scholarly journals Participation in a Virtual Diabetes Clinic Improves Glycemic Control in Adults with Type 2 Diabetes

Iproceedings ◽  
10.2196/15258 ◽  
2019 ◽  
Vol 5 (1) ◽  
pp. e15258
Author(s):  
Ronald Dixon ◽  
Howard Zisser ◽  
Nathan Barleen ◽  
Jennifer Layne ◽  
Daniel Moloney ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Mobile App ◽  
Self Management ◽  
Diabetes Clinic ◽  
Treatment Targets ◽  
Phone Calls

Background Telemedicine for people with type 2 diabetes (T2D) has the potential to positively impact self-management behaviors and improve health outcomes. The Onduo Virtual Diabetes Clinic (VDC) is a comprehensive telehealth program for people with T2D that combines mobile app technology, remote personalized lifestyle coaching from certified diabetes educators and health coaches, connected devices including blood glucose meters and continuous glucose monitoring systems, and clinical support from board certified endocrinologists. Objective To describe the VDC care delivery model and present preliminary data on change in glycemic control in program participants with up to 6 months of follow-up. Methods Adults ≥18 years of age with T2D and who were members of sponsoring health plans and employers throughout the US were eligible to participate. Those who elected to enroll downloaded the VDC app to their smartphone, provided demographic and clinical information, completed an onboarding survey, and were mailed a self-management kit that included a connected blood glucose meter, test strips and a home glycosylated hemoglobin (HbA1c) testing kit. Participants interacted with their care team primarily through the VDC app, with occasional phone calls, and by synchronous video consultations with endocrinologists, as clinically appropriate. Change in glycemic control in participants who completed a baseline survey from February 2018 through December 31, 2018, with an initial HbA1c measurement within 30 days of enrollment and a follow-up measurement between 90 and 180 days after baseline was analyzed. Results Participants (n=740) were (mean ± SD): 53.8 ± 8.8 years of age, 62% female, BMI 35.6 ± 8.5, initial HbA1c 7.7% ± 1.8, 31.0% were on insulin and 25.9% were on sulfonylureas at baseline, and 30.0% lived in a rural area. HbA1c decreased significantly by 2.3% ± 1.9, 0.7% ± 1.0 and 0.2% ± 0.8 across the baseline categories of >9.0%, 8.0% to 9.0% and 7.0% to <8.0%, respectively (all P<.001). Within these categories, HbA1c improved in 91.9%, 77.3% and 63.5% of participants. For the group with an initial HbA1c >9.0%, HbA1c decreased from 10.7% ± 1.4 to 8.3% ± 1.5, and when stratified by HbA1c ≥8.0% the mean decrease in HbA1c was 1.5%, from 9.5% ± 1.5 to 8.0% ± 1.3, with 84.5% of participants demonstrating improvement. Participants with an initial HbA1c <7.0% who were meeting treatment targets at baseline, HbA1c 6.3% ± 0.4, continued to maintain this level of glycemic control at follow-up, HbA1c 6.4% ± 0.6 (ns). Conclusions Participation in the VDC was associated with a significant improvement in HbA1c in adults with T2D who were not meeting treatment targets, with the greatest improvement observed in those with an initial HbA1c >9.0%. Importantly, the majority of program participants experienced an improvement in glycemic control. Our findings suggest that the VDC program is an effective approach to support individuals with T2D and their clinicians in diabetes management between office visits.

scholarly journals Improving glycemic control in patients of South Asian origin with type 2 diabetes using a digital therapeutic (Preprint)

2020 ◽  
Author(s):  
Arjun Krishnakumar ◽  
Rajeev Chawla ◽  
Aravind Sosale ◽  
Banshi Saboo ◽  
Shilpa Joshi ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
South Asian ◽  
Real World ◽  
Self Management ◽  
Post Intervention ◽  
The Mean ◽  
Program Engagement

