the intervention program showed 88.2% of patients with a low level of adherence and 11.8% of patients with a moderate level of adherence. The difference between the pre total satisfaction (49.13±11.01) and post total satisfaction (54.45±9.19) was significant (p=0.001). The correlation analysis between medication adherence and HbA1c in the present study revealed a non-significant correlation. Conclusion: The intervention program has improved medication adherence, satisfaction, and HbA1c level among elderly patients with T2DM. Gender was significantly associated with medication adherence, satisfaction, and HbA1c level. In addition, the patient's education level was significantly associated with medication adherence and satisfaction.
... Seven million people are diagnosed with this disease each year and every 10 seconds, a person dies because of diabetes mellitus-related causes [4]. Diabetes mellitus is a chronic disease which needs the lifelong medical and nursing intervention and lifestyle adjustment [5]. The Diabetes Mellitus Control and Complications Trial (1998) showed that for every 1% reduction in hemoglobin A1c (HbA1c) levels, there was a 40-50% reduction in risk for microvascular and neuropathic complications [6,7]. ...
Traditionality
The first use of the term "coach" arose around 1830 in Oxford University as a slang in relation with an instructor or trainer or tutor who "carried" a student through an exam. The term “coaching” thus refers to the process of transporting people from where they are to where they want to be. In 1915, the National Board of Medical Examiners was founded. In 2002, Wellcoaches partnered with the American College of Sports Medicine. In 2010, the National Consortium for Credentialing Health and Wellness Coaches was founded. In 2017, the International Consortium for Health and Wellness Coaching was established. Coaching as a method to improve healthy lifestyle behaviors has received special attention in recent years.
Abstract
Background: Using health coaching to improve the quality of life and health outcomes of the patients with diabetes mellitus, has emerged as a possible intervention. However, the few published randomized controlled trials using health coaching for patients with diabetes mellitus have reported mixed results. The present meta-analysis aimed to determine the effectiveness of health coaching on modifying health status and quality of life among diabetic patients and to clarify the characteristics of coaching delivery that make it most effective.
Methods: This study searched for articles on randomized controlled trials of health coaching interventions targeting type 2 diabetic patients that were published in the English language from January 2005 through December 2018 in the Cochrane, Medline, PubMed, Trip, and Embase databases. Patients in the control group received usual diabetes mellitus care, and those in the experimental group received health coaching based on usual diabetes mellitus care. The primary outcomes included Hemoglobin A1c (HbA1c) and cardiovascular disease risk factors, including systolic blood pressure, diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol, and body weight. The secondary outcomes included quality of life, self-efficacy, self-care skills, and psychological outcomes.
Results: Health coaching intervention has a significant effect on HbA1c [mean difference (MD) = -0.35, confidence interval (CI) = -0.47, -0.22, I2 = 83%, P < 0.001] and HDL-C (MD = -0.50, CI = -0.93, -0.07, I2 = 10%, P = 0.02). The most effective strategy for health coaching delivery associated with improvement of HbA1c was decreasing the number of sessions and increasing the duration of each session. However, no significant difference was found for weight, SBP, diastolic blood pressure, triglyceride, low-density lipoprotein cholesterol, or total cholesterol. Mixed results were reported for the effect of health coaching on quality of life, self-efficacy, self-care skills, and depressive symptoms outcome.
Conclusion: Health coaching intervention has a significant effect on HbA1c and HDL-C, and the most effective strategy is decreasing the number of sessions while increasing session duration. However, these results should be interpreted with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and imprecision.
... Seven million people are diagnosed with this disease each year and every 10 seconds, a person dies because of diabetes mellitus-related causes [4]. Diabetes mellitus is a chronic disease which needs the lifelong medical and nursing intervention and lifestyle adjustment [5]. The Diabetes Mellitus Control and Complications Trial (1998) showed that for every 1% reduction in hemoglobin A1c (HbA1c) levels, there was a 40-50% reduction in risk for microvascular and neuropathic complications [6,7]. ...
Background: Using health coaching to improve the quality of life and health outcomes of the patients with
diabetes mellitus, has emerged as a possible intervention. However, the few published randomized controlled trials
using health coaching for patients with diabetes mellitus have reported mixed results. The present meta-analysis
aimed to determine the effectiveness of health coaching on modifying health status and quality of life among
diabetic patients and to clarify the characteristics of coaching delivery that make it most effective. Methods: This
study searched for articles on randomized controlled trials of health coaching interventions targeting type 2 diabetic
patients that were published in the English language from January 2005 through December 2018 in the Cochrane,
Medline, PubMed, Trip, and Embase databases. Patients in the control group received usual diabetes mellitus care,
and those in the experimental group received health coaching based on usual diabetes mellitus care. The primary
outcomes included Hemoglobin A1c (HbA1c) and cardiovascular disease risk factors, including systolic blood
pressure, diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol (HDL-C), low-density
lipoprotein cholesterol, total cholesterol, and body weight. The secondary outcomes included quality of life,
self-efficacy, self-care skills, and psychological outcomes. Results: Health coaching intervention has a significant
effect on HbA1c [mean difference (MD) = -0.35, confidence interval (CI) = -0.47, -0.22, I2 = 83%, P < 0.001] and
HDL-C (MD = -0.50, CI = -0.93, -0.07, I2 = 10%, P = 0.02). The most effective strategy for health coaching
delivery associated with improvement of HbA1c was decreasing the number of sessions and increasing the duration
of each session. However, no significant difference was found for weight, SBP, diastolic blood pressure,
triglyceride, low-density lipoprotein cholesterol, or total cholesterol. Mixed results were reported for the effect of
health coaching on quality of life, self-efficacy, self-care skills, and depressive symptoms outcome. Conclusion:
Health coaching intervention has a significant effect on HbA1c and HDL-C, and the most effective strategy is
decreasing the number of sessions while increasing session duration. However, these results should be interpreted
with caution as the evidence comes from studies at some risk of bias with considerable heterogeneity and
imprecision.
... Globally, pharmacist-mediated patient counseling had proven to improve health outcomes in type II DM, this was reinforced by daily mobile phone text message reminder about medication intake. [12,13] The messages have distinct benefits in terms of reducing interferences into the patient's life and their relative easiness and low cost compared to voice communication. [14] Postcounseling session combined with the daily message reminder will greatly improve medication adherence levels and clinical outcomes in type II diabetes. ...
Introduction: Medication nonadherence is the most common issue observed in the management of diabetes because of complex and lifelong therapy. The study aimed to assess the effect of pharmacist-directed counseling and daily text message reminder on medication adherence and clinical profile of patients with type II diabetes. Materials and Methods: This prospective, open-labeled, randomized
control trial was carried out in outpatient medical department of a secondary care referral hospital. A total of 330 patients who met study criteria were enrolled and randomized into an intervention group (n = 165), received counseling and daily messages about medication intake and control group (n = 165), and usual care by physician. Medication adherence and clinical outcomes such as glycosylated hemoglobin (HbA1C), systolic blood pressure (SBP), low-density lipoprotein
(LDL) cholesterol, triglyceride (TG) levels, and body mass index (BMI) were recorded at baseline and follow-up visits. Two-sample Wilcoxon rank sum test was used to compare the mean difference of medication adherence and paired t-test was used to compare clinical outcomes. Results and Discussion: The mean age of intervention and control groups were 57.1 ± 8.55 and 58.5 ± 8.53 years, respectively. The mean difference of medication adherence from baseline to
second follow-up visit was significantly more in intervention group (12.2 ± 7.1 %) compared to that in control group (0.75 ± 10.2 %) with a P < 0.001. From baseline to second follow-up visit, HbA1C (7.79 ± 0.67 to 6.91 ± 0.83 %), SBP (136.75 ± 20.09 to 126.23 ± 18.22 mm Hg), and LDL cholesterol (104.14 ± 26.23 to 98.29 ± 20.87 mg/dL) levels were significantly reduced in intervention group compared to that in control group with a P < 0.01. No significant improvement was observed in TG (169± 33.71 to 168 65 ± 33.90 mg/dL) and BMI (27.9 ± 4.21 to 27.1 ± 3.12 Kg/m2) levels from baseline to second follow-up visit. Conclusion: Pharmacist-directed patient counseling combined with message reminder showed a greater effect on the improvement of medication adherence and control of glycemia, blood pressure, and lipid profile in diabetes.
