scholarly journals Digital Diabetes Management: A Literature Review of Smart Insulin Pens

2021 ◽  
pp. 193229682098386 ◽  
Author(s):  
Lutz Heinemann ◽  
Oliver Schnell ◽  
Bernhard Gehr ◽  
Nanette C. Schloot ◽  
Sven W. Görgens ◽  
...  
Keyword(s):  
Patient Preference ◽  
Diabetes Management ◽  
Electronic Device ◽  
Digital Health ◽  
Memory Function ◽  
Near Field ◽  
Self Management ◽  
Published Data ◽  
Technical Accuracy ◽  
Insulin Pens

Digital health management is increasingly pivotal in the care of patients with diabetes. The aim of this review was to evaluate the clinical benefits of using smart insulin pens with connectivity for diabetes management. The search was performed using PubMed and PubMed Central on May 15, 2019, to identify publications investigating the use of insulin pens. Studies evaluating insulin pens with connectivity via Bluetooth/Near Field Communication, with an associated electronic device enabling connectivity, or with a memory function were included in the review. Nine studies were identified in the search. Overall, these studies lacked data on smart insulin pens with a connectivity function, with eight of the available studies investigating only pens with a memory function. The studies focused primarily on assessing patient preference, usability, and technical accuracy. The number of studies assessing clinical outcomes was small ( n = 3). However, the majority of studies ( n = 8) reported that patients preferred smart insulin pens because they increased confidence with regard to diabetes self-management. These results suggest a lack of published data regarding smart insulin pens with connectivity for the management of diabetes. However, the available published data on usability and patient preference suggest that the use of smart insulin pens holds promise for improving and simplifying diabetes self-management.

scholarly journals Complementarity of Digital Health and Peer Support: “This Is What’s Coming”

2021 ◽  
Vol 2 ◽  
Author(s):  
Patrick Y. Tang ◽  
Janet Duni ◽  
Malinda M. Peeples ◽  
Sarah D. Kowitt ◽  
Nivedita L. Bhushan ◽  
...  
Keyword(s):  
Peer Support ◽  
Diabetes Management ◽  
Digital Health ◽  
Scale Up ◽  
Value Added ◽  
Self Management ◽  
Free Form ◽  
Primary Group ◽  
Management Support ◽  
Health Coaches

PurposeThis study examined integration of peer support and a Food and Drug Administration-cleared, diabetes management app (DMA) in diabetes self-management support as a scalable model for those with type 2 diabetes mellitus (T2DM).MethodsTwo lay health Coaches delivered telephone-based self-management support to adults (N = 43) with T2DM recruited through a primary group practice. Those eligible were offered no-cost access to DMA for the entire 6-month study. Coaches introduced DMA and contacted individuals by phone and text with frequency dependent on participant needs/preferences. DMA supported monitoring of blood glucose, carbohydrate intake, and medication use, as well as messaging personalized to participants’ medication regimens. Clinical data were extracted from DMA, electronic medical records, and Coaches’ records. Structured interviews of 12 participants, 2 Coaches, and 5 project staff were analyzed using deductive pre-identified codes (regarding adoptability, patterns of use, value added, complementarity, and sustainability) utilizing standard procedures for qualitative analysis.ResultsOf the 43 participants, 38 (88.4%) enrolled in DMA. In general, participants used both DMA and lay health coaches, averaging 144.14 DMA entries (structured, e.g., medications, and free form, e.g., “ate at a restaurant” and “stressed”) and 5.86 coach contacts over the 6-month intervention. Correlation between DMA entries and coach contacts (r = .613, p < 0.001) was consistent with complementarity as were participants’ and coaches’ observations that (a) DMA facilitated recognition of patterns and provided reminders and suggestions to achieve self-management plans, whereas (b) coaching provided motivation and addressed challenges that emerged. Mean hemoglobin A1c (A1c) declined from 9.93% to 8.86% (p < 0.001), with no pattern of coaching or DMA use significantly related to reductions. Staff identified resources to coordinate coach/DMA interventions as a major sustainability challenge.ConclusionsDMA and peer support for diabetes management are compatible and complementary. Additional practice integration research is needed for adoption and scale-up.

