TY - JOUR AU - Duong, Tuan AU - Olsen, Quita AU - Menon, Anish AU - Woods, Leanna AU - Wang, Wenyong AU - Varnfield, Marlien AU - Jiang, Lee AU - Sullivan, Clair PY - 2025/4/25 TI - Digital Health Interventions to Prevent Type 2 Diabetes Mellitus: Systematic Review JO - J Med Internet Res SP - e67507 VL - 27 KW - digital health KW - type 2 diabetes KW - prediabetes KW - prevent KW - digital health intervention KW - PRISMA N2 - Background: Digital health interventions (DHIs) have rapidly evolved and significantly revolutionized the health care system. The quadruple aims of health care (improving population health, enhancing consumer experience, enhancing health care provider [HCP] experience, and decreasing health costs) serve as a strategic guiding framework for DHIs. It is unknown how DHIs can impact the burden of type 2 diabetes mellitus (T2DM), as measured by the quadruple aims. Objective: This study aimed to systematically review the effects of DHIs on improving the burden of T2DM, as measured by the quadruple aims. Methods: PubMed, Embase, CINAHL, and Web of Science were searched for studies published from January 2014 to March 2024. Primary outcomes were the development of T2DM, hemoglobin A1c (HbA1c) change, and blood glucose change (dysglycemia changes). Secondary outcomes were consumer experience, HCP experience, and health care costs. Outcomes were mapped to the quadruple aims. DHIs were categorized using the World Health Organization?s DHI classification. For each study, DHI categories were assessed for their effects on each outcome, categorizing the effects as positive, negative, or neutral. The overall effects of each DHI category were determined by synthesizing all reported positive, neutral, or negative effects regardless of the number of studies supporting each effect. The Cochrane risk-of-bias version 2 (RoB 2) tool for randomized trials was used to assess the quality of randomized controlled trials (RCTs), while the ROBINS-I (risk of bias in nonrandomized studies of interventions) tool was applied for nonrandomized studies. Results: In total, 53 papers were included. For the T2DM development outcome, the effects of DHIs were positive in 1 (1.9%) study and neutral in 9 (17%) studies, and there were insufficient data to assess in 4 (7.5%) studies. For the dysglycemia outcome, the effects were positive in 23 (43.4%) studies and neutral in 24 (45.3%) studies, and there were insufficient data in 6 (11.3%) studies. There were mixed effects on consumer experience (n=13, 24.5%) and a lack of studies reporting HCP experience (n=1, 1.9%) and health care costs (n=3, 5.7%). All studies that reported positive population health outcomes used a minimum of 2 distinct categories of DHIs. Among these successful studies, the one that reported delaying the development of T2DM and 16 (69.6%) of those reporting improvements in dysglycemia involved HCP interaction. Targeted communication with persons (TCP), personal health tracking (PHT), and telemedicine (TM) showed some evidence as a potentially useful tool for T2DM prevention and dysglycemia. Conclusions: The effects of DHIs on T2DM prevention, as measured by the quadruple aims, have not been comprehensively assessed, with proven benefits for population health, mixed results for consumer experience, and insufficient studies on HCP experience and health care costs. To maximize their effectiveness in preventing T2DM and managing dysglycemia, DHIs should be used in combination and strategically integrated with in-person or remote HCP interaction. Trial Registration: PROSPERO CRD42024512690; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024512690 UR - https://www.jmir.org/2025/1/e67507 UR - http://dx.doi.org/10.2196/67507 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/67507 ER - TY - JOUR AU - Alzawahreh, Salah AU - Ozturk, Candan PY - 2024/12/10 TI - Improving Self-Efficacy, Quality of Life, and Glycemic Control in Adolescents With Type 1 Diabetes: Randomized Controlled Trial for the Evaluation of the Family-Centered Empowerment Model JO - JMIR Form Res SP - e64463 VL - 8 KW - adolescents KW - family-centered empowerment model KW - glycemic control KW - quality of life KW - self-efficacy KW - type 1 diabetes mellitus KW - T1DM KW - family-centered KW - teenager KW - glycemic KW - experimental evaluation KW - empowerment KW - Jordan KW - glycosylated hemoglobin KW - HbA1c KW - experimental study KW - family KW - care education KW - self-care KW - educational program KW - mobile phone N2 - Background: Poor glycemic management in adolescents with type 1 diabetes mellitus (T1DM) increases complications. Enhanced control is associated with other factors, such as cultural, socioeconomic, and health care system disparities specific to the Middle East, which can greatly influence individuals? ability to get and use health care services as well as their reaction to treatment approaches. Objective: This study aims to evaluate the impact of the family-centered empowerment model on Jordanian adolescents with T1DM, focusing on their glycosylated hemoglobin levels, self-efficacy, and quality of life (QOL). Methods: A randomized controlled trial involved 68 adolescents with T1DM visiting Jordanian Royal Medical Services? clinics. Two sets of participant groups were created: control (n=34) and intervention (n=34). Participants were randomly assigned to either the intervention group, receiving the family-centered empowerment model intervention, or the control group, receiving standard care. Data were collected through face-to-face interviews and medical records. Results: From April to October 2023, a total of 68 adolescents with T1DM participated in the study at the Jordanian Royal Medical Services. QOL had significant improvement among 13 (38%) of the 34 participants in the intervention group, and the program significantly improved moderate self-efficacy levels in 12 (35%) patients (P<.001). In addition, the average glycosylated hemoglobin levels dropped from 11.25% to 10.23% (P<.001). Additionally, improvements were seen in stress management, communication, and treatment adherence, with a substantial decrease in treatment obstacles. The intervention was successful in improving both clinical and psychosocial outcomes, as evidenced by the fact that the control group showed no noticeable improvements in these parameters. Conclusions: The study suggests that patients with T1DM should receive continuous care education sessions, including self-care training, to improve their health. Nurses should also incorporate this training into treatment plans and educational programs for adolescents to enhance their QOL. Trial Registration: ClinicalTrials.gov NCT06694467; https://clinicaltrials.gov/study/NCT06694467 UR - https://formative.jmir.org/2024/1/e64463 UR - http://dx.doi.org/10.2196/64463 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/64463 ER - TY - JOUR AU - Trnka, Pavel AU - Aldaghi, Tahmineh AU - Muzik, Jan PY - 2024/10/10 TI - Categorization of mHealth Coaching Technologies for Children or Adolescents With Type 1 Diabetes: Systematic Review JO - JMIR Pediatr Parent SP - e50370 VL - 7 KW - type 1 diabetes KW - adolescents KW - children KW - parents KW - mHealth KW - information technology KW - PRISMA N2 - Background: Managing type 1 diabetes in children and adolescents can be difficult for parents, health care professionals, and even patients. However, over the last decades, the quality of services provided to patients with diabetes has increased due to advances in IT. Objective: This study aims to comprehensively document the range of IT tools used in the management of diabetes among children and adolescents, with a focus on identifying the technologies most commonly used based on their frequency. In addition, the study aims to explore relevant methodologies for developing diabetes technology and provide valuable information to developers by delineating essential phases of the design process. Methods: The literature search was focused on MEDLINE (PubMed), Web of Science, and Google Scholar for relevant studies. Keywords such as ?type 1 diabetes,? ?adolescents,? ?kids,? ?mHealth,? ?children,? and ?coaching? were combined using Boolean operators. The inclusion criteria were open access, English-language papers published between 2012 and 2023 focusing on patients younger than 18 years and aligned with our research goal. The exclusion criteria included irrelevant topics and papers older than 18 years. By applying the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, 2080 studies were recognized, and after selection, 33 papers were agreed upon between the researchers. Results: Four primary categories were defined: types of IT, methodology identification, purpose identification, and feature determination. Among these, mobile health (mHealth) apps emerged as the predominant type of information, garnering 27 mentions. In particular, user-centered design was identified as the most prevalent methodology, cited 22 times. The primary purpose of self-monitoring blood glucose values was mentioned 20 times, while patient education was the highest among common characteristics, with 23 mentions. Conclusions: Based on our research, we advocate for developers to focus on creating an mHealth app that integrates gamification techniques to develop innovative diabetes management solutions. This app should include vital functionalities such as blood glucose monitoring, strategies to improve hemoglobin A1c levels, carbohydrate tracking, and comprehensive educational materials for patients and caregivers. By prioritizing these features, developers can enhance the usability and effectiveness of the technology, thereby better supporting children or adolescents with diabetes in their daily management endeavors. UR - https://pediatrics.jmir.org/2024/1/e50370 UR - http://dx.doi.org/10.2196/50370 ID - info:doi/10.2196/50370 ER - TY - JOUR AU - Ferber, Christopher AU - Mittelman, D. Steven AU - Moin, Tannaz AU - Wilhalme, Holly AU - Hicks, Rebecca PY - 2024/10/1 TI - Impact of Telemedicine Versus In-Person Pediatric Outpatient Type 1 Diabetes Visits on Immediate Glycemic Control: Retrospective Chart Review JO - JMIR Diabetes SP - e58579 VL - 9 KW - diabetes KW - type 1 diabetes KW - pediatrics KW - continuous glucose monitoring KW - time in range KW - glucose management indicator KW - telemedicine KW - screening labs N2 - Background: Children and adolescents with type 1 diabetes require frequent outpatient evaluation to assess glucose trends, modify insulin doses, and screen for comorbidities. Continuous glucose monitoring (CGM) provides a detailed glycemic control assessment. Telemedicine has been increasingly used since the COVID-19 pandemic. Objective: To investigate CGM profile parameter improvement immediately following pediatric outpatient diabetes visits and determine if visit modality impacted these metrics, completion of screening laboratory tests, or diabetic emergency occurrence. Methods: A dual-center retrospective review of medical records assessed the CGM metrics time in range and glucose management indicator for pediatric