Assessing the impact of mobile-based interventions provided by pharmacists on glycemic control and diabetes related distress in adolescent patients with type 1 diabetes mellitus in Pakistan

Main Article Content

Nadia Hussain
Amal Hussain H.I. Haddad https://orcid.org/0000-0002-4411-5577
Saima Abbass

Keywords

diabetes mellitus, type 1 diabetes mellitus, smartphone, applications

Abstract

Background: Diabetes is a chronic disease characterized by impaired insulin secretion, insulin resistance or both. Challenges in glycemic control for T1DM adolescents include hypoglycemic episodes and keeping the HbA1c within target range. The aim of this study was to evaluate the impact of using mobile based applications to improve glycemic control, in terms of lowering HbA1c and reducing the number of hypoglycemic or hyperglycemic episodes in adolescents with T1DM in Pakistan, South Asia. We hypothesized that Type 1 diabetic adolescents who used mobile based applications, with counseling provided by pharmacists, to track their glucose would have a beneficial impact on their glycaemic control indicated by lower haemoglobin A1C (HbA1c) values and decreased number of hospital admissions linked to hypoglycemic or hyperglycemic conditions. The Diabetes Distress Scale (DDS) was to assess the emotional well-being of all participants. Methods: A total of 112 patients with T1DM in a tertiary-care hospital specific to diabetes were selected as the study population. This study was conducted from January 1, 2023 to June 1, 2023. Of the 112 patients, 56 were randomly assigned to the mobile app using MTG and 56 were assigned to the routine management RTG group. IBM SPSS 25.0 software was used for descriptive statistics, t tests, chi-square tests, and correlation analyses. Haemoglobin A1c (HbA1c) and number of admissions to the hospital for hypoglycemic or hyperglycemic episodes was the effectiveness parameter decided upon. Results: When compared to the RGT group, participants in the MTG group was associated with significant decreases in HbA1c values (P < 0.03), lower number of severe hypoglycaemic (3±1.9 vs. 9±1.4, p 0.02), and ketoacidotic episodes (5±2.0 vs. 16±1.4, p = 0.05). The MTG also had significantly improved diabetes distress levels in comparison to the RTG. Conclusion: Our study showed a significant association between utilizing mobile based applications and glycaemic control and emotional well-being in adolescents with T1DM. Conclusion: Compared with the routine management that is the current model of treatment, the MTG group for adolescents with T1DM had improved glycemic control and enhanced emotional well-being.

