A Diabetes Mobile App With In-App Coaching From a Certified Diabetes Educator Reduces A1C for Individuals With Type 2 Diabetes

Purpose There are currently many diabetes apps available, but there is limited evidence demonstrating clinical impact. The purpose of this study is to evaluate the impact of a diabetes mobile app with in-app coaching by a certified diabetes educator on glycemic control for individuals with type 2 diabetes. Methods A 12 week-long single-arm intent-to-treat trial evaluated the impact of a diabetes mobile app and coaching program (One Drop | Mobile With One Drop | Experts), which facilitated tracking of self-care and included an in-app diabetes education program, on A1C for individuals with type 2 diabetes and an A1C ≥7.5% (58 mmol/mol). An online study platform (Achievement Studies, Evidation Health Inc, San Mateo, CA) was used to screen, consent, and enroll participants; collect study data; and track participants’ progress throughout the study. Baseline and study end A1C measurements as well as questionnaire data from participants were collected. Results Participants (n = 146) were 52 ± 9 years old, 71% female, 25% black or Hispanic, diagnosed with diabetes for 11 ± 7 years, and with a mean baseline A1C of 9.87% ± 2.0 (84 mmol/mol). In adjusted repeated measures models, mean A1C improved by −0.86% among study completers (n = 127), −0.96% among active users of the app and coaching program (n = 93), and −1.32% among active users with a baseline A1C ≥9.0% (75 mmol/mol) (n = 53). Conclusions This program was associated with a clinically meaningful and significant reduction in A1C and can potentially increase access to effective diabetes self-management education and support for individuals with diabetes.

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Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature

The International Journal of Psychiatry in Medicine ◽

10.1177/00912174211067335 ◽

2022 ◽

pp. 009121742110673

Author(s):

Molly McVoy ◽

Heather Hardin ◽

Erin Fulchiero ◽

Kate Caforio ◽

Farren Briggs ◽

...

Keyword(s):

Mental Health ◽

Type 2 Diabetes ◽

Depressive Symptoms ◽

Treatment Options ◽

Study Data ◽

Behavior Changes ◽

Previous Diagnosis ◽

Health Behavior Changes ◽

The Impact

Background Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. Methods A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. Results 13 publications from 8 studies (N=2244, age 6–17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. Conclusions While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.

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The Impact of Structured Diabetes Education on Glycemic Control in Patients with Type 2 Diabetes at Initiation of Basal Insulin – The Basal-EDUC-RO Study: A Randomized Prospective Study

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0020 ◽

2019 ◽

Vol 26 (2) ◽

pp. 185-198

Author(s):

Cornelia Bala ◽

Adriana Rusu ◽

Mihaela Moise ◽

Gabriela Roman

Keyword(s):

Type 2 Diabetes ◽

Insulin Therapy ◽

Basal Insulin ◽

Insulin Analogue ◽

Diabetes Education ◽

Control Group ◽

Structured Education ◽

Education Group ◽

The Impact

Abstract Background: Basal-EDUC-RO Study evaluated the impact of structured education provided at the initiation of basal insulin therapy on glycaemic control in patients with uncontrolled type 2 diabetes mellitus (T2D). Methods: This was a prospective, multicenter, randomized, parallel group study (ACTRN12616001273471) which enrolled 711 patients initiated on insulin therapy with a basal insulin analogue. The subjects were randomized (1:1) to either structured education (structured education group; 353 patients) or standard education (control group; 358 patients) and followed for 6 months. Results: The median HbA1c levels at 6 months after start of basal insulin were significantly lower in the structured education group than in the control group (7.2% vs. 7.4%, p <0.001). In the structured education group, 49.4% of subjects achieved HbA1c targets vs. 34.4% in the control group, p <0.001. Number of documented symptomatic hypoglycemic episodes (all and nocturnal) was lower in the intervention group (139 vs. 217 for all episodes and 13 vs. 26 for nocturnal hypoglycemia) but with no statistical significance. No effect of intervention was seen on body weight, but there was no weight gain in any of the groups at 6 months. Conclusions: A structured diabetes education program delivered to patients with T2D started on a basal insulin analogue significantly improved glucose control at 6 months compared to a less intense education strategy. The positive effect was mainly seen on the percentage of patients who achieved individualized HbA1c pre-set targets, with a non-significant reduction in episodes of overall and nocturnal documented symptomatic hypoglycemia.