... [17] For instance, the effect of a nurse short message service intervention on glycosylated hemoglobin A1c (HbA1c) levels and adherence to treatment diabetes control recommendations was evaluated in Korean patient with diabetes patients. [18] The development of mobile phone health promotion and disease prevention (including short-message service, multimedia message service, and Internet) is growing along with the widespread acceptance of cell phones. It estimated that in the worldwide, 4.55 billion people would use a mobile phone, and 1.75 billion would use a smart phone in 2014. ...
Background:
Health education has been considered as the effectiveness method to increase the self-care skills of diabetes patients. However, limited studies to investigate the association of health education via Wechat platform on increased the basic self-care skills and glycemic control rate in patients with type 2 diabetes.
Methods:
A total number of 120 type 2 diabetes patients were randomized into intervention (health education by Wechat platform plus usual care) and the control group (usual care). Biochemical parameters including fasting plasma glucose (FPG), 2-hour plasma glucose (2hPG), glycosylated hemoglobin A1c (HbA1c) were measured among the 2 groups at baseline 6-month and 12-month. Diabetes Management Self-Efficacy (SE) Scale was completed at baseline 6-month and 12-month.
Results:
Significant difference of HbA1c concentration and SE were found between intervention and control groups at 6-month and 12-month (P <.05). The effect of groups and health education duration times was found on reduced HbA1c concentration and increased the total score of SE (P <.05). No significant difference of FPG and 2hPG concentrations were found between intervention and control groups at 6 months and 12 months (P >.05).
Conclusion:
Health education of diabetic individuals via Wechat platform in conjunction with conventional diabetes treatment could improve glycemic control and positively influence other aspects of diabetes self-care skills.
... MA is a challenge for many older adults with diabetes, as those who are older face more complex medication regimens adding to successful self-management burdens [3,9,10] . Technology-enabled diabetes selfmanagement including mobile health applications (app) has been explored to foster 1-way and 2-way communication between the patient and health care provider(s) (HCPs) and offer education to improve patient outcomes [11][12][13][14] . However, their influence on enhancing MA for older adults remains largely unexplored. ...
... MA is a challenge for many older adults with diabetes, as those who are older face more complex medication regimens adding to successful self-management burdens [3,9,10] . Technology-enabled diabetes selfmanagement including mobile health applications (app) has been explored to foster 1-way and 2-way communication between the patient and health care provider(s) (HCPs) and offer education to improve patient outcomes [11][12][13][14] . However, their influence on enhancing MA for older adults remains largely unexplored. ...
... Recent advances in the widespread use of mobile phones and technology have made mobile health (mHealth) a promising solution. Short message service (SMS) for text messaging is one of the mHealth approaches that has been used in the management of diseases [10] such as asthma [11], human immunodeficiency syndrome (HIV) [12,13], malaria [14], diabetes [15], hypertension [10], and CHD [16,17]. However, the evidence of the effect of mHealth on medication adherence, diet, and physical activities remains inconclusive [10]. ...
Background:
Coronary heart disease (CHD) is the leading cause of cardiovascular mortality worldwide, yet implementation of evidence-based strategies for secondary prevention remains suboptimal.
Objective:
This study aimed to evaluate the feasibility, specifically the usability and acceptability, and estimate the preliminary effectiveness of a mobile health (mHealth) intervention targeting both physicians and patients to improve adherence to evidence-based medications and lifestyle modifications.
Methods:
We conducted a 12-week pre-post interventional pilot study at two sites in Shanghai and Hainan, China. Physicians used the app designed in this study to prescribe evidence-based medicines and record patient information. Eligible and consenting patients received automatic text messages or voice calls 4 to 5 times per week for 12 weeks on medication adherence and healthy behaviors. Interviews were conducted among 10 physicians and 24 patients at the two sites for their thoughts on medication adherence and feedback on the usability and acceptability. Questions on usability and acceptability were also asked in a patient follow-up survey. With regard to estimating effectiveness, the primary outcome was medication adherence (as estimated by the Morisky Green Levine Scale) at 12 weeks. Secondary outcomes included physical activity, smoking status, fruits and vegetables consumption, and facility visit frequency.
Results:
Interview findings and patient survey showed the good usability and acceptability of the intervention. Among 190 patients who completed the intervention, there was a significant increase in medication adherence (odds ratio [OR] 1.80, 95% CI 1.14-2.85). The study also showed decrease of smokers' percentage (-5%, P=.05), increase of daily vegetables consumption frequency (+0.3/day, P=.01), and community health care center visit frequency (+3 in 3 months, P=.04). The following site-specific differences were noted: medication adherence appeared to increase in Hainan (OR 14.68, 95% CI 5.20-41.45) but not in Shanghai (OR 0.61, 95% CI 0.33-1.12).
Conclusions:
Our study demonstrated that the intervention was feasible in both a tertiary care center and an urban community health center in China. Preliminary results from pre-post comparison suggest the possibility that provider and patient-linked mHealth interventions may improve medication adherence and lifestyle modifications among CHD patients, especially in resource-scarce settings. Randomized controlled trials are needed to verify the findings.
... Self-monitoring supported by SMS featured mainly diabetes, CVDs, asthma, and mental health studies. The CARDS study in USA [91], in addition to multiple studies in South Korea [92,93,94,95,96,97,98,99], required diabetic participants to enter their blood glucose readings into a website, and accordingly provided them with SMS feedback. Likewise, the Gluconet [100], Diabetes Phone [101], NICHE [102], DMS [103], and a South Korean study [104] asked diabetics to upload their blood glucose data onto a server via a specially designed glucometer device, mobile broadband, a modem, or a telephone line; and sent them SMS advice and recommendations accordingly. ...
Background:
With the continuous and enormous spread of mobile technologies, mHealth has evolved as a new subfield of eHealth. While eHealth is broadly focused on information and communication technologies, mHealth seeks to explore more into mobile devices and wireless communication. Since mobile phone penetration has exceeded other infrastructure in low and middle-income countries (LMICs), mHealth is seen as a promising component to provide pervasive and patient-centered care.
Objectives:
The aim of our research work for this paper is to examine the mHealth literature to identify application areas, target diseases, and mHealth service and technology types that are most appropriate for LMICs.
Methods:
Based on the 2011 WHO mHealth report, a combination of search terms, all including the word "mHealth", was identified. A literature review was conducted by searching the PubMed and IEEE Xplore databases. Articles were included if they were published in English, covered an mHealth solution/intervention, involved the use of a mobile communication device, and included a pilot evaluation study. Articles were excluded if they did not provide sufficient detail on the solution covered or did not focus on clinical efficacy/effectiveness. Cross-referencing was also performed on included articles.
Results:
842 articles were retrieved and analyzed, 255 of which met the inclusion criteria. North America had the highest number of applications (n=74) followed by Europe (n=50), Asia (n=44), Africa (n=25), and Australia (n=9). The Middle East (n=5) and South America (n=3) had the least number of studies. The majority of solutions addressed diabetes (n=51), obesity (n=25), CVDs (n=24), HIV (n=18), mental health (n=16), health behaviors (n=16), and maternal and child's health (MCH) (n=11). Fewer solutions addressed asthma (n=7), cancer (n=5), family health planning (n=5), TB (n=3), malaria (n=2), chronic obtrusive pulmonary disease (COPD) (n=2), vision care (n=2), and dermatology (n=2). Other solutions targeted stroke, dental health, hepatitis vaccination, cold and flu, ED prescribed antibiotics, iodine deficiency, and liver transplantation (n=1 each). The remainder of solutions (n=14) did not focus on a certain disease. Most applications fell in the areas of health monitoring and surveillance (n=93) and health promotion and raising awareness (n=88). Fewer solutions addressed the areas of communication and reporting (n=11), data collection (n=6), tele-medicine (n=5), emergency medical care (n=3), point of care support (n=2), and decision support (n=2). The majority of solutions used SMS messaging (n=94) or mobile apps (n=71). Fewer used IVR/phone calls (n=8), mobile website/email (n=5), videoconferencing (n=2), MMS (n=2), or video (n=1) or voice messages (n=1). Studies were mostly RCTs, with the majority suffering from small sample sizes and short study durations. Problems addressed by solutions included travel distance for reporting, self-management and disease monitoring, and treatment/medication adherence.
