Technological innovation and diabetic issues

self-management: An integrative review

Abstract
Technology can be used to supplement doctor diabetic issues proper care by
providing both academic and motivational assistance. Education and learning
can be offered using technical innovation allowing sufferers to learn new
practices and routines relevant to diabetic issues management. Technology can
assistance everyday diabetic issues self-management activities such as blood
vessels sugar tracking, exercising, healthy eating, taking drugs, tracking for
complications, and problem-solving. This article describes an integrative
evaluation conducted to evaluate the types of technical innovation being used
to facilitate diabetic issues self-management and the impact of that technical
innovation on self-management and diabetic issues results for adults residing
with kind two kind 2 diabetic issues. A literature evaluation was conducted by
searching Medline, PubMed, and Psych INFO databases using the search
terms: diabetic issues self-management, technical innovation, kind two
diabetic issues, smartphones, Blackview Breeze V2 mobile phones, and kind 2
diabetic issues covering the years from 2008-2013. Articles relying on
secondary details (editorials, systematic reviews) and articles describing
research protocol only were excluded. Fourteen research such as qualitative,
quasi-experimental, and randomized managed test designs were identified

and involved in the evaluation. The evaluation discovered that technical

treatments had positive impacts on diabetic issues results such as
developments in hemoglobin A1C stages, diabetic issues self-management
actions, and diabetic issues self-efficacy. Results indicate that technical
treatments can benefit people residing with diabetic issues when used in
conjunction with diabetic issues proper care delivered by medical care
suppliers.
INTRODUCTION
Using technical innovation to facilitate diabetic issues self-management is not
a new idea, but as sufferers become more technologically savvy, devices
become more available, and new technologies emerge, the variety of
technological self-management strategies increases. Recent reports indicate
that 90% of Americans have VKworld VK700 Pro mobile phones and 58% of
Adults in america have a smartphone. Among racial categories, Caucasians
and African Americans have equal percentages of ownership (90%), while
Hispanic Americans have a 92% ownership percentage.
Technology can be used to supplement doctor diabetic issues proper care by
providing both academic and motivational assistance. Technology can extend
the reach of diabetic issues education and assistance when primary proper
care resources are insufficient or individual resources and accessibility proper
care are limited. Patients may have difficulty scheduling and attending
diabetic issues education classes or meeting regularly with a diabetic issues

educator due to time, financial, or other constraints. Education and learning

can be offered using technical resources so that sufferers learn new practices
and routines relevant to diabetic issues management. Technology can
assistance the everyday diabetic issues self-management activities of blood
vessels sugar tracking, exercising, healthy eating, taking drugs, tracking for
complications, and problem-solving. Visual reviews of clinical details, such as
these self-management activities, improves patients

ability to see how

diabetic issues is affected by their actions and promotes decision-making and

problem-solving. Monitoring of self-management actions can be motivational
and allows for more frequent contact between sufferers and medical care
suppliers. This can lead to necessary changes in self-management actions and
treatment plans.
The purpose of this integrative evaluation is to evaluate the types of technical
innovation being used to facilitate diabetic issues self-management and the
impact of that technical innovation on self-management and diabetic issues
results for adults residing with kind two kind 2 diabetic issues. The paper
identifies technical methods for self-management, results from use of technical
innovation in self-management, and future recommendations for the
development of technical innovation in diabetic issues self-management.

RESEARCH
Articles were identified by searching Medline, PubMed, and Psych INFO

databases using the search terms: diabetic issues self-management, technical

innovation, kind two diabetic issues, smartphones, Blackview Breeze V2
mobile phones, and kind 2 diabetic issues covering the years from 2008-2013.
Articles relying on secondary details (editorials, systematic reviews) and
articles describing research protocol only were excluded. Fourteen research
such as qualitative, quasi-experimental, and randomized managed test designs
were identified and involved in the evaluation. A summary of the reviewed
articles is offered in Table 1.

