scholarly journals The influence of baseline A1c on digital health coaching outcomes for adults with type 2 diabetes: A real-world retrospective cohort study (Preprint)

2020 ◽  
Author(s):  
Martin Martin ◽  
Jonathan Patterson ◽  
Matt Allison ◽  
Blakely B O’Connor ◽  
Dhiren Patel
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
High Risk ◽  
Real World ◽  
Digital Health ◽  
Health Coaching ◽  
Diabetes Distress ◽  
Physical And Mental Health ◽  
Patient Centered

BACKGROUND Digital health coaching is an increasingly common diabetes self-management support strategy for individuals with type 2 diabetes and has been linked to positive mental and physical health outcomes. However, the relationship between baseline risk and outcomes has yet to be evaluated in a real-world setting. OBJECTIVE The purpose of this real-world study was to evaluate trends in digital health coaching outcomes by baseline A1c to better understand which populations may experience the greatest clinical and psychosocial benefit. METHODS Participants were referred to a 12-week digital health coaching program, administered by Pack Health, through their healthcare provider, payer or employer. The program included patient-centered lifestyle counseling and psychosocial support delivered via telephone, text and/or email. Self-reported A1c and weight were collected at baseline and completion. Physical and mental health were assessed using the PROMIS Global Health short form and the Diabetes Distress Scale-2. A retrospective cohort study design was used to evaluate program effect in a convenience sample of participants. Changes in Alc, weight, BMI, physical and mental health were analyzed within three participant cohorts stratified by baseline A1c level. RESULTS Participants with complete A1c datasets (n = 226) were included in the analysis. Participants were 71.68% female, with 61.50% identifying as white and 34.07% as black. Most participants (81.41%) reported a baseline A1c ≥ 7%, and 20.35% were classified as high-risk (A1c > 9%). Across A1c cohorts, the average baseline BMI was 35.83 (SD = 7.79), and the moderate risk cohort (7% ≤ A1c ≤ 9%) reported the highest average (36.6; SD = 7.77). At 12 weeks, patients reported a significant decrease in Alc, and high-risk participants reduced their levels by the greatest margin (2.28 points; P < .0001). Across cohorts, BMI improved by 0.82 (P < .0001), with the moderate risk cohort showing the greatest reduction (-0.88; P < .0001). Overall, participants reported significant improvements for PROMIS scores, with the greatest change occurring in the high-risk cohort for whom physical health improved 3.84 points (P < .001) and mental health improved 3.3 points (P < .001). However, the lowest risk cohort showed the greatest improvements in diabetes distress (-0.76; P < .0052). CONCLUSIONS Acknowledging the limitations in this real-world study design, the results reported here suggest that adults with type 2 diabetes with a high baseline A1c or high BMI may benefit the most from patient-centered digital health coaching programs when compared to their lower risk counterparts. While all participants improved in physical and mental health categories, participants with high A1c experienced the greatest A1c reduction, while individuals with the highest baseline BMI lost the most weight. These results may be used to inform referrals for patients who are more likely to benefit from digital health coaching.

scholarly journals Caregiving Stress Among American Indians With Type 2 Diabetes: The Importance of Awareness of Connectedness and Family Support

2018 ◽  
Vol 24 (4) ◽  
pp. 621-639 ◽  
Author(s):  
Ashleigh Coser ◽  
Kelley J. Sittner ◽  
Melissa L. Walls ◽  
Tina Handeland
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Physical Health ◽  
Family Support ◽  
American Indians ◽  
Diabetes Management ◽  
Cumulative Exposure ◽  
Physical And Mental Health ◽  
Community Connectedness

