Study measures effects of apps on weight reduction.

As the prevalence of obesity continues to rise in the United States (35% in males, 40% in females in 2016), the risks of type 2 diabetes rises as well, supporting the need for ongoing weight control as a simple means of reducing diabetes risk. This concern is especially important in the aging adult population, where at least 66% of those over 65 meet current Centers for Disease Control (CDC) criteria for obesity or being overweight, while 51% of the same population is at risk for type 2 diabetes (US Census Bureau, 2014). The practice of healthy eating and regular exercise in overweight patients reduces the risk of progression from prediabetes or metabolic syndrome to diabetes. Several studies that support this notion have led to the American Association of Clinical Endocrinologists and the American College of Endocrinology including these lifestyle modifications in their first clinical practice guidelines in 2016.

Over time, lifestyle intervention programs were traditionally conducted in a face-to-face environment, typically with an in-person coach. While highly effective, patient barriers to participation (lack of access or lack of interest in this type of program) have demonstrated lack of response in patients who were unable to partake when compared to outcomes in patients who were able to do face-to-face sessions. Recent advances in technology have afforded patients with tools to remotely achieve high-level interaction with a live coach for behavioral counselling, group support, self-paced education, and development of important skills geared toward success. However, very few data are available looking at the Diabetes Prevention Program combined with technology use in older adults. With the rise of Internet availability to the aging population, C.M. Castro-Sweet et al. retrospectively observed a group of Medicare prediabetic patients, examining the effects of an Internet-based DDP digital application on weight status and progression to diabetes.

Subjects were selected from the Humana Medicare Advantage insurance program in the United States. High-risk participants were invited through a 3-week marketing campaign of direct mail, phone call and email contacts describing eligibility for the study as a benefit of their insurance plan. A total of 9,498 members were contacted, of which 501 eligible patients were enrolled. Eligibility was defined as presence of metabolic syndrome, or a combination of three of the following: prediabetes, hypertension, hyperlipidemia, and obesity. Weights were measured and electronically uploaded with an electronic scale. Using Internet-enabled devices (smart phones, computers, tablets), the participants partook in a 16-week intensive curriculum of weekly interactive lessons. Each module was available to all participants for one week at a time, allowing the patients to learn asynchronously but on the same schedule. The program application allowed participants to track weight loss, physical activity, and daily food intake. Following the 16-week weight loss program, a 36-week program focused on weight maintenance was started, for a total intervention length of 12 months. Throughout the duration of the study, all patients were monitored for psychological markers and overall progress using three different approved surveys: The World Health Organization-5 (WHO-5) Well-Being Index (measures subjective well-being), the Patient Health Questionnaire for Depression and Anxiety (PHQ-4), and the Summary of Diabetes Self-Care Activities (SDSCA) scale (reports self-management behaviors relating to diabetes).

Of the 501 participants (mean age 68.8 years), 95% completed at least 4 weekly lessons, and 92% completed 9 or more lessons in the initial 16-week phase. Only 2% failed to complete at least one lesson. Weight change from baseline was found to be significant (mean loss: -6.5%, SD 4.0 at 16 weeks, -8.0%, SD 7.7 at 6 months, and -7.5%, SD 7.8 at 12 months; p=0.01 for all). In the subset of patients (n=96) with available HbA1C and cholesterol measurements, the declines from baseline were also statistically significant (12-month improvement: HbA1c -0.14%, p=0.001; cholesterol -7.08 mg/dl, p=0.0001). As the self-reported surveys were optional, 57% (n=285) provided the surveys. The Who-5 Well-Being Index showed improvement in scores (+12%, p=0.0001), while the PHQ-4 Depression and Anxiety showed improvement in depression scores (-0.26, p=0.0001), but not in anxiety scores (-0.10, p=0.1922). The SDSCA also showed improvement in all 5 markers of healthy lifestyle, with statistical significance, with healthy modifications (better diet, exercise habits) increasing, and unhealthy behaviors (fast food consumption) decreasing.