Inpatient Insulin Pen Implementation, Waste, and Potential Cost Savings: A Community Hospital Experience

2021 ◽  
pp. 193229682110025
Author(s):  
Urooj Najmi ◽  
Waqas Zia Haque ◽  
Umair Ansari ◽  
Eyerusalem Yemane ◽  
Lee Ann Alexander ◽  
...  
Keyword(s):  
Insulin Aspart ◽  
Community Hospital ◽  
Task Force ◽  
Hospital Setting ◽  
Cost Savings ◽  
Self Management ◽  
Self Administration ◽  
Potential Cost ◽  
Hospital Leadership ◽  
Insulin Pens

Background: Insulin pen injectors (“pens”) are intended to facilitate a patient’s self-administration of insulin and can be used in hospitalized patients as a learning opportunity. Unnecessary or duplicate dispensation of insulin pens is associated with increased healthcare costs. Methods: Inpatient dispensation of insulin pens in a 240-bed community hospital between July 2018 and July 2019 was analyzed. We calculated the percentage of insulin pens unnecessarily dispensed for patients who had the same type of insulin pen assigned. The estimated cost of insulin pen waste was calculated. A pharmacist-led task force group implemented hospital-wide awareness and collaborated with hospital leadership to define goals and interventions. Results: 9516 insulin pens were dispensed to 3121 patients. Of the pens dispensed, 6451 (68%) were insulin aspart and 3065 (32%) were glargine. Among patients on insulin aspart, an average of 2.2 aspart pens was dispensed per patient, but only an estimated 1.2 pens/patient were deemed necessary. Similarly, for inpatients prescribed glargine, an average of 2.1 pens/patient was dispensed, but only 1.3 pens/patient were necessary. A number of gaps were identified and interventions were undertaken to reduce insulin pen waste, which resulted in a significant decrease in both aspart (p = 0.0002) and glargine (p = 0.0005) pens/patient over time. Reductions in pen waste resulted in an estimated cost savings of $66 261 per year. Conclusions: In a community hospital setting, identification of causes leading to unnecessary insulin dispensation and implementation of hospital-wide staff education led to change in insulin pen dispensation practice. These changes translated into considerable cost savings and facilitated diabetes self-management education.

scholarly journals Evidence-Based Digital Tools for Weight Loss Maintenance: The NoHoW Project

Obesity Facts ◽  
2021 ◽  
pp. 1-14
Author(s):  
R. James Stubbs ◽  
Cristiana Duarte ◽  
António L. Palmeira ◽  
Falko F. Sniehotta ◽  
Graham Horgan ◽  
...  
Keyword(s):  
Weight Loss ◽  
Behaviour Change ◽  
Digital Health ◽  
Self Regulation ◽  
Self Management ◽  
Behaviour Change Techniques ◽  
Evidence Based ◽  
Behavioural Science ◽  
Digital Architecture

<b><i>Background:</i></b> Effective interventions and commercial programmes for weight loss (WL) are widely available, but most people regain weight. Few effective WL maintenance (WLM) solutions exist. The most promising evidence-based behaviour change techniques for WLM are self-monitoring, goal setting, action planning and control, building self-efficacy, and techniques that promote autonomous motivation (e.g., provide choice). Stress management and emotion regulation techniques show potential for prevention of relapse and weight regain. Digital technologies (including networked-wireless tracking technologies, online tools and smartphone apps, multimedia resources, and internet-based support) offer attractive tools for teaching and supporting long-term behaviour change techniques. However, many digital offerings for weight management tend not to include evidence-based content and the evidence base is still limited. <b><i>The Project:</i></b> First, the project examined why, when, and how many European citizens make WL and WLM attempts and how successful they are. Second, the project employed the most up-to-date behavioural science research to develop a digital toolkit for WLM based on 2 key conditions, i.e., self-management (self-regulation and motivation) of behaviour and self-management of emotional responses for WLM. Then, the NoHoW trial tested the efficacy of this digital toolkit in adults who achieved clinically significant (≥5%) WL in the previous 12 months (initial BMI ≥25). The primary outcome was change in weight (kg) at 12 months from baseline. Secondary outcomes included biological, psychological, and behavioural moderators and mediators of long-term energy balance (EB) behaviours, and user experience, acceptability, and cost-effectiveness. <b><i>Impact:</i></b> The project will directly feed results from studies on European consumer behaviour, design and evaluation of digital toolkits self-management of EB behaviours into development of new products and services for WLM and digital health. The project has developed a framework and digital architecture for interventions in the context of EB tracking and will generate results that will help inform the next generation of personalised interventions for effective self-management of weight and health.

scholarly journals Numerical modelling of historical landslide-generated tsunamis in the French Lesser Antilles

2010 ◽  
Vol 10 (6) ◽  
pp. 1281-1292 ◽  
Author(s):  
B. Poisson ◽  
R. Pedreros
Keyword(s):  
Near Field ◽  
Pyroclastic Flows ◽  
Lesser Antilles ◽  
Published Data ◽  
Tsunami Height ◽  
Tsunami Modelling ◽  
Field Effects ◽  
Wave Heights ◽  
Unique Source ◽  
Height Data