outpatient diabetes visits during 2021. Baseline values were compared with those at 2 and 4 weeks post visit. Rates of completion of screening laboratory tests and diabetic emergencies following visits were determined. Results: A total of 269 outpatient visits (41.2% telemedicine) were included. Mean time in range increased by 1.63% and 1.35% at 2 and 4 weeks post visit (P=.003 and .01, respectively). Mean glucose management indicator decreased by 0.07% and 0.06% at 2 and 4 weeks post visit (P=.003 and .02, respectively). These improvements in time in range and glucose management indicator were seen across both telemedicine visits and in-person visits without a significant difference. However, patients seen in person were 2.69 times more likely to complete screening laboratory tests (P=.03). Diabetic emergencies occurred too infrequently to analyze. Conclusions: Our findings demonstrate an immediate improvement in CGM metrics following outpatient visits, regardless of modality. While statistically significant, the magnitude of these changes was small; hence, multiple visits over time would be required to achieve clinically relevant improvement. However, completion of screening laboratory tests was found to be more likely after visits occurring in person. Therefore, we suggest a hybrid approach that allows patient convenience with telemedicine but also incorporates periodic in-person assessment. UR - https://diabetes.jmir.org/2024/1/e58579 UR - http://dx.doi.org/10.2196/58579 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58579 ER - TY - JOUR AU - Beccia, Chiara AU - Hunter, Barbara AU - Manski-Nankervis, Jo-Anne AU - White, Mary PY - 2024/9/23 TI - Exploring the User Acceptability and Feasibility of a Clinical Decision Support Tool Designed to Facilitate Timely Diagnosis of New-Onset Type 1 Diabetes in Children: Qualitative Interview Study Among General Practitioners JO - JMIR Form Res SP - e60411 VL - 8 KW - type 1 diabetes KW - digital health innovation KW - clinical decision support tool KW - diabetes KW - acceptability KW - feasibility KW - diagnosis KW - child KW - children KW - youth KW - qualitative and simulation study KW - hospital KW - diabetic ketoacidosis KW - diagnostic delay KW - Australian KW - Australia KW - video recorded KW - audio recorded KW - screen recorded KW - video KW - videos KW - patient KW - patients N2 - Background: Up to half of the children with new-onset type 1 diabetes present to the hospital with diabetic ketoacidosis, a life-threatening condition that can develop because of diagnostic delay. Three-quarters of Australian children visit their general practitioner (GP) the week before presenting to the hospital with diabetic ketoacidosis. Our prototype, DIRECT-T1DM (Decision-Support for Integrated, Real-Time Evaluation and Clinical Treatment of Type 1 Diabetes Mellitus), is an electronic clinical decision support tool that promotes immediate point-of-care testing in general practice to confirm the suspicion of diabetes. This avoids laboratory testing, which has been documented internationally as a cause of diagnostic delay. Objective: In this investigation, we aimed to pilot and assess the feasibility and acceptability of our prototype to GP end users. We also explored the challenges of diagnosing type 1 diabetes in the Australian general practice context. Methods: In total, 4 GPs, a pediatric endocrinologist, and a PhD candidate were involved in conceptualizing the DIRECT-T1DM prototype, which was developed at the Department of General Practice and Primary Care at the University of Melbourne. Furthermore, 6 GPs were recruited via convenience sampling to evaluate the tool. The study involved 3 phases: a presimulation interview, simulated clinical scenarios, and a postsimulation interview. The interview guide was developed using the Consolidated Framework for Implementation Research (CFIR) as a guide. All phases of the study were video, audio, and screen recorded. Audio recordings were transcribed by the investigating team. Analysis was carried out using CFIR as the underlying framework. Results: Major themes were identified among three domains and 7 constructs of the CFIR: (1) outer setting?time pressure, difficulty in diagnosing pediatric type 1 diabetes, and secondary care considerations influenced GPs? needs regarding DIRECT-T1DM; (2) inner setting?DIRECT-T1DM fits within existing workflows, it has a high relative priority due to its importance in patient safety, and GPs exhibited high tension for change; and (3) innovation?design recommendations included altering coloring to reflect urgency, font style and bolding, specific language, information and guidelines, and inclusion of patient information sheets. Conclusions: End-user acceptability of DIRECT-T1DM was high. This was largely due to its implications for patient safety and its ?real-time? nature. DIRECT-T1DM may assist in appropriate management of children with new-onset diabetes, which is an uncommon event in general practice, through safety netting. UR - https://formative.jmir.org/2024/1/e60411 UR - http://dx.doi.org/10.2196/60411 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60411 ER - TY - JOUR AU - Shetty, B. Vinutha AU - Fried, Leanne AU - Roby, C. Heather AU - Soon, K. Wayne H. AU - Nguyen, Rebecca AU - Ong, Arthur AU - Jaimangal, Mohinder AU - Francis, Jacinta AU - Paramalingam, Nirubasini AU - Cross, Donna AU - Davis, Elizabeth PY - 2024/7/30 TI - Development of a Novel Mobile Health App to Empower Young People With Type 1 Diabetes to Exercise Safely: Co-Design Approach JO - JMIR Diabetes SP - e51491 VL - 9 KW - Mobile health application KW - Exercise KW - fitness KW - physical activity KW - design KW - co-design KW - focus group KW - focus groups KW - acT1ve KW - Type 1 diabetes KW - Young people KW - Blood glucose level KW - diabetic KW - diabetes KW - young KW - youth KW - type 1 KW - prototype KW - develop KW - development KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - user-centered design KW - mobile phone N2 - Background: Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting. Objective: We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals. Methods: A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app ?acT1ve? during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of ?acT1ve? was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers. Results: Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of ?acT1ve.? acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. ?acT1ve? contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users? activities and associated exercise advice provided by the app?s algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels. Conclusions: The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing ?acT1ve.? The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project. Trial Registration: Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d UR - https://diabetes.jmir.org/2024/1/e51491 UR - http://dx.doi.org/10.2196/51491 UR - http://www.ncbi.nlm.nih.gov/pubmed/39078700 ID - info:doi/10.2196/51491 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - Ma, Yanan AU - Law, Kate AU - Hassan, Lamiece AU - Nenadic, Goran AU - van der Veer, N. Sabine PY - 2024/5/29 TI - Experiences and Views of Young People and Health Care Professionals of Using Social Media to Self-Manage Type 1 Diabetes Mellitus: Thematic Synthesis of Qualitative Studies JO - JMIR Pediatr Parent SP - e56919 VL - 7 KW - adolescents KW - health care professionals KW - social media KW - thematic synthesis KW - type 1 diabetes KW - type 1 diabetes mellitus KW - T1DM KW - young people N2 - Background: Social media have shown the potential to support type 1 diabetes self-management by providing informational, emotional, and peer-to-peer support. However, the perceptions of young people and health care professionals? (HCPs) toward the use of social media for type 1 diabetes self-management have not been systematically reviewed. Objective: The aim of this study is to explore and summarize the experiences and views of young people with type 1 diabetes and their HCPs on using social media for self-management across qualitative findings. Methods: We searched MEDLINE, Embase, PsycINFO, and CINAHL from 2012 to 2023 using Medical Subject Heading terms and text words related to type 1 diabetes and social media. We screened and selected the studies according to the inclusion and exclusion criteria. We quality appraised and characterized the included studies and conducted a thematic synthesis. Results: We included 11 studies in our synthesis. A total of 9 of them were qualitative and 2 were mixed methods studies. Ten focused on young people with type 1 diabetes and 1 on HCPs. All used content analysis and were of moderate to high quality. Thirteen descriptive themes were yielded by our thematic synthesis, contributing to five analytic themes: (1) differences in how young people interact with social media, (2) characteristics of social media platforms that influence their use and uptake for type 1 diabetes self-management, (3) social media as a source of information, (4) impact on young people?s coping and emotional well-being, and (5) impact on support from and relationships with HCPs and services. Conclusions: The synthesis suggests that we should consider leveraging social media?s peer support capabilities to augment the traditional services for young people with type 1 diabetes. However, the patients may have privacy concerns about HCPs? involvement in their online activities. This warrants an update of existing guidelines to help young people use social media safely for self-managing their diabetes. UR - https://pediatrics.jmir.org/2024/1/e56919 UR - http://dx.doi.org/10.2196/56919 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809591 ID - info:doi/10.2196/56919 ER - TY - JOUR AU - Sapre, Manali AU - Elaiho, R. Cordelia AU - Brar Prayaga, Rena AU - Prayaga, Ram AU - Constable, Jeremy AU - Vangeepuram, Nita PY - 2024/5/29 TI - The Development of a Text Messaging Platform to Enhance a Youth Diabetes Prevention Program: Observational Process Study JO - JMIR Form Res SP - e45561 VL - 8 KW - community-based participatory research KW - youth KW - diabetes prevention KW - peer education KW - mobile health technology KW - SMS text messaging KW - mobile phone KW - artificial intelligence KW - AI N2 - Background: Approximately 1 in 5 adolescents in the United States has prediabetes, and racially and ethnically minoritized youths are disproportionately impacted. Unfortunately, there are few effective youth diabetes prevention programs, and in-person interventions are challenging because of barriers to access and engagement. Objective: We aimed to develop and assess the preliminary feasibility and acceptability of a youth-informed SMS text messaging platform to provide additional support and motivation to adolescents with prediabetes participating in a diabetes prevention workshop in East Harlem, New York City, New York, United States. We collaborated with our youth action board and a technology partner (mPulse Mobile) to develop and pilot-test