Conclusions:
SMS and app solutions are the most common forms of mHealth applications. SMS solutions are prevalent in both high and LMICs while app solutions are mostly used in high income countries. Common application areas include health promotion and raising awareness using SMS and health monitoring and surveillance using mobile apps. Remaining application areas are rarely addressed. Diabetes is the most commonly targeted medical condition, yet remains deficient in LMICs.
... An average reduction of 1.1% in glycated hemoglobin levels was also noted. 60 The production of mobile applications to selfconditioning and lifestyle changes are booming. Social marketing is another concept that has been employed for brief interventions with a wide reach in society. ...
Objective:
The main goal of this work was to produce a review of educational strategies to prevent diabetes, hypertension, and obesity.
Method:
PubMed database was consulted using combined descriptors such as [Prevention], [Educational Activities], [Diabetes], [Hypertension], and [Obesity]. Data from randomized trials published between 2002 and 2014 were included in spreadsheets for analysis in duplicate by the reviewers.
Results:
A total of 8,908 articles were found, of which 1,539 were selected about diabetes mellitus (DM, n=369), arterial systemic hypertension (ASH, n=200), and obesity (OBES, n=970). The number of free full text articles available was 1,075 (DM = 276, ASH = 118 and OBES = 681). In most of these studies, demographic characteristics such as gender and age were randomized, and the population mainly composed by students, ethnic groups, family members, pregnant, health or education professionals, patients with chronic diseases (DM, ASH, OBES) or other comorbidities. Group dynamics, physical activity practices, nutritional education, questionnaires, interviews, employment of new technologies, people training and workshops were the main intervention strategies used.
Conclusion:
The most efficient interventions occurred at community level, whenever the intervention was permanent or maintained for long periods, and relied on the continuous education of community health workers that had a constant interference inside the population covered. Many studies focused their actions in children and adolescents, especially on students, because they were more influenced by educational activities of prevention, and the knowledge acquired by them would spread more easily to their family and to society.
... In healthcare mobile phones, vis a vis text messaging, have typically been used to inform service users of appointments (Leong et al, 2006;Pijenborg et al, 2007) and remind them to take medication (Kim et al, 2005) and much of this has been to positive effect. However, the literature largely describes studies in which text messaging is one-directional (from service provider to user) and little is published on the content of messages or how text messaging could be used as an essential component of service delivery. ...
Unilink is an occupation-focused service for students with mental health difficulties based on the university campus. Each occupational therapist working in the service uses mobile phones, including text messaging, to communicate with, and support, students. The objective of this study was to explore the use of text message communication, recorded on therapists’ phones, between Unilink therapists and students attending the service.
... Recent advances in the widespread use of mobile phones and technology have made mobile health (mHealth) a promising solution. Short message service (SMS) for text messaging is one of the mHealth approaches that has been used in the management of diseases [10] such as asthma [11], human immunodeficiency syndrome (HIV) [12,13], malaria [14], diabetes [15], hypertension [10], and CHD [16,17]. However, the evidence of the effect of mHealth on medication adherence, diet, and physical activities remains inconclusive [10]. ...
... 24 SMS was found to affect the promotion of health awareness, 25 health knowledge, 26-28 and changing unhealthy behavior or improving therapy. [29][30][31][32][33][34] SMS was more effective than pamphlets in improving knowledge, attitude, and practices, especially in promoting physical activity. 35 In the present study, we also found that SMSdelivered interventions had positive short-term behavioral outcomes. ...
Background:
The ubiquity of cell phones, which allow for short message service (SMS), provides new and innovative opportunities for disease prevention and health education.
Objective:
To explore the use of cell phone-based health education SMS to improve the health literacy of community residents in China.
Methods:
A multi-stage random sampling method was used to select representative study communities and participants ≥ 18 years old. Intervention participants were sent health education SMSs once a week for 1 year and controls were sent conventional, basic health education measures. Health literacy levels of the residents before and after the intervention were evaluated between intervention and control groups.
Results:
Public health literacy scores increased 1.5 points, from 61.8 to 63.3, after SMS intervention for 1 year (P<0.01); the increase was greater for males than females (2.01 vs. 1.03; P<0.01) and for Shenzhen local residents than non-permanent residents (2.56 vs. 1.14; P<0.01). The frequency of high health literacy scores was greater for the intervention than control group (22.03% to 30.93% vs. 22.07% to 20.82%). With health literacy as a cost-effective index, the cost-effectiveness per intervention was 0.54.
Conclusion:
SMS may be a useful tool for improving health literacy.
... The questions of sample size and statistical validity of the studies are illustrative of the problems encountered with these types of interventions. Recruiting people may be difficult and/or create biase, in particular for some specific groups: women or rural inhabitants or illiterate persons who may not possess a mobile phone or may not be able to read the messages and take part in the intervention [4, 7, 21, 22, 42]. There is also a question of retaining people in the intervention when a mobile is lost/broken and/or the number changes, as is common in LMICs. ...
Background:
Chronic diseases have emerged as a serious threat for health, as well as for global development. They endenger considerably increased health care costs and diminish the productivity of the adult population group and, therefore, create a burden on health, as well as on the global economy. As the management of chronic diseases involves long-term care, often lifelong patient adherence is the key for better health outcomes. We carried out a systematic literature review on the impact of mobile health interventions -mobile phone texts and/or voice messages- in high, middle and low income countries to ascertain the impact on patients' adherence to medical advice, as well as the impact on health outcomes in cases of chronic diseases.
Methods:
The review identified fourteen related studies following the defined inclusion and exclusion criteria, in PubMed, Cochrane Library, the Library of Congress, and Web Sciences. All the interventions were critically analysed according to the study design, sample size, duration, tools used, and the statistical methods used for analysing the primary data. Impacts of the different interventions on outcomes of interest were also analysed.
Results:
The findings showed evidence of improved adherence, as well as health outcomes in disease management, using mobile Short Message Systems and/or Voice Calls. Significant improvement has been found on adherence with taking medicine, following diet and physical activity advice, as well as improvement in clinical parameters like HbA1c, blood glucose, blood cholesterol and control of blood pressure and asthma.
Conclusions:
Though studies showed positive impacts on adherence and health outcomes, three caveats should be considered, (i) there was no clear understanding of the processes through which interventions worked; (ii) none of the studies showed cost data for the m-health interventions and (iii) only short term impacts were captured, it remains unclear whether the effects are sustained. More research is needed in these three areas before drawing concrete conclusions and making suggestions to policy makers for further decision and implementation.
... 14 Participants had difficulties with more sophisticated programs such as smartphone applications 20 in one study that resulted in some subject dropout. Nearly all studies enrolled middle-aged adults, with average ages of 40-63 years, 10,14,[18][19][20][21][22]26,28 but none specifically examined how older adults may use or benefit from Web-based education. Likewise, only one trial enrolled a significant proportion of young adult participants, 15 who may be more Web-savvy and thus navigate these types of programs with greater ease. ...
Peer-led diabetes education has been shown to be as effective, or more effective, than traditional education in improving glycemic control and diabetes self-care measures. A 4-week peer-led diabetes education program was conducted in a homeless community in Grand Rapids, Michigan to increase diabetes knowledge and empowerment. Knowledge scores increased significantly during sessions covering signs, symptoms, and complications of diabetes and diabetes medications (ps <.05). Empowerment scores after attending the 4-week program were significantly increased when compared to scores prior to the first session (p = .027). Field notes and postimplementation focus group support increased empowerment and knowledge among participants.
... Recruiting people may be difficult and/or create biase, in particular for some specific groups: women or rural inhabitants or illiterate persons who may not possess a mobile phone or may not be able to read the messages and take part in the intervention [4,7,21,22,42]. There is also a question of retaining people in the intervention when a mobile is lost/broken and/or the number changes, as is common in LMICs. ...
Background: Chronic diseases have emerged as a serious threat for health, as well as for global development. They endenger considerably increased health care costs and diminish the productivity of the adult population Group and, therefore, create a burden on health, as well as on the global economy. As the management of chronic diseases involves long-term care, often lifelong patient adherence is the key for better health outcomes. We carried out a systematic literature review on the impact of mobile health interventions -mobile phone texts and/or voice messages- in high, middle and low income countries to ascertain the impact on patients’ adherence to medical advice, as well as the impact on health outcomes in cases of chronic diseases.
