Developing the “Healthcare CEO App” for Patients with Type 1 Diabetes Transitioning from Adolescence to Young Adulthood: A Mixed-Methods Study (Preprint)

2021 ◽  
Author(s):  
Yueh-Tao Chiang ◽  
Chi-Wen Chang ◽  
Hsing-Yi Yu ◽  
Pei-Kwei Tsay ◽  
Fu-Sung Lo ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Mixed Methods ◽  
Transition Period ◽  
Controlled Trial ◽  
Early Adulthood ◽  
Blood Glucose Control ◽  
Self Management ◽  
Future Research ◽  
Positive Interaction

BACKGROUND Adolescents with type 1 diabetes face various challenges which are often associated with poor blood glucose control during their transition to early adulthood. Using appropriate mobile applications for health management can improve the efficiency of disease self-management. OBJECTIVE To develop and test a mobile application that supports the disease self-management of adolescents with type 1 diabetes during their transition to early adulthood. METHODS A sequential mixed-methods design was employed. The application content was designed according to previously identified care needs and expectations, followed by application development on the Android operating system. From the outpatient clinic of the Department of Pediatric Endocrinology and Metabolism at a medical center in northern Taiwan, 35 individuals aged between 16 and 25 years participated in application testing. RESULTS The final application consisted of 11 interfaces, namely: CEO’s Profile, Health Tracking, CEO Knowledge Base, Barrier-free Communication, See Here: Diet and Exercise, Help Me, Detective!, CEO Chat Room, CEO's Secretary, SOS Calls, Q & A, and Who’s the Best CEO . The average user interaction satisfaction score of the application was 4.54 (± 0.41), indicating positive interaction satisfaction. CONCLUSIONS In this study, we developed the Healthcare Chief Executive Officer application tailored to the needs of patients with type 1 diabetes in the transition period. The application can support the disease self-management of adolescents with type 1 diabetes in the transition period, as well as provide references for clinical intervention. CLINICALTRIAL Future research will use a randomized controlled trial (RCT) design to evaluate the effectiveness of the application. Trial registration: listed on ClinicalTrials.gov, identifier: NCT05022875.

Habit and Routine Interventions with Emerging Adults with Diabetes: An Integrative Review

2021 ◽  
pp. 019394592110322
Author(s):  
Kathleen M. Hanna ◽  
Jed R. Hansen ◽  
Kim A. Harp ◽  
Kelly J. Betts ◽  
Diane Brage Hudson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Health Outcomes ◽  
Emerging Adults ◽  
Text Messaging ◽  
Integrative Review ◽  
Self Management ◽  
Future Research ◽  
Medical Librarian

Although theoretical and empirical writings on habits and routines are a promising body of science to guide interventions, little is known about such interventions among emerging adults with type 1 diabetes. Thus, an integrative review was conducted to describe interventions in relation to habits and routines, their influence on outcomes, and users’ perspectives. A medical librarian conducted a search. Teams screened titles, abstracts, and articles based upon predefined criteria. Evidence from the final 11 articles was synthesized. A minority of investigators explicitly articulated habits and routines theoretical underpinnings as part of the interventions. However, text messaging or feedback via technology used in other interventions could be implicitly linked to habits and routines. For the most part, these interventions positively influenced diabetes self-management-related behaviors and health outcomes. In general, the interventions were perceived positively by users. Future research is advocated using habit and routine theoretical underpinnings to guide interventions.

scholarly journals Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

2021 ◽  
Vol 9 (1) ◽  
pp. e001934
Author(s):  
Anne M Doherty ◽  
Anne Herrmann-Werner ◽  
Arann Rowe ◽  
Jennie Brown ◽  
Scott Weich ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Real Time ◽  
Instant Messaging ◽  
Controlled Trial ◽  
Self Management ◽  
Diabetes Distress ◽  
The Mean ◽  
Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

scholarly journals Behavioral Factors Influencing Health Outcomes in Youth with Type 1 Diabetes

2012 ◽  
Vol 08 (02) ◽  
pp. 77 ◽  
Author(s):  
Jessica C Kichler ◽  
Ashley Moss ◽  
Astrida S Kaugars ◽  
◽  
◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Health Outcomes ◽  
Metabolic Control ◽  
Self Management ◽  
Future Research ◽  
Behavioral Factors ◽  
Empirically Supported ◽  
Adherence Assessment ◽  
Management Behaviors

The Pediatric Self-Management Model provides an overview of how behavioral factors influence children’s chronic medical illnesses. This general framework is used to organize the present review of how self-management behaviors, contextual factors, and processes impact health outcomes for adolescent youth with type 1 diabetes. Adherence has been widely studied in the diabetes literature, and there are consistent findings demonstrating associations between aspects of self-management, adherence, and metabolic control, yet there are still equivocal approaches to adherence assessment methodology (e.g. global versus specific measures). Metabolic control is a hallmark health outcome for youth with type 1 diabetes, but additional outcomes need to be further explored. Future research should utilize the Pediatric Self-Management Model’s operational definitions to guide empirically-supported interventions for youth with type 1 diabetes.

scholarly journals A Mobile App for the Self-Management of Type 1 Diabetes Among Adolescents: A Randomized Controlled Trial

