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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Research Article

Empowering Patients with Type 1 Diabetes through a Multidisciplinary Team-assisted, Technology-Enabled Education Program

Author(s): Geethu Sanal, Sajna Shijin, Viji Krishna, Jothydev Kesavadev*, Anjana Basanth, Gopika Krishnan and Arun Shankar

Volume 19, Issue 4, 2023

Published on: 04 August, 2022

Article ID: e200522205073 Pages: 9

DOI: 10.2174/1573399818666220520115420

Price: $65

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Abstract

Background: Carbohydrate counting is a tool that helps patients with type 1 diabetes (T1D) to control their blood glucose. It calculates the bolus insulin dose needed from the total amount of carbohydrates consumed at each meal. However, carbohydrate counting can be quite challenging. The Diabetes Tele Management System® (DTMS®) is a telemedicine-based program that enables the patient to interact directly with a professionally trained, multidisciplinary team (MDT) of experts. This, along with technology-enabled education programs, could allow people with T1D to achieve glycemic control.

Methods: Fifty patients with T1D between 5 and 35 years with a diabetes duration of at least 6 months, baseline HbA1c of 7 or above, using SCII or MDI and willing to take part in the study were invited to participate in an MDT-assisted technology-enabled program and trained trimonthly on carbohydrate counting. The control group went on to perform carbohydrate counting independently and used technologies at their convenience. The test group additionally received continuous individual assistance from the MDT.

Results: The MDT-assisted patients had significantly decreased HbA1c, blood glucose levels, decreased episodes of hyperglycemia and hypoglycemia, and reported a more positive outlook on life.

Conclusion: Carbohydrate counting remains a challenge for youth with T1D, and errors in counting can have a clinical impact. Our data suggested that the assistance from an MDT of experts was associated with improved carbohydrate counting, which led to improved glycemic control and reduced complications.

Keywords: Carbohydrate counting, diabetes management, glycated hemoglobin, insulin, type 1 diabetes, telemedicine.