the novel interactive platform. Methods: The technology subcommittee of our community action board (comprising youths and young adults) used the results from focus groups that we had previously conducted with youths from our community to develop 5 message types focused on healthy eating and active living: goal setting, behavior tracking, individually tailored guidance, motivational messages, and photo diary. We used an iterative process to develop and pilot the program with our internal study team, including youths from our community action board and mPulse Mobile developers. We then conducted a pilot of the 12-week SMS text messaging program with 13 youths with prediabetes. Results: Participants (aged 15-21 years; 10/13, 77% female; 3/10, 23% Black and 10/13, 77% Hispanic or Latinx) received an average of 2 automated messages per day. The system correctly sent 84% (2231/2656) of the messages at the time intended; the remaining 16% (425/2656) of the messages were either sent at the incorrect time, or the system did not recognize a participant response to provide the appropriate reply. The level of engagement with the program ranged from 1 (little to no response) to 5 (highly responsive) based on how frequently participants responded to the interactive (2-way) messages. Highly responsive participants (6/13, 46%) responded >75% (1154/1538) of the time to interactive messages sent over 12 weeks, and 69% (9/13) of the participants were still engaged with the program at week 12. During a focus group conducted after program completion, the participants remarked that the message frequency was appropriate, and those who had participated in our in-person workshops reflected that the messages were reminiscent of the workshop content. Participants rated goal setting, behavior tracking, and tailored messages most highly and informed planned adaptations to the platform. Participants described the program as: ?interactive, informative, enjoyable, very convenient, reliable, motivational, productive, and reflective.? Conclusions: We partnered with youths in the initial content development and pilot testing of a novel SMS text messaging platform to support diabetes prevention. This study is unique in the triple partnership we formed among researchers, technology experts, and diverse youths to develop a mobile health platform to address diabetes-related disparities. UR - https://formative.jmir.org/2024/1/e45561 UR - http://dx.doi.org/10.2196/45561 UR - http://www.ncbi.nlm.nih.gov/pubmed/38809599 ID - info:doi/10.2196/45561 ER - TY - JOUR AU - Novak, Daniel PY - 2024/5/7 TI - A Serious Game (MyDiabetic) to Support Children?s Education in Type 1 Diabetes Mellitus: Iterative Participatory Co-Design and Feasibility Study JO - JMIR Serious Games SP - e49478 VL - 12 KW - diabetes mellitus KW - serious games KW - mobile app KW - co-design KW - user-centered design KW - serious game KW - gaming KW - diabetes KW - child with diabetes KW - child KW - children KW - insulin KW - glucometer KW - glucose KW - patient education KW - mobile phone N2 - Background: Serious games, which are gaming applications used for purposes beyond entertainment to educate users on, and address, specific issues, may present a timely approach to promote healthy diabetes management behaviors among children with type 1 diabetes mellitus (T1DM). The lasting benefits associated with these serious games encompass improved patient education; enhanced glycemic control; the reinforcement of bonds within the community of people with diabetes; the facilitation of meaningful dialogues with caregivers, especially within the familial setting; and a significant reduction in the economic burdens associated with subsequent complications. Objective: This paper primarily aims to provide a detailed overview of the iterative design process and the associated evaluation methods used in the development of the educational game. Furthermore, this study aims to enhance motivation for sustained and extended engagement with the game over time. The MyDiabetic game design aims to educate children on various aspects, including the connections among food, insulin, and physical activity. Furthermore, it seeks to impart knowledge related to the operation of a glucometer and an insulin pen, as well as more advanced technologies such as administering glucagon, measuring ketoacidosis, and continuous glucose monitoring. Methods: The co-design methodology was applied, involving interviews, design workshops, and prototype feedback sessions. A combination of several approaches, such as tailoring, observational learning, social and family support, decision-making practice, and reward systems, was used to support children?s compliance. Moreover, incorporating the literature, guidelines, and current practices into the design ensured that the game was aligned with established health care pathways and included relevant information and best practices for diabetes management. Results: The game was tested on 32 children in 3 iterations. Positive responses were received from children who tested the game as well as their parents. The game was also presented to 5 schoolmates of children with T1DM who appreciated a better understanding of the disease and the opportunity to support their friends more efficiently in T1DM compensation. The involvement of children and clinicians in participatory co-design contributed to to the game's high acceptance. With regard to the game?s impact on education, 1 week of testing revealed an enhancement in educational outcomes. Conclusions: The game is especially suitable for children newly diagnosed with T1DM because it acquaints them in a fun way with new terminology; for example, they can try to measure glycemia levels in an interactive way. The game also caters to children who still need to develop reading skills by including an audio guide. The guide ensures that children of all literacy levels can benefit from the game?s educational content and interactive experiences. The game is available for download on Google Play and the Apple App Store. UR - https://games.jmir.org/2024/1/e49478 UR - http://dx.doi.org/10.2196/49478 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713496 ID - info:doi/10.2196/49478 ER - TY - JOUR AU - Garner, Katie AU - Thabrew, Hiran AU - Lim, David AU - Hofman, Paul AU - Jefferies, Craig AU - Serlachius, Anna PY - 2023/12/22 TI - Exploring the Usability and Acceptability of a Well-Being App for Adolescents Living With Type 1 Diabetes: Qualitative Study JO - JMIR Pediatr Parent SP - e52364 VL - 6 KW - well-being KW - digital health interventions KW - type 1 diabetes KW - diabetes KW - diabetic KW - adolescent KW - youth KW - adolescents KW - young people KW - parents KW - parent KW - mHealth KW - mobile health KW - app KW - apps KW - application KW - applications KW - acceptability KW - usability KW - interview KW - interviews KW - opinion KW - opinions KW - perception KW - perceptions KW - perspective KW - perspectives KW - acceptance N2 - Background: Adolescents living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) have an increased risk of psychological disorders due to the demands of managing a chronic illness and the challenges of adolescence. Psychological disorders during adolescence increase the risk of suboptimal glycemic outcomes and may lead to serious diabetes-related complications. Research shows that digital health interventions may increase access to psychological support for adolescents and improve physical and mental health outcomes for youth with diabetes. To our knowledge, there are no evidence-based, publicly available mental health apps with a focus on improving the psychological well-being of adolescents with diabetes. Objective: This study aimed to explore the acceptability and usability of our evidence-based well-being app for New Zealand adolescents, Whitu: 7 Ways in 7 Days (Whitu), to allow us to further tailor it for youth with diabetes. We interviewed adolescents with T1D and T2D, their parents, and health care professionals to explore their views on the Whitu app and suggestions for tailoring the app for adolescent with diabetes. We also explored the cultural acceptability of the Whitu app for M?ori and Pacific adolescents. Methods: A total of 34 participants, comprising 13 adolescents aged 12-16 years (11 with T1D and 2 with T2D), 10 parents, and 11 health care professionals, were recruited from a specialist diabetes outpatient clinic and Facebook diabetes groups. Each participant attended one 1-hour focus group on Zoom, in person, or via phone. Researchers gathered general feedback on what makes an effective and engaging app for adolescents with diabetes, as well as specific feedback about Whitu. Transcribed audio recordings of the focus groups were analyzed using directed content analysis. Results: Adolescents with T1D, their parents, and health care professionals found Whitu to be acceptable and usable. Adolescents with T1D and their parents signaled a preference for more diabetes-specific content. Health care professionals expressed less awareness and trust of digital health interventions and, as such, recommended that they be used with external support. Due to challenges in recruitment and retention, we were unable to include the views of adolescents with T2D in this qualitative study. Conclusions: There appears to be sufficient openness to the use of an app such as Whitu for supporting the well-being of adolescents with T1D, albeit with modifications to make its content more diabetes specific. Based on this qualitative study, we have recently developed a diabetes-specific version of Whitu (called LIFT: Thriving with Diabetes). We are also planning a qualitative study to explore the views of youth with T2D and their perspectives on the new LIFT app, where we are using alternative research approaches to recruit and engage adolescents with T2D and their families. UR - https://pediatrics.jmir.org/2023/1/e52364 UR - http://dx.doi.org/10.2196/52364 ID - info:doi/10.2196/52364 ER - TY - JOUR AU - LeStourgeon, Lauren AU - Bergner, Erin AU - Datye, Karishma AU - Streisand, Randi AU - Jaser, Sarah PY - 2023/10/5 TI - Evaluation of Study Engagement With an mHealth Intervention (THR1VE) to Treat Diabetes Distress in Teens With Type 1 Diabetes: Randomized Clinical Trial JO - JMIR Pediatr Parent SP - e47089 VL - 6 KW - type 1 diabetes mellitus KW - positive psychology KW - adolescents KW - parental positive messaging KW - mHealth KW - engagement KW - diabetes KW - distress KW - teens KW - chronic health conditions KW - sex KW - age KW - device KW - race KW - ethnicity KW - text KW - mobile health N2 - Background: Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. Objective: This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. Methods: Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. Results: Adolescents in both groups reported high levels of satisfaction with the study, with 95% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5% of intervention messages, and their caregivers responded to 88.5% of messages. There were no significant differences in rates