GDM
| No. | Citation | Conclusion |
| 1. |
Wang H, Jiang Y, Wiley J, Ge L. Effectiveness of Smartphone-Based Lifestyle Interventions on Women with Gestational Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Psychol Res Behav Manag. 2022 Dec 5;15:3541-3559. doi: 10.2147/PRBM.S389562. PMID: 36505668; PMCID: PMC9733632. |
Ten studies were included involving 1626 participants. The mean ages of the women were 32.42 ±4.68 years. Eight out of 10 studies were conducted in developed countries. Meta-analysis found that smartphone-based lifestyle interventions statistically improved compliance [SMD = 7.36, 95% CI = (4.05 to 10.68), P < 0.0001] and decreased the incidences of neonatal intensive care unit (NICU) admission [RR = 0.64, 95% CI = (0.47,0.86), P = 0.003], compared with controls. However, intervention effects on HbA1c, maternal outcomes, neonatal hypoglycemia, and infant birth weight were non significant. Moreover, the satisfaction of intervention is high in this review. Contrastingly, no significant effects were observed for psychological status and cost-effectiveness. Future high-quality RCTs must be further studied at larger scales to examine smartphone-based lifestyle interventions' long-term effects and cost-effectiveness. |
| 2. |
Guo P, Chen D, Xu P, Wang X, Zhang W, Mao M, Zheng Q, Jin Y, Feng S. Web-Based Interventions for Pregnant Women With Gestational Diabetes Mellitus: Systematic Review and Meta-analysis. J Med Internet Res. 2023 Jan 19;25:e36922. doi: 10.2196/36922. PMID: 36656629; PMCID: PMC9896357. |
Web-based interventions (WBIs), defined as therapeutic interventions offered via the web, have been implemented to assist in managing GDM owing to their advantages of high accessibility and efficiency, but findings across relevant studies are inconsistent. Overall, 25 publications arising from 21 randomized controlled trials and controlled clinical trials were included. The overall meta-analyses on glycemic control parameters demonstrated that WBIs could significantly improve fasting blood glucose (standardized mean difference=-1.764, 95% CI -2.972 to -0.557; P=.004) and 2-hour postprandial blood glucose (standardized mean difference=-1.433, 95% CI -2.561 to -0.304; P=.01) compared with the control group, whereas no significant effect was found on glycated hemoglobin and 1-hour postprandial blood glucose. WBIs could significantly enhance compliance with the self-monitoring of blood glucose; increase the rate of normal vaginal delivery; and decrease the chance of emergency cesarean, admission to the neonatal intensive care unit, and composite neonatal complications. GDM knowledge, risk perception of the disease, self-efficacy, satisfaction with care, and medical service use of the participants in the WBI group were also improved compared with the control group. |
| 3. |
Xie W, Dai P, Qin Y, Wu M, Yang B, Yu X. Effectiveness of telemedicine for pregnant women with gestational diabetes mellitus: an updated meta-analysis of 32 randomized controlled trials with trial sequential analysis. BMC Pregnancy Childbirth. 2020 Apr 6;20(1):198. doi: 10.1186/s12884-020-02892-1. PMID: 32252676; PMCID: PMC7137255. |
Telemedicine is defined as health services and medical activities provided by healthcare professionals through remote communication technologies. A total of 32 RCTs were identified, with a total of 5108 patients. The meta-analysis showed that telemedicine group had significant improvements in controlling glycated haemoglobin (HbA1c) [mean difference (MD) = - 0.70, P < 0.01], fasting blood glucose (FBG) (MD = -0.52, P < 0.01) and 2-h postprandial blood glucose (2hBG) (MD = -1.03, P = 0.01) compared to the corresponding parameters in the standard care group. In the telemedicine group, lower incidences of caesarean section [relative risk (RR) = 0.82, P = 0.02], neonatal hypoglycaemia (RR = 0.67, P < 0.01), premature rupture of membranes (RR = 0.61, P < 0.01), macrosomia (RR = 0.49, P < 0.01), pregnancy-induced hypertension or preeclampsia (RR = 0.48, P < 0.01), preterm birth (RR = 0.27, P < 0.01), neonatal asphyxia (RR = 0.17, P < 0.01), and polyhydramnios (RR = 0.16, P < 0.01) were found. |
| 4. |
Brown J, Ceysens G, Boulvain M. Exercise for pregnant women with gestational diabetes for improving maternal and fetal outcomes. Cochrane Database Syst Rev. 2017 Jun 22;6(6):CD012202. doi: 10.1002/14651858.CD012202.pub2. PMID: 28639706; PMCID: PMC6481507. https://www.cochranelibrary.com/cdsr/doi/10.1002 |