This study found that willing participants enjoyed a high degree of success, meaningful engagement, and important benefits. Weight loss at for 6 and 12 months (8% and 7.5%) exceeded the standards set by the CDCs National Diabetes Prevention Program (5% reduction). Population presence in 37 states shows good geographic generalizability, supporting the scale that this approach could achieve in reaching patients. Limitations included a lack of a control group, although on average the subjects were not meeting physical activity standards, but by week 16, were all meeting the recommendations. A control group would have provided a better comparator for all data collection points in the 12-month period.

Practice Pearls:

Reference:

Castro Sweet CM, Chiguluri V, Gumpina R, et al. Outcomes of a Digital Health Program With Human Coaching for Diabetes Risk

See the original post here:
Diabetes Risk Reduction Seen with a Digital Health Program, Human Coaching - Diabetes In Control

Stay active and track your reactions

Starstuff/ShutterstockWhen David Weingard was diagnosed with type 1 diabetes at the age of 36, he faced with some tough adjustments. From taking his new medication to monitoring his blood sugar, he fought to stay active and fit, eventually founding his diabetes coaching company, Fit4D. For Weingard, exercising had to remain a part of his life and he encourages other diabetics to do the same.

"Exercise is critical to long-term physical and mental health. Mentally, we need positive energy (and endorphins) to combat the 24/7 strain of the condition. Physically, we need to help our bodies stay strong and avoid the long-term effects and complications of diabetes," he says.

But to figure out how much you can withstand and what works for your body, he also notes that keeping track your reactions will help create a plan that works uniquely for you. "Detailed record keeping is a key factor in realizing the benefits of exercise and minimizing blood sugar swingsespecially highs and lows. You can reference these records to repeat workouts and your body should yield similar results most of the time," he says. Find out what the best exercises are for people with diabetes.

g stockstudio/ShutterstockThough Rachel Zucker is only 24 years old, she's been managing her type 1 diabetes diagnosis since she was four years old, making her quite the expert. She described diabetes as a full-time job: She had to accept that there are no days off, no breaks or vacations. That's why she recommends having supportive friends and family around you who will move with your highs and lowsthey're essential to keeping a good attitude and mindset. Instead of hiding your diagnosis, Zucker says wear it with pride. "I tell anybody and everybody close to me that I'm diabetic. Making sure people around you know you're diabetic can be life-saving in an emergency situation. In college, I made sure everybody around me knew I had type 1 diabetes, so when I went out to a party or to a sorority fundraising event, there was always someone looking out for me. Some people are afraid or embarrassed to tell others about their medical condition; I would highly encourage them not to be. Nobody has to do this alone," she says. Find out how fruit can lower yourdiabetes risk.

Andrey Popov/ShutterstockNow 67, Carol Geewasn't diagnosed with type 2 diabetes until her late 50s. Although her new life was scary at first, she says that leaning into the unknown helped her manage her new lifestyle and adjust her habits, ensuring that she lived vibrantly throughout middle age. "Diabetes is scary, but with knowledge comes power. Take the medications the way you are supposed to and it will get easier. I was afraid of needles, so I considered it a great victory when I injected myself without passing out. Know that you 'can' survive and thrive with diabetes. You just have to say itand more importantlybelieve it." (Learn what interval training can do for diabetes.)

Content continues below ad

Sergey Nivens/ShutterstockAuthor and diabetes advocate, Quinn Nystrom first watched her younger brother get diagnosed with type 1 diagnosis. Then, two years later, she got the news herself at the age of 13. While that day was one of the worst of her life, she says, it's taught her many life lessons and led her to help others. Even though living with diabetes is a 24/7 job, she encourages those who are newly diagnosed to not let it define them. Instead, she says, allow it to refine you. "We are not just a broken down pancreas. We're more than a label that a doctor gives us, society tells us, and even sometimes what we tell ourselves. Seek to understand how the diagnosis of diabetes has brought light into your life. Find the positives," she says.

wavebreakmedia/ShutterstockThough it can be difficult to focus on anything but your blood sugar, Mella Barnes has found that keeping all parts of her health top of mind helps keep her more satisfied and balanced. She discovered her type 1 diabetes at the age of eight, and has been managing the illness ever since. She says that focusing on each day has been helpful. She also discovered that staying in touch with her emotions is crucial. "Take care of your mental and emotional health. This impacts your diabetes more than you think! Stress causes a lot of issues as well as a lack of sleep. If you're depressed or anxious about your diabetes, find a therapist or free support group. Do something that makes you happy every day," she says.

