Effect of Step Count Measurement on Glycemic Control: Secondary Analysis of a Randomized Controlled Trial.

Although walking has proven efficacy for glycemic control, patients struggle to meet daily step goals. This secondary analysis investigated the effect of step count measurement rate on glycemic control. Patients with type 2 diabetes from eight hospitals in Japan participated in a 12-month randomized controlled trial. The intervention group received DialBetesPlus, a self-management support system that allowed patients to monitor step count using a pedometer. We divided the intervention group into two groups based on whether daily step count measurement rate (the percentage of days with pedometer use) increased or decreased during the last three months of the intervention (month 10-12), relative to the first three months of the intervention (month 1-3). Patients with a reduced measurement rate experienced a worsening in glycemic control, with between-group difference of 0.516% in the amount of change in HbA1c (p=0.012). We conclude that step count measurement may lead to a better glycemic profile.

Perspectives and Needs of Malaysian Patients With Diabetes for a Mobile Health App Support on Self-Management of Diabetes: Qualitative Study.

BACKGROUND: Effective self-management of diabetes is crucial for improving clinical outcomes by maintaining glucose levels and preventing the exacerbation of the condition. Mobile health (mHealth) has demonstrated its significance in enhancing self-management practices. However, only 20% of Malaysians are familiar with mHealth technologies and use them for health management. OBJECTIVE: This study aims to explore the perceived benefits and challenges, needs and preferences, and willingness of patients with diabetes to use mHealth apps for self-management of diabetes. METHODS: The study involved one-on-one semistructured online interviews with a total of 15 participants, all of whom were aged 18 years or older and had been diagnosed with diabetes for more than 6 months. An interview guide was developed based on the constructs of the Technology Acceptance Model (TAM), the Health Information Technology Acceptance Model (HITAM), and the aesthetics factor derived from the Mobile Application Rating Scale. All interviews were recorded in audio format and transcribed verbatim. The interview content was then organized and coded using ATLAS.ti version 8. Thematic analysis was conducted in accordance with the recommended guidelines for analyzing the data. RESULTS: From the interviews with participants, 3 key themes emerged regarding the perceived benefits of using mHealth app support in diabetes self-management. These themes were the ability to track and monitor diabetes control, assistance in making lifestyle modifications, and the facilitation of more informed treatment decision-making for health care professionals. The interviews with participants revealed 4 prominent themes regarding the perceived barriers to using mHealth app support for diabetes self-management. These themes were a lack of awareness about the availability of mHealth support, insufficient support in using mHealth apps, the perception that current mHealth apps do not align with users' specific needs, and limited digital literacy among users. The interviews with participants unveiled 4 key themes related to their needs and preferences concerning mHealth app support for diabetes self-management. These themes were the desire for educational information, user-friendly design features, carbohydrate-counting functionality, and the ability to engage socially with both peers and health care professionals. The majority of participants expressed their willingness to use mHealth apps if they received recommendations and guidance from health care professionals. CONCLUSIONS: Patients generally perceive mHealth app support as beneficial for diabetes self-management and are willing to use these apps, particularly if recommended by health care professionals. However, several barriers may hinder the utilization of mHealth apps, including a lack of awareness and recommendations regarding these apps from health care professionals. To ensure the effective development of mHealth app support systems for diabetes self-management, it is crucial to implement user-centered design processes that consider the specific needs and preferences of patients. This approach will help create apps that are tailored to the requirements of individuals managing diabetes.

StepAdd: A personalized mHealth intervention based on social cognitive theory to increase physical activity among type 2 diabetes patients.

OBJECTIVE: Investigate the preliminary efficacy and feasibility of a personalized mobile health (mHealth) intervention based on social cognitive theory (SCT) to promote physical activity among type 2 diabetes patients via self-monitoring, goal setting, and automatic feedback. METHODS: We conducted a pilot study involving 33 type 2 diabetes patients attending Mitsui Memorial Hospital in Japan using a pre-post evaluation design over 12 weeks. Participants measured daily step count, body weight, and blood pressure at home, with the measurements synchronized with the StepAdd application (app) automatically. Participants used the app to review daily results, update personalized step goals, identify individualized barriers to achieving the step goals, find coping strategies to overcome each barrier, and implement these strategies, thereby building effective coping skills to meet the goals. Pharmacists examined the usage of the app and provided coaching on lifestyle modifications. Ultimately, patients established skills to enhance diabetes self-care by using the app. RESULTS: Daily step count increased dramatically with high statistical significance (p < 0.0001), from a mean of 5436 steps/day to 10,150 steps/day, an 86.7 % increase. HbA1c (p = 0.0001) and BMI (p = 0.0038) also improved. Diabetes self-care in diet, exercise, and foot care as well as self-management behavior, self-regulation, and self-efficacy in achieving daily step goals showed significant improvements. The retention rate of the study was very high, at 97.0 % (n = 32). CONCLUSIONS: A personalized smartphone-based mHealth intervention based on SCT is feasible and effective at promoting physical activity among type 2 diabetes patients. The methodology of the intervention could be readily applied to other patient populations.

