Diabetes Website Research Articles

An examination of the content of diabetes websites targeting Arabic speakers

BackgroundThere has been an increase in the numbers of people in the Middle East and North Africa (MENA) region seeking online information about diabetes, as the Internet is considered a helpful tool for finding information about disease prevention and treatment. It is important that the sources available are reliable, trustworthy and easily accessible. However, the quality and readability of such information is questionable. This study examines the content of Arabic diabetes websites and offers recommendations to improve engagement and access to health information. MethodsThis study employed a cross-sectional analysis approach to assess diabetes websites targeting Arabic speakers in the MENA countries. Google trends was utilized to reveal the top searched topics across the MENA region, which were used as search terms to identify the websites in search engines, resulting in the examination of 26 websites. The analysis combined automated tools with expert evaluation methods and involved five dimensions: quality, readability, engagement, popularity, and availability. ResultsOverall, the majority of the websites performed poorly in the five dimensions and thus require careful reassessment of their content, design, and readability; no website performed well in all dimensions. Only two websites (7.6%) were HONcode certified, and none of the websites achieved a high score in the DISCERN analysis. The readability scores indicated that most websites were above the recommended level of reading. The results also revealed that all websites had poor engagement. Half of the websites had good ranking, and 58% of the websites covered all of the target topics. Of the websites examined, the non-commercial and non-professional sites (classified as “others”) seem to have greater readability, higher bounce rates and longer visit duration than the commercial sites. ConclusionsThe results from this study show a need for improving the content of diabetes information websites available to Arabic speakers. In order to develop websites that contain easy-to-read and understand high-quality information, collaboration between multiple stakeholders is necessary.

Diabetes websites lack information on dietary causes, risk factors, and preventions for type 2 diabetes.

Type 2 diabetes (T2D) is a growing public health burden throughout the world. Many people looking for information on how to prevent T2D will search on diabetes websites. Multiple dietary factors have a significant association with T2D risk, such as high intake of added sugars, refined carbohydrates, saturated fat, and red meat or processed meat; and decreased intake of dietary fiber, and fruits/vegetables. Despite this dietary information being available in the scientific literature, it is unclear whether this information is available in gray literature (websites). In this study, we evaluate the use of specific terms from diabetes websites that are significantly associated with causes/risk factors and preventions for T2D from three term categories: (A) dietary factors, (B) nondietary nongenetic (lifestyle-associated) factors, and (C) genetic (non-modifiable) factors. We also evaluate the effect of website type (business, government, nonprofit) on term usage among websites. We used web scraping and coding tools to quantify the use of specific terms from 73 diabetes websites. To determine the effect of term category and website type on the usage of specific terms among 73 websites, a repeated measures general linear model was performed. We found that dietary risk factors that are significantly associated with T2D (e.g., sugar, processed carbohydrates, dietary fat, fruits/vegetables, fiber, processed meat/red meat) were mentioned in significantly fewer websites than either nondietary nongenetic factors (e.g., obesity, physical activity, dyslipidemia, blood pressure) or genetic factors (age, family history, ethnicity). Among websites that provided "eat healthy" guidance, one third provided zero dietary factors associated with type 2 diabetes, and only 30% provided more than two specific dietary factors associates with type 2 diabetes. We also observed that mean percent usage of all terms associated with T2D causes/risk factors and preventions was significantly lower among government websites compared to business websites and nonprofit websites. Diabetes websites need to increase their usage of dietary factors when discussing causes/risk factors and preventions for T2D; as dietary factors are modifiable and strongly associated with all nondietary nongenetic risk factors, in addition to T2D risk.

Increased Breast and Colorectal Cancer Risk in Type 2 Diabetes: Awareness Among Adults With and Without Diabetes and Information Provision on Diabetes Websites.