A total of 11 randomised trials involving 638 women were included. For the woman, both fasting and postprandial blood glucose concentrations were reduced compared with the control groups. Short- and long-term outcomes of interest for this review were poorly reported. Current evidence is confounded by the large variety of exercise interventions. There was insufficient high-quality evidence to be able to determine any differences between exercise and control groups for our outcomes of interest. Development of type 2 diabetes, perineal trauma/tearing, postnatal depression, large-for-gestational age, adiposity (neonate/infant, childhood or adulthood), diabetes (childhood or adulthood) or neurosensory disability (neonate/infant) were not reported. |
| 5. |
Dingena CF, Arofikina D, Campbell MD, Holmes MJ, Scott EM, Zulyniak MA. Nutritional and Exercise-Focused Lifestyle Interventions and Glycemic Control in Women with Diabetes in Pregnancy: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. Nutrients. 2023 Jan 9;15(2):323. doi: 10.3390/nu15020323. PMID: 36678193; PMCID: PMC9864154. |
A total of 26 studies (8 nutritional supplements, 12 dietary, and 6 exercise interventions) were included. All studies were conducted in patients with GDM. Supplement interventions focused on alpha-lipoic acid, probiotic, ginger, fish oil, or zinc and vitamin supplements versus placebo. The dietary interventions primarily focused on higher complex CHO/lower GI, restricted energy intake, and Dietary Approaches to Stop Hypertension (DASH) diets versus a standard care diet. The exercise interventions focused on brisk walks, resistance exercise, home-based exercise, and moderate-intensity aerobics exercise versus standard antenatal care. Overall, supplement- and exercise-based interventions reduced fasting glucose (−0.30 mmol/L; 95% CI = −0.55, −0.06; p = 0.02; and 0.10 mmol/L; 95% CI = −0.20, −0.01; p = 0.04); and supplement- and diet-based interventions reduced HOMA-IR (−0.40; 95% CI = −0.58, −0.22; p < 0.001; and −1.15; 95% CI = −2.12, −0.17; p = 0.02). Our results suggest a favorable role of certain nutritional supplements, diet, and exercise practices on glycemia in women with GDM. |
| 6. |
He J, Chen X, Wang Y, Liu Y, Bai J. The experiences of pregnant women with gestational diabetes mellitus: a systematic review of qualitative evidence. Rev Endocr Metab Disord. 2021 Dec;22(4):777-787. doi: 10.1007/s11154-020-09610-4. Epub 2020 Nov 12. PMID: 33184736. https://doi.org/10.1007/s11154-020-09610-4
Craig L, Sims R, Glasziou P, Thomas R. Women's experiences of a diagnosis of gestational diabetes mellitus: a systematic review. BMC Pregnancy Childbirth. 2020 Feb 7;20(1):76. doi: 10.1186/s12884-020-2745-1. PMID: 32028931; PMCID: PMC7006162. |
Ten studies (totaling 223 pregnant women with GDM), originating from 6 different countries, were included in the review. Of the 223 women, 171 had one pregnancy affected by GDM and 52 had two or more pregnancies affected by GDM. Based on the findings from these studies, three main themes emerged, which were synthesized from 10 separate categories and 46 individual findings: beliefs about illness and health; life-changing experiences and healthy expectations; and difficulties and needs. Both positive and negative experiences of pregnant women with GDM can be understood as a process of “continuous struggle and change”. A total of 41 studies of diverse populations met the selection criteria. The synthesis revealed eight key themes: initial psychological impact; communicating the diagnosis; knowledge of GDM; risk perception; management of GDM; burden of GDM; social support; and gaining control. The identified benefits of a GDM diagnosis were largely behavioural and included an opportunity to make healthy eating changes. The identified harms were emotional, financial and cultural. Women commented about the added responsibility (eating regimens, appointments), financial constraints (expensive food, medical bills) and conflicts with their cultural practices (alternative eating, lack of information about traditional food). Some women reported living in fear of risking the health of their baby and conducted extreme behaviours such as purging and starving themselves. |
