JMIR Diabetes最新文献

Background: The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform.

Objective: This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care.

Methods: Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care.

Results: Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients' health.

Conclusions: Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved.

Background: Technologies evolve at a breakneck pace, and the success of mobile health (mHealth) for people with type 2 diabetes mellitus (T2DM) depends on whether health care professionals, care management, government regulators, and consumers will adopt the technology as a viable solution to enhance patient self-management.

Objective: In this study, we explored the challenges of the implementation of mHealth apps in care for patients with T2DM and determined to what extent these challenges complicate the dissemination, limit scale-up, and influence the sustainability of technological interventions for patients with T2DM.

Methods: The nonadoption, abandonment, and challenges to scale-up, spread, and sustainability (NASSS) framework served as the basis for our study. The 7 domains of the NASSS framework were explored with a citizen science approach using questionnaires, semistructured in-depth interviews, and focus groups together with patients with T2DM, care professionals, technology developers, policy officers, and a patient organization.

Results: Regarding the domain "condition," being aware of their condition and changing lifestyle were crucial for patients with T2DM to get to grips with their life. The rapid development of health apps for T2DM was highlighted in the domain "technology." Users should be aware of these apps and know how to use them. The domain "value proposition" included the patient perspective and elaborated on personal values, as well as care professionals who focus on personalized care and pressure on health care. Regarding the "adopters," it is crucial to know who needs to use and introduce the apps. Responsibility, a shared vision, and resistance among care professionals were mentioned as important determinants for "organization." Finally, the domain "wider system" showed the importance of involving multiple institutes, care guidelines, and reimbursements.

Conclusions: This study investigated the implementation of mHealth apps in an early stage of the implementation process. Key stakeholders were involved, who attributed to the possibilities and limitations of the implementation. It is crucial to have a clear vision from an organizational perspective and specific prerequisites for implementation strategies at micro, meso, and macro levels. Essential strategies at the national level include guidelines for regulations, privacy, and security; the integration of mHealth into T2DM care guidelines; and sufficient reimbursement by health insurers.

Background: Gestational diabetes mellitus (GDM) is an increasingly common high-risk pregnancy condition requiring intensive daily self-management, placing the burden of care directly on the patient. Understanding personal and cultural differences among patients is critical for delivering optimal support for GDM self-management, particularly in high-risk populations. Although mobile apps for GDM self-management are being used, limited research has been done on the personalized and culturally tailored features of these apps and their impact on patient self-management.

Objective: This scoping review aims to explore the extent to which published studies report the integration and effectiveness of personalized and culturally tailored features in GDM mobile apps for patient self-management support.

Methods: We examined English-language peer-reviewed articles published between October 2016 and May 2023 from PubMed, CINAHL, PsycINFO, ClinicalTrials.gov, Proquest Research Library, and Google Scholar using search terms related to digital tools, diabetes, pregnancy, and cultural tailoring. We reviewed eligible articles and extracted data using the Arskey and O'Malley methodological framework.

Results: Our search yielded a total of 1772 articles after the removal of duplicates and 158 articles for full-text review. A total of 21 articles that researched 15 GDM mobile apps were selected for data extraction. Our results demonstrated the stark contrast between the number of GDM mobile apps with personalized features for the individual user (all 15 mobile apps) and those culturally tailored for a specific population (only 3 of the 15 mobile apps). Our findings showed that GDM mobile apps with personalized and culturally tailored features were perceived to be useful to patients and had the potential to improve patients' adherence to glycemic control and nutrition plans.

Conclusions: There is a strong need for increased research and development to foster the implementation of personalized and culturally tailored features in GDM mobile apps for self-management that cater to patients from diverse backgrounds and ethnicities. Personalized and culturally tailored features have the potential to serve the unique needs of patients more efficiently and effectively than generic features alone; however, the impacts of such features still need to be adequately studied. Recommendations for future research include examining the cultural needs of different ethnicities within the increasingly diverse US population in the context of GDM self-management, conducting participatory-based research with these groups, and designing human-centered mobile health solutions for both patients and providers.

Background: Diabetes is a significant health concern in sub-Saharan Africa, emphasizing the importance of assessing the health literacy and eHealth skills of hospitalized patients with diabetes. This study evaluated the health literacy and eHealth literacy of patients with diabetes at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mobile health (mHealth) solutions to improve self-management and treatment outcomes.

Objective: The aim of this study is to evaluate the levels of health literacy and eHealth literacy among patients at Sanou Sourou Hospital in Burkina Faso and Donka Hospital in Guinea.

Methods: The study included 45 participants from Donka Hospital and 47 from Sanou Sourou Hospital. Data collection took place in May 2022, focusing on variables such as gender, age, education, income, and technology access. Health literacy and eHealth literacy were measured using the Brief Health Literacy Screen (BHLS) and the eHealth Literacy Scale (eHEALS), respectively. Statistical analysis was performed using SPSS 28.

Results: The results indicated that 64% (64/99) of participants at Donka Hospital and 57% (57/99) at Sanou Sourou Hospital were female. The majority of participants (48/98, 49% in both hospitals) fell within the age range of 25-50 years. High rates of illiteracy were observed (62/100, 62% in Donka Hospital and 59/100, 59% in Sanou Sourou Hospital). Smartphone ownership was prevalent (62/99, 62% at Donka Hospital and 64/100, 64% at Sanou Sourou Hospital). Participants reported occasional use of technology for basic purposes and frequent internet usage for accessing health information. However, a significant proportion of participants demonstrated low health literacy (73/99, 73% at Donka Hospital; 79/101, 78% at Sanou Sourou Hospital) and inadequate eHealth literacy (57/100, 57% at Donka Hospital; 62/100, 62% at Sanou Sourou Hospital). Education was observed to positively correlate with health literacy, while age displayed a moderate negative correlation. Weak correlations were observed between gender, income, and health literacy, but these were not statistically significant. No significant correlation was found between the scores of the BHLS and the eHEALS in either hospital.