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References

1. Barnett R. Type 1 diabetes. Lancet. 2018;391(10117):195. https://doi.org/10.1016/s0140-6736(18)30024-2
2. Azeem S, Khan U, Liaquat A. The increasing rate of diabetes in Pakistan: A silent killer. Ann Med Surg (Lond). Jul 2022;79:103901. https://doi.org/10.1016/j.amsu.2022.103901
3. Syed FZ. Type 1 Diabetes Mellitus. Annals of Internal Medicine. 2022;175(3):ITC33-ITC48. https://doi.org/10.7326/ AITC202203150
4. Mobasseri M, Shirmohammadi M, Amiri T, et al. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health promotion perspectives. 2020;10(2):98. https://doi.org/10.34172/hpp.2020.18
5. Stene LC, Haynes A. Trending now: modelling global epidemiology of type 1 diabetes in children and adolescents. The Lancet Diabetes & Endocrinology. 2022;10(12):828-829. https://doi.org/10.1016/S2213-8587(22)00306-0
6. Shinde S, Harling G, Assefa N, et al. Counting adolescents in: the development of an adolescent health indicator framework for population-based settings. EClinicalMedicine. 2023;61:102067. https://doi.org/10.1016/j.eclinm.2023.102067
7. Greenbaum C, VanBuecken D, Lord S. Disease-Modifying Therapies in Type 1 Diabetes: A Look into the Future of Diabetes Practice. Drugs. 2019;79(1):43-61. https://doi.org/10.1007/s40265-018-1035-y
8. Irfan E, Ali Y, Sabir M. Analysing role of businesses’ investment in digital literacy: A case of Pakistan. Technological Forecasting and Social Change. 2022;176:121484. https://doi.org/https://doi.org/10.1016/j.techfore.2022.121484
9. Luo J, Wang H, Li X, et al. Factors associated with diabetes distress among adolescents with type 1 diabetes. J Clin Nurs. 2021;30(13-14):1893-1903. https://doi.org/10.1111/jocn.15742
10. Lee SWH, Ooi L, Lai YK. Telemedicine for the Management of Glycemic Control and Clinical Outcomes of Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Studies. Front Pharmacol. 2017;8:330. https:// doi.org/10.3389/fphar.2017.00330
11. Ubaid Ur Rehman M, Aleem M, Islam MA et al. Smart applications for diabetes management: A comprehensive survey and ranking. Health Informatics J. 2020;26(2):1133-1151. https://doi.org/10.1177/1460458219869159
12. Virella Pérez YI, Medlow S, Ho J, et al. Mobile and Web-Based Apps That Support Self-Management and Transition in Young People With Chronic Illness: Systematic Review. J Med Internet Res. 2019;21(11):e13579. https://doi.org/10.2196/13579
13. Veazie S, Winchell K, Gilbert J, et al. Mobile Applications for Self-Management of Diabetes. Agency for Healthcare Research and Quality (US), Rockville (MD); 2018.
14. Stevens S, Gallagher S, Andrews T, et al. The effectiveness of digital health technologies for patients with diabetes mellitus: A systematic review. Front Clin Diabetes Healthc. 2022;3:936752. https://doi.org/10.3389/fcdhc.2022.936752
15. Sun C, Malcolm JC, Wong B, et al. Improving Glycemic Control in Adults and Children With Type 1 Diabetes With the Use of Smartphone-Based Mobile Applications: A Systematic Review. Can J Diabetes. 2019;43(1):51-58.e3. https://doi.org/10.1016/j. jcjd.2018.03.010
16. Ali S, Rizvi SAA, Qureshi MS. Cell phone mania and Pakistani youth: Exploring the cell phone usage patterns among teenagers of South Punjab. FWU Journal of Social Sciences. 2014;8(2):43.
17. Dogar MN, Arif M, Kashif S, et al. Improving Quality of Social Life: A phenomenological Study of Mobile Phones as Leisure Partners. Indian Journal of Economics and Business. 2022;21(2)
18. Nkhoma DE, Soko CJ, Bowrin P, et al. Digital interventions self-management education for type 1 and 2 diabetes: A systematic review and meta-analysis. Comput Methods Programs Biomed. 2021;210:106370. https://doi.org/10.1016/j. cmpb.2021.106370
19. Stephen DA, Nordin A, Nilsson J, et al. Using mHealth applications for self-care - An integrative review on perceptions among adults with type 1 diabetes. BMC Endocr Disord. 2022;22(1):138. https://doi.org/10.1186/s12902-022-01039-x
20. Boggiss AL, Consedine NS, Schache KR, et al. Exploring the views of adolescents with type 1 diabetes on digital mental health interventions: What functionality and content do they want? Diabetic Medicine. 2021;38(11):e14591.
21. Ashrafzadeh S, Hamdy O. Patient-Driven Diabetes Care of the Future in the Technology Era. Cell Metab. 2019;29(3):564-575. https://doi.org/10.1016/j.cmet.2018.09.005
22. Gunawardena KC, Jackson R, Robinett I, et al. The Influence of the Smart Glucose Manager Mobile Application on Diabetes Management. J Diabetes Sci Technol. 2019;13(1):75-81. https://doi.org/10.1177/1932296818804522
