Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis

Front Public Health. 2023;

Objectives

Achieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.

Methods

We systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.

Results

Of 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).

Conclusion

The current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.

Further information – Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis

Accreditation programme set to improve diabetes inpatient care in UK first

The Royal College of Physicians – May 2023

A first-of-its-kind accreditation programme to improve the quality of diabetes inpatient care across the UK is set to launch on 31 May 2023.

The Diabetes Care Accreditation Programme (DCAP), set up by the Royal College of Physicians (RCP) Accreditation Unit and Diabetes UK, aims to improve care by setting quality standards and measuring service performance through external peer assessment.

The programme comes after the Diabetes UK Making hospitals safereport (2018) showed that inpatient diabetes care is not universally standardised, and that currently there is no mechanism to provide assurance that services are delivered to a high standard for all people with diabetes in hospital.

Further information – Accreditation programme set to improve diabetes inpatient care in UK first

Background – Making hospitals safe

Hundreds of children with type 2 diabetes to be offered choice of two life changing technologies

NICE – 11th May 2023

Hundreds of children with type 2 diabetes who currently manage their condition with the ‘burdensome’, ‘tiring’, and ‘stressful’ task of finger prick testing several times a day could be offered a choice between two ‘life changing’ technologies to virtually automate the process, NICE has said.

For the first time new guidance from NICE recommends the use of real-time continuous glucose monitoring (rtCGM) or intermittently scanned glucose monitoring (isCGM) devices for some children living with type 2 diabetes who are currently using finger prick testing and insulin therapy.

The guideline committee has also recommended the technology is offered to children and young people with type 2 diabetes, if they:

• have a need, condition or disability (including a mental health need, learning disability or cognitive impairment) that means they cannot monitor their blood glucose by finger prick testing
• would otherwise be advised to self-measure at least 8 times a day
• have recurrent or severe low blood sugar levels
• have impaired blood sugar awareness.

Further information – Hundreds of children with type 2 diabetes to be offered choice of two life changing technologies

Too many people with diabetes still not receiving vital care, our new report shows

Diabetes Uk – May 2023

Missed checks, disrupted care and health inequalities have been revealed in our new report looking at the state of diabetes care in England.

The report also highlights that:

• there were 7,000 more deaths than normal involving people with diabetes last year – 13% up on pre-pandemic figures
• only 47% of people with diabetes in England received all eight of their required checks in 2021-22, down from 57% before the pandemic
• in some areas, only 10% had received routine checks and these areas were likely to be the most deprived
• one in 10 people surveyed in the poorest areas said they had had no contact with their healthcare team in more than a year 

Diabetes UK is calling for the government to draw up plans to tackle the backlog in diabetes care, reduce health inequalities and provide more support to help prevent people developing type 2 diabetes.

Read the Report – Diabetes care: Is it fair enough?

Practical Guidance for Healthcare Providers on Collaborating with People with Type 2 Diabetes: Advancing Treatment and Initiating Injectable Therapy

Boeder S, Matamoros D, Mansy C. Diabetes Therapy 2023, 14(2): 425-446.

Type 2 diabetes (T2D) progresses over time, and to achieve and maintain adequate glucose control, many people eventually require injectable therapies such as insulin. However, there can be significant barriers to the initiation of these medications, both from people living with T2D and from healthcare practitioners (HCPs). Misconceptions and misinformation relating to the potential risks and benefits of injectable therapies are common and can contribute to negative perceptions regarding their use. Additionally, HCPs are often unaware of the emotional burden associated with T2D. In particular, diabetes distress is a key contributory factor that needs to be addressed to alleviate fears before diabetes education can be successful. The onus is often on the HCP to initiate effective, individualized communication with each patient and make that person feel an active and equal participant in the management of their T2D. Shared decision-making has been demonstrated to improve understanding of the pathophysiology and treatment options, to increase risk awareness, adherence, and persistence, and to improve self-management behaviors (e.g., exercise, self-care) and patient satisfaction. While therapeutic inertia can result from both patient and HCP, HCPs need to bear the responsibility for escalating therapy when necessary. A proactive approach by the HCP, combined with shared decision-making and a patient-centric approach, are important for optimal T2D management; therefore, an open and effective relationship between the HCP and the person living with T2D is essential. This article is written by a person with T2D, a nurse practitioner/Certified Diabetes Care and Education Specialist, and a clinical endocrinologist, with the goal of providing a holistic view of the management experience, exploring patient needs and expectations, recognizing and avoiding HCP and patient barriers, and providing practical advice to HCPs to empower patients who would benefit from injectable therapy.

Further information –Practical Guidance for Healthcare Providers on Collaborating with People with Type 2Diabetes: Advancing Treatment and Initiating Injectable Therapy

Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review

Teoh KW, et al. BMJ Open Diabetes Research and Care 2023;11:e003203

The prevalence of pre-diabetes is increasing globally, affecting an estimated 552 million people by 2030. While lifestyle interventions are the first line of defense against progression toward diabetes, information on barriers toward pre-diabetes management and how to overcome these barriers are scarce. This systematic review describes the publics’ and healthcare professionals’ knowledge, attitude and practice (KAP) toward pre-diabetes and determines the barriers toward pre-diabetes management. A systematic search for studies examining KAP towards pre-diabetes was conducted in six databases from inception to September 2022. Studies that quantitatively assessed at least two KAP elements using questionnaires were included. The quality of studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Barriers and enablers were identified and mapped onto the Capability, Motivation, and Behaviour model to identify factors that influence behavior change. Twenty-one articles that surveyed 8876 participants were included in this review. Most of the reviews (n=13) were directed to healthcare professionals. Overall, positive attitudes toward diabetes prevention efforts were observed, although there were still knowledge deficits and poor behavior toward pre-diabetes management. Barriers and enablers were detected at patients (eg, goals and intention), healthcare professionals (eg, clinical judgement) and system (eg, access and resources) levels. The use of different survey instruments to assess KAP prevented a head-to-head comparison between studies. Most studies conducted among patients were from middle-income countries, while among healthcare professionals (HCPs) were from high-income countries, which may produce some biasness. Nevertheless, the development of pre-diabetes intervention should focus on: (1) increasing knowledge on pre-diabetes and its management; (2) imparting practical skills to manage pre-diabetes; (3) providing resources for lifestyle management; (4) improving the accessibility of lifestyle management programs; and (5) other HCPs and human support to pre-diabetes management.

Read the article – Knowledge, attitude, and practice toward pre-diabetes among the public, patients with pre-diabetes and healthcare professionals: a systematic review