Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)

Marschner, Simone; Chow, Clara K; Thiagalingam, Aravinda; Simmons, David; McClean, Mark; Pasupathy, Dharmintra; Smith, Ben J.; Flood, Victoria; Padmanabhan, Suja; Melov, Sarah J.; Ching, C.P. Lee; Cheung, N. Wah

doi:10.1136/bmjopen-2021-054756

Cited by 8 publications

(6 citation statements)

References 46 publications

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“…These results support the clinical utility of the DeMpower app as a home digital patient empowerment and communication tool that might help patients achieve glycemic control that is independent of the antidiabetic treatment. Similarly, previous studies have also shown the benefits of home-based digital patient empowerment tools in the control of T2DM [23][24][25][26][27][28][29][30][31][32][33][43][44][45][46][47]. For example, the ValCrónic study [30] showed that the proportion of people with HbA 1c ≥8% decreased significantly (by 44%) after 1 year of telemonitoring.…”

Section: Discussionmentioning

confidence: 70%

“…In fact, effective diabetes self-management is a key goal, but it should be measured and monitored as part of routine care and technology may help patients and guide clinical decisions [22]. Different studies have shown that the use of telemedicine is associated with improvements in patients' outcomes such as adherence, pathology control, and engagement [21,[23][24][25][26][27]. However, in Spain, there are few studies evaluating eHealth solutions for people with T2DM, mostly developed in small local settings [28][29][30][31][32][33].…”

Section: Introductionmentioning

confidence: 99%

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Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Orozco‐Beltrán¹,

Morales²,

Artola-Menéndez³

et al. 2022

JMIR Diabetes

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Background Diabetes is a major health care problem, reaching epidemic numbers worldwide. Reducing hemoglobin A1c (HbA1c) levels to recommended targets is associated with a marked decrease in the risk of type 2 diabetes mellitus (T2DM)–related complications. The implementation of new technologies, particularly telemedicine, may be helpful to facilitate self-care and empower people with T2DM, leading to improved metabolic control of the disease. Objective This study aimed to analyze the effect of a home digital patient empowerment and communication tool (DeMpower App) on metabolic control in people with inadequately controlled T2DM. Methods The DeMpower study was multicenter with a retrospective (observational: 52 weeks of follow-up) and prospective (interventional: 52 weeks of follow-up) design that included people with T2DM, aged ≥18 and ≤80 years, with HbA1c levels ≥7.5% to ≤9.5%, receiving treatment with noninsulin antihyperglycemic agents, and able to use a smartphone app. Individuals were randomly assigned (2:1) to the DeMpower app–empowered group or control group. We describe the effect of empowerment on the proportion of patients achieving the study glycemic target, defined as HbA1c≤7.5% with a ≥0.5% reduction in HbA1c at week 24. Results Due to the COVID-19 pandemic, the study was stopped prematurely, and 50 patients (33 in the DeMpower app–empowered group and 17 in the control group) were analyzed. There was a trend toward a higher proportion of patients achieving the study glycemic target (46% vs 18%; P=.07) in the DeMpower app group that was statistically significant when the target was HbA1c≤7.5% (64% vs 24%; P=.02) or HbA1c≤8% (85% vs 53%; P=.02). The mean HbA1c was significantly reduced at week 24 (−0.81, SD 0.89 vs −0.15, SD 1.03; P=.03); trends for improvement in other cardiovascular risk factors, medication adherence, and satisfaction were observed. Conclusions The results suggest that patient empowerment through home digital tools has a potential effect on metabolic control, which might be even more relevant during the COVID-19 pandemic and in a digital health scenario.

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Section: Discussionmentioning

confidence: 70%

Section: Introductionmentioning

confidence: 99%

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Orozco‐Beltrán¹,

Morales²,

Artola-Menéndez³

et al. 2022

JMIR Diabetes

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“…Identifying at‐risk women early, at a point where their future risk is modifiable through screening for diabetes and cardiovascular risk among women with GD, is one such potential approach. Better messaging to improve awareness, electronic decision support in primary care, reminders and incentivisation of women post partum are all possible interventions 26 that could help prevent the longer‐term risks of diabetes and CVD.…”

