JMIR Diabetes最新文献

[This corrects the article DOI: 10.2196/42607.].

Background: Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear.

Objective: We tested whether diabetes group medical visits (GMVs) reduced hemoglobin A1c (HbA1c) by mitigating diabetes distress (DD), an emotional response affecting nearly half of adults with type 2 diabetes in community settings.

Methods: We conducted a mediation and moderation analysis of data from the Women in Control 2.0 comparative effectiveness study, which showed that both technology-enabled and in-person diabetes GMVs improve HbA1c. We tested whether DD mediated the relationship between diabetes GMV engagement and reductions in HbA1c. We also tested whether this relationship was moderated by depressive symptoms and social support. Participants were 309 low-income and minority women. Diabetes GMV engagement was measured using the Group Climate Questionnaire. The mediator, DD, was measured using the Diabetes Distress Screening Scale. The outcome was the 6-month change in HbA1c. Social support was measured using the Medical Outcomes Study Social Support Survey.

Results: DD mediated the relationship between engagement and 6-month HbA1c. Specifically, group engagement affected HbA1c by reducing distress associated with the regimen of diabetes self-management (P=.04), and possibly the emotional burden of diabetes (P=.09). The relationship between engagement and 6-month HbA1c was moderated by depressive symptoms (P=.02), and possibly social support (P=.08).

Conclusions: Engagement in diabetes GMVs improved HbA1c because it helped reduce diabetes-related distress, especially related to the regimen of diabetes management and possibly related to its emotional burden, and especially for women without depressive symptoms and possibly for women who lacked social support.

Federally Qualified Health Centers (FQHCs) provide service to medically underserved areas and communities, providing care to over 32 million patients annually. The burden of diabetes is increasing, but often, the vulnerable communities served by FQHCs lag in the management of the disease due to limited resources and related social determinants of health. With the increasing adoption of technologies in health care delivery, digital tools for continuous glucose monitoring (CGM) are being used to improve disease management and increase patient engagement. In this viewpoint, we share insights on the implementation of a CGM program at an FQHC, the Community-University Health Care Center (CUHCC) in Minneapolis, Minnesota. Our intent is to improve diabetes management through better monitoring of glucose and to ensure that the CGM program enables our organization's overarching digital strategy. Given the resource limitations of our population, we provided Libre Pro devices to uninsured patients through grants to improve health care equity. We used an interdisciplinary approach involving pharmacists, nurses, and clinicians and used hemoglobin A1c (HbA1c) levels as a measure of diabetes management. We assessed the CGM program and noted key aspects to guide future implementation and scalability. We recruited 148 participants with a mean age of 54 years; 39.8% (59/148) self-identified their race as non-White, 9.5% (14/148) self-identified their ethnicity as Hispanic or Latino, and one-third (53/148, 35.8%) were uninsured. Participants had diverse language preferences, with Spanish (54/148, 36.5%), English (52/148, 35.1%), Somali (21/148, 14.2%), and other languages (21/148, 14.2%). Their clinical characteristics included an average BMI of 29.91 kg/m2 and a mean baseline HbA1c level of 9.73%. Results indicate that the CGM program reduced HbA1c levels significantly from baseline to first follow-up (P<.001) and second follow-up (P<.001), but no significant difference between the first and second follow-up (P=.94). We share key lessons learned on cultural and language barriers, the digital divide, technical issues, and interoperability needs. These key lessons are generalizable for improving implementation at FQHCs and refining digital strategies for future scalability.

Background: Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups.

Objective: This study aimed to explore the mental health needs of adolescents with T1D, determine their preferred modalities for app-based mental health support, and identify desirable design features for peer-delivered mental health support modeled on an app designed for adults with T1D.

Methods: A semistructured qualitative focus group study was conducted with adolescents with T1D and parents of adolescents with T1D. Data were collected through pre-focus group surveys, including sociodemographic background, diabetes status, health care experiences, and focus group sessions, including their opinions on peer support and technology. A thematic analysis following an inductive and iterative process was performed to develop themes and subthemes from the collected information.

Results: Focus group participants included 10 adolescents (mean 16, SD 1 years; 8/10, 80% female; who had been living with diabetes for an average of 9, SD 5 years) and 10 parents (mean age 51, SD 7 years; 9/10, 90% female). Four core themes emerged: (1) experience: navigating adolescence with T1D, (2) empowerment: support systems that enabled better management of their T1D, (3) obstacles: societal barriers that affect adolescents' T1D management, and (4) innovation: adolescent-driven preferences for digital peer support platforms.

Conclusions: App-based peer support offers a promising avenue for addressing the mental health needs of adolescents with T1D. Understanding the unique support needs of these adolescents and using this information to suggest design considerations for a mental health peer support app is an important step toward addressing their complex emotional and social challenges.

Background: Type 2 diabetes affects nearly 34.2 million adults and is the seventh leading cause of death in the United States. Digital health communities have emerged as avenues to provide social support to individuals engaging in diabetes self-management (DSM). The analysis of digital peer interactions and social connections can improve our understanding of the factors underlying behavior change, which can inform the development of personalized DSM interventions.

Objective: Our objective is to apply our methodology using a mixed methods approach to (1) characterize the role of context-specific social influence patterns in DSM and (2) derive interventional targets that enhance individual engagement in DSM.

Methods: Using the peer messages from the American Diabetes Association support community for DSM (n=~73,000 peer interactions from 2014 to 2021), (1) a labeled set of peer interactions was generated (n=1501 for the American Diabetes Association) through manual annotation, (2) deep learning models were used to scale the qualitative codes to the entire datasets, (3) the validated model was applied to perform a retrospective analysis, and (4) social network analysis techniques were used to portray large-scale patterns and relationships among the communication dimensions (content and context) embedded in peer interactions.

Results: The affiliation exposure model showed that exposure to community users through sharing interactive communication style speech acts had a positive association with the engagement of community users. Our results also suggest that pre-existing users with type 2 diabetes were more likely to stay engaged in the community when they expressed patient-reported outcomes and progress themes (communication content) using interactive communication style speech acts (communication context). It indicates the potential for targeted social network interventions in the form of structural changes based on the user's context and content exchanges with peers, which can exert social influence to modify user engagement behaviors.

Conclusions: In this study, we characterize the role of social influence in DSM as observed in large-scale social media datasets. Implications for multicomponent digital interventions are discussed.

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.