Content continues below ad

Rawpixel.com/ShutterstockFred Winchar discovered he was a type 2 diabetic six years ago and has worked hard to manage his diagnosis. A successful businessman who knows the importance of good advice, he quickly realized that he needed to talk to someone who had been through the struggle. "When I first was diagnosed, I told a friend who was a type 1 diabetic, and he helped me learn how to test and monitor my sugars. He was one of the most energetic and happy people I have ever met. He was delighted to help another person on the same journey. Not only did I learn but I was able to bond in a special way with someone who knew what I was going through," he says.

Continued here:
Simple Tricks for Living Well with Diabetesfrom People Who Have It - Reader's Digest

While volunteering in Nepal, I was diagnosed with type 1 diabetes at age 31. It was Valentine's Day 2014, and my wife and I were in the middle of a backpacking trip around the globe. We had just finished a hiking trip in the Himalayas that almost killed me.

I had been losing weight and had to run to the bathroom constantly. And I had never in my life been so thirsty. I dismissed the symptoms as consequences of the dry weather, until I stepped on a scale and saw how much weight I'd lost: about 40 pounds.

A trip to a local doctor gave me the diagnosis that would change my life and land me in two hospitals in Nepal before I was cleared to fly home. I spent a month learning about diabetes and understanding the ins and outs of a chronic autoimmune disease. Then it was time to make my decision.

My wife, Cassandra Kramer, and I resolved to get back on the road and finish what we had started. I knew that if I accepted limitations so early in my life with diabetes, I would always accept limitations, and that was a dangerous state of mind.

We caught a flight to Bangkok and made our way through Southeast Asia, South America and Iceland before coming home.

Diabetes is a disease with which the body no longer produces enough insulin to regulate blood sugar. In type 1 diabetes, the pancreas stops producing insulin altogether, requiring daily injections of artificial insulin and constant blood sugar monitoring. In type 2 diabetes, the body's insulin isn't used effectively, which is sometimes the consequence of being overweight. Type 2 diabetes can require some combination of lifestyle change, medication and insulin injections.

Yet the cause of diabetes is unknown. Although some cases of type 2 may be a result of obesity, that answer does not apply to everyone, and there are no such clues for type 1.

Diabetes still has a stigma attached to it, largely because of a lack of education and awareness. But people are constantly defying it by showing that there is no reason to accept limitations or boundaries when living with diabetes.

It may require more planning, but it's not a reason to say "no" to any experience.

Will Cross was diagnosed at the age of 9 in 1976, when diabetes care was nowhere near what it is today. He became the first person with type 1 diabetes to summit Everest when he scaled the highest peak in the world in 2006. He has also climbed the Seven Summits -- the highest peak on each continent -- and traveled to the North and South Poles.

"I never aspired to be a baseball or football player," Cross told Beyond Type 1, an organization dedicated to living with type 1 diabetes. "I just wanted to climb; diabetes didn't hinder that desire."

One person who did want to play football was Jay Cutler. The former quarterback for the Chicago Bears was 24 when he was diagnosed, making him one of a small but growing number of people with type 1 diabetes diagnosed after puberty. (Type 1 diabetes was traditionally called juvenile diabetes, but that term is becoming outmoded as the number of adults diagnosed with type 1 diabetes increases, though researchers don't fully understand why.) Cutler went on to play nine more seasons in the NFL, and he has become one of the best-known athletes with diabetes but certainly not the only one.

Perhaps the most famous celebrity with diabetes was Mary Tyler Moore, who used her fame to advocate for people with diabetes. Moore served as the international chairman of the Juvenile Diabetes Research Foundation. Her death in January sent shockwaves through diabetes community, which had lost one of its biggest influencers.