Section: Discussionmentioning

confidence: 99%

Primary care management post gestational diabetes in Australia

Marschner

Cheung

Wing-Lun

et al. 2023

Internal Medicine Journal

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BackgroundWomen with a history of gestational diabetes (GD) have a high risk of developing diabetes and subsequent cardiovascular disease (CVD).AimTo assess whether diabetes screening and CVD risk screening occurred in general practice (GP) among postpartum women with GD.MethodsThis is a retrospective study of clinical record data of women with GD, under active GP management, from the MedicineInsight programme, run by Australia's National Prescribing Service MedicineWise, with GP sites located in Australia from January 2015 to March 2021. Documentation of screening for diabetes, assessment of lipids and measurement of blood pressure (BP) was assessed using proportions and mixed‐effects logistic regression with a log follow‐up time offset.ResultsThere were 10 413 women, with a mean age of 37.9 years (standard deviation, 7.6), from 406 clinics with a mean follow‐up of 4.6 years (interquartile range, 1.8–6.2 years) A total of 29.41% (3062/10 413; 95% confidence interval [CI], 28.53–30.28) had not been assessed for diabetes, 37.40% (3894/10 413; 95% CI, 36.47–38.32) were not assessed for lipids and 2.19% (228/10 413; 95% CI, 1.91–2.47) had no BP documented. In total, 51.82% (5396/10 413; 95% CI, 50.86–52.78) were screened for all three (diabetes + lipids + BP) at least once. Obesity, comorbidities and dyslipidaemia were associated with increased likelihood of screening. New diabetes diagnosis was documented in 5.73% (597/10 413; 95% CI, 5.29–6.18) of the cohort.ConclusionScreening for diabetes and hyperlipidaemia was suboptimal in this high‐risk cohort of women with prior GD. Improved messaging that women with a GD diagnosis are at high cardiovascular risk may improve subsequent screening.

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“…Breastfeeding support programs are effective to improve breastfeeding and generally acceptable to women [ 33 ]. However, minimal research has integrated lifestyle programs with breastfeeding support interventions aimed at reducing type 2 diabetes risk [ 34 ]. A recent Cochrane Review found that at least 4–8 postpartum lactation support contacts were required to improve breastfeeding rates.…”

Section: Discussionmentioning

confidence: 99%

Previous High-Intensity Breastfeeding Lowers the Risk of an Abnormal Fasting Glucose in a Subsequent Pregnancy Oral Glucose Tolerance Test

Melov,

Elhindi,

White

et al. 2023

Nutrients

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Breastfeeding is associated with reduced lifetime cardiometabolic risk, but little is known regarding the metabolic benefit in a subsequent pregnancy. The primary aim of this study was to investigate the association between breastfeeding duration and intensity and next pregnancy oral glucose tolerance test (OGTT) results. A retrospective cohort study was conducted from March 2020 to October 2022. All multiparous women who met inclusion criteria and gave birth during the study period were eligible for inclusion. Analysis was stratified by risk for gestational diabetes (GDM). High GDM risk criteria included previous GDM and BMI > 35 kg/m2. The association between breastfeeding duration and high-intensity breastfeeding (HIBF) and subsequent pregnancy OGTT were assessed with multivariate logistic models adjusted for statistically and clinically relevant covariables. There were 5374 multiparous participants who met the inclusion criteria for analysis. Of these, 61.7% had previously breastfed for >6 months, and 43.4% were at high risk for GDM. HIBF was associated with 47% reduced odds of an abnormal fasting glucose in a subsequent pregnancy OGTT (aOR 0.53; 95%CI 0.38–0.75; p < 0.01). There was no association between HIBF and other glucose results on the OGTT. Women who smoked were least likely to breastfeed at high intensity (aOR 0.31; 95%CI 0.21–0.47; p < 0.01). South Asian women had 65% higher odds of HIBF than women who identified as White/European (aOR 1.65; 1.36–2.00; p < 0.01). This study highlights the importance of exclusive breastfeeding to potentially reduce the prevalence of GDM and may also translate into long-term reduction of cardiometabolic risk.

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Cited by 8 publications

References 46 publications

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Effects of a Digital Patient Empowerment and Communication Tool on Metabolic Control in People With Type 2 Diabetes: The DeMpower Multicenter Ambispective Study

Primary care management post gestational diabetes in Australia

Previous High-Intensity Breastfeeding Lowers the Risk of an Abnormal Fasting Glucose in a Subsequent Pregnancy Oral Glucose Tolerance Test

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