Diabetes Digital Health

David C. Klonoff, David Kerr, Shelagh A. Mulvaney, David C Klonoff

• Publisher: Elsevier
• Year: 2020
• Print ISBN: 9780128174852
• eBook ISBN: 9780128174869
• Topic: Medicine
• Subtopic: Endocrinology & Metabolism

Diabetes Digital Health brings together the multifaceted information surrounding the science of digital health from an academic, regulatory, industrial, investment and cybersecurity perspective. Clinicians and researchers who are developing and evaluating mobile apps for diabetes patients will find this essential reading, as will industry people whose companies are developing mobile apps and sensors. - Provides valuable information for clinicians, researchers and industry about the design and evaluation of patient-facing diabetes adherence technologies - Highlights cutting-edge topics that are presented and discussed at the Digital Diabetes Congress

Section 1

Building digital health tools for diabetes

Outline

• Chapter 1 Reducing the global burden of diabetes using mobile health
• Chapter 2 Diabetes education reimagined: educator-led, technology-enabled diabetes population health management services
• Chapter 3 Digital technologies to support behavior change: challenges and opportunities
• Chapter 4 Agile science: what and how in digital diabetes research
• Chapter 5 Behavior change techniques for diabetes technologies
• Chapter 6 Integrating behavior and context with glucose data to advance behavioral science and clinical care in diabetes
• Chapter 7 Designing human-centered user experiences and user interfaces

Chapter 1

Reducing the global burden of diabetes using mobile health

Mohan Deepa, Muralidharan Shruti and Viswanathan Mohan, Madras Diabetes Research Foundation & Dr. Mohan’s Diabetes Specialities Centre, WHO Collaborating Centre for Non-Communicable Diseases Prevention and Control & ICMR Center for Advanced Research on Diabetes, Chennai, India

Abstract

The prevalence of type 2 diabetes (T2D) is steadily increasing globally, mainly because of greater access to unhealthy and high-calorie foods and decreased physical activity. Evidence from several randomized control trials has demonstrated that prevention of T2D is possible. There is growing evidence from recent studies and systematic reviews that the use of mobile health (or mHealth) can play an important role in improving the lifestyle behaviors and thereby helps in the prevention and management of T2D. Current evidence supports the role of mHealth devices as a complementary tool in planning diabetes-intervention studies. The challenge is to scale up these activities in order to reach millions of people. The use of mobile applications and wearable activity trackers appears to be promising. However, there is need for long-term studies to evaluate the sustainability of these interventions.

Keywords

Diabetes; mobile health; mHealth; prevention; management; digital technology

Abbreviations

ADA American Diabetes Association

BCW Behavior Change Wheel

BMI body mass index

CVD cardiovascular disease

D-CLIP Diabetes Community Lifestyle Improvement Program

DQDPS Da Qing Diabetes Prevention Study

DPP Diabetes Prevention Program

DPS Diabetes Prevention Study

eHealth electronic health

GSMA Groupe Spécial Mobile—Global System for Mobile Communications

HbA1c glycated hemoglobin

HPFS Health Professionals Follow-Up Study

IDEAS Integrate, Design, Assess, and Share

IDF International Diabetes Federation

IDPP Indian Diabetes Prevention Program

IGT impaired glucose tolerance

IMB information–motivation–behavioral skills model

LSM lifestyle management

mHealth mobile health

MVPA moderate and vigorous physical activity

SMS short message services

T2D type 2 diabetes

WAT wearable activity trackers

Key points

• • Digital health can play an important role in improving the lifestyle behaviors and thereby helps in the prevention and management of type 2 diabetes.
• • Current evidence supports the role of mobile health devices as a complementary tool in diabetes-intervention studies.
• • Though digital health applications seem promising, there is a need for long-term studies to evaluate their efficacy, sustainability, patient satisfaction, and cost-effectiveness.