Conclusions: This study highlights the importance of targeted educational interventions and mHealth solutions aimed at enhancing health and eHealth literacy among hospitalized patients with diabetes. Addressing both health literacy and eHealth literacy is paramount for improving diabetes management and treatment outcomes in Guinea and Burkina Faso. Targeted interventions and mHealth solutions have the potential to empower patients, enabling their active involvement in health care decisions and ultimately improving overall health outcomes.

Unlabelled: Highly effective antiobesity and diabetes medications such as glucagon-like peptide 1 (GLP-1) agonists and glucose-dependent insulinotropic polypeptide/GLP-1 (dual) receptor agonists (RAs) have ushered in a new era of treatment of these highly prevalent, morbid conditions that have increased across the globe. However, the rapidly escalating use of GLP-1/dual RA medications is poised to overwhelm an already overburdened health care provider workforce and health care delivery system, stifling its potentially dramatic benefits. Relying on existing systems and resources to address the oncoming rise in GLP-1/dual RA use will be insufficient. Generative artificial intelligence (GenAI) has the potential to offset the clinical and administrative demands associated with the management of patients on these medication types. Early adoption of GenAI to facilitate the management of these GLP-1/dual RAs has the potential to improve health outcomes while decreasing its concomitant workload. Research and development efforts are urgently needed to develop GenAI obesity medication management tools, as well as to ensure their accessibility and use by encouraging their integration into health care delivery systems.

Background: Type 1 diabetes is a demanding chronic condition that requires diligent blood glucose monitoring and timely insulin administration by patients who must integrate self-management into their daily lives.

Objective: This study aimed to better understand what outcome measures are important to individuals living with type 1 diabetes (T1D) in Ontario, Canada, to help inform the development of type 1 diabetes virtual self-management Education and support (T1ME) trial.

Methods: A qualitative approach was used, in which we conducted 6 focus groups with a total of 24 adult participants living with T1D (from age 18 to >65 years) in Ontario. Each focus group was semistructured in nature; participants were encouraged to talk openly about their experiences with T1D self-management and provide their perspectives on more focused topics such as technology and relationships with health care providers.

Results: An interpretive analysis helped us devise a framework for our results that centered around 6 main discussion themes: (1) adapting self-management to meet evolving needs, (2) looking "beyond A1c" toward more personalized indicators of glycemic management, (3) the benefits and challenges of adopting new T1D technology, (4) establishing trusting relationships with diabetes care providers, (5) perceived benefits of peer support, and (6) pre- and post-COVID-19 perspectives on virtual care.

Conclusions: Our goal is for these findings to help facilitate the development of patient-oriented outcome measures that are in line with the unique needs and preferences of T1D patients in this new, more virtual landscape of clinical care, education, and self-management support.

Background: In-home remote foot temperature monitoring (RTM) holds promise as a method to reduce foot ulceration in high-risk patients with diabetes. Few studies have evaluated adherence to this method or evaluated the factors associated with noncompliance.

Objective: The aims of this study were to estimate noncompliance in patients who were enrolled in RTM nationwide across Department of Veterans Affairs (VA) and to evaluate characteristics associated with noncompliance.

Methods: We conducted an observational study including 1137 patients in the VA who were enrolled in RTM between January 2019 and June 2021, with follow-up through October 2021. Patient information was obtained from the VA's electronic health record and RTM use was obtained from the company. Noncompliance was defined as using the mat <2 days per week for ≥4 of the 12 months of follow-up. Using a multivariable model, we calculated odds ratios (ORs) and 95% CIs for associations between various factors and noncompliance and compared using Akaike information criterion statistics, a measure of model fit.

Results: The sample was predominantly male (n=1125, 98.94%) ; 21.1% (n=230) were Black and 75.7% (n=825) were White. Overall, 37.6% (428/1137) of patients were classified as noncompliant. In the multivariable model, an intermediate area deprivation index was statistically significantly and inversely associated with noncompliance (area deprivation index 50-74 vs 1-24; OR 0.56, 95% CI 0.35-0.89); factors significantly and positively associated with noncompliance included recent history of osteomyelitis (OR 1.44, 95% CI 1.06-1.97), Gagne comorbidity index score ≥4 (vs ≤0; OR 1.81, 95% CI 1.15-2.83), telehealth encounters (28+ vs <6; OR 1.70, 95% CI 1.02-2.84), hemoglobin A1c≥10 (vs <5.7; OR 2.67, 95% CI 1.27-5.58), and current smoking (OR 2.06, 95% CI 1.32-3.20). Based on Akaike information criterion differences, the strongest factors associated with noncompliance were behavioral factors (poor glucose control [as measured by hemoglobin A1c] and smoking), and to a lesser extent, factors such as a recent history of osteomyelitis and an elevated Gagne comorbidity index, indicating a high comorbidity burden.

Conclusions: To reduce the risk of ulcer recurrence and amputation, proactively providing additional support for self-monitoring to patients with characteristics identified in this study (poor glucose control, current smoking, high comorbidity burden) may be helpful. Furthermore, research is needed to better understand barriers to use, and whether the addition of design features, reminders, or incentives may reduce noncompliance and the risk of foot ulcers.