Acceptability of Self-regulation Theory based mHealth Behaviorial Intervention for Older Adults with Type 2 Diabetes and Obesity (Preprint)

2019 ◽  
Author(s):  
Yaguang Zheng ◽  
Katie Weinger ◽  
Jordan Greenberg ◽  
Lora E. Burke ◽  
Susan M. Sereika ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Weight Loss ◽  
Self Regulation ◽  
Self Monitoring ◽  
Regulation Theory ◽  
Régulation Theory ◽  
The Mean ◽  
Diabetes And Obesity

BACKGROUND Mobile health (mHealth) is routinely used in younger adults with diabetes for weight loss. However, it is not known if older adult can use mHealth successfully in making lifestyle changes. OBJECTIVE The aim of the study was to examine the acceptability of a self-regulation theory-based mHealth behaviorial intervention for older adults with type 2 diabetes and obesity. METHODS This was a one-group intervention study. Participants received an 8-week self-regulation theory-based intervention consisting of 5 group sessions. They also used the Lose It! App for daily self-monitoring of food intake, a Fitbit, Bluetooth-enabled glucose meters, and weighing scales. At the end of the 8-week intervention, participants were asked to continue use of these devices for daily self-monitoring for 4 more weeks, without additional group sessions. RESULTS The sample (N=9) was White (88.9%) and female (44.4%), with mean 76.4±6.0 years of age (range: 69-89), 15.7±2.0 years of education, 33.3±3.1 kg/m2 for BMI and 7.4%±0.8 for HbA1c. Mild cognitive impairment was observed in 44.4% of sample. Over the 84 days of self-monitoring, the mean % days of using the Lose It!, Fitbit, blood glucose meter, and scale were 82.7±17.6, 85.2±19.7, 65.3±30.1, and 53.0±34.5, respectively. The mean percent weight loss from baseline was 4.92%±0.25. The dose of oral hypoglycemic agents or insulin was reduced in 55.6% of participants. CONCLUSIONS Older adults are able to use mHealth to improve their lifestyle behaviors and clinical outcomes. CLINICALTRIAL NCT03398590

Acceptability of a Self-Regulation Theory-Based mHealth Behavior Intervention for Older Adults with Type 2 Diabetes and Obesity

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 826-P
Author(s):  
YAGUANG ZHENG ◽  
KATIE WEINGER ◽  
MATT C. GREGAS ◽  
JORDAN GREENBERG ◽  
ZHUOXIN LI ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Self Regulation ◽  
Behavior Intervention ◽  
Regulation Theory ◽  
Régulation Theory ◽  
Diabetes And Obesity

scholarly journals Intervention Enhancement Strategies Among Adults With Type 2 Diabetes in a Very Low–Carbohydrate Web-Based Program: Evaluating the Impact With a Randomized Trial

JMIR Diabetes ◽  
10.2196/15835 ◽  
2020 ◽  
Vol 5 (3) ◽  
pp. e15835
Author(s):  
Laura R Saslow ◽  
Judith Tedlie Moskowitz ◽  
Ashley E Mason ◽  
Jennifer Daubenmier ◽  
Bradley Liestenfeltz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Effect Size ◽  
Text Messages ◽  
Self Monitoring ◽  
Web Based ◽  
Low Carbohydrate ◽  
The Mean ◽  
Diet And Lifestyle