American Indian (AI) communities experience a disproportionate rate of Type 2 diabetes (T2D) and cumulative exposure to stress. Although this link is well researched among various populations, it has not been examined among AI communities. Path analysis was used to examine a multiple-mediator model to explain how caregiver stress influences self-reported mental and physical health among 100 AI participants with T2D. Caregiver stress was negatively associated with physical and mental health. Physical health was positively associated with family/community connectedness and mental health was positively associated with both family support and connectedness. The relationship between caregiver stress and mental health was partially mediated by family/community connectedness; caregiver stress had no indirect effects on physical health via either hypothesized mediator. Findings demonstrate the importance of integrating individuals’ connection to family and community and its influence on caregiver stress and mental health in intervention programs targeting diabetes management and care among AI communities.

scholarly journals Web-Based Benefit-Finding Writing for Adults with Type 1 or Type 2 Diabetes: Preliminary Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Joanna Crawford ◽  
Kay Wilhelm ◽  
Judy Proudfoot
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Positive Affect ◽  
Active Control ◽  
Benefit Finding ◽  
Diabetes Distress ◽  
Web Based ◽  
To Receive

BACKGROUND The high prevalence of diabetes distress and subclinical depression in adults with type 1 and type 2 diabetes mellitus (T1DM and T2DM, respectively) indicates the need for low-intensity self-help interventions that can be used in a stepped care approach to address some of their psychological needs. However, people with diabetes can be reluctant to engage in mental health care. Benefit-finding writing (BFW) is a brief intervention that involves writing about any positive thoughts and feelings concerning a stressful experience such as an illness, avoiding potential mental health stigma. It has been associated with increases in positive affect and positive growth and has demonstrated promising results in trials in other clinical populations. However, BFW has not been examined in people with diabetes. OBJECTIVE This study aimed to evaluate the efficacy of a Web-based BFW intervention for reducing diabetes distress and increasing benefit finding in diabetic adults with T1DM or T2DM compared to a control writing condition. METHODS Adults with T1DM or T2DM and diabetes distress were recruited online through the open access Writing for Health program. After completing baseline questionnaires, they were randomly allocated to receive online BFW or an active control condition of online writing about the use of time (CW). Both groups completed 15-minute online writing sessions, once per day, for 3 consecutive days. Online measures were administered at baseline, 1 month, and 3 months postintervention. Participants were also asked to rate their current mood immediately prior to and following each writing session. RESULTS Seventy-two adults with T1DM or T2DM were recruited and randomly allocated to receive BFW (n=24) or CW (n=48). Participants adhered to the BFW regimen. Greater increases in positive affect immediately postwriting were found in the BFW group than in the CW group. However, there were no significant group-by-time interactions (indicating intervention effects) for benefit finding or diabetes distress at either the 1-month or 3-month follow-up. Both the BFW and CW groups demonstrated small, significant decreases in diabetes distress over time. CONCLUSIONS BFW was well tolerated by adults with diabetes in this study but did not demonstrate efficacy in improving diabetes distress or benefit finding compared to an active control writing condition. However, due to recruitment difficulties, the study was underpowered and the sample was skewed to individuals with minimal diabetes distress and none to minimal depression and anxiety at baseline. Future research should continue to investigate the efficacy of variants of therapeutic writing for adults with T1DM or T2DM, using larger samples of participants with elevated diabetes distress. CLINICALTRIAL Australiand New Zealand Clinical Trials Registry ACTRN12615000241538; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368146

scholarly journals Eleven-year multimorbidity burden among 637 255 people with and without type 2 diabetes: a population-based study using primary care and linked hospitalisation data

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e033866
Author(s):  
Salwa S Zghebi ◽  
Douglas T Steinke ◽  
Martin K Rutter ◽  
Darren M Ashcroft
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Population Based ◽  
Mental Illnesses ◽  
Secondary Outcome ◽  
Clinical Practice Research Datalink ◽  
Physical And Mental Health ◽  
Health Comorbidities

