Stepwise Self-Titration of Oral Glucose-Lowering Medication Using a Mobile Telephone-Based Telehealth Platform in Type 2 Diabetes: A Feasibility Trial in Primary Care

Nagrebetsky, Alexander; Larsen, Mark E.; Craven, Anthea; Turner, Jane; McRobert, Nicky; Murray, Elizabeth; Gibson, Oliver; Neil, Andrew; Tarassenko, Lionel; Farmer, Andrew

doi:10.1177/193229681300700115

Cited by 35 publications

(38 citation statements)

References 30 publications

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“…164,166,168,171,178 We also include in Table 5 a systematic review by Liang et al 173 and a Cochrane review. 174 The systematic review included 22 trials.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

475

389

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A lthough mortality for cardiovascular disease (CVD) has declined for several decades, heart disease and stroke continue to be the leading causes of death, disability, and high healthcare costs. Unhealthy behaviors related to CVD risk (eg, smoking, sedentary lifestyle, and unhealthful eating habits) remain highly prevalent. The high rates of overweight, obesity, and type 2 diabetes mellitus (T2DM); the persistent presence of uncontrolled hypertension; lipid levels not at target; and the ≈18% of adults who continue to smoke cigarettes pose formidable challenges for achieving improved cardiovascular health.1,2 It is apparent that the performance of healthful behaviors related to the management of CVD risk factors has become an increasingly important facet of the prevention and management of CVD. 3In 2010, the American Heart Association (AHA) made a transformative shift in its strategic plan and added the concept of cardiovascular health.2 To operationalize this concept, the AHA targeted 4 health behaviors in the 2020 Strategic Impact Goals: reduction in smoking and weight, healthful eating, and promotion of regular physical activity. Three health indicators also were included: glucose, blood pressure (BP), and cholesterol. On the basis of the AHA Life's Simple 7 metrics for improved cardiovascular health, <1% of adults in the United States follow a healthful eating plan, only 32% have a normal body mass index, and > 30% have not reached the target levels for lipids or BP. National Health and Nutrition Examination Survey (NHANES) data revealed that people who met ≥6 of the cardiovascular health metrics had a significantly better risk profile (hazard ratio for all-cause mortality, 0.49) compared with individuals who had achieved only 1 metric or none.2 The studies reviewed in this statement targeted these behaviors (ie, smoking, physical activity, healthful eating, and maintaining a healthful weight) and cardiovascular health indicators (ie, blood glucose, lipids, BP, body mass index) as the primary outcomes in the clinical trials testing mobile health (mHealth) interventions.eHealth, or digital health, is the use of emerging communication and information technologies, especially the Internet, to improve health and health care 4 (Table 1). mHealth, a subsegment of eHealth, is the use of mobile computing and communication technologies (eg, mobile phones, wearable sensors) for health services and information.4,5 mHealth technology uses techniques and advanced concepts from an array of disciplines, for example, computer science, electrical and

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“…164,166,168,171,178 We also include in Table 5 a systematic review by Liang et al 173 and a Cochrane review. 174 The systematic review included 22 trials.…”

Section: Review Of Evidence For the Efficacy Of Mobile Technologybasementioning

confidence: 99%

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Burke¹,

Ma²,

Azar³

et al. 2015

Circulation

475

389

View full text Add to dashboard Cite

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“…We found that~30% of participants reported self-titrating, which may indicate a potential opportunity for self-focused interventions to improve dosing [36,37]. We found that~30% of participants reported self-titrating, which may indicate a potential opportunity for self-focused interventions to improve dosing [36,37].…”