Background Adults with type 2 diabetes may experience health benefits, including glycemic control and weight loss, from following a very low–carbohydrate, ketogenic (VLC) diet. However, it is unclear which ancillary strategies may enhance these effects. Objective This pilot study aims to estimate the effect sizes of 3 intervention enhancement strategies (text messages, gifts, and breath vs urine ketone self-monitoring) that may improve outcomes of a 12-month web-based ad libitum VLC diet and lifestyle intervention for adults with type 2 diabetes. The primary intervention also included other components to improve adherence and well-being, including positive affect and mindfulness as well as coaching. Methods Overweight or obese adults (n=44; BMI 25-45 kg/m2) with type 2 diabetes (glycated hemoglobin [HbA1c] ≥6.5%), who had been prescribed either no glucose-lowering medications or metformin alone, participated in a 12-month web-based intervention. Using a 2×2×2 randomized factorial design, we compared 3 enhancement strategies: (1) near-daily text messages about the intervention’s recommended behaviors (texts n=22 vs no texts n=22), (2) mailed gifts of diet-relevant foods and cookbooks (6 rounds of mailed gifts n=21 vs no gifts n=23), and (3) urine- or breath-based ketone self-monitoring (urine n=21 vs breath n=23). We assessed HbA1c and weight at baseline and at 4, 8, and 12 months. We evaluated whether each strategy exerted a differential impact on HbA1c and weight at 12 months against an a priori threshold of Cohen d of 0.5 or greater. Results We retained 73% (32/44) of the participants at 12 months. The intervention, across all conditions, led to improvements in glucose control and reductions in body weight at the 12-month follow-up. In intent-to-treat (ITT) analyses, the mean HbA1c reduction was 1.0% (SD 1.6) and the mean weight reduction was 5.3% (SD 6.0), whereas among study completers, these reductions were 1.2% (SD 1.7) and 6.3% (SD 6.4), respectively, all with a P value of less than .001. In ITT analyses, no enhancement strategy met the effect size threshold. Considering only study completers, 2 strategies showed a differential effect size of at least a d value of 0.5 or greater Conclusions Text messages, gifts of food and cookbooks, and urine-based ketone self-monitoring may potentially enhance the glycemic or weight loss benefits of a web-based VLC diet and lifestyle intervention for individuals with type 2 diabetes. Future research could investigate other enhancement strategies to help create even more effective solutions for the treatment of type 2 diabetes. Trial Registration ClinicalTrials.gov NCT02676648; http://clinicaltrials.gov/ct2/show/NCT02676648

scholarly journals Intervention Enhancement Strategies Among Adults With Type 2 Diabetes in a Very Low–Carbohydrate Web-Based Program: Evaluating the Impact With a Randomized Trial (Preprint)

2019 ◽  
Author(s):  
Laura R Saslow ◽  
Judith Tedlie Moskowitz ◽  
Ashley E Mason ◽  
Jennifer Daubenmier ◽  
Bradley Liestenfeltz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Effect Size ◽  
Text Messages ◽  
Self Monitoring ◽  
Web Based ◽  
Low Carbohydrate ◽  
The Mean ◽  
Diet And Lifestyle

BACKGROUND Adults with type 2 diabetes may experience health benefits, including glycemic control and weight loss, from following a very low–carbohydrate, ketogenic (VLC) diet. However, it is unclear which ancillary strategies may enhance these effects. OBJECTIVE This pilot study aims to estimate the effect sizes of 3 intervention enhancement strategies (text messages, gifts, and breath vs urine ketone self-monitoring) that may improve outcomes of a 12-month web-based <i>ad libitum</i> VLC diet and lifestyle intervention for adults with type 2 diabetes. The primary intervention also included other components to improve adherence and well-being, including positive affect and mindfulness as well as coaching. METHODS Overweight or obese adults (n=44; BMI 25-45 kg/m<sup>2</sup>) with type 2 diabetes (glycated hemoglobin [HbA<sub>1c</sub>] ≥6.5%), who had been prescribed either no glucose-lowering medications or metformin alone, participated in a 12-month web-based intervention. Using a 2×2×2 randomized factorial design, we compared 3 enhancement strategies: (1) near-daily text messages about the intervention’s recommended behaviors (texts n=22 vs no texts n=22), (2) mailed gifts of diet-relevant foods and cookbooks (6 rounds of mailed gifts n=21 vs no gifts n=23), and (3) urine- or breath-based ketone self-monitoring (urine n=21 vs breath n=23). We assessed HbA<sub>1c</sub> and weight at baseline and at 4, 8, and 12 months. We evaluated whether each strategy exerted a differential impact on HbA<sub>1c</sub> and weight at 12 months against an a priori threshold of Cohen <i>d</i> of 0.5 or greater. RESULTS We retained 73% (32/44) of the participants at 12 months. The intervention, across all conditions, led to improvements in glucose control and reductions in body weight at the 12-month follow-up. In intent-to-treat (ITT) analyses, the mean HbA<sub>1c</sub> reduction was 1.0% (SD 1.6) and the mean weight reduction was 5.3% (SD 6.0), whereas among study completers, these reductions were 1.2% (SD 1.7) and 6.3% (SD 6.4), respectively, all with a <i>P</i> value of less than .001. In ITT analyses, no enhancement strategy met the effect size threshold. Considering only study completers, 2 strategies showed a differential effect size of at least a <i>d</i> value of 0.5 or greater CONCLUSIONS Text messages, gifts of food and cookbooks, and urine-based ketone self-monitoring may potentially enhance the glycemic or weight loss benefits of a web-based VLC diet and lifestyle intervention for individuals with type 2 diabetes. Future research could investigate other enhancement strategies to help create even more effective solutions for the treatment of type 2 diabetes. CLINICALTRIAL ClinicalTrials.gov NCT02676648; http://clinicaltrials.gov/ct2/show/NCT02676648