23. Martos-Cabrera MB, Velando-Soriano A, Pradas-Hernández L, et al. Smartphones and Apps to Control Glycosylated Hemoglobin (HbA1c) Level in Diabetes: A Systematic Review and Meta-Analysis. J Clin Med. 2020;9(3)https://doi.org/10.3390/jcm9030693
24. Knox ECL, Quirk H, Glazebrook C, et al. Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review. BMC Endocr Disord. 2019;19(1):7. https://doi.org/10.1186/s12902-018-0331-6
25. Jabeen Z, Baig AM, Khawaja KI, et al. Diabetes Distress Among Type 1 Diabetic Adolescents in a Tertiary Care Hospital in Pakistan. Cureus. 2022;14(12)
26. Hagger V, Hendrieckx C, Sturt J, et al. Diabetes Distress Among Adolescents with Type 1 Diabetes: a Systematic Review. Curr Diab Rep. 2016;16(1):9. https://doi.org/10.1007/s11892-015-0694-2
27. Toh ZQ, Koh SSL, Lim PK, et al. Diabetes-Related Emotional Distress among Children/Adolescents and Their Parents: A Descriptive Cross-Sectional Study. Clin Nurs Res. 2021;30(3):311-321. https://doi.org/10.1177/1054773819867252
28. Wentzell K, Vessey JA, Laffel LMB. How Do the Challenges of Emerging Adulthood Inform our Understanding of Diabetes Distress? An Integrative Review. Curr Diab Rep. 2020;20(6):21. https://doi.org/10.1007/s11892-020-01301-3
29. Winkley K, Upsher R, Stahl D, et al. Psychological interventions to improve self-management of type 1 and type 2 diabetes: a systematic review. Health Technol Assess. 2020;24(28):1-232. https://doi.org/10.3310/hta24280
30. Charalampopoulos D, Hesketh KR, Amin R, et al. Psycho-educational interventions for children and young people with Type 1 Diabetes in the UK: How effective are they? A systematic review and meta-analysis. PLoS One. 2017;12(6):e0179685. https:// doi.org/10.1371/journal.pone.0179685
31. ElSayed NA, Aleppo G, Aroda VR, et al. 14. Children and Adolescents: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Suppl 1):S230-s253. https://doi.org/10.2337/dc23-S014
32. Shawahna R, Thawabi F, Salah R, et al. Pharmaceutical care services for patients with diabetes: a systematic scoping review. American Journal of Managed Care. 2022;28(9)
33. Alassaf A, Gharaibeh L, Odeh R, et al. Predictors of glycemic control in children and adolescents with type 1 diabetes at 12 months after diagnosis. Pediatr Diabetes. 2022;23(6):729-735. https://doi.org/10.1111/pedi.13342
34. Pilgaard KA, Breinegaard N, Johannesen J, et al. Episodes of severe hypoglycemia is associated with a progressive increase in hemoglobin A1c in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2020;21(5):808-813. https://doi. org/10.1111/pedi.13020
35. Pi L, Shi X, Wang Z, et al. Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A metaanalysis. Front Public Health. 2023;11:1074946. https://doi.org/10.3389/fpubh.2023.1074946
36. Zhang L, He X, Shen Y, et al. Effectiveness of Smartphone App-Based Interactive Management on Glycemic Control in Chinese Patients With Poorly Controlled Diabetes: Randomized Controlled Trial. J Med Internet Res. 2019;21(12):e15401. https://doi. org/10.2196/15401
37. Pramanik BK, Angelin JJ, Mathai VJ, et al. Smartphone App as Motivational Intervention to Improve Glycemic Control in Adolescents with Type 1 Diabetes. Indian J Pediatr. 2019;86(12):1118-1123. https://doi.org/10.1007/s12098-019-03035-x
38. Ali Sherazi B, Laeer S, Krutisch S, et al. Functions of mHealth Diabetes Apps That Enable the Provision of Pharmaceutical Care: Criteria Development and Evaluation of Popular Apps. Int J Environ Res Public Health. 2022;20(1)https://doi.org/10.3390/ ijerph20010064
39. Liu Z, Wang C, Yang D, et al. High engagement in mobile peer support is associated with better glycemic control in type 1 diabetes: A real‐world study. Journal of Diabetes Investigation. 2022;13(11):1914-1924.
40. Berkanish P, Pan S, Viola A, et al. Technology-based peer support interventions for adolescents with chronic illness: a systematic review. Journal of clinical psychology in medical settings. 2022;29(4):911-942.
41. Woldaregay AZ, Årsand E, Walderhaug S, et al. Data-driven modeling and prediction of blood glucose dynamics: Machine learning applications in type 1 diabetes. Artif Intell Med. 2019;98:109-134. https://doi.org/10.1016/j.artmed.2019.07.007
42. Ellahham S. Artificial Intelligence: The Future for Diabetes Care. Am J Med. 2020;133(8):895-900. https://doi.org/10.1016/j. Amjmed.2020.03.033 

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