Methods: The review identified fourteen related studies following the defined inclusion and exclusion criteria, in PubMed, Cochrane Library, the Library of Congress, and Web Sciences. All the interventions were critically analysed according to the study design, sample size, duration, tools used, and the statistical methods used for analysing the
primary data. Impacts of the different interventions on outcomes of interest were also analysed.
Results: The findings showed evidence of improved adherence, as well as health outcomes in disease management, using mobile Short Message Systems and/or Voice Calls. Significant improvement has been found on adherence with taking medicine, following diet and physical activity advice, as well as improvement in clinical
parameters like HbA1c, blood glucose, blood cholesterol and control of blood pressure and asthma.
Conclusions : Though studies showed positive impacts on adherence and health outcomes, three caveats should be considered, (i) there was no clear understanding of the processes through which interventions worked; (ii) None of the studies showed cost data for the m-health interventions and (iii) only short term impacts were captured, it remains unclear whether the effects are sustained. More research is needed in these three areas before drawing
concrete conclusions and making suggestions to policy makers for further decision and implementation.
Keywords: M-Health, Mobile phone, Short message system (SMS), Adherence, Health outcomes, Chronic disease
... 18 To ensure healthy lifestyle modification, a necessary prerequisite involves the incorporation of a behavioral change agent into one's everyday life. In fact, text messaging is already being utilized to provide many forms of health service, including improvement of medication adherence, 19 clinical appointment reminders, 20,21 monitoring self-management treatments for chronic conditions, [22][23][24][25] reporting test results, 26,27 and patient follow-up and data collection between appointments. 28,29 The ...
Background: Technology continues to play an increasingly important role in the delivery of healthcare. Traditionally, health technology has been defined by instruments that have actively aided in the prevention, diagnosis and treatment of disease. However, the focus of health technology has become centered on the transmission, processing, and storing of health information to decrease costs and improve resource allocation. Mobile health (mHealth) is an emerging component of health information technology (HIT) that utilizes mobile devices to deliver health care. More specifically, short messaging service (SMS) texting has gained increased attention as an affordable, ubiquitous form of mHealth to promote smoking cessation. Methods: In order to analyze the effectiveness of SMS text-based interventions on the promotion of smoking cessation, we searched MEDLINE, EMBASE, Cinahl, PsycInfo, and the Cochrane Library for published literature. Utilizing search phrases such as SMS text messaging and tobacco/smoking cessation, the selection criteria included only randomized clinical trials with participants being smokers of any age who wanted to quit. Results: Three studies were evaluated, including an SMS text-based program in New Zealand, an SMS text intervention in the UK, and an internet and SMS text-based program in Norway involving two different groups. Two studies illustrated statistically significant increases in cessation in the 1-2 month time interval after participants' assigned smoking quit date. Furthermore, one study demonstrated a significant increase in smoking cessation at one, three, six, and twelve months post-SMS text intervention. Conclusion: Research in this area has been limited, but is growing rapidly. Presenting SMS texting as an innovative and cost-effective tool that can effectively promote behavioral modification, this paper illustrates the potential for SMS text-based smoking interventions to significantly reduce tobacco consumption.
... For example, a study in United Kingdom has developed a novel support network, based on a unique text-messaging system designed to deliver individually targeted messages and general diabetes information [17]. Another study in Korea has assessed the impact of a nurse short message service intervention on HbA1c levels and adherence to treatment control recommendations in patients with diabetes [18]. Moreover, results of a study carried out in Bahrain demonstrated effectiveness of mobile phone short message service on diabetes mellitus management [19]. ...
Aim:
The objective of the current study is to assess the effectiveness of Mobile Short Message Service (SMS) intervention on education of basic self-care skills in patients with type 2 diabetes. Moreover, we aimed to determine whether delivering individually-tailored educational messages can be more effective than general educational messages.
Methods:
A total of 150 patients with diabetes type 2 were randomized into three groups: tailored SMS group, non-tailored SMS group, and the control group. Biochemical parameters including HbA1c, FBS, lipid profile were evaluated for the three groups at baseline and after 12 weeks. Moreover, self-care Inventory (SCI), Diabetes Management Self-Efficacy Scale (DMSES) and Diabetes Self-Care Barriers assessment scale for Older Adults (DSCB-OA) were completed. In the tailored SMS group, each person received 75% of their messages based on the top two barriers to adherence that they had experienced and reported in their scale. In the non-tailored SMS group, random messages were sent to every patient.
Results:
After 12 weeks, although HgA1c levels did not significantly change, significant decline was observed in FBS and mean BMI in both intervention groups. Mean SCI-R scores significantly increased and mean DSCB and DMSES scores significantly decreased in both tailored and non-tailored SMS groups. In the control group, mean SCI-R scores decreased and mean DSCB and DMSES scores significantly increased (P<0.001).
Conclusion:
Sending short text messages as a method of education in conjunction with conventional diabetes treatment can improve glycemic control and positively influence other aspects of diabetes self-care. According to our findings, sending SMS regularly in particular times appears to be as effective as sending individually tailored messages.
... Most SMS studies are focused on communicable diseases with a recent shift towards non-communicable diseases. SMS based interventions have shown modest effect [33][34][35][36][37][38][39][40][41]. We feel that in addition to robust RCT design the actual SMS wordings of our intervention were designed on theories of behavior change and may explain some effect as compared to simple knowledge transfer messages [42]. ...
Background:
The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan.
Methods:
This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle.
Results:
Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2-7.6) in the intervention group while 6.7 (95 % CI: 6.4-7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22-0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; -5.5 to 0.15) lower compared to the usual care group.
Conclusion:
A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas.
Trial registration:
Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023.
... SMS has been used previously in diseases such as asthma, HIV and diabetes with variable success [25][26][27][28][29][30][31][32][33][34][35][36]. However, to the best of our knowledge, tailored SMS for each patient based on their dosing frequency, have not been studied before. ...
... SMS has been used previously in diseases such as asthma, HIV and diabetes with variable success [25][26][27][28][29][30][31][32][33][34][35][36]. However, to the best of our knowledge, tailored SMS for each patient based on their dosing frequency, have not been studied before. ...
Background:
Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke.
Methods:
This will be a randomized, controlled, assessor blinded single center superiority trial. Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic. They will be randomized into two parallel groups in a 1:1 ratio via block technique with one group receiving the standard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the standard of care. In addition intervention group will receive messages for lifestyle changes, medication information, risk factors and motivation for medication adherence. These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication. Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale. The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance. The acceptability of the SMS will be determined by a tool designed for this study whose attributes are based Rogers Diffusion of innovation theory. A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups; using an attrition rate of 15 %, 200 participants in all will be randomized.
Discussion:
The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting.
Trial registration:
https://clinicaltrials.gov/ct2/show/NCT01986023 11 /11/2013.
... 14 Participants had difficulties with more sophisticated programs such as smartphone applications 20 in one study that resulted in some subject dropout. Nearly all studies enrolled middle-aged adults, with average ages of 40-63 years, 10,14,[18][19][20][21][22]26,28 but none specifically examined how older adults may use or benefit from Web-based education. Likewise, only one trial enrolled a significant proportion of young adult participants, 15 who may be more Web-savvy and thus navigate these types of programs with greater ease. ...
Background:
Diabetes self-management education is a cornerstone of successful diabetes management. Various methods have been used to reach the increasing numbers of patients with diabetes, including Internet-based education. The purpose of this article is to review various delivery methods of Internet diabetes education that have been evaluated, as well as their effectiveness in improving diabetes-related outcomes.
Materials and methods:
Literature was identified in the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, Medline, EBSCO, the Cochrane Library, and the Web of Science databases through searches using the following terms: "type 2 diabetes AND internet/web based AND education" and "type 2 diabetes AND diabetes self-management education (DSME) AND web-based/internet OR technology assisted education." The search was limited to English language articles published in the last 10 years. The search yielded 111 articles; of these, 14 met criteria for inclusion in this review. Nine studies were randomized controlled trials, and study lengths varied from 2 weeks to 24 months, for a total of 2,802 participants.