People with type 2 diabetes mellitus (T2DM) have a higher risk of developing breast and bowel cancers but are less likely to participate in cancer screening. Two interlinked studies examined public awareness of the fact that T2DM increases breast and bowel cancer risk, and provision of this information on diabetes websites. Study-1: phase-1 surveyed awareness of T2DM-increased cancer risk in a nationally-representative British sample aged 50-74 (N = 1,458) and compared respondents with and without T2DM (n = 125 vs. n = 1,305); phase-2 surveyed an additional exclusively T2DM sample (N = 319). Study-2: High-ranking diabetes websites (N = 25) were reviewed to determine the rate of inclusion of cancer risk and cancer screening information in evident sections about diabetes-related health conditions. A low proportion of respondents were aware that T2DM increases risk of breast (13.7%) and bowel (27.6%) cancers, compared to much higher awareness of other diabetes-related conditions such as sight loss (82.2%) and foot problems (81.8%). Respondents with T2DM were significantly more likely than those without T2DM to be aware of all the surveyed diabetes-related health conditions (e.g., sight loss, OR: 3.14, 95%CI: 1.61-6.15; foot problems, OR: 2.58, 95%CI: 1.38-4.81), except breast (OR: 0.82, 95%CI: 0.46-1.45) and bowel (OR: 0.95, 95%CI: 0.63-1.45) cancer, for which awareness was equally low among people with and without T2DM. Few diabetes websites with a section on diabetes-related health conditions included cancer in this section (n = 4/19), and fewer still included cancer screening among any noted cancer-protective behaviors (n = 2/4). There is low public awareness that T2DM increases the risk of developing breast and bowel cancers, even among people with T2DM, which may be partly due to limited information provision regarding T2DM-increased cancer risk from diabetes care providers and organizations.

Diabetes in the context of incarceration: A scoping review.

The burden of chronic conditions, like diabetes, is disproportionately carried by people facing social disadvantages (e.g., those with experiences of incarceration). A dearth of knowledge remains about this topic. We conducted a scoping review to determine the extent of literature about diabetes management and/or self-management in relation to incarceration. We used the Arksey and O'Malley five stage process, recommendations by Levac etal., and the PRISMA Extension for Scoping Reviews Checklist. Core search terms for diabetes were combined using the Boolean operator AND with terms relevant to incarceration. We initially searched the following electronic academic databases on January 5, 2021, and then updated these searches on September 7, 2022: APA PsycInfo, CINAHL, Criminal Justice Abstracts, EMBASE, MEDLINE, Scopus, and SocINDEX. There were no restrictions on language, study design, quality, location, time, and sex or gender differences. We searched for research articles, conference proceedings, dissertations and theses, government documents, and organization documents. We then searched for other forms of literature using an electronic database (ProQuest Dissertations and Theses - Global), the internet search engine Google, and various corrections and diabetes websites in August 2021 and then updated these searches in September 2022. We also reviewed the reference lists of the final selected documents to identify additional literature. The search from the seven databases identified 3076 records. The search from other sources (e.g., websites) identified an additional 1077 records. A total of 40 documents met our final inclusion criteria and were included in this review. The type of research conducted was primarily quantitative in nature. Clinic and education interventions were most commonly investigated. Clinical outcomes were often reported. Most guidelines were targeted at healthcare providers. Much of the literature originated from high-income countries, which may not be fully applicable for different contexts like low-income countries. Many interventions were associated with improved outcomes. Administrators can use our findings to develop appropriate policies for this population. Tailored diabetes education for this population and healthcare providers may improve management practices. Our findings offer key insights for improving diabetes care and outcomes for this underserved population. Addressing the diabetes-specific health needs of these people may improve overall public health. KD has received the O'Brien Institute for Public Health Postdoctoral Scholarship (University of Calgary), Cumming School of Medicine Postdoctoral Scholarship (University of Calgary), and the Libin Cardiovascular Institute's 2021 Person to Population Seed Grant (University of Calgary).

A personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with type 2 diabetes mellitus, the INTENSE study: study protocol for a randomised controlled trial

BackgroundMedication non-adherence is a prevalent health problem in people with type 2 diabetes mellitus (T2DM). Interventions have previously been developed to improve medication adherence, but inconsistent outcomes have been reported. A potential explanation for this inconsistency is a ‘one size fits all’ approach, with interventions not tailored to the needs and preferences of individuals. Therefore, the aim of this study is to evaluate the effectiveness of a personalised intervention programme aimed at improving adherence to oral antidiabetic and/or antihypertensive medication in people with T2DM.MethodsA parallel-group randomised controlled trial will be conducted in 40–50 community pharmacies in the Netherlands and the United Kingdom (UK). A total of 300 participants will be included and followed up for a period of 6 months. Participants will be people with T2DM identified as non-adherent to oral antidiabetic and/or antihypertensive medication, aged 35–75 years and mobile phone users. The intervention group will receive a personalised intervention programme that is based on one or more of the participants’ pre-defined non-adherence profile(s), namely (I) Knowledge and perceptions, (II) Practical problems, (III) Side effects and (IV) Negative mood and beliefs. The intervention comprises of one or more supporting modules, namely (I) Brief messaging, (II) Clinical medication review, (III) Medication schedule, (IV) Reminding messaging, (V) Medication dispensing systems, (VI) Smart messaging, (VII) Referral to general practitioner and (VIII) Unguided web-based Self Help Application for low mood. The control group will receive usual care including access to a publicly available informative diabetes website. The primary study outcome is medication adherence measured with a telephone pill count. Secondary outcomes are systolic blood pressure, HbA1c level, self-reported medication adherence, attitude and beliefs toward medication, satisfaction with diabetes treatment, health status and medical consumption and productivity cost. In addition, a process evaluation will be undertaken to establish the fidelity, reach and the extent to which intervention delivery is normalised in the daily practice of community pharmacy teams.DiscussionThe study can lead to a personalised intervention programme that improves medication adherence in people with T2DM that are non-adherent to oral antidiabetic and/or antihypertensive medication.Trial registrationDutch Trial Register, Trial NL8747, registered 02 July, 2020; ISRCTN Registry, ISRCTN36009809, registered 05 February, 2020.

Rationale for the Use of Combination Injectable Therapy in Patients With Type 2 Diabetes Who Have High A1C (≥9%) and/or Long Duration (>8 Years): Executive Summary.

Recommended A1C targets for people with type 2 diabetes are between 6.5 and 8%; however, real-world data suggest that an increasing proportion of people with diabetes have suboptimal control, and ∼15% have an A1C level >9%. People with A1C >9% are at increased risk for micro- and macrovascular complications and require treatment intensification to improve glycemic control as early as possible. In a series of short videos now available on the Clinical Diabetes website, the authors discuss the pathophysiological changes that occur during the progression of type 2 diabetes, with particular focus on the key role of declining β-cell function. The authors review clinical characteristics—long diabetes duration and A1C ≥9%—that are indicative of diminishing β-cell function, and they discuss the clinical data that support the use of available treatment options for these individuals, consistent with current diabetes treatment guidelines. This article is intended to briefly summarize those discussions. The videos described below are available in their entirety, along with short biographies of the authors, at https://clinical.diabetesjournals.org/content/combination-injectable-therapy. ### Need for Glycemic Control in Individuals With A1C ≥9% (Video 1) Video 1. Need for Glycemic Control in Individuals With A1C ≥9%. Available from https://bcove.video/3bda5FB. Current treatment guidelines for people with type 2 diabetes from the American Diabetes Association, the American Association of Clinical Endocrinologists, the American College of Endocrinology, and the American College of Physicians recommend A1C targets within the range of 6.5–8% (1–3). However, public health reports suggest that a significant proportion of U.S. adults with diabetes have an A1C >9% (4), which is defined as “poor glycemic control” by the Healthcare Effectiveness Data and Information Set (5). Furthermore, A1C levels >9% can negatively affect reimbursement (e.g., through a decrease in the star ratings used to assess quality and performance) (6). In this video, the authors discuss the deleterious health consequences for patients with high A1C levels, including …

Effective Initiation and Treatment With Basal Insulin in People With Type 2 Diabetes: Focus on Mitigating Hypoglycemia in Patients at Increased Risk: Executive Summary.