| 7. |
Faal Siahkal S, Javadifar N, Najafian M, Iravani M, Zakerkish M, Heshmati R. The psychosocial challenges associated with gestational diabetes mellitus: A systematic review of qualitative studies. Prim Care Diabetes. 2022 Feb;16(1):11-26. doi: 10.1016/j.pcd.2021.09.003. Epub 2021 Sep 15. PMID: 34538572. |
A total of 24 papers were qualitatively analyzed. The CASP score of the included papers was optimal. The 514 findings extracted from the 24 studies were aggregated into five broad conceptual categories: 1) psychological challenges, 2) socio-cultural challenges, 3) information-communication challenges, 4) challenges associated with a lifestyle change, and 5) challenges related to health care. |
| 8. |
Safiee L, Rough DJ, Whitford H. Barriers to and Facilitators of Using eHealth to Support Gestational Diabetes Mellitus Self-management: Systematic Literature Review of Perceptions of Health Care Professionals and Women With Gestational Diabetes Mellitus. J Med Internet Res. 2022 Oct 27;24(10):e39689. doi: 10.2196/39689. PMID: 36301613; PMCID: PMC9650580. |
A total of 26 papers were included in the review. Of these, 19% (5/26) of studies used quantitative research methodologies, 19% (5/26) used qualitative methods, and 62% (16/26) used mixed methods. In all, 4 themes were identified from the qualitative data: the benefits of using technology, engagement with people via technology, the usability of technology, and discouragement factors for the use of technology. The thematic analysis revealed a vast scope of challenges and facilitators in the use of GDM self-management systems. The challenges included usability aspects of the system, technical problems, data privacy, lack of emotional support, the accuracy of reported data, and adoption of the system by HPs. Convenience, improved GDM self-management, peer support, increased motivation, increased independence, and consistent monitoring were facilitators to use these technologies. Quantitative data showed that there is potential for improving the usability of the GDM self-management systems. It also showed that convenience, usefulness, increasing motivation for GDM self-management, helping with GDM self-management, and being monitored by HPs were facilitators to use the GDM self-management systems. |
| 9. |
Amarra MS, Chong MF, Titapant V, Somprasit C, Rogacion J, Irwinda R, Huynh TNK, Nalliah S. ILSI Southeast Asia symposium: prevalence, risk factors, and actions to address gestational diabetes in selected Southeast Asian countries. Eur J Clin Nutr. 2021 Sep;75(9):1303-1308. doi: 10.1038/s41430-020-00838-6. Epub 2021 Feb 2. PMID: 33531635; PMCID: PMC8416657. |
This paper presents findings from a symposium organized by the International Life Sciences Institute Southeast Asia (ILSI SEA) which discussed the growing issue of gestational diabetes and how it can be addressed in the region. GDM together with diabetes in pregnancy (DIP) both fall under the definition of hyperglycemia in pregnancy. GDM is defined as diabetes diagnosed for the first time during pregnancy mostly after 24 weeks gestation. DIP is defined as pregnant women having higher oral glucose tolerance test (OGTT) results [1]. Table 1 shows the WHO criteria that distinguish GDM and DIP. Women with hyperglycemia in pregnancy have a higher risk of developing diabetes over 15 years after the index pregnancy. It was estimated that 75–90% of cases of hyperglycemia in pregnancy are GDM. Although data are lacking, GDM prevalence is thought to parallel the rising incidence of type 2 diabetes mellitus in the background population. Table 2 shows the 2019 prevalence of diabetes and undiagnosed diabetes in Southeast Asian countries. |
| 10. |
Shamsuddin K, Mahdy ZA, Siti Rafiaah I, Jamil MA, Rahimah MD. Risk factor screening for abnormal glucose tolerance in pregnancy. Int J Gynaecol Obstet. 2001 Oct;75(1):27-32. doi: 10.1016/s0020-7292(01)00468-4. PMID: 11597616. |