The Impact of Self-monitoring of Blood Glucose on a Behavioral Weight Loss Intervention for Patients With Type 2 Diabetes

2012 ◽  
Vol 39 (3) ◽  
pp. 397-405 ◽  
Author(s):  
Lisa M. McAndrew ◽  
Melissa A. Napolitano ◽  
Leonard M. Pogach ◽  
Karen S. Quigley ◽  
Kerri Leh Shantz ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Blood Glucose ◽  
Weight Loss Intervention ◽  
Behavioral Weight Loss ◽  
Self Monitoring ◽  
Behavioral Weight Loss Intervention ◽  
The Impact

scholarly journals Flash glucose monitoring helps achieve better glycemic control than conventional self-monitoring of blood glucose in non-insulin-treated type 2 diabetes: a randomized controlled trial

2020 ◽  
Vol 8 (1) ◽  
pp. e001115 ◽  
Author(s):  
Eri Wada ◽  
Takeshi Onoue ◽  
Tomoko Kobayashi ◽  
Tomoko Handa ◽  
Ayaka Hayase ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Blood Glucose ◽  
Glycemic Control ◽  
Glucose Monitoring ◽  
Analysis Of Covariance ◽  
Self Monitoring ◽  
Flash Glucose Monitoring ◽  
Baseline Values ◽  
The Mean

IntroductionThe present study aimed to evaluate the effects of flash glucose monitoring (FGM) and conventional self-monitoring of blood glucose (SMBG) on glycemic control in patients with non-insulin-treated type 2 diabetes.Research design and methodsIn this 24-week, multicenter, open-label, randomized (1:1), parallel-group study, patients with non-insulin-treated type 2 diabetes at five hospitals in Japan were randomly assigned to the FGM (n=49) or SMBG (n=51) groups and were provided each device for 12 weeks. The primary outcome was change in glycated hemoglobin (HbA1c) level, and was compared using analysis of covariance model that included baseline values and group as covariates.ResultsForty-eight participants in the FGM group and 45 in the SMBG group completed the study. The mean HbA1c levels were 7.83% (62.1 mmol/mol) in the FGM group and 7.84% (62.2 mmol/mol) in the SMBG group at baseline, and the values were reduced in both FGM (−0.43% (−4.7 mmol/mol), p<0.001) and SMBG groups (−0.30% (−3.3 mmol/mol), p=0.001) at 12 weeks. On the other hand, HbA1c was significantly decreased from baseline values in the FGM group, but not in the SMBG group at 24 weeks (FGM: −0.46% (−5.0 mmol/mol), p<0.001; SMBG: −0.17% (−1.8 mmol/mol), p=0.124); a significant between-group difference was also observed (difference −0.29% (−3.2 mmol/mol), p=0.022). Diabetes Treatment Satisfaction Questionnaire score was significantly improved, and the mean glucose levels, SD of glucose, mean amplitude of glycemic excursions and time in hyperglycemia were significantly decreased in the FGM group compared with the SMBG group.ConclusionsGlycemic control was better with FGM than with SMBG after cessation of glucose monitoring in patients with non-insulin-treated type 2 diabetes.Trial registration numberUMIN000026452, jRCTs041180082.

scholarly journals Frequency of self-monitoring of blood glucose in relation to weight loss and A1C during intensive multidisciplinary weight management in patients with type 2 diabetes and obesity