of engagement related to adolescents? sex, age, device use, or race/ethnicity. Conclusions: A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination. Trial Registration: ClinicalTrials.gov NCT03845465; https://clinicaltrials.gov/study/NCT03845465 UR - https://pediatrics.jmir.org/2023/1/e47089 UR - http://dx.doi.org/10.2196/47089 ID - info:doi/10.2196/47089 ER - TY - JOUR AU - Nørlev, Jannie AU - Derosche, Christina AU - Sondrup, Katrine AU - Hejlesen, Ole AU - Hangaard, Stine PY - 2022/3/29 TI - Using Distance Communication for the User-Centered Development of a Smartphone-Based Serious Game for Children With Type 1 Diabetes: Participatory Design Approach JO - JMIR Serious Games SP - e33955 VL - 10 IS - 1 KW - type 1 diabetes KW - children KW - serious game KW - distance communication KW - user-centered approach KW - evaluation KW - playtest KW - mobile phone N2 - Background: The complications of type 1 diabetes (T1D) can be delayed or prevented in children with T1D who receive proper self-management education. Smartphone-based serious games are increasingly being used as an effective tool for teaching self-management. When developing a serious game, it is important that the development process be user-centered. Traditionally, different face-to-face methods have been used when children participate in the development process. However, face-to-face data collection is not always feasible. In such situations, distance communication can be used when developing a serious game. Objective: The objective of this study is to develop a user-centered smartphone-based serious game that teaches self-management focused on carbohydrate intake in children aged 8-14 years with T1D using distance communication in both the development and evaluation of the game. Methods: The development and evaluation of a smartphone-based serious game prototype was inspired by the Lean principles, and a user-centered approach was applied. The development process included 1 expert interview and design workshops with children with T1D. On the basis of the interview and design workshop results, a serious game prototype was developed using Microsoft PowerPoint. The evaluation of the serious game prototype included an interview with a dietitian and a playtest with children with T1D. All data were collected using distance communication. Results: A user-centered smartphone-based serious game prototype was developed and evaluated. The expert interview with the dietitian formed the basis for the learning outcomes in the game. Four children and their parents contributed to the preferences, needs, requirements, and ideas for selected parts of the game design. The dietitian evaluated the prototype positively and validated its content and accuracy. The serious game prototype was well-received by the children and their parents during the playtest. The serious game prototype was perceived as a useful and engaging way to learn. However, the difficulty level was not appropriate, and the information was too basic for participants who had been diagnosed over a year ago. The use of digital communication platforms did not cause any problems. Conclusions: The smartphone-based serious game prototype has the potential to be a useful and attractive tool for teaching disease self-management. The use of distance communication proved to be a useful approach in the development of a serious game. UR - https://games.jmir.org/2022/1/e33955 UR - http://dx.doi.org/10.2196/33955 UR - http://www.ncbi.nlm.nih.gov/pubmed/35348466 ID - info:doi/10.2196/33955 ER - TY - JOUR AU - Worth, Chris AU - Harper, Simon AU - Salomon-Estebanez, Maria AU - O'Shea, Elaine AU - Nutter, W. Paul AU - Dunne, J. Mark AU - Banerjee, Indraneel PY - 2021/10/29 TI - Clustering of Hypoglycemia Events in Patients With Hyperinsulinism: Extension of the Digital Phenotype Through Retrospective Data Analysis JO - J Med Internet Res SP - e26957 VL - 23 IS - 10 KW - hyperinsulinism KW - continuous glucose monitoring KW - digital phenotype KW - hypoglycemia KW - nocturnal hypoglycemia N2 - Background: Hyperinsulinism (HI) due to excess and dysregulated insulin secretion is the most common cause of severe and recurrent hypoglycemia in childhood. High cerebral glucose use in the early hours results in a high risk of hypoglycemia in people with diabetes and carries a significant risk of brain injury. Prevention of hypoglycemia is the cornerstone of the management of HI, but the risk of hypoglycemia at night or the timing of hypoglycemia in children with HI has not been studied; thus, the digital phenotype remains incomplete and management suboptimal. Objective: This study aims to quantify the timing of hypoglycemia in patients with HI to describe glycemic variability and to extend the digital phenotype. This will facilitate future work using computational modeling to enable behavior change and reduce exposure of patients with HI to injurious hypoglycemic events. Methods: Patients underwent continuous glucose monitoring (CGM) with a Dexcom G4 or G6 CGM device as part of their clinical assessment for either HI (N=23) or idiopathic ketotic hypoglycemia (IKH; N=24). The CGM data were analyzed for temporal trends. Hypoglycemia was defined as glucose levels <3.5 mmol/L. Results: A total of 449 hypoglycemic events totaling 15,610 minutes were captured over 237 days from 47 patients (29 males; mean age 70 months, SD 53). The mean length of hypoglycemic events was 35 minutes. There was a clear tendency for hypoglycemia in the early hours (3-7 AM), particularly for patients with HI older than 10 months who experienced hypoglycemia 7.6% (1480/19,370 minutes) of time in this period compared with 2.6% (2405/92,840 minutes) of time outside this period (P<.001). This tendency was less pronounced in patients with HI who were younger than 10 months, patients with a negative genetic test result, and patients with IKH. Despite real-time CGM, there were 42 hypoglycemic events from 13 separate patients with HI lasting >30 minutes. Conclusions: This is the first study to have taken the first step in extending the digital phenotype of HI by describing the glycemic trends and identifying the timing of hypoglycemia measured by CGM. We have identified the early hours as a time of high hypoglycemia risk for patients with HI and demonstrated that simple provision of CGM data to patients is not sufficient to eliminate hypoglycemia. Future work in HI should concentrate on the early hours as a period of high risk for hypoglycemia and must target personalized hypoglycemia predictions. Focus must move to the human-computer interaction as an aspect of the digital phenotype that is susceptible to change rather than simple mathematical modeling to produce small improvements in hypoglycemia prediction accuracy. UR - https://www.jmir.org/2021/10/e26957 UR - http://dx.doi.org/10.2196/26957 UR - http://www.ncbi.nlm.nih.gov/pubmed/34435596 ID - info:doi/10.2196/26957 ER - TY - JOUR AU - Middleton, Timothy AU - Constantino, Maria AU - McGill, Margaret AU - D'Souza, Mario AU - Twigg, M. Stephen AU - Wu, Ted AU - Thiagalingam, Aravinda AU - Chow, Clara AU - Wong, Jencia PY - 2021/10/21 TI - An Enhanced SMS Text Message?Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial JO - J Med Internet Res SP - e27263 VL - 23 IS - 10 KW - young-onset type 2 diabetes KW - SMS KW - clinic attendance KW - engagement KW - diabetes KW - digital health KW - mobile health KW - adolescents N2 - Background: Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective: We examined the effectiveness of an enhanced SMS text message?based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods: A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message?based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results: A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3% (SD 1.9%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100% attendance (12/21, 57%, vs 5/19, 26%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale?Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95% CI 0.9-11). Program acceptability was high; >90% of participants would recommend the program to new patients. Conclusions: An enhanced SMS text message?based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579 UR - https://www.jmir.org/2021/10/e27263 UR - http://dx.doi.org/10.2196/27263 UR - http://www.ncbi.nlm.nih.gov/pubmed/34524102 ID - info:doi/10.2196/27263 ER - TY - JOUR AU - Shetty, B. Vinutha AU - Soon, K. Wayne H. AU - Roberts, G. Alison AU - Fried, Leanne AU - Roby, C. Heather AU - Smith, J. Grant AU - Fournier, A. Paul AU - Jones, W. Timothy AU - Davis, A. Elizabeth PY - 2021/10/14 TI - A Novel Mobile Health App to Educate and Empower Young People With Type 1 Diabetes to Exercise Safely: Prospective Single-Arm Mixed Methods Pilot Study JO - JMIR Diabetes SP - e29739 VL - 6 IS - 4 KW - mobile health app KW - exercise KW - acT1ve KW - type 1 diabetes KW - young people KW - blood glucose level N2 - Background: Empowering young people with type 1 diabetes (T1D) to manage their blood glucose levels during exercise is a complex challenge faced by health care professionals due to the unpredictable nature of exercise and its effect on blood glucose levels. Mobile health (mHealth) apps would be useful as a decision-support aid to effectively contextualize a blood glucose result and take appropriate action to optimize glucose levels during and after exercise. A novel mHealth app acT1ve was recently developed, based on expert consensus exercise guidelines, to provide real-time support for young people with T1D during exercise. Objective: Our aim was to pilot acT1ve in a free-living setting to assess its acceptability and functionality, and gather feedback on the user experience before testing it in a larger clinical trial. Methods: A prospective single-arm mixed method design was used. Ten participants with T1D (mean age 17.7 years, SD 4.2 years; mean HbA1c, 54 mmol/mol, SD 5.5 mmol/mol [7.1%, SD 0.5%]) had acT1ve installed on their phones, and were asked to use the app to guide their exercise management for 6 weeks. At the end of 6 weeks, participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS). All semistructured interviews were transcribed. Thematic analysis was conducted whereby interview transcripts were independently analyzed by 2 researchers to uncover important and relevant themes. The uMARS was scored for 4 quality subscales (engagement, functionality, esthetics, and information), and a total quality score was obtained from the weighted average of the 4 subscales. Scores for the 4 objective subscales were determined by the mean score of each of its individual questions. The perceived impact and subjective quality of acT1ve for each participant were calculated by averaging the scores of their related questions, but were not considered in the total quality score. All scores have a maximal possible value of 5, and they are presented as medians, IQRs, and ranges. Results: The main themes arising from the interview analysis were ?increased knowledge,? ?increased confidence to exercise,? and ?suitability? for people who were less engaged in exercise. The uMARS scores for acT1ve were high (out of 5) for its total quality (median 4.3, IQR 4.2-4.6), engagement (median 3.9, IQR 3.6-4.2), functionality (median 4.8, IQR 4.5-4.8), information (median 4.6, IQR 4.5-4.8), esthetics (median 4.3, IQR 4.0-4.7), subjective quality (median 4.0, IQR 3.8-4.2), and perceived impact (median 4.3, IQR 3.6-4.5). Conclusions: The acT1ve app is functional and acceptable, with a high user satisfaction. The efficacy and safety of this app will be tested in a randomized controlled trial in the next phase of this study. Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12619001414101; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=378373 UR - https://diabetes.jmir.org/2021/4/e29739 UR - http://dx.doi.org/10.2196/29739 UR - http://www.ncbi.nlm.nih.gov/pubmed/34647896 ID - info:doi/10.2196/29739 ER - TY - JOUR AU - Holtz, Bree AU - Mitchell, M. Katharine AU - Holmstrom, J. Amanda AU - Cotten, R. Shelia AU - Dunneback, K. Julie AU - Jimenez-Vega, Jose AU - Ellis, A. Deborah AU - Wood, A. Michael PY - 2021/9/14 TI - An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study JO - JMIR Mhealth Uhealth SP - e23916 VL - 9 IS - 9 KW - mobile health (mHealth) KW - adolescents KW - type 1 diabetes KW - mobile phone KW - parent-adolescent KW - chronic disease KW - feasibility KW - diabetes management N2 - Background: Type 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. Objective: The aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents? overall satisfaction with this intervention. Methods: This pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. Results: The final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=?2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. Conclusions: In a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial Registration: ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 UR - https://mhealth.jmir.org/2021/9/e23916 UR - http://dx.doi.org/10.2196/23916 UR - http://www.ncbi.nlm.nih.gov/pubmed/34519670 ID - info:doi/10.2196/23916 ER - TY - JOUR AU - Ray, Katherine Mary AU - McMichael, Alana AU - Rivera-Santana, Maria AU - Noel, Jacob AU - Hershey, Tamara PY - 2021/6/3 TI - Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies JO - JMIR Diabetes SP - e27027 VL - 6 IS - 2 KW - ecological momentary assessment KW - continuous glucose monitoring KW - actigraphy KW - accelerometer KW - ambulatory blood pressure monitoring KW - personal digital assistant KW - mobile phone KW - smartphone KW - mHealth UR - https://diabetes.jmir.org/2021/2/e27027 UR - http://dx.doi.org/10.2196/27027 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081017 ID - info:doi/10.2196/27027 ER - TY - JOUR AU - Pike, M. Julie AU - Moore, M. Courtney AU - Yazel, G. Lisa AU - Lynch, O. Dustin AU - Haberlin-Pittz, M. Kathryn AU - Wiehe, E. Sarah AU - Hannon, S. Tamara PY - 2021/2/24 TI - Diabetes Prevention in Adolescents: Co-design Study Using Human-Centered Design Methodologies JO - J Participat Med SP - e18245 VL - 13 IS - 1 KW - diabetes prevention KW - adolescents KW - human-centered design N2 - Background: The rise in pediatric obesity and its accompanying condition, type 2 diabetes (T2D), is a serious public health concern. T2D in adolescents is associated with poor health outcomes and decreased life expectancy. Effective diabetes prevention strategies for high-risk adolescents and their families are urgently needed. Objective: The aim of this study was to co-design a diabetes prevention program for adolescents by using human-centered design methodologies. Methods: We partnered with at-risk adolescents, parents, and professionals with expertise in diabetes prevention or those working with adolescents to conduct a series of human-centered design research sessions to co-design a diabetes prevention intervention for youth and their families. In order to do so, we needed to (1) better understand environmental factors that inhibit/promote recommended lifestyle changes to decrease T2D risk, (2) elucidate desired program characteristics, and (3) explore improved activation in diabetes prevention programs. Results: Financial resources, limited access to healthy foods, safe places for physical activity, and competing priorities pose barriers to adopting lifestyle changes. Adolescents and their parents desire interactive, hands-on learning experiences that incorporate a sense of fun, play, and community in diabetes prevention programs. Conclusions: The findings of this study highlight important insights of 3 specific stakeholder groups regarding diabetes prevention and lifestyle changes. The findings of this study demonstrate that, with appropriate methods and facilitation, adolescents, parents, and professionals can be empowered to co-design diabetes prevention programs. UR - https://jopm.jmir.org/2021/1/e18245 UR - http://dx.doi.org/10.2196/18245 UR - http://www.ncbi.nlm.nih.gov/pubmed/33625364 ID - info:doi/10.2196/18245 ER - TY - JOUR AU - Alfonsi, E. Jeffrey AU - Choi, Y. Elizabeth E. AU - Arshad, Taha AU - Sammott, S. Stacie-Ann AU - Pais, Vanita AU - Nguyen, Cynthia AU - Maguire, R. Bryan AU - Stinson, N. Jennifer AU - Palmert, R. Mark PY - 2020/10/28 TI - Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial JO - JMIR Mhealth Uhealth SP - e22074 VL - 8 IS - 10 KW - carbohydrate counting KW - type 1 diabetes KW - image recognition KW - youth KW - digital health applications (apps) KW - mHealth N2 - Background: Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective: Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods: Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results: Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions: Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration: ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142 UR - http://mhealth.jmir.org/2020/10/e22074/ UR - http://dx.doi.org/10.2196/22074 UR - http://www.ncbi.nlm.nih.gov/pubmed/33112249 ID - info:doi/10.2196/22074 ER - TY - JOUR AU - Patton, R. Susana AU - McConville, Andrew AU - Marker, M. Arwen AU - Monzon, D. Alexandra AU - Driscoll, A. Kimberly AU - Clements, A. Mark PY - 2020/8/18 TI - Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP): Protocol for a Randomized Clinical Trial to Test a Video-Based Telehealth Intervention JO - JMIR Res Protoc SP - e17877 VL - 9 IS - 8 KW - diabetes mellitus, type 1 KW - telemedicine KW - eHealth KW - child KW - parents KW - hypoglycemia KW - fear N2 - Background: Despite the introduction of new insulin analogs, insulin pumps, and continuous glucose monitoring (CGM), young children with type 1 diabetes mellitus (T1D) remain vulnerable to episodes of hypoglycemia because of their unpredictable eating and activity patterns and high degree of insulin sensitivity. Caregivers and young children living with T1D learn to fear hypoglycemia because it is uncomfortable, unpredictable, and dangerous. Up to 60% of caregivers of young children with T1D report moderate to severe levels of fear of hypoglycemia, and caregiver fear of hypoglycemia relates to lower quality of life for families and suboptimal child glycemic control. Yet, until recently, there have been no studies reporting on a targeted intervention to treat caregiver fear of hypoglycemia in families of young children. Objective: The aim of this project is to conduct a randomized clinical trial of an innovative, video-based telehealth intervention to treat fear of hypoglycemia in caregivers of young children with T1D versus a relevant, age-appropriate attention control intervention. Methods: We created the Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) intervention by merging age-appropriate T1D education and behavioral parenting strategies with cognitive behavioral therapy strategies that are effective for reducing fear and promoting adaptive coping. REDCHiP uses 10 video-based telehealth sessions that are a combination of group and individual sessions. We will recruit up to 180 families of young children with T1D to participate in this clinical trial from two pediatric diabetes clinics located in the midwestern and southern United States. Once families have been enrolled, we will randomize caregivers based on child age (age 2-3 years or 4-5 years), child sex, and family CGM use to participate in the REDCHiP or attention control intervention. Families will complete 3 assessment visits that coincide with study entry, end of treatment, and 3-month posttreatment. At each assessment visit, we will collect questionnaire data from caregivers, accelerometry data from caregivers and children, CGM data from children, and a blood sample to measure glycated hemoglobin levels from children. Results: Recruitment began in July 2019, and enrollment is ongoing. The first wave of intervention delivery began in December 2019. We anticipate completing enrollment in 2023. Final reporting of results will occur within 12 months of the primary completion date. Conclusions: If the REDCHiP intervention is efficacious, next steps will be to examine multiple implementation strategies to determine how best to disseminate the intervention to pediatric diabetes clinics around the world. Trial Registration: ClinicalTrials.gov NCT03914547; https://clinicaltrials.gov/ct2/show/NCT03914547 International Registered Report Identifier (IRRID): PRR1-10.2196/17877 UR - http://www.researchprotocols.org/2020/8/e17877/ UR - http://dx.doi.org/10.2196/17877 UR - http://www.ncbi.nlm.nih.gov/pubmed/32808936 ID - info:doi/10.2196/17877 ER - TY - JOUR AU - Oser, K. Tamara AU - Oser, M. Sean AU - Parascando, A. Jessica AU - Grisolano, Ann Lee AU - Krishna, Bangalore Kanthi AU - Hale, E. Daniel AU - Litchman, Michelle AU - Majidi, Shideh AU - Haidet, Paul PY - 2020/6/3 TI - Challenges and Successes in Raising a Child With Type 1 Diabetes and Autism Spectrum Disorder: Mixed Methods Study JO - J Med Internet Res SP - e17184 VL - 22 IS - 6 KW - type 1 diabetes KW - autism spectrum disorder KW - child KW - blogs KW - social media KW - qualitative research N2 - Background: Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. Objective: This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. Methods: Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child?s most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. Results: For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. Conclusions: Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community. UR - https://www.jmir.org/2020/6/e17184 UR - http://dx.doi.org/10.2196/17184 UR - http://www.ncbi.nlm.nih.gov/pubmed/32217508 ID - info:doi/10.2196/17184 ER - TY - JOUR AU - Mayoral, Karina AU - Rajmil, Luis AU - Murillo, Marta AU - Garin, Olatz AU - Pont, Angels AU - Alonso, Jordi AU - Bel, Joan AU - Perez, Jacobo AU - Corripio, Raquel AU - Carreras, Gemma AU - Herrero, Javier AU - Mengibar, Jose-Maria AU - Rodriguez-Arjona, Dolors AU - Ravens-Sieberer, Ulrike AU - Raat, Hein AU - Serra-Sutton, Vicky AU - Ferrer, Montse PY - 2019/11/12 TI - Measurement Properties of the Online EuroQol-5D-Youth Instrument in Children and Adolescents With Type 1 Diabetes Mellitus: Questionnaire Study JO - J