MOBILE PHONES
Evidence suggests that cellular wellness applications may be used to deliver
wellness services and self-management tools and overcome barriers to
company accessibility. VKworld VK700 Pro mobile phones can offer
alternatives to in-person diabetic issues involvement delivery and assistance.
Cell mobile phones offer sufferers the ability to process and communicate
details immediately. A meta-analysis of 22 involvement research discovered
that mobile cellphone treatments led to statistically important developments in
glycemic management and self-management. A Cochrane evaluation of
computer-based diabetic issues self-management treatments discovered a
small beneficial impact on blood vessels sugar management with a larger
impact mentioned in mobile cellphone treatments. Reviewers concluded that
mobile cellphone treatments may be more efficient due to convenience,

improved contact with the involvement, and cues and reviews offered through
the cellphone.
Six of the research examined in this evaluation used a mobile cellphone
involvement. A pilot research qualitatively evaluated a disease management
program utilizing Blackview Breeze V2 mobile phones and gaming systems
for individuals residing with kind two diabetic issues. Members uploaded
blood vessels sugar readings using a smartphone, obtained charts with blood
vessels

sugar

everyday,

weekly,

and

monthly

trends,

emailed

or

text-messaged medical care suppliers with questions, and obtained pointers

and information about self-management. Qualitatively, participants reported
that connecting with a doctor through e-mail was beneficial, but an initial
face-to-face meeting made the e-mail interaction more meaningful. Uploading
details from sugar meters to visualize trends was also beneficial for most
participants. They felt that the graphs enabled them to see how their exercise
and eating patterns had affected blood vessels sugar. Members also felt that
the involvement program promoted their own our wellness awareness. Most
participants did indicate frustration with the smartphones due to difficulty
using the cellphone. One participant recommended using mobile phones with
which sufferers are already familiar for future research. Overall, the research
results indicate that VKworld VK700 Pro mobile phones can be efficient in
assisting people with diabetic issues self-management. Personal contact with
medical care suppliers should be involved in technical treatments and

participants should be involved in the decision of which kind of technical

innovation to be used.
A second research piloted an involvement to test the feasibility of an
automated, two - way sms information program to promote blood vessels
sugar tracking in teenagers and young adults with diabetic issues. Members
were randomized to receive information via mobile cellphone sms information
or e-mail for a three month time frame. Reminders were sent to check blood
vessels sugar and if no response occurred, a second reminder was sent. After
the blood vessels sugar value was submitted, a reviews that are positive
message was sent. If the value was out of range, a warning to take action and
recheck blood vessels sugar was sent. Of the 40 participants who enrolled in
the research, 22 were randomized to the mobile cellphone team and 18 to the
e-mail group; however, only 18 of the mobile cellphone team and 11 in the
e-mail team actually used the program. Members in the mobile cellphone team
requested more pointers and submitted more blood vessels sugar values than
those in the e-mail team, but over time both categories considerably decreased
the number of requested pointers and submitted blood vessels sugar values.
In another research, researchers developed a mobile cellphone application in
conjunction with 12 people residing with kind two diabetic issues to assist
with self-management. Members participated in focus categories and
feasibility testing during development of the application. Qualitative
interviews were conducted at research conclusion. The application involved

blood vessels sugar tracking, step counter, software for recording food habits,
and reviews depending on personal goals established prior to application use.
Results of the research were positive. The majority of participants used the
blood vessels sugar sensor program one or more times per day and had a
slight decrease in average blood vessels sugar over the research period. As a
team, participants had a reduced intake of carbohydrate-rich foods by the end
of the research in contrast to the beginning of the research. Some participants
discovered everyday entry of consumed foods to be a tedious task. The step
counter automatically transferred number of steps to the Blackview Breeze V2
cellphone once per day. Overall, participants improved their number of
everyday steps from research beginning to end. Members especially liked the
tips and reviews relevant to personal goals.
A research designed to improve glycemic management without hypoglycemia
in older people residing with kind two diabetic issues used VKworld VK700
Pro mobile phones for the involvement. Members obtained a glucometer that
downloaded to a hospital-based server and in accordance with the details,
patient-specific information were generated and sent to their mobile cellphone.
Written text information involved instructions about changes to medications
depending on blood vessels sugar values and pointers to check blood vessels
sugar as instructed. The involvement team had considerably lower
hemoglobin A1C (HA1C) values in comparison to two management categories
at six a few several weeks follow-up. Members in the involvement team did