Many people with type 2 diabetes are treated with insulin with the goal of achieving a specific A1C target. The most prominent risk for people on insulin therapy is hypoglycemia. When basal insulin analogs are used appropriately, the risk of hypoglycemia can be reduced while still achieving individualized glycemic goals. In a series of short videos now available on the Clinical Diabetes website, the authors discuss approaches to optimizing basal insulin initiation and treatment in people with type 2 diabetes, including those at high risk such as individuals with renal impairment and older adults, with a focus on reaching A1C goals while mitigating the risk for hypoglycemia. This article is intended to briefly summarize those discussions, and readers are encouraged to view the videos in their entirety at https://clinical.diabetesjournals.org/content/basal-insulin-videos. ### Introduction (Available at https://bcove.video/2Q2Rb9b) Approximately 50% of people with type 2 diabetes have poorly controlled disease and are vulnerable to long-term micro- and macrovascular complications (1). As type 2 diabetes progresses, many patients will require insulin to maintain glycemic control. The appropriate use of insulin requires a balance between the need for tight glucose control and the potential risk for hypoglycemia. Definitions of hypoglycemia have evolved over time, and the American Diabetes Association (ADA) now uses a three-level classification of hypoglycemia severity (2). Mitigating the risk for hypoglycemia is crucial to the successful treatment of people with type 2 diabetes. In the following series of videos, the authors discuss the use of available insulin formulations in the context of hypoglycemia risk. ### Basal Insulin Therapy—Balancing Glycemic Control With Risk for Hypoglycemia (Available at https://bcove.video/3h3Y85h) The achievement of tight glycemic control reduces micro- and macrovascular complications, and adherence to treatment improves quality of life and decreases health care costs (3–9). The authors discuss the association between A1C reduction and microvascular complications, as reported in the UK …

Evaluating the most popular diabetes websites in the USA: a content analysis.

Over 1.5 million Americans are diagnosed with diabetes every year, and the majority of them go online to learn about their condition. Unfortunately, the online diabetes landscape is crowded, and the quality of website content is unknown-guidance for patients and healthcare providers regarding online diabetes information is needed. To address this, nine of the top diabetes websites in the USA were identified through a comprehensive, multiple-query search and a content analysis was conducted. Two coders, with high inter-coder reliability, evaluated these websites on six factors: (i) Design; (ii) Credibility; (iii) Accessibility; (iv) Literacy; (v) Engagement; and (vi) Diabetes Content. The analysis revealed that the websites presented most of the assessed design features. Few of the sites scored well on the credibility assessment, while the majority of sites did not note an author, editor or reviewer. With regard to accessibility, less than half of the items we assessed were met. Furthermore, the websites possessed wide variability in literacy, with an average readability grade level of 8.8. Most of the websites fared well in engagement, demonstrating multiple avenues to interact with the organization. All of the websites provided basic information regarding diabetes, but many did not include information for caregivers, providers or insurance information. In conclusion, patients and their family members will continue to seek online information about diabetes, its effects and treatment options. Therefore, this multiple-metric evaluation provides essential information for these individuals, and healthcare providers, who can now give better informed website recommendations to their patients and families.

Engagement and Usage Patterns of a Diabetes Education Website Tailored for Arabic Speakers: A Case Study of a Diabetes Website from Kuwait

Despite the high prevalence of diabetes in the Middle East and North Africa (MENA) region, there is limited access to education and support resources about diabetes and its complications tailored to the customs, culture, and language of people living in the region. While health websites promise greater and more convenient access to health information, accredited websites to educate Arabs with diabetes remain scarce. In this paper, we present an assessment about a diabetes-focused website offering information tailored to the needs of people living in the MENA region who primarily speak Arabic. We also offer recommendations to improve similar health-focused websites.

When knowing is not enough: Emotional distress and depression reduce the positive effects of health literacy on diabetes self-management

ObjectivesAdequate self-management activities are important predictors of diabetes outcomes. As diabetes literacy and self-efficacy are strong predictors of diabetes self-care, self-management education programs focus essentially on these factors. This study investigated whether emotional distress or depression moderates the relation between health literacy, self-efficacy and diabetes self-care behaviors. Methods128 people with type 2 diabetes were recruited in hospitals, through general practitioners and via a diabetes website, and completed a questionnaire assessing health literacy, self-efficacy, diabetes-related distress, depression and self-care behaviors. ResultsMultiple regression analysis confirms that health literacy and self-efficacy significantly predict reported self-care behaviors. Additional regression analyses reveal that distress or depression do not predict self-care behaviors directly, but moderate the effect of health literacy, which has a weaker impact in patients experiencing distress or depression. In contrast, distress and depression do not moderate the effect of self-efficacy on diabetes self-care behaviors. ConclusionEmotional distress, whether related to diabetes or not, prevents patients from acting on their competence to perform adequate self-management behaviors. Practice implicationsDiabetes Professionals should pay more attention to the patients’ affective state and its influence on self-care. Psychological support should be integrated in the care for people suffering from type 2 diabetes.