2019 ◽  
Vol 7 (1) ◽  
pp. e000659 ◽  
Author(s):  
Shaheen Tomah ◽  
Noor Mahmoud ◽  
Adham Mottalib ◽  
David M Pober ◽  
Mhd Wael Tasabehji ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Blood Glucose ◽  
Weight Management ◽  
Average Frequency ◽  
Baseline Body Mass Index ◽  
Self Monitoring ◽  
Median Change

ObjectiveWe evaluated the relationship between frequency of self-monitoring of blood glucose (SMBG) and body weight, A1C, and cardiovascular risk factors in patients with type 2 diabetes (T2D) and obesity enrolled in a 12-week intensive multidisciplinary weight management (IMWM) program.Research design and methodsWe conducted a retrospective analysis of 42 patients who electronically uploaded their SMBG data over 12 weeks of an IMWM program and divided them into tertiles based on their average frequency of SMBG per day. Mean (range) SMBG frequencies were 2.3 (1.1–2.9) times/day, 3.4 (3–3.9) times/day, and 5 (4–7.7) times/day in the lowest, middle, and highest tertiles, respectively. Anthropometric and metabolic parameters were measured at baseline and after 12 weeks of intervention.ResultsParticipants in the highest tertile achieved a median change (IQR) in body weight of −10.4 kg (−7.6 to −14.4 kg) compared with −8.3 kg (−5.2 to −12.2 kg), and −6.9 kg (−4.2 to −8.9 kg) in the middle and lowest tertiles, respectively (p=0.018 for trend). Participants in the highest tertile had a median change (IQR) in A1C of −1.25% (−0.6 to −3.1%) compared with −0.8% (−0.3% to −2%) and −0.5% (−0.2% to −1.2%) in the middle and lowest tertiles, respectively (p=0.048 for trend). The association between change in body weight and SMBG frequency remained significant after adjusting for age, sex, baseline body mass index, diabetes duration, and use of insulin therapy.ConclusionsIncreased frequency of SMBG during IMWM is associated with significantly better weight loss and improvement of A1C in patients with T2D and obesity. These findings may suggest future clinical recommendations aimed at increasing SMBG frequency to achieve the most favorable outcomes.

Diabetes and obesity in older adults: a call to action

2009 ◽  
Vol 19 (2) ◽  
pp. 135-147 ◽  
Author(s):  
Emily J. Edson ◽  
Justo Sierra-Johnson ◽  
Bradley Curtis
Keyword(s):  
Type 2 Diabetes ◽  
Older Adults ◽  
Treatment Strategies ◽  
Special Population ◽  
Older Population ◽  
Call To Action ◽  
The Metabolic Syndrome ◽  
Weight Loss Interventions ◽  
Diabetes And Obesity

SummaryThe world's older population is projected to rise to some two billion people in the next 50 years. The health of older adults deteriorates with increasing age and creates greater demand for healthcare resources. Prevalence of the metabolic syndrome in older adults is causing concern due to its interplay between type 2 diabetes, obesity and associated morbidity and mortality. This call to action discusses comorbidities associated with type 2 diabetes and obesity in the older population and its impact on patients. We cover several topics to consider when designing prevention and treatment strategies for older adults and areas for improvement in our care of this special population are discussed. We know that dietary, exercise and weight-loss interventions are effective. However, these strategies require effort by both patient and physician. If all parties responsible in patient care take action, a change in lifestyle can lead to longer, healthier lives in older adults.

scholarly journals Process Evaluation of the Type 2 Diabetes Mellitus PULSE Program Randomized Controlled Trial: Recruitment, Engagement, and Overall Satisfaction

2017 ◽  
Vol 11 (4) ◽  
pp. 1055-1068 ◽  
Author(s):  
Elroy J. Aguiar ◽  
Philip J. Morgan ◽  
Clare E. Collins ◽  
Ronald C. Plotnikoff ◽  
Myles D. Young ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Type 2 Diabetes Mellitus ◽  
High Risk ◽  
Process Evaluation ◽  
Controlled Trial ◽  
Screening Process ◽  
Self Monitoring