BACKGROUND Global prevalence of type 2 diabetes (T2D), especially among South Asians, has risen alarmingly in the last decade with little improvements in glucose control. OBJECTIVE We investigated the real-world effectiveness of the Wellthy CareTM (WC) digital therapeutic in improving glycemic control among the South Asian population of Indian origin. METHODS We conducted a retrospective, real-world, observational study on 102 patients with T2D from India enrolled on a 16-week structured self-management program delivered through the WC mobile app. Patients recorded their meals, weight, physical activity, and blood sugar in the app and received coaching on self-care behaviors (healthy eating, being active, monitoring, medication adherence, problem-solving, healthy coping, and reducing risks) through structured lessons, an artificial intelligence (AI)-powered chatbot, that provided real-time feedback, and periodic, planned interactions through certified diabetes educators via voice calls and chats. The Primary outcome of the program was change in HbA1c. Secondary outcomes included, difference between the pre-and post-intervention fasting blood glucose (FBG) and postprandial blood glucose (PPBG); change in BMI and weight at the completion of 16-week program; the association between program engagement, that was measured as the total number of interactions with the health coach and the AI-powered chat-bot, and the change in HbA1c, FBG, and PPBG. RESULTS At the end of 16 weeks, the average change in HbA1c was –0.49% (95% CI −0.73 to −0.25, P < .001). Out of all the patients, 63.72% had improved HbA1c levels with the mean change being −1.16% (95% CI −1.40 to −0.92, P < .001). The mean pre-and post-intervention FBG were 145.38 mg/dl (95% CI: 135.44 to 155.33) and 134.3 mg/dl (95% CI: 122.15 to 146.54, P = .023), and PPBG was 187.84 mg/dl (95% CI: 172.47 to 203.21) and 166.36 mg/dl (95% CI: 152.83 to 179.89, P = .028). Mean change in BMI and weight was –0.47 kg/m2 (95% CI −0.22 to −0.71 kg/m2, P < 0.001), and –1.32 kg (95% CI −0.63 to −2.01 kg, P < 0.001), respectively. There was a step-wise decrease in HbA1c, FBG, and PPBG as the program engagement increased. Patients in the highest tertile of program engagement had a significantly higher reduction in HbA1c (−0.84% vs −0.06%, P = .016), FBG (−21.4 mg/dl vs −0.18 mg/dl, P = .023), and PPBG (−22.03 mg/dl vs 2.35 mg/dl, P = .0022) than those in the lowest tertile. CONCLUSIONS The WC digital therapeutic intervention is associated with improved glucose control and other health outcomes. Digital interventions could potentially help in relieving the rising diabetes burden among South Asian populations by bringing about effective behavior change and better diabetes self-management.

scholarly journals Individualized Meal Replacement Therapy Improves Clinically Relevant Long-Term Glycemic Control in Poorly Controlled Type 2 Diabetes Patients

Nutrients ◽  
2018 ◽  
Vol 10 (8) ◽  
pp. 1022 ◽  
Author(s):  
Kerstin Kempf ◽  
Martin Röhling ◽  
Katja Niedermeier ◽  
Babette Gärtner ◽  
Stephan Martin
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Control Group ◽  
Meal Replacement ◽  
Low Carbohydrate ◽  
Meal Replacements

Background Formula diets can improve glycemic control or can even induce remission in type 2 diabetes. We hypothesized that especially an individualized intense meal replacement by a low-carbohydrate formula diet with accompanied self-monitoring of blood glucose (SMBG) contributes to long-term improvements in HbA1c, weight, and cardiometabolic risk factors in poorly controlled type 2 diabetes. Methods Type 2 diabetes patients were randomized into either a moderate group (M-group) with two meal replacements/day (n = 160) or a stringent group (S-group) with three meal replacements/day (n = 149) during the first week of intervention (1300–1500 kcal/day). Subsequently, both groups reintroduced a low-carbohydrate lunch based on individual adaption due to SMBG in weeks 2–4. After week 4, breakfast was reintroduced until week 12. During the follow-up period, all of the participants were asked to continue replacing one meal per day until the 52-weeks follow-up. Additionally, an observational control group (n = 100) remained in routine care. Parameters were compared at baseline, after 12 and 52 weeks within and between all of the groups. Results 321 participants (83%) completed the acute meal replacement phase after 12 weeks and 279 participants (72%) the whole intervention after 52 weeks. Both intervention groups achieved improvements in HbA1c, fasting blood glucose, blood pressure, and weight (all p < 0.001) within 12 weeks. However, these results were not significantly different between both of the intervention groups. The estimated treatment difference in HbA1c reduction was (mean (95% confidence interval [CI]) -0.10% with 95% CI [−0.40; 0.21] also (p > 0.05) (S-group vs. M-group) not statistically different after 12 weeks. However, only the S-group showed a clinically relevant improvement in HbA1c of −0.81% [−1.06; −0.55] (p < 0.001) after 52 weeks of follow-up, whereas HbA1c was not statistically different between the M- and control group. Conclusion Individualized meal replacement with SMBG demonstrated beneficial effects on HbA1c and cardiometabolic parameters in type 2 diabetes. Furthermore, the initiation of a weight loss program with one week of full meal replacement (three meals per day) resulted in a clinically relevant long-term HbA1c reduction, as compared to an observational control group that had standard care.

