NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

Wagner, David V.; Barry, Samantha A.; Stoeckel, Maggie; Teplitsky, Lena; Harris, Michael A.

doi:10.1177/1932296817695337

Cited by 39 publications

(30 citation statements)

References 31 publications

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“…More intensive coordination of care with patients and increased family engagement are some of the additional strategies for the prevention of recurrent episodes of DKA. The Novel Interventions in Children's Healthcare programme uses care coordination with the family and telemedicine as a part of the preventive strategy to engage young people with multiple hospitalizations for DKA 224 . This work used text messages and other forms of communication with the adolescents and showed that daily communication decreased DKA readmissions.…”

Section: Clinical Prioritiesmentioning

confidence: 99%

Diabetic ketoacidosis

Dhatariya

Glaser

Codner

et al. 2020

Nat Rev Dis Primers

233

201

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Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present-'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy , electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology , pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.

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Section: Clinical Prioritiesmentioning

confidence: 99%

Diabetic ketoacidosis

Dhatariya

Glaser

Codner

et al. 2020

Nat Rev Dis Primers

233

201

View full text Add to dashboard Cite

show abstract

“…One meta-analysis of mobile phone interventions showed a 3.3-mmol/mol (0.3%) reduction in HbA 1c in those with Type 1 diabetes receiving the mobile intervention [9]. E-mail: lori.laffel@joslin.harvard.edu component, demonstrated a reduction in diabetic ketoacidosis-related emergency department visits [11]. E-mail: lori.laffel@joslin.harvard.edu component, demonstrated a reduction in diabetic ketoacidosis-related emergency department visits [11].…”

Section: Introductionmentioning

confidence: 99%

“…One meta-analysis of mobile phone interventions showed a 3.3-mmol/mol (0.3%) reduction in HbA 1c in those with Type 1 diabetes receiving the mobile intervention [9]. An intensive intervention, the Novel Interventions in Children's Healthcare (NICH) programme, which targeted high-risk young people with Type 1 diabetes and included a text-messaging component, demonstrated a reduction in diabetic ketoacidosis-related emergency department visits [11]. There may also be additional, non-glycaemic, benefits of text-messaging interventions.…”

Section: Introductionmentioning

confidence: 99%

Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA_1c benefit in teenagers with Type 1 diabetes

et al. 2019

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AimsTo evaluate an 18-month text-messaging intervention in teenagers with Type 1 diabetes and to assess factors associated with text responsiveness and glycaemic benefit.Methods Teenagers with diabetes (N = 147), aged 13-17 years, received two-way text reminders at self-selected times to check blood glucose levels and reply with blood glucose results.Results At baseline, the participants (48% boys, 78% white, 63% pump-treated) had a mean AE sd age of 14.9 AE 1.3 years, diabetes duration of 7.1 AE 3.9 years and HbA 1c concentration of 69 AE 12 mmol/mol (8.5 AE 1.1%). The mean proportion of days with ≥1 blood glucose response declined over time (0-6 months, 60 AE 26% of days, 7-12 months, 53 AE 31% of days, 13-18 months, 43 AE 33% of days). Over 18 months, 49% responded with ≥1 blood glucose result on ≥50% of days (high responders). Regression analysis controlling for baseline HbA 1c revealed no significant change in HbA 1c from baseline to 18 months in high responders (P = 0.54) compared with a significant HbA 1c increase in low responders (+0.3%, P = 0.01). In participants with baseline HbA 1c ≥64 mmol/mol (≥8%), high responders were 2.5 times more likely than low responders to have a clinically significant [≥5.5 mmol/mol (≥0.5%)] HbA 1c decrease over 18 months (P < 0.05). In participants with baseline HbA 1c <64 mmol/mol(<8%), high responders were 5.7 times more likely than low responders to have an 18-month HbA 1c <58 mmol/mol (<7.5%; P < 0.05).Conclusions Teenagers with Type 1 diabetes who responded to text reminders on ≥50% of days over 18 months experienced clinically significant glycaemic benefit. There remains a need to tailor interventions to maintain teenager engagement and optimize improvements.