Abstract. Two historical landslide-induced tsunamis that reached the coasts of the French Lesser Antilles are studied. First, the Martinique coast was hit by a tsunami down the western flank of Montagne Pelée at the beginning of the big eruption of May 1902. More recently, the northeastern coast of Guadeloupe was affected by a tsunami that had been generated around Montserrat by pyroclastic flows entering the sea, during the July 2003 eruption of the Soufrière Hills volcano. We use a modified version of the GEOWAVE model to compute numerical simulations of both events. Two source hypotheses are considered for each tsunami. The comparison of the simulation results with reported tsunami height data helps to discriminate between the tested source decriptions. In the Martinique case, we obtain a better fit to data when considering three successive lahars entering the sea, as a simplified single source leads to an overstimation of the tsunami wave heights at the coast. In the Montserrat case, the best model uses a unique source which volume corresponds to published data concerning the peak volume flow. These findings emphasize the importance of an accurate description of the relevant volume as well as the timing sequence of the source event in landslide-generated tsunami modelling. They also show that considering far-field effects in addition to near-field effects may significantly improve tsunami modelling.

scholarly journals Diabetes clinic reinvented: will technology change the future of diabetes care?

2021 ◽  
Vol 12 ◽  
pp. 204201882199536
Author(s):  
Marwa Al-Badri ◽  
Osama Hamdy
Keyword(s):  
Mobile Health ◽  
Diabetes Care ◽  
Rural Areas ◽  
Patient Monitoring ◽  
Diabetes Management ◽  
Digital Health ◽  
Future Application ◽  
Diabetes Clinic ◽  
Digital Ecosystem ◽  
Morbid Conditions

Diabetes is a chronic disease that affects nearly 463 million people globally and involves multiple co-morbid conditions that require effective treatment and continuous management. These include lifestyle and behavioral modifications, compliance to diabetes medications and close patient monitoring, all of which can be efficiently conducted via telehealth. Integrating digital technology of telehealth and mobile health into diabetes care may improve diabetes management and increase its efficiency. In this review, we examine recent advances in healthcare technology of diabetes. Moreover, we present an example of a comprehensive virtual diabetes clinic, the “Joslin HOME,” as an innovative digital ecosystem for future application in diabetes care. This model utilizes digital health technology and comprises frequent short visits with easy two-way scheduling, focused documentation and simple billing methods. In this new model, a multidisciplinary team is connected with their patients using telehealth and mobile health to overcome the barriers of distance and location. It may possibly extend quality diabetes care to remote, underserved or rural areas.

Type 2 diabetes self-management: spirituality, coping and responsibility

2021 ◽  
Vol 26 (8) ◽  
pp. 743-760
Author(s):  
Natasha Duke
Keyword(s):  
Type 2 Diabetes ◽  
Health Beliefs ◽  
Diabetes Management ◽  
Coping Styles ◽  
Glycated Haemoglobin ◽  
Self Management ◽  
Living Situation ◽  
Care Plans ◽  
Interpretive Method

Background In England, although The National Institute of Health and Care Excellence recommends that patients’ religious beliefs should be incorporated into individual healthcare plans, these components are often neglected in diabetes management care plans. A literature review identified a paucity of research regarding how the spirituality of British people may influence their approach to their self-management of type 2 diabetes (T2D). Aims To explore how the spirituality of a small group of adults with T2D, living in England, influenced their coping strategies and self-management of diet and exercise. Methods Biographic Narrative Interpretive Method of two interviews per participant and thematic analysis for data interrogation ( n = 8). Data as glycated haemoglobin, living situation, age, length of time since T2D diagnosis, body mass index and diabetic medicines contextualised the interview data. Results Participants’ spirituality, health beliefs, coping and sense of responsibility for T2D self-management overlapped in complex layers. Three themes were generated: (a) spirituality influences expectations in life; (b) beliefs influence coping styles of diabetes self-management; and (c) responsibility influences diabetes self-management. A model was created to assist nurses in addressing these components. Conclusion Nurses should consider how patients’ self-management of T2D may be influenced by their spirituality, health beliefs, coping and sense of responsibility.

scholarly journals Translating Research into Practice: Impact of an Interprofessional Diabetes Education Model on Patient Health Outcomes

2014 ◽  
Vol 4 (2) ◽  
Author(s):  
Olayinka O. Shiyanbola ◽  
Becky Randall ◽  
Cristina Lammers ◽  
Karly A. Hegge ◽  
Michelle Anderson
Keyword(s):  
Health Promotion ◽  
Clinical Outcomes ◽  
Diabetes Management ◽  
Diabetes Education ◽  
Health Behaviours ◽  
Self Management ◽  
Health Promotion Program ◽  
Diabetes Knowledge ◽  
Foot Care ◽  
Eye Care