ObjectivesTo compare the patterns of 18 physical and mental health comorbidities between people with recently diagnosed type 2 diabetes (T2D) and people without diabetes and how these change by age, gender and deprivation over time between 2004 and 2014. Also, to develop a metric to identify most prevalent comorbidities in people with T2D.DesignPopulation-based cohort study.SettingPrimary and secondary care, England, UK.Participants108 588 people with T2D and 528 667 comparators registered in 391 English general practices. Each patient with T2D aged ≥16 years between January 2004 and December 2014 registered in Clinical Practice Research Datalink GOLD practices was matched to up to five comparators without diabetes on age, gender and general practice.Primary and secondary outcome measuresPrevalence of 18 physical and mental health comorbidities in people with T2D and comparators categorised by age, gender and deprivation. Odds for association between T2D diagnosis and comorbidities versus comparators. A metric for comorbidities with prevalence of ≥5% and/or odds ≥2 in patients with T2D.ResultsOverall, 77% of patients with T2D had ≥1 comorbidity and all comorbidities were more prevalent in patients with T2D than in comparators. Across both groups, prevalence rates were higher in older people, women and those most socially deprived. Conditional logistic regression models fitted to estimate (OR, 95% CI) for association between T2D diagnosis and comorbidities showed that T2D diagnosis was significantly associated with higher odds for all conditions including myocardial infarction (OR 2.13, 95% CI 1.85 to 2.46); heart failure (OR 2.12, 1.84 to 2.43); depression (OR 1.75, 1.62 to 1.89), but non-significant for cancer (OR 1.12, 0.98 to 1.28). In addition to cardiovascular disease, the metric identified osteoarthritis, hypothyroidism, anxiety, schizophrenia and respiratory conditions as highly prevalent comorbidities in people with T2D.ConclusionsT2D diagnosis is associated with higher likelihood of experiencing other physical and mental illnesses. People with T2D are twice as likely to have cardiovascular disease as the general population. The findings highlight highly prevalent and under-reported comorbidities in people with T2D. These findings can inform future research and clinical guidelines and can have important implications on healthcare resource allocation and highlight the need for more holistic clinical care for people with recently diagnosed T2D.

scholarly journals Digital Coaching Strategies to Facilitate Behavioral Change in Type 2 Diabetes: A Systematic Review

2020 ◽  
Author(s):  
Bradley D Gershkowitz ◽  
Conor J Hillert ◽  
Bradley H Crotty
Keyword(s):  
Systematic Review ◽  
Type 2 Diabetes ◽  
Weight Loss ◽  
Digital Health ◽  
Evidence Synthesis ◽  
Fasting Blood Glucose ◽  
Health Coaching ◽  
Digital Tools ◽  
Coaching Strategies

Abstract Context In this systematic review, we focus on the clinical impact of digital tools for providing health coaching, education, and facilitating behavior in patients with prediabetes or type 2 diabetes. Our approach was designed to provide insights for clinicians and health care systems that are considering adopting such digital tools. Evidence Acquisition We searched the CINAHL, Scopus, and Ovid/MEDLINE databases using PRISMA guidelines for studies that reported digital coaching strategies for management and prevention of type 2 diabetes published from January 2014 to June 2019. Articles were reviewed by 2 independent blinded reviewers. Twenty-one articles met inclusion criteria. Evidence Synthesis We found that 20 of 21 studies in our analysis showed statistically significant improvements in at least one measure of diabetes control including HbA1c, weight loss, fasting blood glucose, and BMI. Studies that reported weight loss percentage from baseline at 1 year reported values ranging from −3.04% to −8.98%, similar to outcomes with traditional coaching in the Diabetes Prevention Program (N = 4). Additionally, all studies that included a comparison group of in-person or telephone-based coaching showed statistically better or similar outcomes in the digital coaching group (N = 5). Conclusions The evidence reported in this systematic review suggests that digital health coaching offers a promising strategy for long-term management and prevention of type 2 diabetes in diverse populations with similar benefits to in-person or telephone-based health coaching. We argue that, with the potential to treat large numbers of individuals in diverse geographic locations, digital coaching offers a promising solution to the rapid increase in diabetes prevalence.