Med Internet Res SP - e14947 VL - 21 IS - 11 KW - health-related quality of life KW - type 1 diabetes KW - EQ-5D-Y KW - EuroQol KW - validity N2 - Background: The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM). Objective: This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online. Methods: Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ?4.5 points, respectively, from the first to the fourth visit. Results: Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were ?having pain/discomfort? (34.6%) and ?worried/sad/unhappy? (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ?15 and >16, respectively) were found in three EQ-5D-Y dimensions (?doing usual activities,? ?having pain/discomfort,? and ?feeling worried/sad/unhappy?), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in ?looking after myself? (P=.005) and according to family function in ?having pain/discomfort? (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001). Conclusions: These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM. UR - http://www.jmir.org/2019/11/e14947/ UR - http://dx.doi.org/10.2196/14947 UR - http://www.ncbi.nlm.nih.gov/pubmed/31714252 ID - info:doi/10.2196/14947 ER - TY - JOUR AU - Thompson, Debbe AU - Callender, Chishinga AU - Gonynor, Caroline AU - Cullen, W. Karen AU - Redondo, J. Maria AU - Butler, Ashley AU - Anderson, J. Barbara PY - 2019/09/13 TI - Using Relational Agents to Promote Family Communication Around Type 1 Diabetes Self-Management in the Diabetes Family Teamwork Online Intervention: Longitudinal Pilot Study JO - J Med Internet Res SP - e15318 VL - 21 IS - 9 KW - adolescents KW - family communication KW - preadolescents KW - relational agent KW - type 1 diabetes N2 - Background: Family conflict can reduce adolescent adherence to type 1 diabetes management tasks. The Family Teamwork in-person intervention was shown to be efficacious in reducing conflict and low adherence to diabetes-related tasks. Its reach and potential impact, however, were limited by the need to deliver the intervention sessions in person. Relational agents (ie, computerized versions of humans) have been shown to appeal to diverse audiences and may be an acceptable replacement for a human in technology-based behavior change interventions. Objective: The purpose of this paper is to present the results of a pilot study assessing feasibility and acceptability of Diabetes Family Teamwork Online, an adapted version of the Family Teamwork intervention, delivered over the internet and guided by a relational agent. Methods: Parent-adolescent dyads were recruited through a diabetes care clinic at a large tertiary care hospital in the southwestern United States. A one-group design, with assessments at baseline, immediate postintervention, and 3 months later, was used to assess feasibility. A priori feasibility criteria included an assessment of recruitment, completion, attrition, program satisfaction, therapeutic alliance, attitudes toward the relational agent, and data collection. The institutional review board at Baylor College of Medicine approved the protocol (H-37245). Results: Twenty-seven adolescents aged 10 to 15 years with type 1 diabetes and their parents were enrolled. Criteria used to assess feasibility were (1) recruitment goals were met (n=20), (2) families completed ?75% of the modules, (3) attrition rate was ?10%, (4) program satisfaction was high (?80% of families), (5) therapeutic alliance was high (average score of ?60/84), (6) families expressed positive attitudes toward the relational agent (average item score of ?5 on ?4 items), (7) ?80% of data were collected at post 1 and post 2, and (8) few technical issues (?10%) occurred during intervention delivery. All feasibility criteria were met. Qualitative data confirmed that adolescents and parents had positive reactions to both the content and approach. Conclusions: The Diabetes Family Teamwork Online intervention proved to be a feasible and acceptable method for enhancing communication around diabetes management tasks in families with an adolescent who has type 1 diabetes. International Registered Report Identifier (IRRID): RR2-10.2196/resprot.5817 UR - https://www.jmir.org/2019/9/e15318/ UR - http://dx.doi.org/10.2196/15318 UR - http://www.ncbi.nlm.nih.gov/pubmed/31538940 ID - info:doi/10.2196/15318 ER - TY - JOUR AU - Albanese-O'Neill, Anastasia AU - Schatz, A. Desmond AU - Thomas, Nicole AU - Bernhardt, M. Jay AU - Cook, L. Christa AU - Haller, J. Michael AU - Bernier, V. Angelina AU - Silverstein, H. Janet AU - Westen, C. Sarah AU - Elder, H. Jennifer PY - 2019/08/06 TI - Designing Online and Mobile Diabetes Education for Fathers of Children With Type 1 Diabetes: Mixed Methods Study JO - JMIR Diabetes SP - e13724 VL - 4 IS - 3 KW - type 1 diabetes KW - mobile health KW - fathers KW - stakeholder participation N2 - Background: Fathers make unique and central contributions to the health of their children. However, research in type 1 diabetes (T1D) education largely ignores the needs of fathers, including during the development of online and mobile educational materials. Objective: The purpose of this study was to solicit and incorporate input from fathers of children with T1D into the design, content, and infrastructure of a suite of online diabetes self-management education and support (DSMES) resources. Methods: The study took part in three phases: (1) exploratory research, (2) website and subdomain development, and (3) evaluation. Fathers of children with T1D (n=30) completed surveys and semistructured qualitative interviews. Thematic content analysis was used to identify fathers? content and design preferences. An online DSMES website (T1DToolkit.org) and a separate mobile subdomain targeting fathers (Mobile Diabetes Advice for Dads, or mDAD) were developed. A prototype of the site for fathers was evaluated by 33 additional father participants. End user feedback was elicited via survey. Results: Participants in the exploratory phase were enthusiastic about the online diabetes resources. Preferences included high-quality design, availability via mobile phone and tablet, brief text content supplemented with multimedia and interactive features, reminders via text or email, endorsement by medical professionals, and links to scientific evidence. The mDAD subdomain received high usability and acceptability ratings, with 100% of participants very likely or likely to use the site again. Conclusions: The development of eHealth educational platforms for fathers of children with T1D remains an unmet need in optimizing diabetes management. This study incorporated fathers? feedback into the development of a suite of online diabetes education resources. The findings will serve as the basis for future research to assess the clinical efficacy of the website, its subdomain targeting fathers, and additional subdomains targeting unique populations. UR - http://diabetes.jmir.org/2019/3/e13724/ UR - http://dx.doi.org/10.2196/13724 UR - http://www.ncbi.nlm.nih.gov/pubmed/31389338 ID - info:doi/10.2196/13724 ER - TY - JOUR AU - Braune, Katarina AU - O'Donnell, Shane AU - Cleal, Bryan AU - Lewis, Dana AU - Tappe, Adrian AU - Willaing, Ingrid AU - Hauck, Bastian AU - Raile, Klemens PY - 2019/07/30 TI - Real-World Use of Do-It-Yourself Artificial Pancreas Systems in Children and Adolescents With Type 1 Diabetes: Online Survey and Analysis of Self-Reported Clinical Outcomes JO - JMIR Mhealth Uhealth SP - e14087 VL - 7 IS - 7 KW - artificial pancreas KW - do it yourself KW - open source KW - mobile health KW - diabetes KW - type 1 diabetes KW - pediatric diabetes KW - closed loop KW - automated insulin delivery N2 - Background: Patient-driven initiatives have made uptake of Do-it-Yourself Artificial Pancreas Systems (DIYAPS) increasingly popular among people with diabetes of all ages. Observational studies have shown improvements in glycemic control and quality of life among adults with diabetes. However, there is a lack of research examining outcomes of children and adolescents with DIYAPS in everyday life and their social context. Objective: This survey assesses the self-reported clinical outcomes of a pediatric population using DIYAPS in the real world. Methods: An online survey was distributed to caregivers to assess the hemoglobin A1c levels and time in range (TIR) before and after DIYAPS initiation and problems during DIYAPS use. Results: A total of 209 caregivers of children from 21 countries responded to the survey. Of the children, 47.4% were female, with a median age of 10 years, and 99.4% had type 1 diabetes, with a median duration of 4.3 years (SD 3.9). The median duration of DIYAPS use was 7.5 (SD 10.0) months. Clinical outcomes improved significantly, including the hemoglobin A1c levels (from 6.91% [SD 0.88%] to 6.27% [SD 0.67]; P<.001) and TIR (from 64.2% [SD 15.94] to 80.68% [SD 9.26]; P<.001). Conclusions: Improved glycemic outcomes were found across all pediatric age groups, including adolescents and very young children. These findings are in line with clinical trial results from commercially developed closed-loop systems. UR - http://mhealth.jmir.org/2019/7/e14087/ UR - http://dx.doi.org/10.2196/14087 UR - http://www.ncbi.nlm.nih.gov/pubmed/31364599 ID - info:doi/10.2196/14087 ER - TY - JOUR AU - Malik, S. Faisal AU - Panlasigui, Neil AU - Gritton, Jesse AU - Gill, Harsimrat AU - Yi-Frazier, P. Joyce AU - Moreno, A. Megan PY - 2019/5/30 TI - Adolescent Perspectives on the Use of Social Media to Support Type 1 Diabetes Management: Focus Group Study JO - J Med Internet Res SP - e12149 VL - 21 IS - 6 KW - type 1 diabetes KW - adolescents KW - social media KW - qualitative research N2 - Background: A majority of adolescents report the use of some form of social media, and many prefer to communicate via social networking sites. Social media may offer new opportunities in diabetes management, particularly in terms of how health care teams provide tailored support and treatment to adolescents with diabetes. Objective: The aim of this study was to explore the experiences and perspectives of adolescents with type 1 diabetes on the feasibility of social media use as a tool to collaboratively manage their diabetes with their diabetes care team. Methods: Focus groups of adolescents with type 1 diabetes were conducted in the Seattle metropolitan area in Washington State. Semistructured questions were used to elicit views around the preferred means of communication with the adolescents? diabetes care team, how to best support diabetes self-management, and how social media could be used outside of the clinic setting by the diabetes care team to engage with adolescents with type 1 diabetes. Focus groups were audio recorded and transcribed verbatim. Qualitative content analysis was carried out, and emergent themes were subsequently mapped onto 4 domains of feasibility, which included acceptability, demand, implementation, and practicality. Results: Participants included 45 adolescents with type 1 diabetes (mean age 15.9, SD 1.7 years; 58% male; diabetes duration mean 6.2, SD 3.6 years; 76% on insulin pumps; 49% wore continuous