A cross-sectional survey of 768 pregnant women at > or = 24 weeks' gestation who were attending the antenatal clinic at the Hospital Universiti Kebangsaan Malaysia (HUKM) was made. Risk factors were determined using a questionnaire. An abnormal oral glucose tolerance test was defined as a 2-h post-prandial blood sugar level of > or = 7.8 mmol/l. A total of 191 pregnant mothers (24.9%) had GDM. The most commonly identified screening factors were positive family history of diabetes mellitus (31.4%), history of spontaneous abortion (17.8%), vaginal discharge and pruritus vulvae in current pregnancy (16.0%), and maternal age greater than 35 years (14.7%). Five hundred and thirteen mothers (66.8%) had at least one risk factor. All screening risk factors, except past history of diabetes mellitus in previous pregnancy and maternal age, were not significantly associated with abnormal glucose tolerance (GT). Universal screening would cost RM 12.06 while traditional risk factor screening would cost RM 11.15 per identified case and will have missed 53 of the 191 cases. Risk factor screening scored poorly in predicting GDM. Cost analysis of universal compared with traditional risk factor screening showed a negligible difference. |
Type 2 Diabetes
| No. | Citation | Conclusion |
| 1. | Ahmad E, Lim S, Lamptey R, Webb DR, Davies MJ.Type 2 diabetes. Lancet. 2022 Nov 1:S0140-6736(22)01655-5. doi: 10.1016/S0140-6736(22)01655-5. Epub ahead of print. PMID: 36332637. | This review paper offers a clinically focused review of the recent developments in type 2 diabetes care including controversies and future directions. |
| https://doi.org/10.1016/S0140-6736(22)01655-5 | ||
| 2. | Khunti K, Griffin S, Brennan A, et al. Promoting physical activity in a multi-ethnic population at high risk of diabetes: the 48-month PROPELS randomised controlled trial. BMC Med. 2021 Jun 3;19(1):130. doi: 10.1186/s12916-021-01997-4. | This RCT investigated the long-term effectiveness of the Walking Away programme, an established group-based behavioural physical activity intervention with pedometer use, when delivered alone or with a supporting mHealth intervention concluded that combining a pragmatic group-based intervention with text messaging and telephone support resulted in modest changes to physical activity at 12 months, but changes were not maintained at 48 months. |
| https://bmcmedicine.biomedcentral.com/articles /10.1186/s12916-021-01997-4 | ||
| 3. |
Crowley MJ, Tarkington PE, Bosworth HB, et al. Effect of a Comprehensive Telehealth Intervention vs Telemonitoring and Care Coordination in Patients With Persistently Poor Type 2 Diabetes Control: A Randomized Clinical Trial. JAMA Intern Med. 2022 Sep 1;182(9):943-952. doi: 10.1001/jamainternmed.2022.2947. PMID: 35877092; PMCID: PMC9315987. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2794747 |
This randomized clinical trial found that compared with telemonitoring/care coordination, comprehensive telehealth improved multiple outcomes in patients with PPDM at a reasonable additional cost. This study supports consideration of comprehensive telehealth implementation for persistently poorly controlled type 2 diabetes in systems with appropriate infrastructure and may enhance the value of telehealth during the COVID-19 pandemic and beyond. |
| 4. |
Ceriello A, Prattichizzo F, Phillip M, Hirsch IB, Mathieu C, Battelino T. Glycaemic management in diabetes: old and new approaches. Lancet Diabetes Endocrinol. 2022 Jan;10(1):75-84. doi: 10.1016/S2213-8587(21)00245-X. Epub 2021 Nov 15. PMID: 34793722. |
HbA1c is the most used parameter to assess glycaemic control. However, evidence suggests that the concept of hyperglycaemia has profoundly changed and that different facets of hyperglycaemia must be considered. A modern approach to glycaemic control should focus not only on reaching and maintaining optimal HbA1c concentrations as early as possible, but to also do so by reducing postprandial hyperglycaemia, glycaemic variability, and to extend as much as possible the time in range in near-normoglycaemia. These goals should be achieved while avoiding hypoglycaemia, which, should it occur, should be reverted to normoglycaemia. Modern technology, such as intermittently scanned glucose monitoring and continuous glucose monitoring, together with new drug therapies (eg, ultra-fast insulins, SGLT2 inhibitors, and GLP-1 receptor agonists), could help to change the landscape of glycaemia management based on HbA1c in favour of a more holistic approach that considers all the different aspects of this commonly oversimplified pathophysiological feature of diabetes. |
| 5. |
Nuha A. ElSayed, Grazia Aleppo, et al; on behalf of the American Diabetes Association, 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes—2023. Diabetes Care 1 January 2023; 46 (Supplement_1): S68–S96. |
