Browsing by Author "Farmer, Andrew J"
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- ItemComparing the Efficacy of a Mobile Phone-Based Blood Glucose Management System With Standard Clinic Care in Women With Gestational Diabetes: Randomized Controlled Trial.(0000-00-00) Mackillop, Lucy; Hirst, Jane Elizabeth; Bartlett, Katy Jane; Birks, Jacqueline Susan; Clifton, Lei; Farmer, Andrew J; Gibson, Oliver; Kenworthy, Yvonne; Levy, Jonathan Cummings; Loerup, Lise; Rivero-Arias, Oliver; Ming, Wai-Kit; Velardo, Carmelo; Tarassenko, LionelBACKGROUND Treatment of hyperglycemia in women with gestational diabetes mellitus GDM is associated with improved maternal and neonatal outcomes and requires intensive clinical input This is currently achieved by hospital clinic attendance every 2 to 4 weeks with limited opportunity for intervention between these visits OBJECTIVE We conducted a randomized controlled trial to determine whether the use of a mobile phone based real time blood glucose management system to manage women with GDM remotely was as effective in controlling blood glucose as standard care through clinic attendance METHODS Women with an abnormal oral glucose tolerance test before 34 completed weeks of gestation were individually randomized to a mobile phone based blood glucose management solution GDm health the intervention or routine clinic care The primary outcome was change in mean blood glucose in each group from recruitment to delivery calculated with adjustments made for number of blood glucose measurements proportion of preprandial and postprandial readings baseline characteristics and length of time in the study RESULTS A total of 203 women were randomized Blood glucose data were available for 98 intervention and 85 control women There was no significant difference in rate of change of blood glucose 0 16 mmol L in the intervention and 0 14 mmol L in the control group per 28 days P 78 Women using the intervention had higher satisfaction with care P 049 Preterm birth was less common in the intervention group 5 101 5 0 vs 13 102 12 7 OR 0 36 95 CI 0 12 1 01 There were fewer cesarean deliveries compared with vaginal deliveries in the intervention group 27 101 26 7 vs 47 102 46 1 P 005 Other glycemic maternal and neonatal outcomes were similar in both groups The median time from recruitment to delivery was similar intervention 54 days control 49 days P 23 However there were significantly more blood glucose readings in the intervention group mean 3 80 SD 1 80 and mean 2 63 SD 1 71 readings per day in the intervention and control groups respectively PUnder 001 There was no significant difference in direct health care costs between the two groups with a mean cost difference of the intervention group compared to control of 1044 95 CI 2186 to 99 There were no unexpected adverse outcomes CONCLUSIONS Remote blood glucocse monitoring in women with GDM is safe We demonstrated superior data capture using GDm health Although glycemic control and maternal and neonatal outcomes were similar women preferred this model of care Further studies are required to explore whether digital health solutions can promote desired self management lifestyle behaviors and dietetic adherence and influence maternal and neonatal outcomes Digital blood glucose monitoring may provide a scalable practical method to address the growing burden of GDM around the world TRIAL REGISTRATION ClinicalTrials gov NCT01916694 https clinicaltrials gov ct2 show NCT01916694 Archived by WebCite at http www webcitation org 6y3lh2BOQ
- ItemComputer-based diabetes self-management interventions for adults with type 2 diabetes mellitus.(2013-04-01) Pal, Kingshuk; Eastwood, Sophie V; Michie, Susan; Farmer, Andrew J; Barnard, Maria L; Peacock, Richard; Wood, Bindie; Inniss, Joni D; Murray, ElizabethBACKGROUND Diabetes is one of the commonest chronic medical conditions affecting around 347 million adults worldwide Structured patient education programmes reduce the risk of diabetes related complications four fold Internet based self management programmes have been shown to be effective for a number of long term conditions but it is unclear what are the essential or effective components of such programmes If computer based self management interventions improve outcomes in type 2 diabetes they could potentially provide a cost effective option for reducing the burdens placed on patients and healthcare systems by this long term condition OBJECTIVES To assess the effects on health status and health related quality of life of computer based diabetes self management interventions for adults with type 2 diabetes mellitus SEARCH METHODS We searched six electronic bibliographic databases for published articles and conference proceedings and three online databases for theses all up to November 2011 Reference lists of relevant reports and reviews were also screened SELECTION CRITERIA Randomised controlled trials of computer based self management interventions for adults with type 2 diabetes i e computer based software applications that respond to user input and aim to generate tailored content to improve one or more self management domains through feedback tailored advice reinforcement and rewards patient decision support goal setting or reminders DATA COLLECTION AND ANALYSIS Two review authors independently screened the abstracts and extracted data A taxonomy for behaviour change techniques was used to describe the active ingredients of