Section: Discussionmentioning

confidence: 71%

Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial

et al. 2018

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Aims To evaluate the effectiveness of automated symptom and side effect monitoring on quality of life among individuals with symptomatic diabetic peripheral neuropathy. Methods We conducted a pragmatic, cluster randomized controlled trial (July 2014 to July 2016) within a large healthcare system. We randomized 1834 primary care physicians and prospectively recruited from their lists 1270 individuals with neuropathy who were newly prescribed medications for their symptoms. Intervention participants received automated telephone-based symptom and side effect monitoring with physician feedback over 6 months. The control group received usual care plus three non-interactive diabetes educational calls. Our primary outcomes were quality of life (EQ-5D) and select symptoms (e.g. pain) measured 4-8 weeks after starting medication and again 8 months after baseline. Process outcomes included receiving a clinically effective dose and communication between individuals with neuropathy and their primary care provider over 12 months. Interviewers collecting outcome data were blinded to intervention assignment.Results Some 1252 participants completed the baseline measures [mean age (SD): 67 (11.7), 53% female, 57% white, 8% Asian, 13% black, 20% Hispanic]. In total, 1179 participants (93%) completed follow-up (619 control, 560 intervention). Quality of life scores (intervention: 0.658 AE 0.094; control: 0.653 AE 0.092) and symptom severity were similar at baseline. The intervention had no effect on primary [EQ-5D: À0.002 (95% CI À0.01, 0.01), P = 0.623; pain: 0.295 (À0.75, 1.34), P = 0.579; sleep disruption: 0.342 (À0.18, 0.86), P = 0.196; lower extremity functioning: À0.079 (À1.27, 1.11), P = 0.896; depression: À0.462 (À1.24, 0.32); P = 0.247] or process outcomes.Conclusions Automated telephone monitoring and feedback alone were not effective at improving quality of life or symptoms for people with symptomatic diabetic peripheral neuropathy.Trial Registration: ClinicalTrials.gov (NCT02056431).

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“…Nagrebetsky et al. investigated telehealth system with real‐time graphical feedback and remote nurse monitoring through mobile phones for adjusting the dose of oral hypoglycaemic agents in type 2 diabetic patients. The study concluded with a significant decrease in the HbA1c levels.…”

Section: Resultsmentioning

confidence: 99%

“…The selection criteria was original articles that reported clinical studies evaluating mobile apps in diabetes patients. These studies were reported from several countries including France , UK , Italy , Canada , USA , South Korea , Taiwan , Norway , Australia and Austria . Patients were recruited from primary and tertiary hospitals and community settings.…”

Section: Methodsmentioning

confidence: 99%

Innovative health informatics as an effective modern strategy in diabetes management: a critical review

David

Rafiullah

2016

Int J Clin Pract

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Objective: Diabetes mellitus is the most common metabolic disorder in developing countries. Mobile health applications are helpful in improving the diabetes management. However, the effectiveness of these techniques needs to be assessed rigorously. Therefore, the authors have systematically reviewed the recent clinical studies using mobile health applications for diabetes management. Materials and methods: Original articles that were published in ISI indexed journals listed in PubMed from the year 2007 till 2014 were searched using specific search key phrases. The intervention technology and study methodology were analysed to have a better understanding of the outcomes of each study. Results: Twenty-one articles were selected for the review. Most studies (76%) reported positive outcomes after use of the mobile health applications. Smartphone apps significantly improved the clinical outcomes. Userfriendliness of the systems often influence the patient compliance and the clinical outcomes. Conclusion: Smartphone/web applications offer significant benefits for patient care, education and behavioural modifications. Providing a continuous patient support using mobile may be a challenging task and would require adequate infrastructure and personnel. Review criteriaUsing specific key phrases 'clinical study on use of mobile phones/smartphones/cell phones/mobile applications for diabetes' original articles that were published between 2007 to 2014 in ISI indexed journals from PubMed database were gathered. The articles were analyzed by classifying them into mobile applications for diabetes management, patient education and patient behavior modifications. Message for the clinicWeb based tools have shown very good effect on diabetic patient management and education but had limited behavioral modification role. Phone calls are becoming less popular and only two studies that have been used for behavioral modification with good outcome. The text messages were effective, but Smartphone Apps and teleconsultation techniques fared better in the clinical outcomes.

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Stepwise Self-Titration of Oral Glucose-Lowering Medication Using a Mobile Telephone-Based Telehealth Platform in Type 2 Diabetes: A Feasibility Trial in Primary Care

Cited by 35 publications

References 30 publications

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Current Science on Consumer Use of Mobile Health for Cardiovascular Disease Prevention

Automated symptom and treatment side effect monitoring for improved quality of life among adults with diabetic peripheral neuropathy in primary care: a pragmatic, cluster, randomized, controlled trial

Innovative health informatics as an effective modern strategy in diabetes management: a critical review

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