scholarly journals Genetic contributions to self-reported tiredness

2016 ◽  
Author(s):  
Vincent Deary ◽  
Saskia P Hagenaars ◽  
Sarah E Harris ◽  
W David Hill ◽  
Gail Davies ◽  
...  
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Bipolar Disorder ◽  
Major Depressive Disorder ◽  
Smoking Status ◽  
Hdl Cholesterol ◽  
Physical And Mental Health ◽  
Major Depressive ◽  
Genome Wide

Self-reported tiredness and low energy, often called fatigue, is associated with poorer physical and mental health. Twin studies have indicated that this has a heritability between 6% and 50%. In the UK Biobank sample (N = 108 976) we carried out a genome-wide association study of responses to the question, ″Over the last two weeks, how often have you felt tired or had little energy?″ Univariate GCTA-GREML found that the proportion of variance explained by all common SNPs for this tiredness question was 8.4% (SE = 0.6%). GWAS identified one genome-wide significant hit (Affymetrix id 1:64178756_C_T; p = 1.36 x 10-11). LD score regression and polygenic profile analysis were used to test for pleiotropy between tiredness and up to 28 physical and mental health traits from GWAS consortia. Significant genetic correlations were identified between tiredness and BMI, HDL cholesterol, forced expiratory volume, grip strength, HbA1c, longevity, obesity, self-rated health, smoking status, triglycerides, type 2 diabetes, waist-hip ratio, ADHD, bipolar disorder, major depressive disorder, neuroticism, schizophrenia, and verbal-numerical reasoning (absolute rg effect sizes between 0.11 and 0.78). Significant associations were identified between tiredness phenotypic scores and polygenic profile scores for BMI, HDL cholesterol, LDL cholesterol, coronary artery disease, HbA1c, height, obesity, smoking status, triglycerides, type 2 diabetes, and waist-hip ratio, childhood cognitive ability, neuroticism, bipolar disorder, major depressive disorder, and schizophrenia (standardised β′s between -0.016 and 0.03). These results suggest that tiredness is a partly-heritable, heterogeneous and complex phenomenon that is phenotypically and genetically associated with affective, cognitive, personality, and physiological processes.

scholarly journals A Web-Based Mental Health Intervention to Improve Social and Occupational Functioning in Adults With Type 2 Diabetes (The Springboard Trial): 12-Month Outcomes of a Randomized Controlled Trial (Preprint)

2019 ◽  
Author(s):  
Peter Andrew Baldwin ◽  
Samineh Sanatkar ◽  
Janine Clarke ◽  
Susan Fletcher ◽  
Jane Gunn ◽  
...  
Keyword(s):  
Mental Health ◽  
Type 2 Diabetes ◽  
Depressive Symptoms ◽  
Social Functioning ◽  
Self Management ◽  
Diabetes Distress ◽  
Healthy Lifestyles ◽  
Occupational Functioning ◽  
Web Based

