scholarly journals Combining Wireless technology and Behavioral Economics to Engage Patients with cardiometabolic disease (WiBEEP): A Pilot Study (Preprint)

2017 ◽  
Author(s):  
Edith Angellotti ◽  
John Wong ◽  
Ayal Pierce ◽  
Benjamin Hescott ◽  
Anastassios Pittas
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Pilot Study ◽  
Behavioral Economics ◽  
Text Messages ◽  
Cardiometabolic Disease ◽  
Wireless Technology ◽  
Cardiometabolic Diseases

BACKGROUND The long-term management of cardiometabolic diseases, such as type 2 diabetes and hypertension, is complex and can be facilitated by supporting patient-directed behavioral changes. The concurrent application of wireless technology and personalized text messages (PTMs) based on behavioral economics in managing cardiometabolic diseases although promising, has not been studied. OBJECTIVE The aim of this pilot study was to evaluate the feasibility and acceptability of the concurrent application of wireless home blood pressure (BP) monitoring (as an example of “automatic hovering”) and PTMs (as an example of “nudging”) targeting pharmacotherapy and lifestyle habits in patients with type 2 diabetes and/or hypertension. METHODS The Wireless technology and Behavioral Economics to Engage Patients with cardiometabolic disease (WiBEEP) study was a single-arm, open-label, 7-week long pilot study in 12 patients (age 58.5 y) with access to a mobile phone. The study took place at Tufts Medical Center (Boston, MA) between March and September 2017. All patients received PTMs; nine patients received wireless home BP monitoring. At baseline, patients completed questionnaires to learn about their health goals and to assess medication adherence; at the end of week 7, all participants completed questionnaires to evaluate the feasibility and acceptability of the intervention and assess for medication adherence. Hemoglobin A1c was ascertained from data collected during routine clinical care in 7 patients. RESULTS The majority of patients reported the texts messages to be easy to understand (88%), appropriate in frequency (71%) and language (88%). All patients reported BP monitoring to be useful. Mean arterial pressure was lower at the end-of-study compared to baseline (-3.4 mmHg [95% CI, -5 to -1.8]. Mean change in HbA1c was -0.31% [95% CI, -0.56 to -0.06]. CONCLUSIONS Among patients with type 2 diabetes and/or hypertension the combination of wireless BP monitoring and lifestyle-focused text messaging was feasible and acceptable. Larger studies will determine the long-term effectiveness of such an approach.

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

scholarly journals Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

2020 ◽  
Author(s):  
Lyndsay A. Nelson ◽  
Robert A. Greevy ◽  
Andrew Spieker ◽  
Kenneth A. Wallston ◽  
Tom A. Elasy ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Self Efficacy ◽  
Text Messaging ◽  
Self Care ◽  
Baseline Hba1c ◽  
Median Response ◽  
Text Messaging Intervention

<b>Objective:</b> Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention. <p><b>Research Design and Methods:</b> Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy. </p> <p><b>Results:</b> Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. <a>Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n<i>=</i>219 having HbA1c≥8.5% (69 mmol/mol)</a> and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements. </p> <p><b>Conclusions:</b> REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects. </p>

Long-term effects of a community-based lifestyle intervention to prevent type 2 diabetes: the DEPLOY extension pilot study

2011 ◽  
Vol 7 (4) ◽  
pp. 279-290 ◽  
Author(s):  
Ronald T Ackermann ◽  
Emily A Finch ◽  
Helena M Caffrey ◽  
Elaine R Lipscomb ◽  
Laura M Hays ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Pilot Study ◽  
Lifestyle Intervention ◽  
Long Term Effects ◽  
Community Based

scholarly journals ANGPTL8 protein-truncating variant and the risk of coronary disease, type 2 diabetes and adverse effects

2020 ◽  
Author(s):  
Pyry Helkkula ◽  
Tuomo Kiiskinen ◽  
Aki S. Havulinna ◽  
Juha Karjalainen ◽  
Seppo Koskinen ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Disease Risk ◽  
Low Frequency ◽  
Hdl Cholesterol ◽  
Cardiometabolic Disease ◽  
Lipid Levels ◽  
Finnish Population ◽  
Artery Disease

AbstractProtein-truncating variants (PTVs) affecting dyslipidemia risk may point to therapeutic targets for cardiometabolic disease. Our objective was to identify PTVs that associated with both lipid levels and cardiometabolic disease risk and assess their possible associations with risks of other diseases. To achieve this aim, we leveraged the enrichment of PTVs in the Finnish population and tested the association of low-frequency PTVs in 1,209 genes with serum lipid levels in the Finrisk Study (n = 23,435). We then tested which of the lipid-associated PTVs also associated with risks of cardiometabolic diseases or 2,264 disease endpoints curated in the FinnGen Study (n = 176,899). Three PTVs were associated with both lipid levels and the risk of cardiometabolic disease: triglyceride-lowering variants in ANGPTL8 (−24.0[-30.4 to −16.9] mg/dL per rs760351239-T allele, P = 3.4× 10−9) and ANGPTL4 (−14.4[-18.6 to −9.8] mg/dL per rs746226153-G allele, P = 4.3 × 10−9) and the HDL cholesterol-elevating variant in LIPG (10.2[7.5 to 13.0] mg/dL per rs200435657-A allele, P = 5.0 × 10−13). The risk of type 2 diabetes was lower in carriers of ANGPTL8 (odds ratio [OR] = 0.67[0.47-0.92], P = 0.01), ANGPTL4 (OR = 0.70[0.60-0.82], P = 1.4× 10−5) and LIPG (OR = 0.67[0.48-0.91], P = 0.01) PTVs than in noncarriers. Moreover, the odds of coronary artery disease were 44% lower in carriers of a PTV in ANGPTL8 (OR = 0.56[0.38-0.83], P = 0.004). Finally, the phenome-wide scan of the ANGPTL8 PTV showed a markedly higher associated risk of esophagitis (585 cases, OR = 174.3[17.7-1715.1], P = 9.7 × 10−6) and sensorineural hearing loss (12,250 cases, OR = 2.45[1.63-3.68], P = 1.8 × 10−5). The ANGPTL8 PTV carriers were less likely to use statin therapy (53,518 cases, OR = 0.53[0.41-0.71], P = 1.2 × 10−5). Our findings provide genetic evidence of potential long-term efficacy and safety of therapeutic targeting of dyslipidemias.