Results:
DSME delivered via the Internet is effective at improving measures of glycemic control and diabetes knowledge compared with usual care. In addition, results demonstrate that improved eating habits and increased attendance at clinic appointments occur after the online DSME, although engagement and usage of Internet materials waned over time. Interventions that included an element of interaction with healthcare providers were seen as attractive to participants.
Conclusions:
Internet-delivered diabetes education has the added benefit of easier access for many individuals, and patients can self-pace themselves through materials. More research on the cost-benefits of Internet diabetes education and best methods to maintain patient engagement are needed, along with more studies assessing the long-term impact of Internet-delivered DSME.
... In interventions that just included participants with T2D that were not on insulin, the regimen adjustments included recommendations for lifestyle modifications such as diet or exercise behaviors [43, 48••], and dosing adjustments of oral medications [24,37,52]. Additional recommendations for participants with T2D also on insulin would include adjustments to the insulin regimen as well [28,29,32,33,42,49,53,54]. In the T1D studies the intervention recommendations mostly involved just insulin adjustment suggestions [25, 26, 30, 34, 36, 38-41, 46, 50, 55]. ...
Many studies have tested clinical and behavioral approaches for improving glycemic control in people with diabetes. We reviewed studies to identify how blood glucose (BG) values have been used in patient-focused clinical research and interventions. We sought to describe the frequency that BG values have been the focus of patient education research and to characterize the different methods to integrate BG into an intervention, the approaches implemented to support patient education, and behavior change, and the nature of communication about BG values. Thirty-four eligible studies were identified that included patient education using BG values. Information regarding the study and intervention characteristics include: (1) characteristics of the study sample, (2) how BG values were obtained, (3) use of a graphical interface for BG values, (4) use of a BG log, (5) BG interpretation and regimen adjustments, (6) recommended actions to patient, (7) modality of intervention, and (8) intervention communication schedule. The review demonstrated that new BG technologies provide outstanding opportunities for greater access to BG data, and for patient support and intervention. However, it also indicated a need to improve and expand support for people with diabetes in their daily use of BG values to maintain and improve glycemic control. In order to make the most sustainable impact on behavior, generalizable skills such as problem solving need to be integrated into BG education.
Background Stroke patients have low medication adherence after discharge, which leads to a high recurrence rate and poor disease control. Various strategies have been explored to enhance medication adherence in this patient population. Aim To evaluate the effects of mobile health (mHealth) and telehealth technology on medication adherence in stroke patients. Method All English studies that met the inclusion criteria published before September 2021 were obtained from PubMed, EMBASE, Web of Science, and Cochrane Library. Two researchers independently screened articles, extracted data, and evaluated the quality of the included studies. All articles were about randomized controlled trials. Medication adherence was used as the outcome index of this review. Random or fixed-effect models were used in statistical methods. I2 statistics were used to evaluate heterogeneity. Results A total of ten studies met the inclusion criteria, covering 2151 stroke patients. Compared with the Usual Care group, the medication adherence scores of the mHealth technology group were better (standard mean deviation 0.67, 95% confidence interval, CI [0.49, 0.85], P < 0.001). The medication adherence ratio of the mHealth technology group was higher (odds ratio, OR, 2.81, 95% CI [1.35, 5.85], P = 0.006). Subgroup analysis showed that application and messaging interventions were more effective than the telephone call intervention (OR 4.05, 95% CI [2.10, 7.80], P < 0.001). The shorter the interval of the intervention, the better the medication adherence of patients (OR 4.24, 95% CI [2.30, 7.81], P < 0.001). Conclusion Compared with Usual Care, mHealth can effectively improve the medication adherence of stroke patients.
Background:
The aim of this study was to analyze the persistence with oral antihyperglycemic drugs in type 2 diabetes mellitus (T2DM) patients with dementia in Germany.
Methods:
This study included adults with T2DM who were treated with oral antihyperglycemic drugs and were diagnosed with dementia in 1262 German general practices between January 2013 and December 2015 (index date). Dementia cases were matched (1:1) to controls without dementia by age, gender, type of practice, type of residence, physician, and initial antihyperglycemic therapy, using a propensity score method. The primary outcome of the study was the rate of persistence with oral antihyperglycemic drugs in dementia cases and controls without dementia in the year following the index date. Persistence was estimated as therapy time without treatment discontinuation, which was defined as at least 90 days without oral antihyperglycemic therapy. Cox regressions were used to determine the impact of dementia on persistence with oral antihyperglycemic treatment in the entire population and in different subgroups.
Results:
This study included 848 T2DM patients with dementia and 848 T2DM patients without dementia. In the dementia group, 39.2% of patients were men, while the control group included 40.8% men. After 12 months of follow-up, 72.7% of dementia cases and 71.4% of controls without dementia were persistent ( P = .291). No significant association was found between dementia and persistence with oral antihyperglycemic drugs in the entire population and in different subgroups (HR ranging from 0.84 to 1.25).
Conclusions:
Dementia did not have a significant impact on persistence with oral antihyperglycemic drugs in T2DM patients in Germany.
• Objectives: To conduct a systematic review of the literature examining interventions delivered by health care practitioners to improve medication adherence in patients with diabetes mellitus (DM). • Methods: Databases were searched up to 2 July 2013 to identify eligible studies that included interventions that were conducted in a clinic-based setting and delivered by a health care practitioner (eg, nurse, physician, diabetes educator) to improve adherence to diabetes medications (including oral hypoglycemic agents and insulin). Articles were limited to published clinical trials conducted in adults ≥ 18 years of age and published in English-language journals. • Results: 18 papers were reviewed: 15 trials targeted patients with DM, 3 targeted health care practitioners. 7 patient-focused and 1 practitioner-focused trial demonstrated a beneficial effect of the intervention compared with a control group. The patient-focused trials were complex interventions involving a combination of adherence-enhancing strategies such as individualized patient counseling, tailored patient education, medication reminders, behavioral feedback and reinforcement, and care management by ancillary staff, nurses, text message or telephone-linked system. The practitioner-focused trial employed an electronic feedback system for individualized care and quality improvement. Limitations included the diversity in the measures employed to assess adherence; differing definitions of adherence; the inclusion of patients regardless of baseline adherence status; and the short duration of the trials. • Conclusions: Additional research is needed to understand the conditions under which interventions targeting the patient-practitioner interaction can be implemented in clinic settings to improve medication adherence in patients with DM.
Background:
Chronic disease has become an increasingly important issue for individuals and healthcare organizations across Canada. Home telehealth may have the potential to alleviate the economic and social challenges associated with rising rates of chronic disease. An aim of this review was to gather and synthesize the evidence on the effectiveness of home telehealth in chronic disease management.
Materials and methods:
We searched the Medline, EMBASE, Web of Science, CINAHL, and PAIS databases for studies published in English from January 1, 2005, and December 31, 2010. Academic publications, white papers, and gray literature were all considered eligible for inclusion, provided an original research element was present. Articles were screened for relevance.
Results:
One hundred one articles on quantitative or mixed-methods studies reported the effects of home telehealth on disease state, symptoms, and quality of life in chronic disease patients. Studies were consistent in finding that home telehealth was equivalent or superior to usual care.
Conclusions:
The literature strongly supports the use of home telehealth as an equally effective alternative to usual care. The circumstances under which home telehealth emerges as significantly better than usual care have not been extensively researched. Further research into factors affecting the effectiveness of home telehealth would support more widespread realization of telehealth's potential benefits.
Objective
Numerous telecare interventions and technologies are used in the management of type 2 diabetes mellitus. This systematic review examines the different telecare interventions implemented, the technologies used, as well as the outcomes. Such a synthesis serves to optimize telecare use for diabetic patients and inform decision makers on technology selection and the impacts that can be expected with telecare use.
Materials and Methods
Following a systematic, comprehensive search of databases, 2,139 qualitative and quantitative studies were initially selected; after careful review and screening, 50 studies were coded and analyzed.
Results
A typology is proposed that identifies the nature of telecare interventions and technologies used as well as the outcomes associated with their use. Overall, telecare produces positive results with a variety of outcomes, such as improved health status, increased quality of care, decreased health service use or cost, increased satisfaction and increased patient knowledge.
Discussion
While telecare is seen to have overall positive outcomes, some caveats have been identified. There is no “one size fits all” solution. Inexperience with technology combined with a mediocre user interface can create many problems that inhibit appropriate adoption of the technology. There is a growing presence of mobile technologies, which provide immediate feedback and can be integrated with social media.