Introduction

The marked increase in prevalence rates of type 2 diabetes (T2D) that is now reaching epidemic proportions is one of the major global health challenges today. Once considered a disease of affluence, diabetes is now more prevalent in emerging economies than in the industrialized nations of the world. The rapid rise in diabetes prevalence is due to greater access to unhealthy and high-calorie foods and decreased physical activity coupled with population growth and improved longevity [1]. There are several randomized clinical trials showing that the prevention of diabetes is possible. The challenge is to scale these up at a population level, to reach millions of people. With recent advances in information technology and mobile health (mHealth) or the use of mobile communications for health information and services, prevention of diabetes should become possible even at a population level. This chapter will provide an overview of the prevalence and risk factors of T2D and the role of mHealth in reducing the burden of T2D.

Global prevalence of type 2 diabetes

The number of people with diabetes is increasing due to population growth, improved longevity, urbanization, physical inactivity, unhealthy diets, and the consequent increase in prevalence of obesity. Wild et al. [2] estimated that in 2004, the global prevalence of T2D across all age groups was 2.8%. More recently, these figures have risen sharply and the projection is that it will rise still higher, in the next decade [3]. According to the International Diabetes Federation (IDF) Diabetes Atlas (2017), now 425 million adults aged 20–79 years have diabetes and the number projected for the year 2045 is 629 million people with diabetes [4].

Epidemiology of type 2 diabetes—ethnic and regional differences in the prevalence

China and India have the largest numbers of people with T2D [3]. The highest prevalence rates are in the Pacific Islands and the Middle East. South and Central America and Africa, although currently having relatively lower numbers, are expected to experience a very rapid increase in prevalence rates [4]. Individuals of certain ethnicities are more prone to develop T2D, for example, South Asians, Pima Indians, Pacific Islanders, and Hispanics [2,5]. Studies have shown that Asian-Indian immigrants have a higher prevalence of T2D compared to the white US population and Europeans [6,7]. There can also be variation between immigrants within a region. In Canada the risk for diabetes was higher among immigrants from South Asia, Latin America, the Caribbean, and sub-Saharan Africa than immigrants from Western Europe and North America [8]. The “South Indian phenotype” suggests that South Asians develop diabetes at younger ages, progressing faster from prediabetes to diabetes, when compared to white Caucasians of similar body mass index [9].

Type 2 diabetes—a modifiable pandemic

Economic development in many countries has led to environmental factors that promote obesity and diabetes. These include a marked decrease in physical activity levels along with unhealthy diets rich in carbohydrates (sugars), fat, and excess calories. Additional risk factors include depression, smoking, inadequate sleep, lack of adequate built environment and green areas, and increasing exposure to environmental pollutants, all of which are associated with an increase in T2D. Many of the factors are modifiable, and thus addressing them can lead to prevention of diabetes. Three major modifiable risk factors—physical inactivity, diet, and built environment—are discussed here.

1. 1. Physical inactivity: Physical inactivity has been shown to increase the risk of T2D across all ethnicities [10]. The absence of recreational physical activity has not yet become a major risk factor in some developing nations, where the level of occupational physical activity remains high. Recreational physical activity, for instance, is reported to be less than 10% in India [11]. Nevertheless, even in these countries, mechanization and industrialization have resulted in a major decline in physical activity. Studies have shown that sedentary individuals are at a higher risk for T2D compared to individuals leading an active lifestyle [12]. A systematic review reported that achieving the recommended physical activity levels of 150 minutes of moderate aerobic physical activity led to 26% decrease in T2D incidence after adjusting for body weight [13]. A global economic analysis of physical inactivity showed that it costs the world economy, US$67.5 billion per year in health-care costs, in addition to lost productivity [14]. Thus, the need for increasing physical activity is very clear.
2. 2. Dietary factors: Nutrition transition has been linked to rapid economic development leading to increased consumption of fast foods, sweetened beverages, and foods high in calories, and this disproportionately affects people living in urban areas and younger individuals. Traditionally, the staple diet in several parts of the world was unpolished whole grains that were rich in fiber and thus had a low glycemic index and glycemic load. Unfortunately, there has been a shift to the use of refined polished grains owing to the availab...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• List of contributors
• Preface
• Section 1: Building digital health tools for diabetes
• Section 2: Clinical aspects of digital health for diabetes
• Section 3: Technical aspects of digital health for diabetes
• Index