Background: Patient education programs encouraging diabetes self-management can improve clinical outcomes and lessen diabetes complications. This study implemented an innovative interprofessional student-led diabetes self-management and health promotion program for an underserved population and demonstrated an improvement in participant clinical outcomes and students’ understanding of interprofessional aspects of diabetes care.Methods and Findings: This community-based program was implemented at two sites that serve medically underserved individuals. Students from five health career professions led educational sessions designed to demonstrate critical components of diabetes self-management. The six-month longitudinal program covered topics within the Alphabet Strategy, including Advice, Blood pressure, Cholesterol, Diabetes control, Dental care, Diet, Eye care, Foot care, and Guardian drugs. Participants completed surveys evaluating diabetes knowledge, understanding of diabetes care, and health behaviours. Clinical values were collected before and after the program. Student surveys assessed their understanding of diabetes self-management. Upon completion of the program, all assessments were repeated to determine if there were improvements in outcomes. Thirty-eight participants and thirty students completed the study. There were significant improvements in participants’ diabetes knowledge, understanding of diabetes management, and clinical outcomes. There were significant improvements in the students’ ability to educate patients about foot care, eye care, and guardian drugs, as well as increased awareness of the role of each health profession in diabetes care.Conclusions: This interprofessional health promotion model showed significant improvements in patient and student outcomes. This innovative student-led program could be implemented in other settings and for the management of other chronic diseases.

Diabetes management in Senegalese families: A dyadic-narrative illustration

2017 ◽  
Vol 14 (3) ◽  
pp. 182-193 ◽  
Author(s):  
R BeLue ◽  
K Ndiaye ◽  
PY Miranda ◽  
F Ndao ◽  
P Canagarajah
Keyword(s):  
Family Caregivers ◽  
Diabetes Prevention ◽  
Diabetes Management ◽  
Self Management ◽  
Healthy Behaviors ◽  
Management Interventions ◽  
Dietary Sugar ◽  
Sub Saharan ◽  
Family Based ◽  
Management Behaviors

Objectives In many Sub-Saharan African cultures, diabetes self-management behaviors such as dietary adherence do not occur in isolation but are carried out in the context of local culture, a significant factor in shaping those health behaviors. Methods Using a family-based narrative approach, we explore how Senegalese families manage diabetes. We interviewed twenty people living with diabetes and selected family caregivers from MBour, Senegal. Results We found that people living with diabetes experienced physical, emotional, and financial stressors as a result of managing their condition. In addition, family caregivers play an important role in managing their family member's diabetes. Discussion The act of caregiving affects caregiver diabetes prevention behaviors. In some cases, this caregiving role leads to an increase of healthy behaviors such as reducing dietary sugar; however, in some cases, caregivers do not see the need to engage in healthy behaviors. Diabetes prevention and management interventions that support both Senegalese people living with diabetes and their family caregivers are warranted.

Near-field mean flow dynamics of a cylindrical canopy patch suspended in deep water

2018 ◽  
Vol 858 ◽  
pp. 634-655 ◽  
Author(s):  
Jian Zhou ◽  
Subhas K. Venayagamoorthy
Keyword(s):  
Deep Water ◽  
Near Field ◽  
Flow Dynamics ◽  
Flow Diversion ◽  
Circular Cylinders ◽  
Published Data ◽  
Global Flow ◽  
Mean Flow ◽  
Near Wake ◽  
Local Flow

The time-averaged flow dynamics of a suspended cylindrical canopy patch with a bulk diameter of $D$ is investigated using large-eddy simulations (LES). The patch consists of $N_{c}$ constituent solid circular cylinders of height $h$ and diameter $d$, mimicking patchy vegetation suspended in deep water ($H/h\gg 1$, where $H$ is the total flow depth). After validation against published data, LES of a uniform incident flow impinging on the canopy patch was conducted to study the effects of canopy density ($0.16\leqslant \unicode[STIX]{x1D719}=N_{c}(d/D)^{2}\leqslant 1$, by varying $N_{c}$) and bulk aspect ratio ($0.25\leqslant AR=h/D\leqslant 1$, by varying $h$) on the near-wake structure and adjustment of flow pathways. The relationships between patch geometry, local flow bleeding (three-dimensional redistribution of flow entering the patch) and global flow diversion (streamwise redistribution of upstream undisturbed flow) are identified. An increase in either $\unicode[STIX]{x1D719}$ or $AR$ decreases/increases/increases bleeding velocities through the patch surface area along the streamwise/lateral/vertical directions, respectively. However, a volumetric flux budget shows that a larger $AR$ causes a smaller proportion of the flow rate entering the patch to bleed out vertically. The global flow diversion is found to be determined by both the patch geometrical dimensions and the local bleeding which modifies the sizes of the patch-scale near wake. While loss of flow penetrating the patch increases monotonically with increasing $\unicode[STIX]{x1D719}$, its partition into flow diversion around and beneath the patch shows a non-monotonic dependence. The spatial extents of the wake, the flow-diversion dynamics and the bulk drag coefficients of the patch jointly reveal the fundamental differences of flow responses between suspended porous patches and their solid counterparts.

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