scholarly journals Patterns of Glycemic Variability During a Diabetes Self-Management Educational Program

2019 ◽  
Vol 7 (3) ◽  
pp. 52 ◽  
Author(s):  
Ankur Joshi ◽  
Arun Mitra ◽  
Nikhat Anjum ◽  
Neelesh Shrivastava ◽  
Sagar Khadanga ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Optimal Control ◽  
Type 2 Diabetes Mellitus ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glycemic Variability ◽  
Self Management ◽  
Control Group

Background: Variations in blood glucose levels over a given time interval is termed as glycemic variability (GV). Higher GV is associated with higher diabetes-related complications. The current study was done with the aim of detecting the sensitivity of various GV indices among individuals with type 2 diabetes mellitus of different glycemic control status. Methods: We performed a longitudinal study among individuals with type 2 diabetes mellitus (T2DM) who were participating in a two-week diabetes self-management education (DSME) program. Participants were categorized by their HbA1c as poor (≥8%), acceptable (7%–8%), and optimal control (<7%). Continuous glucose monitoring (CGM) sensors recorded interstitial glucose every 15 min from day 1. The evaluated GV measures include standard deviation (SD), coefficient of variation (CV), mean amplitude of glycemic excursion (MAGE), continuous overlapping net glycemic action (CONGA), mean of daily difference for inter-day variation (MODD), high blood glucose index (HBGI), and low blood glucose index (LBGI). Results: A total of 41 study participants with 46347 CGM values were available for analysis. Of 41 participants, 20 (48.7%) were in the poor, 10 (24.3%) in the acceptable, and 11 (26.8%) in the optimal control group. The GV indices (SD; CV; MODD; MAGE; CONGA; HBGI) of poorly controlled (77.43; 38.02; 45.82; 216.63; 14.10; 16.62) were higher than acceptable (50.02; 39.32; 30.79; 138.01; 8.87; 5.56) and optimal (34.15; 29.46; 24.56; 126.15; 8.67; 3.13) control group. Glycemic variability was reduced in the poorly and acceptably controlled groups by the end of the 2-week period. There was a rise in LBGI in the optimally controlled group, indicating pitfalls of tight glycemic control. Conclusion: Indices of glycemic variability are useful complements, and changes in it can be demonstrated within short periods.

941-P: Frequency of Blood Glucose Monitoring in Relation to Medical Cost and Glycemic Control in Hospitalized Patients with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 941-P
Author(s):  
LEI ZHANG ◽  
YAN GU ◽  
YUXIU YANG ◽  
NA WANG ◽  
WEIGUO GAO ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Medical Cost ◽  
Glucose Monitoring ◽  
Hospitalized Patients ◽  
Blood Glucose Monitoring

2180-PUB: Integration of Continuous Glucose Monitoring in Diabetes Self-Management Education for Type 2 Diabetes Improves Glycemic Control

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 2180-PUB
Author(s):  
ADDIE L. FORTMANN ◽  
ALESSANDRA BASTIAN ◽  
CODY J. LENSING ◽  
SHANE HOVERSTEN ◽  
KIMBERLY LUU ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Continuous Glucose Monitoring ◽  
Management Education ◽  
Glucose Monitoring ◽  
Self Management

scholarly journals Self-Management Education for Adults With Type 2 Diabetes: A meta-analysis of the effect on glycemic control

Diabetes Care ◽  
2002 ◽  
Vol 25 (7) ◽  
pp. 1159-1171 ◽  
Author(s):  
S. L. Norris ◽  
J. Lau ◽  
S. J. Smith ◽  
C. H. Schmid ◽  
M. M. Engelgau
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Management Education ◽  
Meta Analysis ◽  
Self Management
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