BACKGROUND People with type 2 diabetes mellitus (T2DM) often experience mental health symptoms that exacerbate illness and increase mortality risk. Access to psychological support is low in people with T2DM. Detection of depression is variable in primary care and can be further hampered by mental health stigma. Electronic mental health (eMH) programs may provide an accessible, private, nonstigmatizing mental health solution for this group. OBJECTIVE This study aims to evaluate the efficacy over 12 months of follow-up of an eMH program (myCompass) for improving social and occupational functioning in a community sample of people with T2DM and self-reported mild-to-moderate depressive symptoms. myCompass is a fully automated and self-guided web-based public health program for people with depression or anxiety. The effects of myCompass on depressive symptoms, diabetes-related distress, anxiety symptoms, and self-care behavior were also examined. METHODS Adults with T2DM and mild-to-moderate depressive symptoms (N=780) were recruited via online advertisements, community organizations, and general practices. Screening, consent, and self-report questionnaires were administered online. Eligible participants were randomized to receive either myCompass (n=391) or an attention control generic health literacy program (Healthy Lifestyles; n=379) for 8 weeks. At baseline and at 3, 6, and 12 months postintervention, participants completed the Work and Social Adjustment Scale, the Patient Health Questionnaire-9 item, the Diabetes Distress Scale, the Generalized Anxiety Disorder Questionnaire-7 item, and items from the Self-Management Profile for Type 2 Diabetes. Glycosylated hemoglobin measurements were obtained at baseline and 6 and 12 months postintervention. RESULTS A total of 38.9% (304/780) of the trial participants completed all postintervention assessments. myCompass users logged in on an average of 6 times and completed an average of 0.29 modules. Healthy Lifestyles users logged in on an average of 4 times and completed an average of 1.37 modules. At baseline, the mean scores on several outcome measures, including the primary outcome of work and social functioning, were close to the normal range, despite a varied and extensive recruitment process. Intention-to-treat analyses revealed slightly greater improvement at 12 months in work and social functioning for the Healthy Lifestyles group relative to the myCompass group. All participants reported equivalent improvements in depression anxiety, diabetes distress, diabetes self-management, and glycemic control across the trial. CONCLUSIONS The Healthy Lifestyles group reported higher ratings of social and occupational functioning than the myCompass group, but no differences were observed for any secondary outcome. Although these findings should be interpreted in light of the near-floor symptom scores at baseline, the trial yields important insights into how people with T2DM might be engaged in eMH programs and the challenges of focusing specifically on mental health. Several avenues emerge for continued investigation into how best to deal with the growing mental health burden in adults with T2DM. CLINICALTRIAL Australian New Zealand Clinical Trials Registry Number (ACTRN) 12615000931572; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368109&amp;isReview=true

scholarly journals mHealth Technology and Nurse Health Coaching to Improve Health in Diabetes: Protocol for a Randomized Controlled Trial (Preprint)

2017 ◽  
Author(s):  
Sheridan Miyamoto ◽  
Madan Dharmar ◽  
Sarina Fazio ◽  
Yajarayma Tang-Feldman ◽  
Heather M Young
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Randomized Controlled Trial ◽  
Self Efficacy ◽  
Daily Activity ◽  
Controlled Trial ◽  
Health Coaching ◽  
Patient Centered ◽  
Randomized Controlled

BACKGROUND Chronic diseases, including diabetes mellitus, are the leading cause of mortality and disability in the United States. Current solutions focus primarily on diagnosis and pharmacological treatment, yet there is increasing evidence that patient-centered models of care are more successful in improving and addressing chronic disease outcomes. OBJECTIVE The objective of this clinical trial is to evaluate the impact of a mobile health (mHealth) enabled nurse health coaching intervention on self-efficacy among adults with type-2 diabetes mellitus. METHODS A randomized controlled trial was conducted at an academic health system in Northern California. A total of 300 participants with type-2 diabetes were scheduled to be enrolled through three primary care clinics. Participants were randomized to either usual care or intervention. All participants received training on use of the health system patient portal. Participants in the intervention arm received six scheduled health-coaching telephone calls with a registered nurse and were provided with an activity tracker and mobile application that integrated data into the electronic health record (EHR) to track their daily activity and health behavior decisions. All participants completed a baseline survey and follow-up surveys at 3 and 9 months. Primary and secondary outcomes include diabetes self-efficacy, hemoglobin A1c (HbA1c), and quality of life measures. RESULTS Data collection for this trial, funded by the Patient-Centered Outcomes Research Institute, will be completed by December 2017. Results from the trial will be available mid-2018. CONCLUSIONS This protocol details a patient-centered intervention using nurse health coaching, mHealth technologies, and integration of patient-generated data into the EHR. The aim of the intervention is to enhance self-efficacy and health outcomes by providing participants with a mechanism to track daily activity by offering coaching support to set reasonable and attainable health goals, and by creating a complete feedback loop by bringing patient-generated data into the EHR. CLINICALTRIAL ClinicalTrials.gov NCT02672176; https://clinicaltrials.gov/ct2/show/NCT02672176 (Archived by WebCite at http://www.webcitation.org/6xEQXe1M5)

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