Usability testing of existing type 2 diabetes mellitus websites

BackgroundGiven the significant increase in the use of the internet as an educational tool for diabetes, very little research has been published on the usability of healthcare websites, even though it is a determining factor for user satisfaction. ObjectiveThe aim of this study is to evaluate and critique the interfaces of existing diabetes websites for usability concerns and provide design solutions for improvement. Emphasis is placed on Type 2 Diabetes Mellitus since it is the most common and life threatening form of diabetes. MethodA usability test was performed on the interfaces of three existing diabetes websites, American Diabetes Association (www.diabetes.org), WebMD (www.webmd.com) and the National Diabetes Education Program (ndep.nih.gov). The goal was to collect qualitative and quantitative data to determine: (1) if participants are able to complete specified tasks successfully; (2) the length of time it takes participants to complete the specified tasks and; (3) participants’ satisfaction with the three websites. Twenty adults, 18 years of age and older participated in the study. ResultsThe results from the MANOVA test revealed a significant difference between the three websites for number of clicks, number of errors and completion time when analyzed simultaneously. The ANOVA tests revealed a significant difference for all three variables. The Student-Newman-Keuls (SNK) test shows a significant difference for completion time between American Diabetes Association and WebMD. A significant difference was found for the number of clicks for the National Diabetes Education Program compared to the American Diabetes Association and WebMD. However, no significant difference was found for the number of clicks between American Diabetes Association and WebMD. Lastly, a significant difference was found between each interface for number of errors. DiscussionAlthough, the American Diabetes Association web-interface was most favorable, there were many positive design elements for each interface. On the other hand, the significant amount of information overload experienced for each website left participants feeling perplexed. Thus, innovative solutions are needed to reduce information overload and ensure users are engaged and empowered to make informed decisions about their healthcare.

Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site

To assess the frequency of impaired awareness of hypoglycaemia (IAH) using a specific questionnaire (Spanish version) in a free access diabetes-related web site. Data from a free access Spanish version of the Clarke test previously uploaded to the website of the Fundación para la Diabetes (March 2014–January 2015) were assessed. In addition to the eight questions in Clarke's questionnaire, information on type of diabetes, age, and disease duration was obtained. The Clarke test divided participants into three categories: normal awareness, uncertain and IAH. Of the 418 participants with type 1 diabetes, 51.2% were aged 36–55 years. In 34.7%, diabetes had been diagnosed >15 years before, while disease duration was <2 years in 11%. According to Clarke categories, 23.4% had IAH, 15.3% uncertain awareness, and 61.3% normal awareness. The longer the duration of diabetes, the higher the Clarke test score. According to the Clarke test, 14.1% of participants had experienced at least one episode of severe hypoglycaemia in the previous year, and half of these (7.4%) had suffered severe hypoglycaemia two or more times. All but one of the participants with two or more episodes of severe hypoglycaemia had IAH. Our study shows that the rate of IAH using an online survey is similar (25%) to that previously reported in other geographical areas, increases with diabetes duration, and identifies subjects prone to severe hypoglycaemia. Determinar la frecuencia de hipoglucemia desapercibida (HD) en una amplia cohorte de pacientes adultos con diabetes tipo 1 (DT1) a través de un cuestionario específico disponible para ser rellenado en la Web de manera voluntaria. Desde marzo de 2014 a enero de 2015 se recogieron los resultados del cuestionario en lengua española de percepción de la hipoglucemia para adultos con DT1 (Test de Clarke versión en castellano) disponible on-line en la página Web de la Fundación para la Diabetes. Además, la encuesta on-line incluía datos sobre el tipo de diabetes, la edad y el tiempo de evolución de la enfermedad. La puntuación final del cuestionario cataloga a los pacientes en 3 categorías: percepción normal, indeterminada y anormal-HD ante una situación de hipoglucemia. De los 418 participantes con DT1 el 51,2% tenía una edad entre 36-55 años. En el 34,7% la DT1 la diabetes tenía una duración > 15 años y en el 11% menos de 2 años. De acuerdo con el resultado del cuestionario de Clarke, un 23,4% de los pacientes presentaba una HD, un 15,3% una percepción indeterminada y en el 61,3% el resultado fue normal. A mayor duración de la DT1, mayor puntuación del cuestionario. El 14,1% de los participantes había tenido una hipoglucemia grave durante el año anterior y la mitad de ellos (7,4%) había presentado ≥ 2 episodios. De estos últimos todos, excepto uno, presentaban HD. Como en estudios precedentes realizados en otras áreas geográficas, nuestro estudio demuestra que casi una cuarta parte de los pacientes con DT1 tiene alterada la capacidad para percibir los síntomas de hipoglucemia. Esta anomalía es más frecuente conforme aumenta la duración de la enfermedad, e identifica las personas en riesgo de presentar hipoglucemia grave.