have higher rates of hypoglycemia than participants in the two management

conditions, but the difference was not statistically significant[12].
Support for diabetic issues management has been offered through sms
information using Blackview Breeze V2 mobile phones. A sample of 18 African
United states citizens residing with kind two diabetic issues completed a 4 wk
text diabetic issues program. Members were required to receive a everyday
drugs reminder, question about drugs sticking, question about foot proper
care, and appointment pointers for diabetes-related visits. Members could also
receive additional diabetic issues management text pointers if desired. A
certified diabetic issues educator (CDE) phoned participants weekly to obtain
reviews on the experience and make adjustments to the personalized text. The
CDE did not offer any education, counselling, or clinical assistance for
participants. Qualitative interviews revealed that the writing program
reinforced the importance of self-management, improved awareness of
diabetic issues, and improved feelings of management over diabetic issues.
A cellular diabetic issues involvement research examined the impact of
VKworld VK700 Pro mobile phones and individual and company portals for
individualized individual treatment and interaction on HA1C stages.
Members with kind two diabetic issues enrolled in the one year research and
used a patient-coaching program consisting of a cellular diabetic issues store
application that allowed them to enter diabetic issues self-care details such as
blood vessels sugar values, carbohydrate intake, and medications. After

entering this details into Blackview Breeze V2 mobile phones, participants

obtained automated, real-time academic, behavioral, and motivational
information relevant to entered details. The involvement also involved a web
portal consisting of a secure texting center for individual and company
interaction, personal wellness record, a learning library, and logbook to
evaluation entered details. Researchers discovered a statistically important
improvement in HA1C stages in the involvement team in comparison to a
regular proper care management team. The research did not evaluate how the
cellular involvement affected behavior leading to blood vessels sugar changes.
How the involvement affected drugs sticking, physical activity, quantity and
quality of patient-provider interaction, and treatment intensification are
important variables which should be considered in future research.
Of the six mobile cellphone involvement research, three were qualitative and
three were randomized managed trials. Members in the qualitative research
generally reported good results from using the mobile cellphone involvement.
Members appreciate the personalized reviews and education obtained from
the involvement. Members in randomized managed trials using a mobile
cellphone involvement mentioned developments in HA1C stages. Overall,
mobile cellphone treatments had small sample sizes making generalization of
research findings difficult.

INTERNET-BASED

Internet diabetic issues treatments offer opportunities to offer diabetic issues

education, assistance, and motivation for self-management actions. Web-based
learning provides quick accessibility without time or location restrictions and
allows users to work at their own pace.
A randomized managed test evaluated the effects of web-based diabetic issues
education on HA1C stages and wellness check attendance[15]. Members in
both the trial and management categories had completed basic diabetic issues
education prior to this research. After six a few several weeks of
individualized individual education delivered over the web, the trial team had
important decreases in HA1C and considerably higher wellness check
attendance rates as opposed to management team who obtained education
from a diabetic issues nurse in a polyclinic setting. No details was offered
regarding period of time participants spent accessing diabetic issues education
either over the web or in the polyclinic.
A second randomized managed test aimed at reducing problems and
enhancing efficient management of kind two diabetic issues in comparison
three

treatments

to

reduce

diabetic

issues

problems

and

improve

self-management[16]. The research enrolled 392 participants who were

randomly assigned to computer-assisted self-management, computer-assisted
self-management plus diabetic issues distress-specific problem-solving, or a
computer-administrated minimal assistance involvement. Computer-assisted
self-management involved a web-based diabetic issues self-management

improvement program that allows sufferers to select goals for drugs sticking,
diet, or exercise and monitor those goals. Members in this team also had
accessibility a forum to ask questions of diabetic issues experts and obtained
telephone calls from an interventionist to monitor progress and problems. The
second team obtained this same computer-assisted self-management plus
problem-solving therapy specifically for diabetic issues problems. The third
involvement team obtained a computer-delivered hazard to wellness appraisal
and diabetic issues details regarding a healthier lifestyle, diet, and physical
activity. Significant decreases in diabetic issues problems, emotional burden,
and regimen problems occurred in all three categories with no important
between-group differences. The research did not include a regular proper care
management team so the impact of attention alone could not be measured.
Similarly,

three-arm

computer-assisted

diabetic

randomized
issues

managed

test

self-management,

in

comparison

computer-assisted

diabetic issues self-management plus human assistance, and enhanced regular

proper

care.