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Does where you live matter? : physical characteristics of neighbourhoods and type 2 diabetes in Toronto ; a cross sectional survey of ethnoracial groups living in St. James Town and Flemingdon Park

10.32920/ryerson.14662728.v1 ◽

2021 ◽

Author(s):

Anne-Marie Tynan

Keyword(s):

Type 2 Diabetes ◽

Diabetes Education ◽

Grocery Stores ◽

Education Programs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Individual Level ◽

Self Reported Health Status ◽

The Impact

The purpose of this study is to explore the impact of neighbourhood on type 2 diabetes among a sample of immigrants attending diabetes education programs in Toronto. Flemingdon Park (FP) has higher overall rates of diabetes than does St. James Town (SJ), even though both areas share similar socio-economic and immigrant profiles. A cross-sectional survey administered to participants of Diabetes Education Programs at Flemingdon and Sherbourne Health Centres asked questions about proximity of resources such as grocery stores, walking, biking trails, parks, access to and availability of recreation sites, public transit, social support and self-reported health status. The results provide individual-level information on the impact of neighbourhood and other social determinants on type 2 diabetes among a sample of immigrants. While the results support the notion that 'where you live' does matter, bigger sample size and further study are needed.

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Effect of psychotherapy for depression via home telehealth on glycemic control in adults with type 2 diabetes: Subgroup analysis of a randomized clinical trial

Journal of Telemedicine and Telecare ◽

10.1177/1357633x17730419 ◽

2017 ◽

Vol 24 (9) ◽

pp. 596-602 ◽

Cited By ~ 5

Author(s):

Leonard E Egede ◽

Rebekah J Walker ◽

Elizabeth H Payne ◽

Rebecca G Knapp ◽

Ronald Acierno ◽

...

Keyword(s):

Type 2 Diabetes ◽

Older Adults ◽

Glycemic Control ◽

Subgroup Analysis ◽

Repeated Measures ◽

Controlled Trial ◽

Treatment Groups ◽

Design And Methods ◽

The Impact

Objective We evaluated the impact of telemedicine-delivered behaviour activation treatment (BAT) on glycemic control in a subgroup of older adults with diabetes who participated in a randomized controlled trial for depression. Research design and methods We randomized older adults with major depression to same-room or telemedicine BAT. Each group received eight weekly sessions. For the subgroup analysis, we identified individuals with type 2 diabetes and obtained hemoglobin A1c at baseline and 12 months’ follow-up. We used mixed-effects models (MEM) for repeated measures analysis to compare the longitudinal mean A1c. We estimated model-derived mean A1c values and considered an adjusted model to account for baseline health status. Results We included 90 individuals with type 2 diabetes of the original 241 in the subgroup analysis (43 in telemedicine and 47 in same room). Treatment groups were not significantly different at baseline for demographics, depression, anxiety or A1c levels (telemedicine 6.9 vs. same room 7.3, p = 0.19). Baseline mean A1c for the telemedicine group remained at 6.9 (55 mmol/mol) at 12 months, whereas baseline mean A1c for the same-room group increased to 7.7 (61 mmol/mol). Longitudinal trajectories of model-derived mean A1c indicated a significant main effect of treatment group on mean A1c value at study end (difference = −0.82, 95% CI −1.41, −0.24). Adjusted analyses gave comparable results. Conclusions Telemedicine-delivered BAT was superior to same room in achieving lower mean A1c values in participants with type 2 diabetes, suggesting BAT-delivered via telemedicine is a viable treatment option for adults with diabetes.

