Dominique Bird

Randomised controlled trial of an automated, interactive telephone intervention to improve type 2 diabetes self-management (Telephone-Linked Care Diabetes Project): study protocol

BackgroundAn estimated 285 million people worldwide have diabetes and its prevalence is predicted to increase to 439 million by 2030. For the year 2010, it is estimated that 3.96 million excess deaths in the age group 20-79 years are attributable to diabetes around the world. Self-management is recognised as an integral part of diabetes care. This paper describes the protocol of a randomised controlled trial of an automated interactive telephone system aiming to improve the uptake and maintenance of essential diabetes self-management behaviours.Methods/DesignA total of 340 individuals with type 2 diabetes will be randomised, either to the routine care arm, or to the intervention arm in which participants receive the Telephone-Linked Care (TLC) Diabetes program in addition to their routine care. The intervention requires the participants to telephone the TLC Diabetes phone system weekly for 6 months. They receive the study handbook and a glucose meter linked to a data uploading device. The TLC system consists of a computer with software designed to provide monitoring, tailored feedback and education on key aspects of diabetes self-management, based on answers voiced or entered during the current or previous conversations. Data collection is conducted at baseline (Time 1), 6-month follow-up (Time 2), and 12-month follow-up (Time 3). The primary outcomes are glycaemic control (HbA1c) and quality of life (Short Form-36 Health Survey version 2). Secondary outcomes include anthropometric measures, blood pressure, blood lipid profile, psychosocial measures as well as measures of diet, physical activity, blood glucose monitoring, foot care and medication taking. Information on utilisation of healthcare services including hospital admissions, medication use and costs is collected. An economic evaluation is also planned.DiscussionOutcomes will provide evidence concerning the efficacy of a telephone-linked care intervention for self-management of diabetes. Furthermore, the study will provide insight into the potential for more widespread uptake of automated telehealth interventions, globally.Trial Registration NumberACTRN12607000594426

The effects of ingestion time of gliclazide in relationship to meals on plasma glucose, insulin and c-peptide levels

SummaryThe effect of altering the timing of gliclazide administration in relation to a meal was studied in ten type 2 (non-insulin dependent) chronically treated diabetics. Gliclazide was given 30 min before, at the start of and 30 min after breakfast or omitted altogether.Plasma gliclazide was present at greater than 2 mg/l throughout the study periods. Administration at 30 min after the meal significantly delayed the time to peak for plasma gliclazide. No significant difference was noted in plasma glucose, insulin or c-peptide patterns with any protocol.It is concluded that, in clinical practice, with chronically treated diabetics the timing of gliclazide ingestion in relation to meals is not critical.

Diabetes Care in the Digital Era: a Synoptic Overview

Purpose of ReviewDiabetes care is undergoing a remarkable transformation by the advancements in information and communications technology (ICT). The aim of this review is to provide a general overview of various ICT-based interventions for diabetes care, challenges of their adoption, and consider future directions.Recent FindingsA number of systematic reviews have examined studies on various aspects of telemedicine and eHealth for diabetes care, but they are generally focused on one specific type of technology application for diabetes care.SummaryA wide range of solutions from manual or automated telephone calls, short message services, websites, mobile health apps, remote monitoring devices, and sophisticated artificial intelligence systems has been studied in different settings and scopes with mixed results. However, despite the promising results of research studies, such innovative solutions are not widely adopted by health systems worldwide. Lack of supportive policy and legislation, unsustainable reimbursement, inefficient business models, and concerns regarding the security and privacy of health data are among the most problematic barriers.

A comparison of characteristics of patients seen in a tertiary hospital diabetes telehealth service versus specialist face-to-face outpatients

This study aimed to describe patient-related characteristics of those attending the diabetes telehealth service delivered from a tertiary hospital and compare these with the characteristics of patients attending face-to-face visits at the same hospital’s diabetes outpatient service. This analysis could inform diabetes telehealth service improvements. To our knowledge, there has been no prior evaluation of a diabetes telehealth service in Australia. A cross-sectional survey was conducted as part of the Australian National Diabetes Audit in May 2016 for all patients attending the diabetes telehealth service and diabetes outpatient service. The diabetes telehealth service was serving a greater proportion of females, indigenous people and patients with a longer mean duration of type 2 diabetes mellitus. Type 2 diabetes mellitus patients in the diabetes telehealth service group had a higher average glycated haemoglobin of 9.1% (76 mmol/mol) vs 8.1% (65 mmol/mol) in the diabetes outpatient service group. The diabetes telehealth service had more people with initial visits; had higher self-reported smoking rates in type 2 diabetes mellitus patients; and had adequate access to allied health supports as recommended for diabetes management. Diabetes telehealth service patients had more complex diabetes as evidenced by a higher proportion of indigenous clients, higher glycated haemoglobin and longer mean duration of diabetes.

Telehealth for chronic disease management: do we need to RE-AIM?

An increasing number of individuals are living with long term health conditions which they manage most of the time by themselves. This paper evaluates the use of information and communications technology platforms to provide evidence-based programs to help people with chronic disease to self-management these. It describes two different self-management strategies for chronic conditions, and the evaluation of their implementation in clinical trials, specifically in terms of reach, implementation fidelity, adoption and user perceptions. It also discusses the challenges in replicating trial findings in the real world, using the RE-AIM framework.

Implementation trial of an automated telephone system targeting diabetes self-management

Stress management prolongs life for CHD patients : a randomized clinical trial assessing the effects of group intervention on all cause mortality, recurrent cardiovascular disease, and quality of life

Using an automated telephone system to promote the patient's central role in diabetes self-management

A number of computerized automated programs for preventing and managing chronic diseases are now available. Some have even been transferred from their country of origin to other countries. In 2004, we performed a usability assessment of a Telephone Linked Care (TLC) system designed by Boston University Medical Center to promote physical activity which was transferred to Australia. The results highlighted the need to consider language, health system and other socio-environmental factors when “translating” such programs. In 2005, we adapted a more complex TLC program (TLC-Diabetes) aimed at providing self-management support for people with Type 2 diabetes in Australia. In doing so, we considered how the program might impact patients’ self-care skills and behaviors. TLC-Diabetes targets key diabetes self-care behaviors. Self-management is enhanced by emphasizing the central role of the patients in their care and by ensuring the system supports informed personal decision-making. Goals are set collaboratively between physicians and patients at the outset. Patients are encouraged to prioritize the sequencing of behaviors targeted in the weekly conversations with the system over 6 months. These conversations include monitoring and feedback against goals, and strategies for overcoming barriers to behaviors. TLC-Diabetes is currently being studied to assess its usability with a small group of individuals with Type 2 diabetes. The findings from this study will be used in a controlled evaluation comparing the Australian version of TLC-Diabetes against usual care.