the intervention MAIN RESULTS We identified 16 randomised controlled trials with 3578 participants that fitted our inclusion criteria These studies included a wide spectrum of interventions covering clinic based brief interventions Internet based interventions that could be used from home and mobile phone based interventions The mean age of participants was between 46 to 67 years old and mean time since diagnosis was 6 to 13 years The duration of the interventions varied between 1 to 12 months There were three reported deaths out of 3578 participants Computer based diabetes self management interventions currently have limited effectiveness They appear to have small benefits on glycaemic control pooled effect on glycosylated haemoglobin A1c HbA1c 2 3 mmol mol or 0 2 95 confidence interval CI 0 4 to 0 1 P 0 009 2637 participants 11 trials The effect size on HbA1c was larger in the mobile phone subgroup subgroup analysis mean difference in HbA1c 5 5 mmol mol or 0 5 95 CI 0 7 to 0 3 P Under 0 00001 280 participants three trials Current interventions do not show adequate evidence for improving depression health related quality of life or weight Four out of 10 interventions showed beneficial effects on lipid profile One participant withdrew because of anxiety but there were no other documented adverse effects Two studies provided limited cost effectiveness data with one study suggesting costs per patient of less than 140 in 1997 or 105 EURO and another study showed no change in health behaviour and resource utilisation AUTHORS CONCLUSIONS Computer based diabetes self management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and the effect was larger in the mobile phone subgroup There is no evidence to show benefits in other biological outcomes or any cognitive behavioural or emotional outcomes
- ItemIdentifying Brief Message Content for Interventions Delivered via Mobile Devices to Improve Medication Adherence in People With Type 2 Diabetes Mellitus: A Rapid Systematic Review.(0000-00-00) Long, Hannah; Bartlett, Yvonne K; Farmer, Andrew J; French, David PBACKGROUND Current interventions to support medication adherence in people with type 2 diabetes are generally resource intensive and ineffective Brief messages such as those delivered via short message service SMS systems are increasingly used in digital health interventions to support adherence because they can be delivered on a wide scale and at low cost The content of SMS text messages is a crucial intervention feature for promoting behavior change but it is often unclear what the rationale is for chosen wording or any underlying mechanisms targeted for behavioral change There is little guidance for developing and optimizing brief message content for use in mobile device delivered interventions OBJECTIVE This review aimed to 1 identify theoretical constructs ie the targets that interventions aim to change and behavioral strategies ie features of intervention content found to be associated with medication adherence in patients with type 2 diabetes and 2 map these onto a standard taxonomy for behavior change techniques BCTs that is active ingredients of interventions used to promote behavioral change to produce an evidence based set of approaches that have shown promise of improving adherence in previous studies and which could be further tested in digital health interventions METHODS A rapid systematic review of existing relevant systematic reviews was conducted MEDLINE and PsycINFO databases were searched from inception to April 10 2017 Inclusion criteria were 1 systematic reviews of quantitative data if the studies reviewed identified predictors of or correlates with medication adherence or evaluated medication adherence enhancing interventions and included adult participants taking medication to manage a chronic physical health condition and 2 systematic reviews of qualitative studies of experiences of medication adherence for adult participants with type 2 diabetes Data were extracted on review characteristics and BCTs theoretical constructs or behavioral strategies associated with improved adherence Constructs and strategies were mapped onto the BCT version 1 taxonomy RESULTS A total of 1701 references were identified 25 systematic reviews 19 quantitative reviews 3 qualitative reviews and 3 mixed method reviews were included Moreover 20 theoretical constructs eg self efficacy and 19 behavioral strategies eg habit analysis were identified in the included reviews In total 46 BCTs were identified as being related to medication adherence in type 2 diabetes eg habit formation prompts or cues and information about health consequences CONCLUSIONS We identified 46 promising BCTs related to medication adherence in type 2 diabetes on which the content of brief messages delivered through mobile devices to improve adherence could be based By using explicit systematic review methods and linking our findings to a standardized taxonomy of BCTs we have described a novel approach for the development of digital message content Future brief message interventions that aim to support medication adherence could incorporate the identified BCTs
- ItemA randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446).(2005-10-26) Farmer, Andrew J; Gibson, Oliver J; Dudley, Christina; Bryden, Kathryn; Hayton, Paul M; Tarassenko, Lionel; Neil, AndrewTo determine whether a system of telemedicine support can improve glycemic control in type 1 diabetes