Conclusion
The results of this review can be used by healthcare professionals, organizations and patient support groups to tailor their policies with regards to the choice, planning, diffusion and monitoring of telecare interventions and the technologies implemented to care for patients with diabetes.
Background Improved blood-glucose control decreases the progression of diabetic microvascular disease, but the effect on macrovascular complications is unknown. There is concern that sulphonylureas may increase cardiovascular mortality in patients with type 2 diabetes and that high insulin concentrations may enhance atheroma formation. We compared the effects of intensive blood-glucose control with either sulphonylurea or insulin and conventional treatment on the risk of microvascular and macrovascular complications in patients with type 2 diabetes in a randomised controlled trial. Methods 3867 newly diagnosed patients with type 2 diabetes, median age 54 years (IQR 48-60 years), who after 3 months' diet treatment had a mean of two fasting plasma glucose (FPG) concentrations of 6.1-15.0 mmol/L were randomly assigned intensive policy with a sulphonylurea (chlorpropamide, glibenclamide, or. glipizide) or with insulin, or conventional policy with diet. The aim in the intensive group was FPG less than 6 mmol/L. in the conventional group, the aim was the best achievable FPG with diet atone; drugs were added only if there were hyperglycaemic symptoms or FPG greater than 15 mmol/L. Three aggregate endpoints were used to assess differences between conventional and intensive treatment: any diabetes-related endpoint (sudden death, death from hyperglycaemia or hypoglycaemia, fatal or non-fatal myocardial infarction, angina, heart failure, stroke, renal failure, amputation [of at least one digit], vitreous haemorrhage, retinopathy requiring photocoagulation, blindness in one eye,or cataract extraction); diabetes-related death (death from myocardial infarction, stroke, peripheral vascular disease, renal disease, hyperglycaemia or hypoglycaemia, and sudden death); all-cause mortality. Single clinical endpoints and surrogate subclinical endpoints were also assessed. All analyses were by intention to treat and frequency of hypoglycaemia was also analysed by actual therapy. Findings Over 10 years, haemoglobin A(1c) (HbA(1c)) was 7.0% (6.2-8.2) in the intensive group compared with 7.9% (6.9-8.8) in the conventional group-an 11% reduction. There was no difference in HbA(1c) among agents in the intensive group. Compared with the conventional group, the risk in the intensive group was 12% lower (95% CI 1-21, p=0.029) for any diabetes-related endpoint; 10% lower (-11 to 27, p=0.34) for any diabetes-related death; and 6% lower (-10 to 20, p=0.44) for all-cause mortality. Most of the risk reduction in the any diabetes-related aggregate endpoint was due to a 25% risk reduction (7-40, p=0.0099) in microvascular endpoints, including the need for retinal photocoagulation. There was no difference for any of the three aggregate endpoints the three intensive agents (chlorpropamide, glibenclamide, or insulin). Patients in the intensive group had more hypoglycaemic episodes than those in the conventional group on both types of analysis (both p<0.0001). The rates of major hypoglycaemic episodes per year were 0.7% with conventional treatment, 1.0% with chlorpropamide, 1.4% with glibenclamide, and 1.8% with insulin. Weight gain was significantly higher in the intensive group (mean 2.9 kg) than in the conventional group (p<0.001), and patients assigned insulin had a greater gain in weight (4.0 kg) than those assigned chlorpropamide (2.6 kg) or glibenclamide (1.7 kg). Interpretation Intensive blood-glucose control by either sulphonylureas or insulin substantially decreases the risk of microvascular complications, but not macrovascular disease, in patients with type 2 diabetes. None of the individual drugs had an adverse effect on cardiovascular outcomes. All intensive treatment increased the risk of hypoglycaemia.
In Brief
Existing knowledge from the literature demonstrates that primary prevention of diabetes complications is possible. However, patient-, provider-, and health system-based barriers may prevent implementation of evidence-based practices. This article explores barriers to diabetes care that are external to the patient and that may require particular attention when attempting to translate primary prevention strategies into clinical care in the community.
To compare the compliance with diabetes care performance indicators by diabetes specialists using a diabetes electronic management system (DEMS) and by those using the traditional paper medical record.
A DEMS has been gradually introduced into our subspecialty practice for diabetes care. To assess the value of this DEMS as a disease management tool, we completed a retrospective review of the medical records of 82 randomly selected patients attending a subspecialty diabetes clinic (DC) during the first quarter of 1996. Eligible patients were defined by the suggested criteria from the American Diabetes Association Provider Recognition Program. During the first quarter of 1996, approximately one half of the providers began using the DEMS for some but not all of their patient encounters. Neither abstractors nor providers were aware of the intent to examine performance in relationship to use of the DEMS.
Several measures were positively influenced when providers used the DEMS. The number of foot examinations, the number of blood pressure readings, and a weighted criterion score were greater (P < 0.01) for providers using the DEMS. There was evidence, although not statistically significant, for lower mean diastolic blood pressures (P = 0.043) in patients and for number of glycated hemoglobins documented (P = 0.018) by users of the DEMS.
Performance and documentation of the process of care for patients with diabetes in a subspecialty clinic are greater with the use of a DEMS than with the traditional paper record.
To review reliability, validity, and normative data from 7 different studies, involving a total of 1,988 people with diabetes, and provide a revised version of the Summary of Diabetes Self-Care Activities (SDSCA) measure.
The SDSCA measure is a brief self-report questionnaire of diabetes self-management that includes items assessing the following aspects of the diabetes regimen: general diet, specific diet, exercise, blood-glucose testing, foot care, and smoking. Normative data (means and SD), inter-item and test-retest reliability, correlations between the SDSCA subscales and a range of criterion measures, and sensitivity to change scores are presented for the 7 different studies (5 randomized interventions and 2 observational studies).
Participants were typically older patients, having type 2 diabetes for a number of years, with a slight preponderance of women. The average inter-item correlations within scales were high (mean = 0.47), with the exception of specific diet; test-retest correlations were moderate (mean = 0.40). Correlations with other measures of diet and exercise generally supported the validity of the SDSCA subscales (mean = 0.23).
There are numerous benefits from standardization of measures across studies. The SDSCA questionnaire is a brief yet reliable and valid self-report measure of diabetes self-management that is useful both for research and practice. The revised version and its scoring are presented, and the inclusion of this measure in studies of diabetes self-management is recommended when appropriate.
We aimed to identify barriers to improving care for individuals with diabetes in community health centers. These findings are important because many such patients, as in most other practice settings, receive care that does not meet evidence-based standards.
In 42 Midwestern health centers, we surveyed 389 health providers and administrators about the barriers they faced delivering diabetes care. We report on home blood glucose monitoring, HbA1c tests, dilated eye examinations, foot examinations, diet, and exercise, all of which are a subset of the larger clinical practice recommendations of the American Diabetes Association (ADA).
Among the 279 (72%) respondents, providers perceived that patients were significantly less likely than providers to believe that key processes of care were important (overall mean on 30-point scale: providers 26.8, patients 18.2, P = 0.0001). Providers were more confident in their ability to instruct patients on diet and exercise than on their ability to help them make changes in these areas. Ratings of the importance of access to care and finances as barriers varied widely; however, >25% of the providers and administrators agreed that significant barriers included affordability of home blood glucose monitoring, HbA1c testing, dilated eye examination, and special diets; nonproximity of ophthalmologist; forgetting to order eye examinations and to examine patients' feet; time required to teach home blood glucose monitoring; and language or cultural barriers.
Providers in health centers indicate a need to enhance behavioral change in diabetic patients. In addition, better health care delivery systems and reforms that improve the affordability, accessibility, and efficiency of care are also likely to help health centers meet ADA standards of care.
We evaluated automated telephone disease management (ATDM) with telephone nurse follow-up as a strategy for improving diabetes treatment processes and outcomes in Department of Veterans Affairs (VA) clinics. We also compared the results with those of a prior ATDM trial conducted in a county health care system.