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0686 Diabetes Sleep Treatment Trial: The Effect Of Treatment Of OSA With CPAP On Glycemic Control In Type 2 Diabetes

SLEEP ◽

10.1093/sleep/zsaa056.682 ◽

2020 ◽

Vol 43 (Supplement_1) ◽

pp. A261-A262

Author(s):

E R Chasens ◽

S M Sereika ◽

M Kortykowski ◽

R Stansbury ◽

L Burke ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Glucose Control ◽

Diabetes Education ◽

Rate Of Change ◽

Apnea Hypopnea Index ◽

Double Blind ◽

Significant Difference ◽

Intent To Treat

Abstract Introduction Evidence remains unclear whether treatment of OSA with CPAP results in improved glycemic control. This study evaluated if CPAP improved glucose control compared to sham-CPAP and the effect of adherence to active CPAP on glucose control after 6 and 12 weeks of treatment. Methods This was a multi-center, double-blind clinical trial. Participants were adults with type 2 diabetes (T2D), A1C≥6.5%, apnea + hypopnea index (AHI)≥10, and naïve to CPAP. All participants received diabetes education. Glucose control was evaluated with frucostamine and A1C levels; CPAP adherence with a wireless modem system. Statistical analysis followed an “intent-to-treat” approach with linear mixed modeling. The dose of active CPAP was calculated as the percentage of days with active CPAP use≥4 hours and the average adherence of active CPAP with sham coded as “0”dose”. Results Randomized participants (N=98, CPAP=50; sham-CPAP=48) were primarily middle-aged (age=58.7±9.8 years), White (75%), males (57%) obese (BMI=36.2±6.6), suboptimal glucose control (A1C=7.9%±0.9) and OSA (AHI=23.9±14.4). There were no significant baseline differences except in A1C (Active CPAP=7.7%±0.8; sham-CPAP=8.1%±1.0). There was no significant difference in use of their devices at 6 or 12 weeks. Based on linear mixed modeling, participants on active CPAP had improved A1C (b (SE): -.76 (.24), P<.01) and frucostamine (-21.8 (10.5), P=.04) at 6 weeks with A1C trending to significance at 12 weeks (p=0.10). Both the % of cumulative days of active CPAP usage (≥4 hours/day) (.002 (.003), P=.09) and cumulative hours of active CPAP use (.03 (.03), P=.08) showed a trend being associated with greater change in A1C but not in frucostamine (P=.61, P=.51). The rate of change in A1C varied by time, increasing the % of cumulative days of CPAP use (≥4 hours/day) at week 6 predicted greater change in A1C (.006 (.002), P=.01) than week 12 (.002 (.003), P=.38). Higher average hours of CPAP usage were associated with greater change in A1C (.08 (.03), P=.01) at week 6 compared to week 12 (.03 (.03), P=.47). Conclusion In our study, individuals with T2D and OSA, adherence to active CPAP use improved glycemic control over 6 weeks. Support NIDDK grant R01DK096028; CTRI grant UL1TR001857 and UL1TR000005.

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The impact of health coaching and diabetes education in type 2 diabetes mellitus (T2DM) patient’s lifestyle

10.26226/morressier.5d9b6234ea541d6ca849433e ◽

2019 ◽

Author(s):

Lyra Puspa

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Diabetes Education ◽

Health Coaching ◽

The Impact

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Does where you live matter? : physical characteristics of neighbourhoods and type 2 diabetes in Toronto ; a cross sectional survey of ethnoracial groups living in St. James Town and Flemingdon Park

10.32920/ryerson.14662728 ◽

2021 ◽

Author(s):

Anne-Marie Tynan

Keyword(s):

Type 2 Diabetes ◽

Diabetes Education ◽

Grocery Stores ◽

Education Programs ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Individual Level ◽

Self Reported Health Status ◽

The Impact

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Cost-Utility of an Online Education Platform and Diabetes Personal Health Record: Analysis Over Ten Years

Journal of Diabetes Science and Technology ◽

10.1177/19322968211069172 ◽

2022 ◽

pp. 193229682110691

Author(s):

Scott G. Cunningham ◽

Andrew Stoddart ◽

Sarah H. Wild ◽

Nicholas J. Conway ◽

Alastair M. Gray ◽

...