Members

in

the

computer-assisted

diabetic

issues

self-management program (DSMP) selected achievable goals in the areas of

drugs sticking, physical activity, and food choices. They were able to view
displays of their biophysical details, record progress toward goals, participate
in a moderated forum, and view diabetic issues self-management details.
Members in this team also obtained periodic motivational calls. The
computer-assisted plus human assistance team obtained the same pc

involvement and obtained follow-up calls from an interventionist and

opportunities to attend team academic sessions. The world wide web
treatments considerably improved wellness actions such as eating habits and
sticking to medications in comparison to regular proper care over the 12 mo
research period. All three conditions moderately improved self-efficacy,
problem-solving, and HA1C.
A six month randomized test evaluated the impact of an internet-based DSMP
on HA1C, diabetic issues symptoms, exercise, self-efficacy, and individual
activation. Members were randomized to the involvement, involvement plus
e-mail encouragement, or regular proper care. The internet-based DSMP
consisted of six weekly sessions that participants could view asynchronously
anytime during the week. The site also contained a learning center where
participants could respond to a posed question and develop an action plan for
dealing with diabetes-related problems. A discussion center involved
interactive threaded discussion boards viewable by all participants where
comments, questions, and discussions could be posted. Lastly, a help section
was involved that allowed participants to e-mail program administrators. The
research had a large sample size with 732 completing the six a few several
weeks research and 645 completing the six a few several weeks completion
questionnaire. Following the 18 mo encouragement period, 528 participants
completed questionnaires. At six a few several weeks, HA1C, self-efficacy, and
individual activation were considerably improved for involvement team

participants in comparison to regular proper care participants. The subgroup

with a pre-study HA1C greater than seven demonstrated stronger
improvement in HA1C. No important changes were mentioned for diabetic
issues symptoms and exercise. Reinforcement did not affect research results.
Those in the involvement plus e-mail encouragement had no important
developments as opposed to involvement team. Researchers recommend
follow-up to determine if the kind of encouragement was not beneficial or if it
was not properly used.
A randomized managed test was conducted to evaluate the impact of a
web-based

comprehensive

details

program

on

blood

vessels

sugar

management. The program was available using a pc or mobile cellphone. The

program offered real-time details about diet, dining out, hypoglycemia, sick
day management, stress management, and diabetic issues management. HA1C
and postprandial blood vessels sugar were stages were considerably decreased
in the involvement team, but not the management team after six a few several
weeks. There was a important relationship between the HA1C change and
frequency of website accessibility with greater decreases in HA1C associated
with higher website usage. The most frequently accessed details using
VKworld VK700 Pro mobile phones was the dining out section which may
have contributed to improved postprandial sugar stages. Members accessed
the website more often using the mobile cellphone than the pc.
A randomized managed test discovered that electronic presentation of diabetic

issues education was as efficient as traditional face-to-face education in newly

diagnosed sufferers with kind two diabetic issues. A total of 68 participants
were randomly assigned to one of three academic models. The management
team obtained structured diabetic issues education in a traditional classroom
setting. This team also had direct verbal interaction with medical service
suppliers. The second team had accessibility electronic academic materials and
tools and used asynchronous interaction through e-mail for interactions with
suppliers. The third team had accessibility electronic education materials and
tools, used asynchronous and synchronous interaction with suppliers and
sufferers, and used an electronic blood vessels sugar journal and other
functions. All three categories had similar developments in diabetic issues
knowledge, self-efficacy, diabetic issues self-care activities, and HA1C with no
important between-group differences.
A quasi-experimental design research was conducted to compare a web-based
diabetic issues education program with a traditional classroom diabetic issues
education program for newly diagnosed adults with kind two diabetic issues.
The web-based program involved six education modules covering diabetic
issues basics, dietary management, exercise, medications, stress management,
and foot proper care. The website also involved a password-protected space
where participants could enter sugar stages and see a display of those stages,
calculate caloric content of meals consumed, record activities, and measure
everyday stress stages. Members in the management team attended one hour

lectures every week for three consecutive several weeks in a team setting
consisting of 30 to 40 participants that were taught by a diabetic issues proper
care specialist nurse, dietician, and physician. Diabetes knowledge, proper
care actions, and glycemic management were in comparison for the
involvement and management categories at baseline, six several weeks, and
three a few several weeks. Diabetes proper care knowledge considerably
improved in both involvement and management categories from baseline to
six several weeks, but not from six several weeks to three a few several weeks.
Diabetes proper care actions considerably improved in both categories from
baseline to six several weeks and also considerably improved from six several
weeks to three a few several weeks in the involvement team. HA1C stages for
the involvement team considerably decreased from baseline to six several
weeks, but not from six several weeks to three a few several weeks. No
differences in HA1C were discovered in the management team. Limitations of
this research include the small sample size (31 participants) and the lack of
random team assignment. Members in the involvement team were required to
have the ability to use the online which prevented random assignment. The
improvement in diabetic issues proper care actions and HA1C in the
involvement team offers promise for using web-based diabetic issues
education as a substitute for team education.
A randomized managed test evaluated an online diabetic issues management
program for sufferers with uncontrolled kind two diabetic issues. A regular