Background: Men are underrepresented in weight loss and type 2 diabetes mellitus (T2DM) prevention studies. Purpose: To determine the effectiveness of recruitment, and acceptability of the T2DM Prevention Using LifeStyle Education (PULSE) Program—a gender-targeted, self-administered intervention for men. Methods: Men (18–65 years, high risk for T2DM) were randomized to intervention ( n = 53) or wait-list control groups ( n = 48). The 6-month PULSE Program intervention focused on weight loss, diet, and exercise for T2DM prevention. A process evaluation questionnaire was administered at 6 months to examine recruitment and selection processes, and acceptability of the intervention’s delivery and content. Associations between self-monitoring and selected outcomes were assessed using Spearman’s rank correlation. Results: A pragmatic recruitment and online screening process was effective in identifying men at high risk of T2DM (prediabetes prevalence 70%). Men reported the trial was appealing because it targeted weight loss, T2DM prevention, and getting fit, and because it was perceived as “doable” and tailored for men. The intervention was considered acceptable, with men reporting high overall satisfaction (83%) and engagement with the various components. Adherence to self-monitoring was poor, with only 13% meeting requisite criteria. However, significant associations were observed between weekly self-monitoring of weight and change in weight ( rs = −.47, p = .004) and waist circumference ( rs = −.38, p = .026). Men reported they would have preferred more intervention contact, for example, by phone or email. Conclusions: Gender-targeted, self-administered lifestyle interventions are feasible, appealing, and satisfying for men. Future studies should explore the effects of additional non-face-to-face contact on motivation, accountability, self-monitoring adherence, and program efficacy.

scholarly journals Outcomes of a Digitally Delivered Low-Carbohydrate Type 2 Diabetes Self-Management Program: 1-Year Results of a Single-Arm Longitudinal Study (Preprint)

2017 ◽  
Author(s):  
Laura R Saslow ◽  
Charlotte Summers ◽  
James E Aikens ◽  
David J Unwin
Keyword(s):  
Type 2 Diabetes ◽  
Weight Loss ◽  
Body Weight ◽  
Glycemic Control ◽  
Management Program ◽  
Open Label ◽  
Post Intervention ◽  
Self Monitoring ◽  
Quasi Experimental

BACKGROUND Type 2 diabetes mellitus has serious health consequences, including blindness, amputation, stroke, and dementia, and its annual global costs are more than US $800 billion. Although typically considered a progressive, nonreversible disease, some researchers and clinicians now argue that type 2 diabetes may be effectively treated with a carbohydrate-reduced diet. OBJECTIVE Our objective was to evaluate the 1-year outcomes of the digitally delivered Low-Carb Program, a nutritionally focused, 10-session educational intervention for glycemic control and weight loss for adults with type 2 diabetes. The program reinforces carbohydrate restriction using behavioral techniques including goal setting, peer support, and behavioral self-monitoring. METHODS The study used a quasi-experimental research design comprised of an open-label, single-arm, pre-post intervention using a sample of convenience. From adults with type 2 diabetes who had joined the program and had a complete baseline dataset, we randomly selected participants to be followed for 1 year (N=1000; mean age 56.1, SD 15.7 years; 59.30% (593/1000) women; mean glycated hemoglobin A1c (HbA1c) 7.8%, SD 2.1%; mean body weight 89.6 kg, SD 23.1 kg; taking mean 1.2, SD 1.01 diabetes medications). RESULTS Of the 1000 study participants, 708 (70.80%) individuals reported outcomes at 12 months, 672 (67.20%) completed at least 40% of the lessons, and 528 (52.80%) completed all lessons of the program. Of the 743 participants with a starting HbA1c at or above the type 2 diabetes threshold of 6.5%, 195 (26.2%) reduced their HbA1c to below the threshold while taking no glucose-lowering medications or just metformin. Of the participants who were taking at least one hypoglycemic medication at baseline, 40.4% (289/714) reduced one or more of these medications. Almost half (46.40%, 464/1000) of all participants lost at least 5% of their body weight. Overall, glycemic control and weight loss improved, especially for participants who completed all 10 modules of the program. For example, participants with elevated baseline HbA1c (≥7.5%) who engaged with all 10 weekly modules reduced their HbA1c from 9.2% to 7.1% (P<.001) and lost an average of 6.9% of their body weight (P<.001). CONCLUSIONS Especially for participants who fully engage, an online program that teaches a carbohydrate-reduced diet to adults with type 2 diabetes can be effective for glycemic control, weight loss, and reducing hypoglycemic medications.

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