Impaired awareness of hypoglycaemia in subjects with type 1 diabetes. Results of an online survey in a diabetes web site

ObjectiveTo assess the frequency of impaired awareness of hypoglycaemia (IAH) using a specific questionnaire (Spanish version) in a free access diabetes-related web site. MethodsData from a free access Spanish version of the Clarke test previously uploaded to the website of the Fundación para la Diabetes (March 2014–January 2015) were assessed. In addition to the eight questions in Clarke's questionnaire, information on type of diabetes, age, and disease duration was obtained. The Clarke test divided participants into three categories: normal awareness, uncertain and IAH. ResultsOf the 418 participants with type 1 diabetes, 51.2% were aged 36–55 years. In 34.7%, diabetes had been diagnosed >15 years before, while disease duration was <2 years in 11%. According to Clarke categories, 23.4% had IAH, 15.3% uncertain awareness, and 61.3% normal awareness. The longer the duration of diabetes, the higher the Clarke test score. According to the Clarke test, 14.1% of participants had experienced at least one episode of severe hypoglycaemia in the previous year, and half of these (7.4%) had suffered severe hypoglycaemia two or more times. All but one of the participants with two or more episodes of severe hypoglycaemia had IAH. ConclusionsOur study shows that the rate of IAH using an online survey is similar (25%) to that previously reported in other geographical areas, increases with diabetes duration, and identifies subjects prone to severe hypoglycaemia.

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.

BackgroundFor 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.ObjectiveThis 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.MethodsAdolescents (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).ResultsMost 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).ConclusionsAdolescents 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.

Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes

The purpose of the study was to evaluate the participation and preliminary efficacy of an Internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared with an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QoL), and secondary outcomes of psychosocial and behavioral factors. Teens with type 1 diabetes (n = 124, 11-14 yr) from two clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of log ins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used. Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and log ins were similar between groups (satisfaction ranged 3.3-3.5/5; mean log ins = 14/teen). Posts to the discussion forum were higher in Planet D (mean = 28 vs. 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QoL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01). Teens do not actively participate in an Internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes.

Perceptions about professionally and non-professionally trained hypoglycemia detection dogs

AimsPatients with diabetes increasingly have questions about diabetes alert dogs. This study evaluated perceptions about dogs trained professionally or otherwise to detect glucose levels. MethodsA link to a survey about glucose detecting dogs was announced on diabetes websites. Results135 persons responded, with 63 answering about their child with diabetes. Most respondents obtained their dog from a professional trainer (n=54) or trained it themselves (n=51). Owners of self- and professionally-trained dogs were very positive about dogs’ abilities to alert them to low and high glucose levels, while owners of dogs that learned entirely on their own (n=15) reported lower frequencies of alerts and more missed hypoglycemic episodes, p<.01. Regardless of how dogs learned, perceptions about managing diabetes were improved during periods of dog ownership relative to times without, p<.001. Self-reported rates of diabetes-related hospitalizations, assistance from others for treating hypoglycemia, and accidents or near accidents while driving reduced during periods of dog ownership compared to periods without dogs, ps<.01. ConclusionsThese data suggest potential effectiveness of and high satisfaction with glucose-detecting dogs. Clinicians can use these results to address pros and cons of dog ownership with patients who inquire about them.