2017 ◽  
Vol 5 (6) ◽  
pp. e82 ◽  
Author(s):  
Shivani Goyal ◽  
Caitlin A Nunn ◽  
Michael Rotondi ◽  
Amy B Couperthwaite ◽  
Sally Reiser ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Type 1 Diabetes ◽  
Controlled Trial ◽  
Mobile App ◽  
The Self ◽  
Self Management ◽  
Randomized Controlled

scholarly journals Improving management of type 1 diabetes in the UK: the Dose Adjustment For Normal Eating (DAFNE) programme as a research test-bed. A mixed-method analysis of the barriers to and facilitators of successful diabetes self-management, a health economic analysis, a cluster randomised controlled trial of different models of delivery of an educational intervention and the potential of insulin pumps and additional educator input to improve outcomes

2014 ◽  
Vol 2 (5) ◽  
pp. 1-188 ◽  
Author(s):  
Simon Heller ◽  
Julia Lawton ◽  
Stephanie Amiel ◽  
Debbie Cooke ◽  
Peter Mansell ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Dose Adjustment ◽  
Controlled Trial ◽  
Explanatory Power ◽  
Research Programme ◽  
Self Management ◽  
Randomised Controlled ◽  
The Uk ◽  
Hypoglycaemia Awareness

BackgroundMany adults with type 1 diabetes cannot self-manage their diabetes effectively and die prematurely with diabetic complications as a result of poor glucose control. Following the positive results obtained from a randomised controlled trial (RCT) by the Dose Adjustment For Normal Eating (DAFNE) group, published in 2002, structured training is recommended for all adults with type 1 diabetes in the UK.AimWith evidence that blood glucose control is not always improved or sustained, we sought to determine factors explaining why some patients benefit from training more than other patients, identifying barriers to successful self-management, while developing other models to make skills training more accessible and effective.FindingsWe confirmed that glycaemic outcomes are not always improved or sustained when the DAFNE programme is delivered routinely, although improvements in psychosocial outcomes are maintained. DAFNE courses and follow-up support is needed to help participants instil and habituate key self-management practices such as regular diary/record keeping. DAFNE graduates need structured professional support following training. This is currently either unavailable or provided ad hoc without a supporting evidence base. Demographic and psychosocial characteristics had minimal explanatory power in predicting glycaemic control but good explanatory power in predicting diabetes-specific quality of life over the following year. We developed a DAFNE course delivered for 1 day per week over 5 weeks. There were no major differences in outcomes between this and a standard 1-week DAFNE course; in both arms of a RCT, glycaemic control improved by less than in the original DAFNE trial. We piloted a course delivering both the DAFNE programme and pump training. The pilot demonstrated the feasibility of a full multicentre RCT and resulted in us obtaining subsequent Health Technology Assessment programme funding. In collaboration with the National Institute for Health Research (NIHR) Diabetes Research Programme at King’s College Hospital (RG-PG-0606-1142), London, an intervention for patients with hypoglycaemic problems, DAFNE HART (Dose Adjustment for Normal Eating Hypoglycaemia Awareness Restoration Training), improved impaired hypoglycaemia awareness and is worthy of a formal trial. The health economic work developed a new type 1 diabetes model and confirmed that the DAFNE programme is cost-effective compared with no structured education; indeed, it is cost-saving in the majority of our analyses despite limited glycated haemoglobin benefit. Users made important contributions but this could have been maximised by involving them with grant writing, delaying training until the group was established and funding users’ time off work to maximise attendance. Collecting routine clinical data to conduct continuing evaluated roll-out is possible but to do this effectively requires additional administrator support and/or routine electronic data capture.ConclusionsWe propose that, in future work, we should modify the current DAFNE curricula to incorporate emerging understanding of behaviour change principles to instil and habituate key self-management behaviours that include key DAFNE competencies. An assessment of numeracy, critical for insulin dose adjustment, may help to determine whether or not additional input/support is required both before and after training. Models of structured support involving professionals should be developed and evaluated, incorporating technological interventions to help overcome the barriers identified above and enable participants to build effective self-management behaviours into their everyday lives.Trial registrationClinicalTrials.gov NCT01069393.FundingThe NIHR Programme Grants for Applied Research programme.

scholarly journals Diabetes Self-Care in Older Adults With Type 1 Diabetes Mellitus: How Does Cognition Influence Self-Management

2021 ◽  
Vol 2 ◽  
Author(s):  
Ana Lúcia Taboada Gjorup ◽  
Frank J. Snoek ◽  
Eelco van Duinkerken
Keyword(s):  
Diabetes Mellitus ◽  
Older Adults ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Cognitive Functions ◽  
Self Care ◽  
Self Management ◽  
Future Research

With increasing knowledge and improvements in options for glycemic control, the life-expectancy of patients with type 1 diabetes mellitus (T1DM) has increased considerably over the past decades. Whereas this is undeniably positive for patients, aging is related to natural decline in cognitive functions. As patients with T1DM across the life-span are susceptible to cognitive deterioration, an interaction with aging may be expected and the risk of development of dementia might be increased. As achieving glycemic control depends on a set of diabetes self-management behaviors, it is imperative to understand how cognitive functions are involved in the upkeep of these behaviors and how cognitive impairment may affect them. In this narrative review, we set out to understand the relationship between cognition and T1DM self-care by first reviewing the glycemic targets in older adults, what treatment options are available, and what cognitive functions they draw upon. We will then review the cognitive literature in older adults that is available and then link both together. Lastly, we finish with clinical recommendations and suggestions for future research.

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