A total of 272 VA patients with diabetes using hypoglycemic medications were randomized. During the 1-year study period, intervention patients received biweekly ATDM health assessment and self-care education calls, and a nurse educator followed up with patients based on their ATDM assessment reports. Telephone surveys were used to measure patients' self-care, symptoms, and satisfaction with care. Outpatient service use was evaluated using electronic databases and self-reports, and glycemic control was measured by HbA1c and serum glucose testing.
At 12 months, intervention patients reported more frequent glucose self-monitoring and foot inspections than patients receiving usual care and were more likely to be seen in podiatry and diabetes specialty clinics. Intervention patients also were more likely than control patients to have had a cholesterol test. Among patients with baseline HbA1c levels > or =8%, mean end-point values were lower among intervention patients than control patients (8.7 vs. 9.2%, respectively; P = 0.04). Among intervention and control patients with baseline values > or =9%, mean end-point values were 9.1 and 10.2%, respectively (P = 0.04). At follow-up, intervention patients reported fewer symptoms of poor glycemic control than control patients and greater satisfaction with their health care.
This intervention improved the quality of VA diabetes care. Intervention effects for most end points replicated findings from the prior county clinic trial, although intervention-control differences in the current study were smaller because of the relatively good self-care and health status among the current study's enrollees.
The public is increasingly aware of the importance of HbA(1c) testing, yet the vast majority of patients with diabetes do not know their HbA(1c) status or goal. We set forth to evaluate the impact of a system that provides uniquely formatted and personalized reports of diabetes status and goals on changes in HbA(1c) levels.
A total of 150 patients with diabetes were randomized to receive either standard care or intervention inclusive of a computer-generated 11" x 17" color poster depicting an individual's HbA(1c) status and goals along with personalized steps to aid in goal achievement. All patients enrolled received diabetes education during the 3 months before enrollment. HbA(1c) was performed at baseline and 6 months.
At baseline, there were no significant differences between patient groups in terms of age, sex, education level, race, and HbA(1c) or lipid levels. Among patients with baseline HbA(1c) > or =7.0%, there was an 8.6% (0.77% absolute) reduction in HbA(1c) among control subjects compared with a 17.0% (1.69% absolute) decline in the intervention group (P = 0.032). There were no differences between the control and intervention groups with respect to the frequency of patients experiencing any decline in HbA(1c) (63 vs. 69%, P = 0.87); among these patients experiencing a decline, the most substantial reductions were seen with the control group, which had a 13.3% (1.15% absolute) decline compared with the intervention patients, who reduced their HbA(1c) by 24.2% (2.26% absolute reduction; P = 0.0048). At study close, 77% of the patients had their poster displayed on their refrigerator.
This unique and personalized computer-generated intervention resulted in HbA(1c) lowering comparable to that of hypoglycemic agents.
The Diabetes Prevention Program demonstrated the ability to delay or prevent type 2 diabetes in participants with impaired glucose tolerance (IGT). Participants with IGT are at high risk for cardiovascular disease (CVD), with a marked increase in the number and severity of CVD risk factors. We prospectively assessed the impact of our interventions on hypertension, dyslipidemia, and CVD events.
The study group consisted of 3,234 individuals with IGT randomly assigned to receive intensive lifestyle intervention, metformin, or placebo. Annual assessment of blood pressure, lipids, electrocardiogram, and CVD events was undertaken.
Hypertension was present in 30% of participants at study entry and then increased in the placebo and metformin groups, although it significantly decreased with intensive lifestyle intervention. Triglyceride levels fell in all treatment groups, but fell significantly more with intensive lifestyle intervention. Total cholesterol and LDL cholesterol levels were similar among treatment groups. Intensive lifestyle intervention significantly increased the HDL cholesterol level and reduced the cumulative incidence of the proatherogenic LDL phenotype B. At 3 years of follow-up, the use for pharmacologic therapy to achieve established goals in the intensive lifestyle group was 27-28% less for hypertension and 25% less for hyperlipidemia compared with placebo and metformin groups. Over an average of 3 years, 89 CVD events from 64 participants were positively adjudicated studywide, with no differences among treatment groups.
Lifestyle intervention improves CVD risk factor status compared with placebo and metformin therapy. Although no differences in CVD events were noted after 3 years, achieved risk factor modifications suggest that longer intervention may reduce CVD event rates.
BACKGROUND
Long-term microvascular and neurologic complications cause major morbidity and mortality in patients with insulin-dependent diabetes mellitus (IDDM). We examined whether intensive treatment with the goal of maintaining blood glucose concentrations close to the normal range could decrease the frequency and severity of these complications.
METHODS
A total of 1441 patients with IDDM -- 726 with no retinopathy at base line (the primary-prevention cohort) and 715 with mild retinopathy (the secondary-intervention cohort) were randomly assigned to intensive therapy administered either with an external insulin pump or by three or more daily insulin injections and guided by frequent blood glucose monitoring or to conventional therapy with one or two daily insulin injections. The patients were followed for a mean of 6.5 years, and the appearance and progression of retinopathy and other complications were assessed regularly.
RESULTS
In the primary-prevention cohort, intensive therapy reduced the adjusted mean risk for the development of retinopathy by 76 percent (95 percent confidence interval, 62 to 85 percent), as compared with conventional therapy. In the secondary-intervention cohort, intensive therapy slowed the progression of retinopathy by 54 percent (95 percent confidence interval, 39 to 66 percent) and reduced the development of proliferative or severe nonproliferative retinopathy by 47 percent (95 percent confidence interval, 14 to 67 percent). In the two cohorts combined, intensive therapy reduced the occurrence of microalbuminuria (urinary albumin excretion of ≥ 40 mg per 24 hours) by 39 percent (95 percent confidence interval, 21 to 52 percent), that of albuminuria (urinary albumin excretion of ≥ 300 mg per 24 hours) by 54 percent (95 percent confidence interval, 19 to 74 percent), and that of clinical neuropathy by 60 percent (95 percent confidence interval, 38 to 74 percent). The chief adverse event associated with intensive therapy was a two-to-threefold increase in severe hypoglycemia.
CONCLUSIONS
Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
PURPOSE: Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of a clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record.
The relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent diabetes mellitus in Hong Kong
This study examines the relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent diabetes mellitus (NIDDM) in Hong Kong. A cross-sectional design was used to collect data through structured self-report interviews based on validated scales assessing diabetes knowledge, compliance behaviours and demographic data. The Diabetes Knowledge Scale was used to sample knowledge in the major areas of basic physiology of diabetes and general principles of diabetes care. Compliance level was assessed by using the Compliance Behaviour Questionnaire, inspection of patients’ feet and the value of HbA1c. A convenience sample of 52 Chinese with NIDDM receiving out-patient diabetes care participated in the study on a voluntary basis. Descriptive and correlational statistical analyses were used to analyse the data. The findings indicated that there was no association between diabetes knowledge and compliance. There was a gap between what the patients were taught and what they were actually doing. Most of the patients gained higher marks on factual knowledge on diabetes but lost marks on the application of knowledge to their real life situations. Strategies are suggested to close the ‘knowledge–action gap’ and increase patients’ motivation and ability to comply with the health regimen.
To examine whether intensive glycemic control could decrease the frequency or severity of diabetic microvascular complications, we performed a prospective study of Japanese patients with non-insulin-dependent diabetes mellitus (NIDDM) treated with multiple insulin injection treatment. A total of 110 patients with NIDDM was randomly assigned to multiple insulin injection treatment group (MIT group) or to conventional insulin injection treatment group (CIT group). Fifty-five NIDDM patients who showed no retinopathy and urinary albumin excretions < 30 mg/24 h at the baseline were evaluated in the primary-prevention cohort, and the other 55 NIDDM patients who showed simple retinopathy and urinary albumin excretions < 300 mg/24 h were evaluated in the secondary-intervention cohort. The appearance and the progression of retinopathy, nephropathy and neuropathy were evaluated every 6 months over a 6-year period. The worsening of complications in this study was defined as an increase of 2 or more steps in the 19 stages of the modified ETDRS interim scale for retinopathy and an increase of one or more steps in 3 stages (normoalbuminuria, microalbuminuria and albuminuria) for nephropathy. The cumulative percentages of the development and the progression in retinopathy after 6 years were 7.7% for the MIT group and 32.0% for the CIT group in the primary-prevention cohort (P = 0.039), and 19.2% for MIT group and 44.0% for CIT group in the secondary-intervention cohort (P = 0.049). The cumulative percentages of the development and the progression in nephropathy after 6 years were 7.7% for the MIT group and 28.0% for the CIT group in the primary-prevention cohort (P = 0.032), and 11.5% and 32.0%, respectively, for the MIT and CIT groups in the secondary-intervention cohort (P = 0.044). In neurological tests after 6 years, MIT group showed significant improvement in the nerve conduction velocities, while the CIT group showed significant deterioration in the median nerve conduction velocities and vibration threshold. Although both postural hypotension and the coefficient of variation of R-R interval tended to improve in the MIT group, they deteriorated in the CIT group. In conclusion, intensive glycemic control by multiple insulin injection therapy can delay the onset and the progression of diabetic retinopathy, nephropathy and neuropathy in Japanese patients with NIDDM. From this study, the glycemic threshold to prevent the onset and the progression of diabetic microangiopathy is indicated as follows; HbA1c < 6.5%, FBG < 110 mg/dl, and 2-h post-prandial blood glucose concentration < 180 mg/dl.