And if you're looking for a celebrity to pick up where Moore left off, singer Nick Jonas has carried the mantle so far, founding Beyond Type 1 and being candid about dealing with diabetes.

"It is very easy to want to hide what diabetes means for us in the workplace, but that just does a disservice to us, to other people with diabetes and to our coworkers," adventure athlete Erin Spineto said.

Diagnosed with type 1 diabetes in college, Spineto has completed a 100-mile standup paddling trip and sailed the Florida Keys solo, all the while proving that anything is possible, despite the disease. "The more real information and firsthand experience people get with this disease, the less stigma will be attached to it."

I was able to use my diabetes diagnosis, in a way, to improve my health. Though I have a chronic disease that requires constant blood sugar checks and insulin injections each day, I also have the most powerful of reasons to eat healthy, exercise and take better care of myself: a functional life.

Failure to stay healthy and keep my blood sugars in check can lead to the severe complications of diabetes: nerve damage, eye damage, cardiovascular disease and much more. Regular exercise and healthy eating help regulate blood sugar levels in people with diabetes.

Diabetes was the catalyst for that change, even if it means I am now walking around with a medical time bomb waiting for me to make a mistake.

Perhaps the most frustrating part about diabetes is the lack of definitive answers. Questions such as "how did I get it?" or "will there ever be a cure?" must remain open-ended for now. Although there are procedures that show promise for reducing or eliminating the need for insulin and an artificial pancreas (a device that manages blood sugar automatically) is on the horizon, a true cure for diabetes remains elusive. The same is true for understanding the cause.

Yet it is a manageable disease. With experience, discipline and a support network, diabetes should never be a reason to say "no." It's just a matter of figuring out what preparations you need to make to be able to say "yes."

Since finishing our backpacking trip, my wife and I have continued to travel when we can. Hiking Kilimanjaro is high on our priority list, and I want to return to the Himalayas to hike once again, this time knowing how to treat my diabetes.

For me, it is an extension of the most important decision I have ever made: the decision to live life without limits.

Maybe I'll even climb Everest.

See the article here:
Diabetes can't stop you from climbing Everest - CNN

HARI SREENIVASAN: More than eight million Americans suffer from diabetes, and more than $320 billion are spent every year treating the disease.

But an innovative program in San Diego is trying to improve health and reduce those costs by encouraging better self-management of the disease.

Special correspondent Cat Wise has our report.

CAT WISE: Fifty-one year old Alma Ayala is not a doctor or a nurse, but she is on the front lines of the diabetes epidemic in her community. Shes a peer educator for a program called Project Dulce, which works with people who have diabetes or are at risk of developing the chronic illness.

Her classes are part informational, part support group. Ayala says the goal of the program, which has been held up as a national model, is for people to feel empowered about changing their health. Thats something she didnt feel 30 years ago when she was first diagnosed with the disease.

ALMA AYALA, Peer Educator: I was devastated. I didnt want to hear the word diabetes. I felt that my life was done, that I was signing a certificate of death.

CAT WISE: Here in San Diego County, nearly half the adult population has pre-diabetes and about 8 percent have diabetes. Its a disease that affects all socioeconomic groups and races, but the Latino community has been disproportionately impacted. And thats the population Project Dulce has been targeting for the past 20 years.

ALMA AYALA: There are lots of barriers for the Latino community, language, insurance. Sometimes, doctors dont have the time to spend with them. So the classes that we provide is that extra support, working together with a clinical team to help our participants stay healthy.

CAT WISE: The program is scattered throughout 12 clinics in Latino neighborhoods throughout San Diego County and was designed by several local health care organizations, including the Scripps Whittier Diabetes Institute.

Dr. Athena Philis-Tsimikas is an endocrinologist who oversees the program.