glucose monitors; 93% reported use of social media; 84% used smartphones as the primary means for social media access). A total of 7 major topics were identified and mapped onto areas consistent with our focus on feasibility. For acceptability and demand, participants expressed how communication over social media could help facilitate (1) improved communication outside of clinic visits to optimize diabetes management, (2) independence in diabetes self-management, (3) connection to other youth with diabetes for additional diabetes support, and (4) delivery of more timely and personalized care. Addressing implementation and practicality, participants shared the need to (1) ensure patient privacy, (2) maintain professional nature of provider-patient relationship, and (3) recognize that social media is not currently used for medical care by youth with diabetes. Conclusions: Adolescents with type 1 diabetes expressed interest in the use of social media as a tool to support diabetes management and increase engagement with their diabetes care team. Specific implementation measures around privacy and professionalism should be considered when developing a social media intervention to facilitate communication between adolescents and care teams. UR - https://www.jmir.org/2019/6/e12149/ UR - http://dx.doi.org/10.2196/12149 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199310 ID - info:doi/10.2196/12149 ER - TY - JOUR AU - Wysocki, Tim AU - Pierce, Jessica AU - Caldwell, Cindy AU - Aroian, Karen AU - Miller, Louis AU - Farless, Rebecca AU - Hafezzadeh, Ivy AU - McAninch, Terri AU - Lee, M. Joyce PY - 2018/12/17 TI - A Web-Based Coping Intervention by and for Parents of Very Young Children With Type 1 Diabetes: User-Centered Design JO - JMIR Diabetes SP - e16 VL - 3 IS - 4 KW - coping KW - mobile phone KW - parenting KW - social media KW - type 1 diabetes N2 - Background: Management of type 1 diabetes (T1D) among children aged <6 years is exceptionally challenging for parents and caregivers. Metabolic and psychosocial outcomes among very young children with T1D (YC-T1D) are tightly associated with their parents? ability to meet these challenges. There is scant research testing interventions targeting these issues and few resources to equip health care providers with feasible and effective coping strategies for these parents. User-centered design (UCD) of a continuously accessible Web-based resource could be a mechanism for helping parents of YC-T1D cope more effectively with the complex challenges they face by providing them with information, solutions, and emotional support. Objective: The objectives of this paper are to (1) describe the application of UCD principles to the development of a Web-based coping intervention designed by and for parents of very young children (<6 years old) with T1D; (2) illustrate the use of crowdsourcing methods in obtaining the perspectives of parents, health care providers, and Web development professionals in designing and creating this resource; and (3) summarize the design of an ongoing randomized controlled trial (RCT) that is evaluating the effects of parental access to this resource on pertinent child and parent outcomes. Methods: This paper illustrates the application of UCD principles to create a Web-based coping resource designed by and for parents of YC-T1D. A Web-based Parent Crowd, a Health Care Provider Crowd, and a Focus Group of minority parents provided input throughout the design process. A formal usability testing session and design webinars yielded additional stakeholder input to further refine the end product. Results: This paper describes the completed website and the ongoing RCT to evaluate the effects of using this Web-based resource on pertinent parent and child outcomes. Conclusions: UCD principles and the targeted application of crowdsourcing methods provided the foundation for the development, construction, and evaluation of a continuously accessible, archived, user-responsive coping resource designed by and for parents of YC-T1D. The process described here could be a template for the development of similar resources for other special populations that are enduring specific medical or psychosocial distress. The ongoing RCT is the final step in the UCD process and is designed to validate its merits. UR - http://diabetes.jmir.org/2018/4/e16/ UR - http://dx.doi.org/10.2196/diabetes.9926 UR - http://www.ncbi.nlm.nih.gov/pubmed/30559089 ID - info:doi/10.2196/diabetes.9926 ER - TY - JOUR AU - Bashi, Nazli AU - Fatehi, Farhad AU - Fallah, Mina AU - Walters, Darren AU - Karunanithi, Mohanraj PY - 2018/10/19 TI - Self-Management Education Through mHealth: Review of Strategies and Structures JO - JMIR Mhealth Uhealth SP - e10771 VL - 6 IS - 10 KW - health education KW - mHealth KW - mobile apps KW - mobile phone KW - patient education KW - self-management education N2 - Background: Despite the plethora of evidence on mHealth interventions for patient education, there is a lack of information regarding their structures and delivery strategies. Objective: This review aimed to investigate the structures and strategies of patient education programs delivered through smartphone apps for people with diverse conditions and illnesses. We also examined the aim of educational interventions in terms of health promotion, disease prevention, and illness management. Methods: We searched PubMed, Cumulative Index to Nursing and Allied Health Literature, Embase, and PsycINFO for peer-reviewed papers that reported patient educational interventions using mobile apps and published from 2006 to 2016. We explored various determinants of educational interventions, including the content, mode of delivery, interactivity with health care providers, theoretical basis, duration, and follow-up. The reporting quality of studies was evaluated according to the mHealth evidence and reporting assessment criteria. Results: In this study, 15 papers met the inclusion criteria and were reviewed. The studies mainly focused on the use of mHealth educational interventions for chronic disease management, and the main format for delivering interventions was text. Of the 15 studies, 6 were randomized controlled trials (RCTs), which have shown statistically significant effects on patients? health outcomes, including patients? engagement level, hemoglobin A1c, weight loss, and depression. Although the results of RCTs were mostly positive, we were unable to identify any specific effective structure and strategy for mHealth educational interventions owing to the poor reporting quality and heterogeneity of the interventions. Conclusions: Evidence on mHealth interventions for patient education published in peer-reviewed journals demonstrates that current reporting on essential mHealth criteria is insufficient for assessing, understanding, and replicating mHealth interventions. There is a lack of theory or conceptual framework for the development of mHealth interventions for patient education. Therefore, further research is required to determine the optimal structure, strategies, and delivery methods of mHealth educational interventions. UR - https://mhealth.jmir.org/2018/10/e10771/ UR - http://dx.doi.org/10.2196/10771 UR - http://www.ncbi.nlm.nih.gov/pubmed/30341042 ID - info:doi/10.2196/10771 ER - TY - JOUR AU - Bernier, Angelina AU - Fedele, David AU - Guo, Yi AU - Chavez, Sarah AU - Smith, D. Megan AU - Warnick, Jennifer AU - Lieberman, Leora AU - Modave, François PY - 2018/06/06 TI - New-Onset Diabetes Educator to Educate Children and Their Caregivers About Diabetes at the Time of Diagnosis: Usability Study JO - JMIR Diabetes SP - e10 VL - 3 IS - 2 KW - mHealth KW - information technology KW - diabetes education KW - pediatrics N2 - Background: Diabetes self-management education is essential at the time of diagnosis. We developed the New-Onset Diabetes Educator (NODE), an animation-based educational web application for type 1 diabetes mellitus patients. Objective: Our hypothesis is that NODE is a feasible, effective and user-friendly intervention in improving diabetes self-management education delivery to child/caregiver-dyads at the time of diagnosis. Methods: We used a pragmatic parallel randomized trial design. Dyads were recruited within 48 hours of diagnosis and randomized into a NODE-enhanced diabetes self-management education or a standard diabetes self-management education group. Dyads randomized in the NODE group received the intervention on an iPad before receiving the standard diabetes self-management education with a nurse educator. The Diabetes Knowledge Test 2 assessed disease-specific knowledge pre- and postintervention in both groups, and was compared using t tests. Usability of the NODE mobile health intervention was assessed in the NODE group. Results: We recruited 16 dyads (mean child age 10.75, SD 3.44). Mean Diabetes Knowledge Test 2 scores were 14.25 (SD 4.17) and 18.13 (SD 2.17) pre- and postintervention in the NODE group, and 15.50 (SD 2.67) and 17.38 (SD 2.26) in the standard diabetes self-management education group. The effect size was medium (?=0.56). Usability ratings of NODE were excellent. Conclusions: NODE is a feasible mobile health strategy for type 1 diabetes education. It has the potential to be an effective and scalable tool to enhance diabetes self-management education at time of diagnosis, and consequently, could lead to improved long-term clinical outcomes for patients living with the disease. UR - http://diabetes.jmir.org/2018/2/e10/ UR - http://dx.doi.org/10.2196/diabetes.9202 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291069 ID - info:doi/10.2196/diabetes.9202 ER - TY - JOUR AU - Hannon, S. Tamara AU - Moore, M. Courtney AU - Cheng, R. Erika AU - Lynch, O. Dustin AU - Yazel-Smith, G. Lisa AU - Claxton, EM Gina AU - Carroll, E. Aaron AU - Wiehe, E. Sarah PY - 2018/05/10 TI - Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test JO - J Participat Med SP - e8 VL - 10 IS - 2 KW - adolescent health services KW - patient-centered care KW - research design KW - diabetes mellitus, type 1 KW - self-management N2 - Background: Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents? thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective: The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods: The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution?s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results: Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions: Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus. UR - http://jopm.jmir.org/2018/2/e8/ UR - http://dx.doi.org/10.2196/jopm.9652 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/jopm.9652 ER - TY - JOUR AU - Brazeau, Anne-Sophie AU - Nakhla, Meranda AU - Wright, Michael AU - Henderson, Mélanie AU - Panagiotopoulos, Constadina AU - Pacaud, Daniele AU - Kearns, Patricia AU - Rahme, Elham AU - Da Costa, Deborah AU - Dasgupta, Kaberi PY - 2018/04/20 TI - Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study JO - J Med Internet Res SP - e151 VL - 20 IS - 4 KW - type 1 diabetes KW - youth KW - young adult KW - social stigma KW - perception KW - glycated hemoglobin A1c N2 - Background: Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. Objective: The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. Methods: Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA1c) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA1c>9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ?1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). Results: Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA1c>9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). Conclusions: There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. Trial Registration: ClinicalTrials.gov NCT02796248; http://clinicaltrials.gov/ct2/show/NCT02796248 (Archived by WebCite at http://www.webcitation.org/6yisxeV0B) UR - http://www.jmir.org/2018/4/e151/ UR - http://dx.doi.org/10.2196/jmir.9432 UR - http://www.ncbi.nlm.nih.gov/pubmed/29678801 ID - info:doi/10.2196/jmir.9432 ER - TY - JOUR AU - Husted, Reventlov Gitte AU - Weis, Janne AU - Teilmann, Grete AU - Castensøe-Seidenfaden, Pernille PY - 2018/02/28 TI - Exploring the Influence of a Smartphone App (Young with Diabetes) on Young People?s Self-Management: Qualitative Study JO - JMIR Mhealth Uhealth SP - e43 VL - 6 IS - 2 KW - mHealth KW - diabetes mellitus, type 1 KW - youth KW - self-management KW - qualitative research N2 - Background: Adequate self-management is the cornerstone of preventing type 1 diabetes mellitus (T1DM) complications. However, T1DM self-management is challenging for young people, who often struggle during the transition from childhood to adulthood. The mobile health (mHealth) app Young with Diabetes (YWD) was developed in collaboration with young people to enhance their T1DM self-management during this transition. Objective: The purpose of this study was to explore the influence of YWD on young people?s self-management during a 12-month period. Methods: A qualitative explorative approach was used, comprising a purposive sample of 20 young people (11 females and 9 males, ages 15 to 23 years, with app use of 3 to 64 days) from 3 pediatric and 3 adult departments. Participants were interviewed individually using a semistructured interview guide. Data were collected from January to March 2017 and analyzed using thematic analysis. Results: A total of 5 themes were identified: (1) not feeling alone anymore (?we are in this together?); (2) gaining competence by sharing experiences and practical knowledge (?they know what they are talking about?); (3) feeling safer (?it?s just a click away?); (4) breaking the ice by starting to share thoughts and feelings and asking for help (?it is an outstretched hand?); and (5) lack of motivating factors (?done with the app?). Young people reported that YWD promoted self-management by peer-to-peer social support, exchanging messages with health care providers, and sharing YWD with parents. Participants recommended YWD as a supplement to self-management for newly diagnosed young people with T1DM and suggested improvements in app content and functionality. Conclusions: The mHealth app YWD has the potential to support self-management. In particular, peer-to-peer support reduced feelings of loneliness and helped young people to gain knowledge and skills for managing T1DM. A need exists for alternative ways to train health care providers in using YWD and to support collaboration between young people and their parents to further improve young people?s self-management of T1DM. UR - http://mhealth.jmir.org/2018/2/e43/ UR - http://dx.doi.org/10.2196/mhealth.8876 UR - http://www.ncbi.nlm.nih.gov/pubmed/29490897 ID - info:doi/10.2196/mhealth.8876 ER - TY - JOUR AU - Bellfield, J. Edward AU - Sharp, K. Lisa AU - Xia, Yinglin AU - Gerber, S. Ben PY - 2018/02/07 TI - Use of a Mobile App to Facilitate Blood Glucose Monitoring in Adolescents With Type 1 Diabetes: Single-Subject Nonrandomized Clinical Trial JO - JMIR Diabetes SP - e3 VL - 3 IS - 1 KW - type 1 diabetes KW - adolescence KW - mobile health KW - mHealth KW - mobile phone N2 - Background: Cloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D). Objective: The purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency. Methods: We used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0%-10.7%, self-monitoring behavior of ?5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate. Results: For mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=?.47, P<.001). Although all participants had positive opinions about the app, its utilization was highly variable. Conclusions: We demonstrated modest feasibility of adolescents with uncontrolled T1D utilizing a glucose monitoring mobile app. Further study is needed to better determine its effects on BG level and monitoring frequency. Psychosocial factors and motivational barriers likely influence adoption and continuous use of technology for diabetes management. UR - http://diabetes.jmir.org/2018/1/e3/ UR - http://dx.doi.org/10.2196/diabetes.8357 UR - http://www.ncbi.nlm.nih.gov/pubmed/30291085 ID - info:doi/10.2196/diabetes.8357 ER - TY - JOUR UR - ID - ref1 ER - TY - JOUR AU - Holtz, E. Bree AU - Murray, M. Katharine AU - Hershey, D. Denise AU - Dunneback, K. Julie AU - Cotten, R. Shelia AU - Holmstrom, J. Amanda AU - Vyas, Arpita AU - Kaiser, K. Molly AU - Wood, A. Michael PY - 2017/04/19 TI - Developing a Patient-Centered mHealth App: A Tool for Adolescents With Type 1 Diabetes and Their Parents JO - JMIR Mhealth Uhealth SP - e53 VL - 5 IS - 4 KW - mHealth KW - qualitative research KW - type 1 diabetes KW - family N2 - Background: Type 1 diabetes (T1D) afflicts approximately 154,000 people under 20 years of age. Three-quarters of adolescents are not achieving glycosylated hemoglobin (HbA1c) targets, which leads to negative health outcomes. Mobile health (mHealth), the use of technology in health, has been used successfully to improve health in many chronic conditions, including diabetes. Objective: The purpose of this study was to use patient-centered research methods to inform and improve the design and functionality of our T1D app, MyT1DHero, and to provide insight for others who are designing a health app for adolescents and parents. Methods: This study included data from focus groups with participants recruited from the Juvenile Diabetes Research Foundation (JDRF) southeast Michigan?s family network. All data collected during the sessions were audio-recorded, transcribed, and coded. Results: Four key themes were identified: (1) diabetes is unpredictable, (2) negative and frustrated communication, (3) motivations to use an app, and (4) feedback specific to our app. Conclusions: A patient-centered approach was used to assist in the development of an app for adolescents with T1D. Participants were satisfied with overall app design; customization, interactivity, and tangible rewards were identified as being necessary for continued use. Participants believed the app would help improve the communication between parents and adolescents. Many apps developed in the health context have not used a patient-centered design method or have seen vast improvements in health. This paper offers suggestions to others seeking to develop apps for adolescents and their parents. UR - http://mhealth.jmir.org/2017/4/e53/ UR - http://dx.doi.org/10.2196/mhealth.6654 UR - http://www.ncbi.nlm.nih.gov/pubmed/28428167 ID - info:doi/10.2196/mhealth.6654 ER - TY - JOUR AU - Vaala, E. Sarah AU - Hood, K. Korey AU - Laffel, Lori AU - Kumah-Crystal, A. Yaa AU - Lybarger, K. Cindy AU - Mulvaney, A. Shelagh PY - 2015/12/29 TI - Use of Commonly Available Technologies for Diabetes Information and Self-Management Among Adolescents With Type 1 Diabetes and Their Parents: A Web-Based Survey Study JO - Interact J Med Res SP - e24 VL - 4 IS - 4 KW - diabetes mellitus, Type 1 KW - adolescent KW - technology KW - adoption KW - self-management KW - self-care N2 - Background: For individuals with Type 1 diabetes (T1D), following a complicated daily medical regimen is critical to maintaining optimal health. Adolescents in particular struggle with regimen adherence. Commonly available technologies (eg, diabetes websites, apps) can provide diabetes-related support, yet little is known about how many adolescents with T1D use them, why they are used, or relationships between use and self-management. Objective: This study examined adolescent and parent use of 5 commonly available technologies for diabetes, including proportions who use each technology, frequency of use, and number of different technologies used for diabetes. Analyses also investigated the reasons adolescents reported for using or not using technologies for diabetes, and factors correlated with adolescents? technology use. Finally, this study examined relationships between the type and number of technologies adolescents use for diabetes and their self-management and glycemic control. Methods: Adolescents (12-17 years) and their parents (N=174 pairs), recruited from a pediatric diabetes clinic (n=134) and the Children with Diabetes community website (n=40), participated in this Web-based survey study. Glycosylated hemoglobin (A1C) values were obtained from medical records for pediatric clinic patients. Adolescents reported their use of 5 commonly available technologies for diabetes (ie, social networking, diabetes websites, mobile diabetes apps, text messaging, and glucometer/insulin pump software), reasons for use, and self-management behavior (Self-Care Inventory-Revised, SCI-R). Results: Most adolescents and parents used at least one of the 5 technologies for diabetes. Among adolescents, the most commonly used technology for diabetes was text messaging (53%), and the least commonly used was diabetes websites (25%). Most adolescents who used diabetes apps, text messaging, or pump/glucometer software did so more frequently (?2 times per week), compared to social networking and website use (?1 time per week). The demographic, clinical, and parent-technology use factors related to adolescents? technology use varied by technology. Adolescents who used social networking, websites, or pump/glucometer software for diabetes had better self-management behavior (SCI-R scores: beta=.18, P=.02; beta=.15, P=.046; beta=.15, P=.04, respectively), as did those who used several technologies for diabetes (beta=.23, P=.003). However, use of diabetes websites was related to poorer glycemic control (A1C: beta=.18, P=.01). Conclusions: Adolescents with T1D may be drawn to different technologies for different purposes, as individual technologies likely offer differing forms of support for diabetes self-management (eg, tracking blood glucose or aiding problem solving). Findings suggest that technologies that are especially useful for adolescents? diabetes problem solving may be particularly beneficial for their self-management. Additional research should examine relationships between the nature of technology use and adolescents? T1D self-management over time. UR - http://www.i-jmr.org/2015/4/e24/ UR - http://dx.doi.org/10.2196/ijmr.4504 UR - http://www.ncbi.nlm.nih.gov/pubmed/26715191 ID - info:doi/10.2196/ijmr.4504 ER -