Building positive health behaviors and maintaining psychological well-being are foundational for achieving diabetes treatment goals and maximizing quality of life. Essential to achieving these goals are diabetes self-management education and support (DSMES), medical nutrition therapy (MNT), routine physical activity, tobacco cessation counseling when needed, health behavior counseling, and psychosocial care. People with diabetes and health care professionals are encouraged to engage in person-centered collaborative care, which is guided by shared decision-making in treatment plan selection; facilitation of obtaining medical, behavioral, psychosocial, and technology resources as needed; and shared monitoring of agreed-upon treatment plans and behavioral goals. Reevaluation during routine care should include assessment of medical, behavioral, and mental health outcomes, especially during times of change in health and well-being. |
Type 1 Diabetes and others
| No. | Citation | Conclusion |
| 1. |
Sperling MA, Laffel LM. Current Management of Glycemia in Children with Type 1 Diabetes Mellitus. N Engl J Med. 2022 Mar 24;386(12):1155-1164. doi: 10.1056/NEJMcp2112175. PMID: 35320645. https://www.nejm.org/doi/full/10.1056/NEJMcp2112175?query=endocrinology
|
[A review article that is locked behind the paywall] Management of type 1 diabetes mellitus in children involves close family support and glucose monitoring. Improved means of insulin administration include newer pumps or smart pens that receive data from continuous glucose monitoring and can assist in calculation of insulin doses. |
| 2. |
Hirsch JS. FDA approves teplizumab: a milestone in type 1 diabetes. Lancet Diabetes Endocrinol. 2023 Jan;11(1):18. doi: 10.1016/S2213-8587(22)00351-5. Epub 2022 Nov 24. PMID: 36436528. https://www.thelancet.com/journals/landia/article/PIIS2213-8587(22)00351-5/fulltext?s=03 |
New therapies come slowly for type 1 diabetes, so the approval of teplizumab by the USA Food and Drug Administration (FDA) marks a milestone. The drug itself, a humanised anti-CD3 monoclonal antibody, delays clinical type 1 diabetes in at-risk individuals and is the first approved disease-modifying drug for type 1 diabetes. |
| 3. |
Nourelden AZ, Elshanbary AA, El-Sherif L, Benmelouka AY, Rohim HI, Helmy SK, Sayed MK, Ismail A, Ali AS, Ragab KM, Zaazouee MS. Safety and Efficacy of Teplizumab for Treatment of Type One Diabetes Mellitus: A Systematic Review and Meta-Analysis. Endocr Metab Immune Disord Drug Targets. 2021;21(10):1895-1904. doi: 10.2174/1871530320999201209222921. PMID: 33302842. |
Eight randomized clinical trials with 866 patients were included. Teplizumab was associated with lower insulin use than placebo at 12 months (MD = -0.12, 95% CI [-0.18, -0.06], P < 0.001), and 24 months (MD = -0.17, 95% CI [-0.28, -0.06], P = 0.003). The area under the curve of C-peptide was significantly increased in teplizumab group at 12 months (MD = 0.08, 95% CI [0.01, 0.15], P = 0.03), and 24 months (MD = 0.13, 95% CI [0.01, 0.24], P = 0.03). No significant effect of teplizumab on HbA1c levels was observed at any time point. Teplizumab was found to be associated with some side effects such as lymphopenia, skin and subcutaneous tissue disorders. |
| 4. |
Eberle C, Stichling S, Löhnert M. Diabetology 4.0: Scoping Review of Novel Insights and Possibilities Offered by Digitalization. J Med Internet Res. 2021 Mar 24;23(3):e23475. doi: 10.2196/23475. PMID: 33759789; PMCID: PMC8074865. |
Different types of technology (eg, glucose monitoring systems, insulin pens, insulin pumps, closed-loop systems, mobile health apps, telemedicine, and electronic medical records) may help to improve diabetes treatment. These improvements primarily affect glycemic control. However, they may also help in increasing the autonomy and quality of life of people who are diagnosed with diabetes mellitus. Diabetes technologies have developed rapidly over the last few years and offer novel insights into diabetes therapy and a chance to improve and individualize diabetes treatment. Challenges that need to be addressed in the following years relate to data security, interoperability, and the development of standards. |
| 5. |
Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes digital app technology: benefits, challenges, and recommendations. A consensus report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetologia. 2020 Feb;63(2):229-241. doi: 10.1007/s00125-019-05034-1. PMID: 31802144. https://doi.org/10.1007/s00125-019-05034-1 Fleming GA, Petrie JR, Bergenstal RM, Holl RW, Peters AL, Heinemann L. Diabetes Digital App Technology: Benefits, Challenges, and Recommendations. A Consensus Report by the European Association for the Study of Diabetes (EASD) and the American Diabetes Association (ADA) Diabetes Technology Working Group. Diabetes Care. 2020 Jan;43(1):250-260. doi: 10.2337/dci19-0062. Epub 2019 Dec 5. PMID: 31806649. https://doi.org/10.2337/dci19-0062 |
Digital health technology, especially digital and health applications ("apps"), have been developing rapidly to help people manage their diabetes. Numerous health-related apps provided on smartphones and other wireless devices are available to support people with diabetes who need to adopt either lifestyle interventions or medication adjustments in response to glucose-monitoring data. However, regulations and guidelines have not caught up with the burgeoning field to standardize how mobile health apps are reviewed and monitored for patient safety and clinical validity. The available evidence on the safety and effectiveness of mobile health apps, especially for diabetes, remains limited. Issues range from inadequate evidence on app accuracy and clinical validity to lack of training provision, poor interoperability and standardization, and insufficient data security were discussed. A series of recommended actions to resolve some of these shortcomings were also given. |
| 6. |
Veazie S, Winchell K, Gilbert J, Paynter R, Ivlev I, Eden KB, Nussbaum K, Weiskopf N, Guise JM, Helfand M. Rapid Evidence Review of Mobile Applications for Self-management of Diabetes. J Gen Intern Med. 2018 Jul;33(7):1167-1176. doi: 10.1007/s11606-018-4410-1. Epub 2018 May 8. PMID: 29740786; PMCID: PMC6025680. |
Fifteen articles evaluating 11 apps were identified: six apps for type 1 and five apps for type 2 diabetes. Common features of apps included setting reminders and tracking blood glucose and hemoglobin A1c (HbA1c), medication use, physical activity, and weight. Compared with controls, use of eight apps, when paired with support from a healthcare provider or study staff, improved at least one outcome, most often HbA1c. Patients did not experience improvements in quality of life, blood pressure, or weight, regardless of app used or type of diabetes. Study quality was variable. Of the eight apps available for usability testing, two were scored "acceptable," three were "marginal," and three were "not acceptable." Limited evidence suggests that use of some commercially available apps, when combined with additional support from a healthcare provider or study staff, may improve some short-term diabetes-related outcomes. The impact of these apps on longer-term outcomes is unclear. More rigorous and longer-term studies of apps are needed. |
| 7. |
Adu MD, Malabu UH, Malau-Aduli AEO, Malau-Aduli BS. The development of My Care Hub Mobile-Phone App to Support Self-Management in Australians with Type 1 or Type 2 Diabetes. Sci Rep. 2020 Jan 8;10(1):7. doi: 10.1038/s41598-019-56411-0. PMID: 31913296; PMCID: PMC6949290. |
This paper describes the development of My Care Hub mobile phone application (app) aimed at supporting self-management in people with type 1 or type 2 diabetes. The development of My Care Hub involved a comprehensive process of healthy behavioural change identification, end users' needs, expert consensus, data security and privacy considerations. The app translation was a highly iterative process accompanied by usability testing and design modification. The app development process included: (1) behaviour change strategy selection; (2) users' involvement; (3) expert advisory involvement; (4) data security and privacy considerations; (5) design creation and output translation into a smartphone app and (6) two usability testings of the app prototype version. The app features include self-management activities documentation, analytics, personalized and generalized messages for diabetes self-management as well as carbohydrate components of common foods in Australia. Twelve respondents provided feedback on the usability of the app. Overall, results indicated good user satisfaction rate. |