scholarly journals SUN-668 Elevated Osmolal Gap in Long-Term Complication of Type 2 Diabetes

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Monika Klimek ◽  
Beata Wojtysiak-Duma ◽  
Dariusz Duma ◽  
Janusz Solski
Keyword(s):  
Type 2 Diabetes ◽  
Pilot Study ◽  
Statistical Significance ◽  
Venous Blood ◽  
Multiple Organ ◽  
Serum Osmolality ◽  
Artificial Organs ◽  
Osmolal Gap

Abstract Osmolal gap (OG) is the difference between the measured osmolality and calculated osmolality estimated by using the mathematical equation. Elevated OG indicates the presence of osmotically active particles undetected in the plasma of healthy individuals. Elevated OG has been observed in multiorgan trauma as a useful prognostic factor of patient survival [1, 2]. We hypothesized that elevated OG may occur in patients with type 2 diabetes (T2D) and may become a useful indicator of unmeasured endotoxins. One of the major mechanisms of this phenomenon may be non-enzymatic glycation of proteins in hyperglycemia, in which the osmotic active carbonyl compounds such as glyoxal, methylglyoxal, and 3-deoxyglucosone, are formed. Testing was performed for participants with T2D, aged 18 to 85. The osmolality measurement was performed with venous blood using the osmometer. The concentration of individual osmols (sodium, potassium, glucose, urea) was determined and on this basis, osmolality was calculated using the Dorwart-Chalmers formula: osmolality (mOsm/kg H2O) = 1.86 x [Na+] + glucose + urea + 9 (Dorwart, 1975). The clinical profile of patients was established based on history and physical examination (age, sex, age, duration of T2D, complications of T2D, HbA1c, LDL-cholesterol, triglyceride, BMI, coexisting diseases, medication). Data were analyzed using descriptive statistics. This study is currently ongoing, but preliminary data from the pilot study suggest an increased mean measured osmolality as well as elevated OG in patients with T2D compared to the reference values for healthy adults. These values differed depending on the type of long-term complications and the duration of the disease. In the pilot study, the highest OG was reported in diabetic retinopathy. A follow-up study with a larger sample may have a better ability to detect the statistical significance of the association of OG and complications of T2D. The association of the osmolal gap and complication of type 2 diabetes is poorly understood, and further investigation is warranted. References: [1] Inaba, H., Hirasawa, H., Mizuguchi, T. (1987), Serum Osmolality Gap In Postoperative Patients In Intensive Care. Lancet, 329 (8546): 1331-1335. [2] Hirasawa, H., Odaka, M., Sugai, T., Ohtake, Y., Inaba, H., Tabata, Y., Kobayashi, H. and Isono, K. (1988), Prognostic Value of Serum Osmolality Gap in Patients with Multiple Organ Failure Treated with Hemopurification. Artificial Organs, 12: 382-387.

scholarly journals Use of Brief Messages Based on Behavior Change Techniques to Encourage Medication Adherence in People With Type 2 Diabetes: Developmental Studies (Preprint)

2019 ◽  
Author(s):  
Yvonne Kiera Bartlett ◽  
Andrew Farmer ◽  
Rustam Rea ◽  
David P French
Keyword(s):  
Type 2 Diabetes ◽  
Medication Adherence ◽  
Behavior Change ◽  
Health Care Professionals ◽  
Text Messages ◽  
Test Theory ◽  
Behavior Change Techniques ◽  
Adherence To Medication ◽  
Adherence Support

BACKGROUND Brief messages are a promising way to improve adherence to medication for people with type 2 diabetes. However, it is often unclear how messages have been developed and their precise content, making it difficult to ascertain why certain messages are successful and some are not. OBJECTIVE The goal of the research was to develop messages that have proven fidelity to specified evidence-derived behavior change techniques (BCTs) and are acceptable to people with type 2 diabetes. METHODS Four studies were conducted: (1) a workshop (n=21) where behavioral change researchers and health care professionals developed messages based on specific BCTs or beliefs or concerns related to taking medication, (2) a focus group study with people with type 2 diabetes (n=23) to assess acceptability of the approach, (3) a survey to ascertain the acceptability of a subset of messages to people with type 2 diabetes (n=61) and, (4) a survey with behavior change researchers to assess the fidelity of a subset of messages to their intended BCT (n=18). RESULTS In study 1, 371 messages based on 38 BCTs and beliefs/concerns were developed. Workshop participants rated BCTs to be relevant to medication adherence (mean 7.12/10 [SD 1.55]) and messages to have good fidelity (mean 7.42/10 [SD 1.19]). In study 2, the approach of providing medication adherence support through text messages was found to be acceptable. In study 3, mean acceptability of all BCTs was found to be above the midpoint (mean 3.49/5 [SD 0.26]). In study 4, mean fidelity for all BCTs was found to be above the midpoint (mean 7.61/10 [SD 1.38]). CONCLUSIONS A library of brief messages acceptable to people with type 2 diabetes and representative of specific evidence-derived BCTs was developed. This approach allowed brief messages to be developed with known content that can be used to test theory.

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