[1]
International diabetes federation IDF Diabetes Atlas 2021. Available from: https://diabetesatlas.org
[2]
Butler AE, Galasso R, Meier JJ, Basu R, Rizza RA, Butler PC. Modestly increased beta cell apoptosis but no increased beta cell replication in recent-onset type 1 diabetic patients who died of diabetic ketoacidosis. Diabetologia 2007; 50(11): 2323-31.
[http://dx.doi.org/10.1007/s00125-007-0794-x] [PMID: 17805509]
[3]
Nathan DM, Genuth S, Lachin J, et al. The effect of intensive treatment of diabetes on the development and progression of longterm complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329(14): 977-86.
[http://dx.doi.org/10.1056/NEJM199309303291401] [PMID: 8366922]
[4]
Franz MJ, Bantle JP, Beebe CA, et al. Evidence-based nutrition principles and recommendations for the treatment and prevention of diabetes and related complications. Diabetes Care 2003; 26 (Suppl. 1): S51-61.
[http://dx.doi.org/10.2337/diacare.26.2007.S51] [PMID: 12502619]
[5]
Tascini G, Berioli MG, Cerquiglini L, et al. Carbohydrate counting in children and adolescents with type 1 diabetes. Nutrients 2018; 10(1): 109.
[http://dx.doi.org/10.3390/nu10010109] [PMID: 29361766]
[6]
White RO, Wolff K, Cavanaugh KL, Rothman R. Addressing health literacy and numeracy to improve diabetes education and care. Diabetes Spectr 2010; 23(4): 238-43.
[http://dx.doi.org/10.2337/diaspect.23.4.238] [PMID: 21297890]
[7]
Kesavadev J, Saboo B, Shankar A, Krishnan G, Jothydev S. Telemedicine for diabetes care: An Indian perspective - feasibility and efficacy. Indian J Endocrinol Metab 2015; 19(6): 764-9.
[http://dx.doi.org/10.4103/2230-8210.167560] [PMID: 26693425]
[8]
Altman JJ, Niarra R, Balkau B, Vincent-Cassy C. The JUBILE cohort: Quality of life after more than 40 years with type 1 diabetes. Diabet Med 2021; 38(9): e14460.
[http://dx.doi.org/10.1111/dme.14460] [PMID: 33197286]
[9]
Laffel LM, Connell A, Vangsness L, Goebel-Fabbri A, Mansfield A, Anderson BJ. General quality of life in youth with type 1 diabetes: Relationship to patient management and diabetes-specific family conflict. Diabetes Care 2003; 26(11): 3067-73.
[http://dx.doi.org/10.2337/diacare.26.11.3067] [PMID: 14578241]
[10]
Opperman AM, Venter CS, Oosthuizen W, Thompson RL, Vorster HH. Meta-analysis of the health effects of using the glycaemic index in meal-planning. Br J Nutr 2004; 92(3): 367-81.
[http://dx.doi.org/10.1079/BJN20041203] [PMID: 15469640]
[11]
Brand-Miller J, Hayne S, Petocz P, Colagiuri S. Low-glycemic index diets in the management of diabetes: A meta-analysis of randomized controlled trials. Diabetes Care 2003; 26(8): 2261-7.
[http://dx.doi.org/10.2337/diacare.26.8.2261] [PMID: 12882846]
[12]
Norris SL, Engelgau MM, Narayan KM. Effectiveness of selfmanagement training in type 2 diabetes: A systematic review of randomized controlled trials. Diabetes Care 2001; 24(3): 561-87.
[http://dx.doi.org/10.2337/diacare.24.3.561] [PMID: 11289485]
[13]
Mazzuca SA, Moorman NH, Wheeler ML, et al. The diabetes education study: A controlled trial of the effects of diabetes patient education. Diabetes Care 1986; 9(1): 1-10.
[http://dx.doi.org/10.2337/diacare.9.1.1] [PMID: 3948638]
[14]
Brown SA. Studies of educational interventions and outcomes in diabetic adults: A meta-analysis revisited. Patient Educ Couns 1990; 16(3): 189-215.
[http://dx.doi.org/10.1016/0738-3991(90)90070-2] [PMID: 2149753]
[15]
Brown SA. Effects of educational interventions in diabetes care: A meta-analysis of findings. Nurs Res 1988; 37(4): 223-30.
[http://dx.doi.org/10.1097/00006199-198807000-00010] [PMID: 3293025]
[16]
Jiang Y, Ramachandran HJ, Teo JYC, et al. Effectiveness of a nurse-led smartphone-based self-management programme for people with poorly controlled type 2 diabetes: A randomized controlled trial. J Adv Nurs 2022; 78(4): 1154-65.
[http://dx.doi.org/10.1111/jan.15178] [PMID: 35170786]
[17]
Zaman SB, Khan RK, Evans RG, Thrift AG, Maddison R, Islam SMS. Exploring barriers to and enablers of the adoption of information and communication technology for the care of older adults with chronic diseases: Scoping review. JMIR Aging 2022; 5(1): e25251.
[http://dx.doi.org/10.2196/25251] [PMID: 34994695]
[18]
Tavasanli NG, Karadakovan A, Saygili F. The use of videophone technology (telenursing) in the glycaemic control of diabetic patients: A randomized controlled trial. J Diabetes Res Clin Metab 2013; 2(1): 1.
[http://dx.doi.org/10.7243/2050-0866-2-1]
[19]
Norris SL, Lau J, Smith SJ, Schmid CH, Engelgau MM. Self-management education for adults with type 2 diabetes: A meta-analysis of the effect on glycemic control. Diabetes Care 2002; 25(7): 1159-71.
[http://dx.doi.org/10.2337/diacare.25.7.1159] [PMID: 12087014]
[20]
Kesavadev J, Rasheed SA, Nair DR. Achieving desirable glycemic targets without the risks of hypoglycemia using a teletitration programme. 67th Scientific Sessions of American Diabetes Association. 2007; Abstract number: 0421.
[21]
Kesavadev J, Shankar A, Shamsudeen J, et al. Telefollow up and SMBG via “DTMS” – A cost effective Tool for A1c lowering. 67th Scientific Sessions – American Diabetes Association. 2010; Abstract number: 2083-PO.
[22]
Kesavadev J, Pillai PB, Shankar A, et al. A1c, BP and LDL goals: Successful use of telemedicine (DTMS™) in 1000 compliant T2DM subjects over 6 months. Diabetes 2011; 60 (Suppl 1): A63.

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