| 8. |
Modave F, Bian J, Rosenberg E, Mendoza T, Liang Z, Bhosale R, Maeztu C, Rodriguez C, Cardel MI. DiaFit: The Development of a Smart App for Patients with Type 2 Diabetes and Obesity. JMIR Diabetes. 2016 Jul-Dec;1(2):e5. doi: 10.2196/diabetes.6662. PMID: 29388609; PMCID: PMC5788459. |
The iterative design, development, and testing of DiaFit, an app designed to improve the self-management of T2D and obesity, using an adapted Agile approach to software implementation were presented. The production team consisted of experts in mobile health, nutrition sciences, and obesity; software engineers; and clinicians. Additionally, the team included citizen scientists and clinicians who acted as the de facto software clients for DiaFit and therefore interacted with the production team throughout the entire app creation, from design to testing. DiaFit (version 1.0) is an open-source, inclusive iOS app that incorporates nutrition data, physical activity data, and medication and glucose values, as well as patient-reported outcomes. DiaFit supports the uploading of data from sensory devices via Bluetooth for physical activity (iOS step counts, FitBit, Apple watch) and glucose monitoring (iHealth glucose meter). The app provides summary statistics and graphics for step counts, dietary information, and glucose values that can be used by patients and their providers to make informed health decisions. The DiaFit iOS app was developed in Swift (version 2.2) with a Web back-end deployed on the Health Insurance Portability and Accountability Act compliant-ready Amazon Web Services cloud computing platform. |
| 9. |
Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: A scoping review. Int J Med Inform. 2019 Jun;126:95-104. doi: 10.1016/j.ijmedinf.2019.03.018. Epub 2019 Mar 31. PMID: 31029270. |
A total of 133 articles met the inclusion criteria. The methods used for usability testing, in decreasing order of frequency were: questionnaires (n = 105), task completion (n = 57), 'Think-Aloud' (n = 45), interviews (n = 37), heuristic testing (n = 18) and focus groups (n = 13). Majority of the studies used one (n = 45) or two (n = 46) methods of testing. The rest used a combination of three (n = 30) or four (n = 12) methods of testing usability. None of the studies used automated mechanisms to test usability. The System Usability Scale (SUS) was the most frequently used questionnaire (n = 44). The number of digital health applications that publish their usability evaluation results remains only a small fraction. Questionnaires are the most prevalent method of evaluating usability in eHealth applications, which provide an overall measure of usability but do not pinpoint the problems that need to be addressed. Qualitative methods may be more useful in this regard. The use of multiple evaluation methods has increased. Automated methods such as eye tracking have not gained traction in evaluating health apps. Further research is needed into which methods are best suited for the different types of eHealth applications, according to their target users and the health conditions being addressed. |
| 10. |
Larbi D, Randine P, Årsand E, Antypas K, Bradway M, Gabarron E. Methods and Evaluation Criteria for Apps and Digital Interventions for Diabetes Self-Management: Systematic Review. J Med Internet Res. 2020 Jul 6;22(7):e18480. doi: 10.2196/18480. PMID: 32628125; PMCID: PMC7381260. |
A total of 31 fulfilled the inclusion criteria. A total of 7 articles were considered of high confidence in the evidence. Apps were the most commonly used platform for diabetes self-management (18/31, 58%), and type 2 diabetes (T2D) was the targeted health condition most studies focused on (12/31, 38%). Questionnaires, interviews, and user-group meetings were the most common methods of evaluation. Furthermore, the most evaluated criteria for apps and digital diabetes self-management interventions were cognitive impact, clinical impact, and usability. Feasibility and security and privacy were not evaluated by studies considered of high confidence in the evidence. Additional evaluation criteria, such as sustainability and interoperability, should be focused on more in future studies to provide a better understanding of the effects and potential of apps and digital interventions for diabetes self-management. |