Keyword(s):

Type 2 Diabetes ◽

Online Education ◽

Diabetes Education ◽

Personal Health Record ◽

Cost Utility ◽

Mobile App ◽

Personal Health ◽

Life Years ◽

Matching Criteria

Background and Aims: My Diabetes My Way (MDMW) is Scotland’s interactive website and mobile app for people with diabetes and their caregivers. It contains multimedia resources for diabetes education and offers access to electronic personal health records. This study aims to assess the cost-utility of MDMW compared with routine diabetes care in people with type 2 diabetes who do not use insulin. Materials and Methods: Analysis used the United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model 2. Clinical parameters of MDMW users (n = 2576) were compared with a matched cohort of individuals receiving routine care alone (n = 11 628). Matching criteria: age, diabetes duration, sex, and socioeconomic status. Impact on life expectancy, quality-adjusted life years (QALYs), and costs of treatment and complications were simulated over ten years, including a 10% sensitivity analysis. Results: MDMW cohort: 1670 (64.8%) men; average age 64.3 years; duration of diabetes 5.5 years. 906 (35.2%) women: average age 61.6 years; duration 4.7 years. The cumulative mean QALY (95% CI) gain: 0.054 (0.044-0.062) years. Mean difference in cost: –£118.72 (–£150.16 to –£54.16) over ten years. Increasing MDMW costs (10%): –£50.49 (–£82.24-£14.14). Decreasing MDMW costs (10%): –£186.95 (–£218.53 to –£122.51). Conclusions: MDMW is “dominant” over usual care (cost-saving and life improving) in supporting self-management in people with type 2 diabetes not treated with insulin. Wider use may result in significant cost savings through delay or reduction of long-term complications and improved QALYs in Scotland and other countries. MDMW may be among the most cost-effective interventions currently available to support diabetes.

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Abstract 13426: The Dual GIP/GLP-1 Receptor Agonist Tirzepatide Improves Cardiovascular Risk Protein Biomarkers in Patients With Type 2 Diabetes

Circulation ◽

10.1161/circ.142.suppl_3.13426 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Jonathan M Wilson ◽

Yanzhu Lin ◽

Gary Considine ◽

Amy L Cox ◽

Lenden M Bowsman ◽

...

Keyword(s):

Type 2 Diabetes ◽

Cardiovascular Risk ◽

Endothelial Dysfunction ◽

Repeated Measures ◽

Receptor Agonist ◽

Protein Biomarkers ◽

Mixed Effect ◽

Phase 2 Trial ◽

Intent To Treat

Introduction: The dual GIP/GLP-1 receptor agonist tirzepatide dose-dependently reduced HbA1c and body weight in patients with obesity and type 2 diabetes (T2D) in a Phase 2 trial. Hypothesis: In this post hoc analysis, additional biomarkers of inflammation, endothelial dysfunction, and cellular stress were measured to better understand possible additional effects of tirzepatide treatment on cardiovascular risk factors. Methods: Patients with T2D were randomly assigned to receive either once-weekly subcutaneous injection of tirzepatide (1, 5, 10, or 15 mg), GLP-1 receptor agonist dulaglutide (1.5 mg), or placebo for 26 weeks. Soluble ICAM-1 and VCAM-1, IL-6, NT-proBNP, hsCRP and GDF-15 were assessed by immunoassay at baseline and 26 weeks in stored serum or EDTA plasma samples. Results were analyzed in a modified intent-to-treat population using a mixed effect model for repeated measures. Results: At 26 weeks, tirzepatide dose-dependently decreased ICAM-1 levels compared to baseline (Table). ICAM-1 levels were also significantly lower with tirzepatide 15 mg than placebo or dulaglutide. Moreover, tirzepatide 15 mg significantly decreased hsCRP levels from baseline compared with placebo. GDF-15 levels were decreased from baseline with all tirzepatide doses and with dulaglutide; however, changes in GDF-15 levels with tirzepatide were not significantly different from those with placebo or dulaglutide. Levels of IL-6, VCAM-1 or NT-proBNP were unchanged in all groups. Conclusions: In a 26-week study in patients with obesity and T2D, treatment with tirzepatide dose-dependently decreased circulating levels of specific biomarkers of inflammation and endothelial dysfunction previously associated with cardiovascular events, thus suggesting a net improvement in the cardiovascular risk profile of these patients. Clinical relevance of these changes will be assessed in the planned cardiovascular outcome study SURPASS-CVOT (NCT04255433).

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