Addressing the Needs of Latinos With Type 2 Diabetes Through Online Patient Education

Patients with Type 2 diabetes are increasingly turning to the Web for information about diabetes and self-management. These sites, however, fail to address the cultural and linguistic needs of the growing community of Latinos with diabetes. The Juntos Controlamos la Diabetes Web site was designed as a low-cost patient education tool to be used by patients, caregivers, and healthcare providers to provide ongoing information about diabetes self-management tailored to the needs of the regional Latino community.

Automatic information timeliness assessment of diabetes web sites by evidence based medicine

Studies on health domain have shown that health websites provide imperfect information and give recommendations which are not up to date with the recent literature even when their last modified dates are quite recent. In this paper, we propose a framework which assesses the timeliness of the content of health websites automatically by evidence based medicine. Our aim is to assess the accordance of website contents with the current literature and information timeliness disregarding the update time stated on the websites.The proposed method is based on automatic term recognition, relevance feedback and information retrieval techniques in order to generate time-aware structured queries. We tested the framework on diabetes health web sites which were archived between 2006 and 2013 by Archive-it using American Diabetes Association's (ADA) guidelines. The results showed that the proposed framework achieves 65% and 77% accuracy in detecting the timeliness of the web content according to years and pre-determined time intervals respectively. Information seekers and web site owners may benefit from the proposed framework in finding relevant and up-to-date diabetes web sites.

A framework for automatic information quality ranking of diabetes websites

Objective: When searching for particular medical information on the internet the challenge lies in distinguishing the websites that are relevant to the topic, and contain accurate information. In this article, we propose a framework that automatically identifies and ranks diabetes websites according to their relevance and information quality based on the website content.Design: The proposed framework ranks diabetes websites according to their content quality, relevance and evidence based medicine. The framework combines information retrieval techniques with a lexical resource based on Sentiwordnet making it possible to work with biased and untrusted websites while, at the same time, ensuring the content relevance.Measurement: The evaluation measurements used were Pearson-correlation, true positives, false positives and accuracy. We tested the framework with a benchmark data set consisting of 55 websites with varying degrees of information quality problems.Results: The proposed framework gives good results that are comparable with the non-automated information quality measuring approaches in the literature. The correlation between the results of the proposed automated framework and ground-truth is 0.68 on an average with p < 0.001 which is greater than the other proposed automated methods in the literature (r score in average is 0.33).

Experiences of Children and Adolescents With Type 1 Diabetes in School: Survey of Children, Parents, and Schools

More than 160,000 children and adolescents with type 1 diabetes are enrolled in public and private schools in the United States.1,2 School children with type 1 diabetes must be afforded the proper time and tools for diabetes self-care to be safe, learn effectively, and be able to participate in all school activities.3,4 In addition, knowledgeable school personnel are needed to assist them when they do need help. Thanks to the efforts of the American Diabetes Association (ADA), the Juvenile Diabetes Research Foundation (JDRF), the National Diabetes Education Program (NDEP), and the Children with Diabetes Web site, much progress has been made in the past 20 years to ensure that children in schools are safe and protected. Each of these organizations has provided valuable educational and advocacy resources for parents and educational materials for school systems. The daily self-management of children and adolescents with type 1 diabetes is complex and dynamic. It requires frequent self-monitoring of blood glucose (SMBG), insulin injections, and individual meal plans.5-7 However, changes in daily schedules (e.g., recess, physical education class, school outings, and participation in sports) or an acute illness complicate children's blood glucose management while at school. In addition, children are continually growing during each academic year, requiring frequent changes to their individualized treatment plans. Decisions concerning adjustments in insulin doses occur often while children are in school and frequently must be made by a school nurse, parent, or guardian following protocols in the comprehensive diabetes care plan prescribed by the children's physicians.8,9 School nurses are the principal contact person between parents and guardians and health care providers with regard to updating children's individualized diabetes care plans for management of acute problems during the school day. Unfortunately, some school systems do not have …