Glycemic Control, Renal Progression, and Use of Telemedicine Phone Consultations Among Japanese Patients With Type 2 Diabetes Mellitus During the COVID-19 Pandemic: Retrospective Cohort Study.

BACKGROUND: Reduced or delayed medical follow-ups have been reported during the COVID-19 pandemic, which may lead to worsening clinical outcomes for patients with diabetes. The Japanese government granted special permission for medical institutions to use telephone consultations and other remote communication modes during the COVID-19 pandemic. OBJECTIVE: We aimed to evaluate changes in the frequency of outpatient consultations, glycemic control, and renal function among patients with type 2 diabetes before and during the COVID-19 pandemic. METHODS: This is a retrospective single-cohort study conducted in Tokyo, Japan, analyzing results for 3035 patients who visited the hospital regularly. We compared the frequency of outpatient consultations attended (both in person and via telemedicine phone consultation), glycated hemoglobin A1c (HbA1c), and estimated glomerular filtration rate (eGFR) among patients with type 2 diabetes mellitus during the 6 months from April 2020 to September 2020 (ie, during the COVID-19 pandemic) with those during the same period of the previous year, 2019, using Wilcoxon signed rank tests. We conducted a multivariate logistic regression analysis to identify factors related to the changes in glycemic control and eGFR. We also compared the changes in HbA1c and eGFR from 2019 to 2020 among telemedicine users and telemedicine nonusers using difference-in-differences design. RESULTS: The overall median number of outpatient consultations attended decreased significantly from 3 (IQR 2-3) in 2019 to 2 (IQR 2-3) in 2020 (P<.001). Median HbA1c levels deteriorated, though not to a clinically significant degree (6.90%, IQR 6.47%-7.39% vs 6.95%, IQR 6.47%-7.40%; P<.001). The decline in median eGFR was greater during the year 2019-2020 compared to the year 2018-2019 (-0.9 vs -0.5 mL/min/1.73 m2; P=.01). Changes in HbA1c and eGFR did not differ between patients who used telemedicine phone consultations and those who did not. Age and HbA1c level before the pandemic were positive predictors of worsening glycemic control during the COVID-19 pandemic, whereas the number of outpatient consultations attended was identified as a negative predictor of worsening glycemic control during the pandemic. CONCLUSIONS: The COVID-19 pandemic resulted in reduced attendance of outpatient consultations among patients with type 2 diabetes, and these patients also experienced deterioration in kidney function. Difference in consultation modality (in person or by phone) did not affect glycemic control and renal progression of the patients.

Inpatients' satisfaction towards information received about medicines.

OBJECTIVE: Healthcare providers (HCPs) often overestimate the quality and quantity of information they provide to patients. This study aimed to find out inpatients' satisfaction towards information about medicines provided during inpatient stay. METHODS: This cross-sectional study was conducted at Lewisham Hospital and Queen Elizabeth Hospital in June 2017. Patients' satisfaction with information about medicines provided during inpatient stay was assessed using a 17-item Satisfaction with Information about Medicines Scale (SIMS). RESULTS: 71 patients completed the questionnaire. The average percentage of patients being satisfied with the information provided in the nine-item 'action and usage' subscale of SIMS was 74.4%, compared with the eight-item 'potential problems' subscale with an average percentage of 56%. Patients aged 45-64 were more likely to be satisfied with information on 'how the medicines work' than the 65 and above as well as the 18-44 age groups (p=0.045). Patients who attended secondary school and below were more likely to be satisfied than those attending college and above towards this information (p=0.002). Patients of white or mixed white and black ethnicity were less satisfied than other ethnic groups of information regarding the impact of medication on sex life (p=0.019). Black or black British were more likely to be satisfied towards information on unwanted medication side effects compared with other ethnic groups (p=0.025). CONCLUSIONS: HCPs could improve on the provision of information on potential problems that patients might experience with their medicines. Patients' age, educational level and ethnicity should be taken into consideration when providing information about medicines.

Self-Measured Bed-Time, Arising and Day Blood Pressures of Normotensive Young Male and Female Adults

Morning surge in blood pressure is an independent cardiovascular risk factor in the middleaged and the elderly. Whether such a surge occurs in young subjects is not known. Eighty normotensive subjects (age: 21.8 ± 1.3 yr) measured their own blood pressure (BP) using an automatic device (Omron HEM-7080,) on going to bed and on waking up, for 2 consecutive days. In contrast to large morning BP surges reported for older age groups, there was much smaller but significant (P<0.002) rise only in the DBP (1.9 ± 5 mm Hg) on waking up on day 2 in young subjects. The duration of sleep and the time the subjects slept influence the sleep-wake BP change.