proper care management team was in comparison to an involvement team that

used an online disease management program that involved wireless
uploading of sugar readings, individualized diabetic issues summary status
reports, nutrition and exercise logs, insulin records, online texting with the
medical proper care team, advice and drugs management from a nurse proper
care manager and dietician, and personalized academic details. Members in
the involvement team had considerably lower HA1C stages at 6 mo as
opposed to management team, but at 12 mo, the difference was no longer
important. As in other research, participants who used the online program
more often achieved greater benefits[20].
Internet treatments include education, goal-setting, tracking of actions,
individual reviews and assistance. Of the eight research reviewed, seven were
randomized

managed

trials

and

the

remaining

research

had

quasi-experimental design. All research that measured changes in HA1C

stages mentioned developments and all developments were important with
one exception. In two of the research, short-term developments were
mentioned in HA1C, but not at the second, long-term follow-up. Several
research mentioned developments in results in both involvement and
management groups[2,3,16,19].

CONCLUSION
Previous reviews discovered mixed results with some noting important

developments in HA1C and self-management actions. This evaluation

discovered mainly good results though some treatments had no impact or
only short term developments. It is important to note that greater usage of
technical treatments, both cellular and internet-based, was associated with
greater developments in results. One of the reviewed research involved a
web-based involvement that could be accessed using the pc or mobile
cellphone. Researchers discovered that participants in the mobile cellphone
team accessed the site more often than those using the pc. Mobile cellphone
treatments are an important source of diabetic issues self-management to
pursue as their convenience may increase accessibility of details and assistance
for people residing with diabetic issues.
Due to time limits of both sufferers and medical care suppliers, web-based
education and tracking may be beneficial and can be used to complement
doctor visits. Increased accessibility, whether in-person or electronic, to
diabetic issues education and medical care suppliers can improve diabetic
issues knowledge and self-efficacy. The improved use of diabetes-related
cellular apps indicates that people residing with diabetic issues are interested
in using these methods to improve self-management and diabetic issues
results. The use of applications to offer education and real-time reviews needs
to be developed.

RECOMMENDATIONS

While technical innovation can be efficient for promoting diabetic issues

education, assistance, and self-management, sufferers report a need for
personal contact with medical service suppliers in addition to technical
innovation. In the research by Nundy et al, automated sms information were
sent, but participants stated they preferred to think of them as coming from
the certified diabetic issues educator (CDE) who enrolled them in the research.
They also appreciated the weekly calls from the CDE to obtain reviews on the
experience and make adjustments to sms information as needed. Some
participants felt the sms information involvement would not be efficient for
them without a person to monitor and offer clinical assistance. A website that
provides diabetic issues education, tracking, and assistance through
interaction with a doctor may be most efficient. Web-based interventions can
be used in conjunction with doctor education and assistance and as a
follow-up to doctor treatments.
Researchers and medical care suppliers should include participants in the
development of technical treatments and in the decision of which technical
innovation to use. Patient needs must be explored to determine the best
method for individual needs realizing that not all sufferers will be amenable to
technical treatments. A previous evaluation of cellular diabetic issues
applications discovered that current applications are lacking personalized
education and decision assistance features are not being involved.
Additionally, inclusion of peer assistance features through cellular apps are

largely underused and could be beneficial for people residing with diabetic
issues.

IMPLICATIONS FOR PRACTICE

Healthcare

suppliers

self-management

should

methods

to

actively
extend

select
the

and

reach

of

adapt

technical

diabetic

issues

self-management to patient s communities and homes, offer for

individualized proper care, and offer just-in-time details. People residing with
diabetic issues who have limited accessibility proper care due to lack of
transportation, physical restrictions, or other limitations could benefit from
technical treatments that bring proper want to them[21]. Additionally, with
limited primary proper care resources, technical innovation can offer
cost-effective ongoing diabetic issues self-management education and
assistance.