The purpose of this pilot study was to determine the feasibility of using data from replicated descriptive studies to test a four-variable model designed to explain metabolic control in diabetes. Predictors of metabolic control selected for this analysis were knowledge; health beliefs (and the subscales of barriers, commitment, cues, expectancies, impact on lifestyle, support, and susceptibility); and compliance/adherence. A total of 17 studies, published between 1982 and 1991, were located that met inclusion criteria. Findings indicated that health beliefs have direct and indirect effects on diabetes metabolic control, depending on the individual health belief subscale analyzed. For example, commitment to the benefits of therapy was found to have a statistically significant direct effect on metabolic control; barriers had a statistically significant indirect effect through compliance. The effects of knowledge were consistent throughout the five path models explored. An inverse direct effect was noted on metabolic control and a positive indirect effect was noted on metabolic control through compliance.
Clinical guidelines are designed to assist in the management of specific diseases; however, these guidelines are often neglected in the delivery of care. The purpose of this study was to determine whether clinician use of an clinical practice guideline would increase in response to having, at the patient visit, a decision support system based on a practice guideline that generates a customized management protocol for the individual patient using data from the patient's electronic medical record.
In a 6-month controlled trial at a primary care clinic, 58 primary care clinicians were randomized to receive either a special encounter form with the computer-generated guideline recommendations or a standard encounter form. The effect of computer-generated advice on clinician behavior was measured as rate of compliance with guideline recommendations. Data from 30 clinicians were analyzed; data from 28 clinicians were excluded because these clinicians did not meet predefined criteria for minimum exposure to diabetic patient care.
Availability of patient management recommendations generated by the decision support system resulted in a two-fold increase in clinician compliance with care guidelines for diabetes mellitus (P = 0.01). Median compliance for the group receiving the recommendations was 32.0% versus 15.6% for the control group.
Decision support based on a clinical practice guideline is an effective tool for assisting clinicians in the management of diabetic patients. This decision support system provides a model for how a clinical practice guideline can be integrated into the care process by computer to assist clinicians in managing a specific disease through helping them comply with care standards. Use of decision support systems based on clinical practice guidelines could ultimately improve the quality of medical care.
This study examines the relationship between diabetes knowledge and compliance among Chinese with non-insulin dependent diabetes mellitus (NIDDM) in Hong Kong. A cross-sectional design was used to collect data through structured self-report interviews based on validated scales assessing diabetes knowledge, compliance behaviours and demographic data. The Diabetes Knowledge Scale was used to sample knowledge in the major areas of basic physiology of diabetes and general principles of diabetes care. Compliance level was assessed by using the Compliance Behaviour Questionnaire, inspection of patients' feet and the value of HbA1c. A convenience sample of 52 Chinese with NIDDM receiving out-patient diabetes care participated in the study on a voluntary basis. Descriptive and correlational statistical analyses were used to analyse the data. The findings indicated that there was no association between diabetes knowledge and compliance. There was a gap between what the patients were taught and what they were actually doing. Most of the patients gained higher marks on factual knowledge on diabetes but lost marks on the application of knowledge to their real life situations. Strategies are suggested to close the 'knowledge-action gap' and increase patients' motivation and ability to comply with the health regimen.
To measure the quality of diabetic care as indicated by HbA1c testing frequency and HbA1c values and to demonstrate improvement in care after an appropriate quality improvement intervention.
The quality improvement project used computerized claims and laboratory data relating to HbA1c testing among the private practices of nine physicians caring for diabetic Medicare patients. Nine indicators evaluated three main areas: HbA1c testing frequency, HbA1c values, and frequency of office visits. A quality improvement intervention consisting of a physician component and a patient component was implemented.
There were 835 patients and 4,367 visits studied. After the intervention, statistically significant improvements in HbA1c testing frequency and values were noted. Rates of seized opportunities for testing HbA1c improved from 17.7 to 33.9% (P < 0.0001). The percentage of patients with a current HbA1c value improved from 31.3 to 47.6% (P < 0.0001). The median HbA1c values fell from 8.5 to 7.8% (P < 0.006). Patients achieving good or fair control (HbA1c < or = 8%) improved from 43.8 to 56.9% (P = 0.007). The median time between physician visits fell from 70 days to 60 days (P < 0.0001).
The study revealed that HbA1c testing was underused but that after a quality improvement initiative, a significant increase in testing use could be achieved. The quality improvement initiative also resulted in significant improvements in glycemic control. The techniques and interventions used in this study could be used to intervene in larger populations and practice settings to improve medical care for diabetic patients.
• The purpose of the study reported in this paper was to describe adherence to self-care, perceived difficulties and social support in a group of adult patients (n=213) with insulin-treated diabetes from two outpatient clinics in Northern Finland.
• Data were collected by questionnaire. The instruments were developed to measure adherence to self-care, difficulties in self-care and social support. The response rate was 76%.
• One-way ANOVA, logistic regression analysis, contingency and Pearson’s correlation coefficients were used in the statistical analysis.
• A fifth of the respondents were neglecting their self-care. The others undertook flexible, regimen-adherent or self-planned self-care.
• The subjects had no difficulties with insulin treatment, but had more problems with other aspects of self-care.
• Poor metabolic control, smoking and living alone predicted neglect of self-care, but if patients had support from family and friends, living alone was not a predictor of neglect of self-care.
• Those with poor metabolic control perceived themselves as getting peer support from other persons with diabetes.
Type 2 diabetes mellitus is increasing in incidence and research has shown that normalization of blood glucose levels can moderate the risk of microvascular and neurological complications.
The purpose of this study was to investigate the effect of nurse telephone calls on glycosylated haemoglobin (HbA1c) levels and adherence to diabetes control recommendations.
A randomized design with control and experimental groups being assessed pre- and post intervention was used to assess the effectiveness of nurse telephone calls. Twenty patients were randomly assigned to an intervention group and 16 to a control group. The goal of the intervention was to keep blood glucose concentrations close to the normal range (HbA1c < 7%). The intervention was applied to the intervention group for 12 weeks, and consisted of continued education and reinforcement of diet, exercise, medication adjustment recommendations, as well as frequent self-monitoring of blood glucose levels. Telephone intervention was performed twice per week for the first month and then weekly for the second and third month. Participants were requested to write self-management logs including blood glucose levels, diet and an exercise diary. A dietitian analysed the diet diaries and participants were informed about their results by telephone or mail. All medication adjustments were communicated to participants' doctors. The HbA1c and diabetes adherence were measured before and after the intervention.
Patients in the intervention group had a mean decrease of 1.2% in HbA1c levels and those in the control group had a mean increase of 0.6% in HbA1c levels. The intervention group had greater diet and blood glucose testing adherence than the control group.
These findings indicate that a nurse telephone intervention can improve HbA1c, and diet and blood glucose testing adherence.
This study applied a 12-week educational intervention that used both the cellular phone and the Internet to send short message service. Forty-two diabetic patients were asked to access a Web site by using a cellular phone or wire Internet and input their blood glucose levels every day. Patients were sent the optimal recommendations by both the cellular phone and the Internet. After 12 weeks, the patients had a mean decrease of 28.6 mg/dL in fasting plasma glucose and 78.4 mg/dL in 2-hour postprandial blood sugar levels and a mean increase in the care satisfaction score.
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