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“…Importantly, the clinical and economical information from our intervention can be applied to other aspects of health care, such as diabetes care [ 37 , 38 ], eldercare [ 39 ], and many other chronic diseases where patient treatment fatigue is a known barrier [ 15 , 40 - 43 ]. As bidirectional mHealth offers patients real-time advice from HCPs and improves self-management of chronic diseases, the benefits may extend beyond what we are able to quantify.…”

Section: Discussionmentioning

confidence: 99%

Health Care Provider Utilization and Cost of an mHealth Intervention in Vulnerable People Living With HIV in Vancouver, Canada: Prospective Study

Campbell¹,

Kinvig²,

Côté³

et al. 2018

JMIR Mhealth Uhealth

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BackgroundImproving adherence to combined antiretroviral therapy (cART) can be challenging, especially among vulnerable populations living with HIV. Even where cART is available free of charge, social determinants of health act as barriers to optimal adherence rates. Patient-centered approaches exploiting mobile phone communications (mHealth) have been shown to improve adherence to cART and promote achievement of suppressed HIV plasma viral loads. However, data are scarce on the health care provider (HCP) time commitments and health care costs associated with such interventions. This knowledge is needed to inform policy and programmatic implementation.ObjectiveThe purpose of this study was to approximate the resources required and to provide an estimate of the costs associated with running an mHealth intervention program to improve medication adherence in people living with HIV (PLWH).MethodsThis prospective study of HCP utilization and costs was embedded within a repeated measures effectiveness study of the WelTel short-message service (SMS) mHealth program. The study included 85 vulnerable, nonadherent PLWH in Vancouver, Canada, and resulted in improved medication adherence and HIV plasma viral load among participants. Study participants were provided mobile phones with unlimited texting (where required) and received weekly bidirectional text messages to inquire on their status for one year. A clinic nurse triaged and managed participants' responses, immediately logging all patient interactions by topic, HCP involvement, and time dedicated to addressing issues raised by participants. Interaction costs were determined in Canadian dollars based on HCP type, median salary within our health authority, and their time utilized as part of the intervention.ResultsParticipant-identified problems within text responses included health-related, social, and logistical issues. Taken together, management of problems required a median of 43 minutes (interquartile range, IQR 17-99) of HCP time per participant per year, for a median yearly cost of Can $36.72 (IQR 15.50-81.60) per participant who responded with at least one problem. The clinic nurse who monitored the texts solved or managed 65% of these issues, and the remaining were referred to a variety of other HCPs. The total intervention costs, including mobile phones, plans, and staffing were a median Can $347.74/highly vulnerable participant per year for all participants or Can $383.18/highly vulnerable participant per year for those who responded with at least one problem.ConclusionsBidirectional mHealth programs improve HIV care and treatment outcomes for PLWH. Knowledge about the HCP cost associated, here less than Can $50/year, provides stakeholders and decision makers with information relevant to determining the feasibility and sustainability of mHealth programs in a real-world setting.Trial RegistrationClinicalTrials.gov NCT02603536; https://clinicaltrials.gov/ct2/show/NCT02603536 (Archived by WebCite at http://www.webcitation.org/70IYqKUjV).

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NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

Cited by 39 publications

References 31 publications

Diabetic ketoacidosis

Diabetic ketoacidosis

Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA_1c benefit in teenagers with Type 1 diabetes

Health Care Provider Utilization and Cost of an mHealth Intervention in Vulnerable People Living With HIV in Vancouver, Canada: Prospective Study

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NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

Cited by 39 publications

References 31 publications

Diabetic ketoacidosis

Diabetic ketoacidosis

Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA1c benefit in teenagers with Type 1 diabetes

Health Care Provider Utilization and Cost of an mHealth Intervention in Vulnerable People Living With HIV in Vancouver, Canada: Prospective Study

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Product

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Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA_1c benefit in teenagers with Type 1 diabetes