DR. ATHENA PHILIS-TSIMIKAS, Scripps Whittier Diabetes Institute: This is a disease in which you have to do a number of management components, not only every day, but many times a day. And its not that easy to expect someone to remember to test their blood sugar, take their pill, to go out and take that walk, to have exactly the right meal on the table all the time to take care of this.

I dont see any lows there, so I dont think we have to worry that you might dip down too low.

CAT WISE: To help patients, a team is set up at each clinic with a physician, nurse practitioner, a dietitian and multiple peer counselors like Ayala who come from the communities they serve and also have the disease.

DR. ATHENA PHILIS-TSIMIKAS: If you can train these other people and professionals to help you do the other components that take longer, but are still absolutely necessary, then youre using your team to work very synergistically to deliver everything that patient needs in order to improve their care.

CAT WISE: The program is now adding another layer, technology. Last year, Tsimikas conducted a study to see if patients receiving daily text messages could manage their disease even better.

Artist Gloria Favela-Rocha was one of the participants. Shes a muralist who does large scale works for hospitals, schools and private clients. She says, before the study, she often forgot to regularly check her glucose levels. Project Dulce changed that.

GLORIA FAVELA-ROCHA, Diabetes Patient: The text message would come every day at the same time, so if I would lose track of where I was during my day, I would hear it ring, and so I would start checking my blood sugars, send in my result right away. It would send me back a message according to whatever my result was, like good job, or maybe you need to eat something that has a little more protein today.

So, it was just very it was very convenient.

CAT WISE: Dr. Tsimikas team has also been studying the effects of continuous glucose monitoring, which uses Bluetooth technology to send results to the patient and physician in real time.

MAGDALENA HERNANDEZ, Diabetes Patient: This device is reading my sugar levels.

CAT WISE: Magdalena Hernandez wears a small monitor on her stomach.

MAGDALENA HERNANDEZ: I love it. I love it because I dont have to prick my finger many times during the day, and it alerts me when my blood sugar goes high or goes low.

CAT WISE: And what happens if your levels go above 200? What do you do?

MAGDALENA HERNANDEZ: I grab a bottle of water, and I get up and walk for five minutes.

CAT WISE: Thirty miles away, Dr. Tsimikas is also able to keep tabs on Hernandezs levels.

DR. ATHENA PHILIS-TSIMIKAS: This is just over the last three hours, that she probably ate breakfast here, it went up, and is now declining.

CAT WISE: This technology has been on the market for several years, but has not been widely used because of cost and a somewhat complicated user interface. But Tsimikas says those barriers are being reduced and she predicts it will have a big impact on health.

DR. ATHENA PHILIS-TSIMIKAS: It is reinforcement to both the patient and to the provider thats helping to make recommendations on whether this is working or not. I think its really going to revolutionize the way we can take care of patients.

CAT WISE: Dr. Tsimikas says the objective is to prevent the serious complications that can accompany diabetes, including blindness, kidney failure, amputations or heart failure.

MAGDALENA HERNANDEZ: I really love the black beans and all the vegetables in here.

CAT WISE: According to studies conducted by the University of California, San Diego, and elsewhere, Project Dulce has helped lower patients blood sugar and cholesterol levels, while at the same time reduced the number of costly hospitalizations and emergency room visits.

While some elements of the program are being used in other communities, Project Dulce stands out for its comprehensive approach. So, why arent similar initiatives being rolled out in every neighborhood in America?

DR. ATHENA PHILIS-TSIMIKAS: Its probably the way we reimburse for each of these components. Thats probably the biggest hurdle. We traditionally have reimbursed only for physician visits. If we could find a way to actually reimburse for each of these components, it may be more sustainable for the future.

Or maybe we simply reimburse based on our success. If you are successful in achieving better outcomes, maybe then you pay for what led to those better outcomes.

CAT WISE: In the coming weeks, Project Dulce will begin a new study of patients that combines text messaging with continuous glucose monitoring and a wireless pill box that will alert a nurse if a patient isnt taking his or her medication.

From San Diego, Im Cat Wise for the PBS NewsHour.

Follow this link:
Self-empowerment is sweet for diabetes patients in this innovative program - PBS NewsHour