Kathryn Anne McMillan

A Systematic and Integrated Review of Mobile-Based Technology to Promote Active Lifestyles in People With Type 2 Diabetes.

Aim: The aim was to review studies examining the effectiveness, acceptability, and feasibility of mobile-based technology for promoting active lifestyles in people with type 2 diabetes (T2D). Background: Benefits of leading an active lifestyle following a diagnosis of T2D, including improved glycemic control, have been reported. Studies examining the specific use of mobile-based technologies to promote an active lifestyle in T2D have not previously been reviewed. Methods: Research studies examining effectiveness, feasibility or acceptability of mobile-based technology for active lifestyle promotion for T2D management were included (n = 9). The databases searched included PubMed, Medline, ScienceDirect, and ACM Digital Library (January 2005 to October 2015). Studies were categorized as (1) informing, (2) monitoring, (3) provoking, or (4) sustaining behavior change. Results: Technologies used included smartphone or tablet apps, diabetes personal digital assistant, continuous glucose monitor and accelerometer, pedometer, and a website delivered by a smartphone. No articles examined the effectiveness of mobile-based technology in monitoring health behaviors and behavior change. Four of the studies found mobile-based technology to be motivational and supportive for behavior change. The visual reinforcement was identified as motivational. The feasibility and acceptability of using mobile-based technology to provide sustained lifestyle change and the effectiveness of mobile-based technology in monitoring health behaviors and behavior change have not been investigated. No studies examined all 3 of the outcomes or focused decreasing the participants’ sedentary behavior. Conclusions: Limited research has examined the feasibility, acceptability, and effectiveness of mobile-based technology to promote active lifestyles and subsequently good diabetes management in people with T2D.

The associations of sedentary time and breaks in sedentary time with 24-hour glycaemic control in type 2 diabetes

The aim of this study was to investigate the associations of accelerometer-assessed sedentary time and breaks in sedentary time with 24-h events and duration of hypoglycaemia (<3.9 mmol/l), euglycaemia (3.9–7.8 mmol/l), hyperglycaemia (>7.8 mmol/l) and above target glucose (>9 mmol/l). Thirty-seven participants with type 2 diabetes (age, 62.8 ± 10.5 years; body mass index, 29.6 ± 6.8 kg/m2) in Glasgow, United Kingdom were enrolled between February 2016 and February 2017. Participants wore an activity monitor (activPAL3) recording the time and pattern of sedentary behaviour and a continuous glucose monitoring (CGM, Abbott FreeStyle Libre) for up to 14 days. Linear regression analyses were used to investigate the associations. Participants spent 3.7%, 64.7%, 32.1% and 19.2% of recording h/day in hypoglycaemia, euglycaemia, hyperglycaemia and above target, respectively. There was a negative association between sedentary time and time in euglycaemia (β = −0.44, 95% CI −0.86; −0.03, p = 0.04). There was a trend towards a positive association between sedentary time and time in hyperglycaemia (β = 0.36, 95% CI −0.05; 0.78, p = 0.08). Breaks in sedentary time was associated with higher time in euglycaemia (β = 0.38, 95% CI 0.00; 0.75, p = 0.04). To conclude, in individuals with type 2 diabetes, more time spent in unbroken and continuous sedentary behaviour was associated with poorer glucose control. Conversely, interrupting sedentary time with frequent breaks appears to improve glycaemic control. Therefore, this should be considered as a simple adjunct therapy to improve clinical outcomes in type 2 diabetes.

Methods for combining continuously measured glucose and activity data in people with type 2 diabetes: challenges and solutions.

Aims To present the novel application of combining continuously measured glucose with continuous accelerometer measured physical activity and sedentary behaviour data and discusses the principles used and challenges faced in combining and analysing these two sets of data in the context of diabetes management. Methods The background and rationale for exploring glucose, physical activity and sedentary behaviour in people with Type 2 diabetes is presented, the paper outlines the technologies used, the individual data extraction and finally the combined data analysis. A case study approach is used to illustrate the application of the combined data processing and analysis. Results The data analytic principles used could be transferred to different conditions where continuous data sets are being combined to help individuals or health professionals better manage and care for people with long term conditions. Conclusions Future work should focus on generating validated techniques to visualise combined data sets and explore ways to present data back to the individual in an effective way to support health care management and rehabilitation.

An e-Prehabilitation System of Care for Teenagers and Young Adults Diagnosed With Cancer: Protocol for a Qualitative Co-Design Study

Background A diagnosis of cancer in young adulthood can pose many different and unique challenges for individuals. The provision of adequate and appropriate information as well as care and support for teenagers and young adults at the time of diagnosis is central to their health care experience going forward. Moreover, appropriate and accessible information provision is critical to ensure that young individuals with cancer feel equipped and empowered to make decisions about, and be involved in, their treatment and recovery throughout their experience; this is a concept known as prehabilitation. As digital interventions and resources that support teenagers and young adults with cancer are an increasingly desirable part of health care provision, this study will focus on the development of an age- and population-appropriate electronic prehabilitation (e-Prehabilitation) system of care. Objective We will conduct an exploratory, co-design research project that will inform the development of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. A collaborative approach to data collection and prototype design will ensure that a patient-centered approach is embedded throughout. Methods A qualitative, co-design study utilizing surveys, interviews, and focus group discussions is being conducted with teenagers and young adults, health care professionals, and technologists. Results This research study is in progress; recruitment and data collection activities have commenced and findings are expected in early 2019. Conclusions The findings of this study will have important implications for informing the future development and evaluation of an e-Prehabilitation system of care to support teenagers and young adults diagnosed with cancer. Registered Report Identifier RR1-10.2196/10287

Dose–response between frequency of interruption of sedentary time and fasting glucose, the dawn phenomenon and night-time glucose in Type 2 diabetes

To explore the dose–response between frequency of interruption of sedentary time and basal glucose (fasting glucose, the dawn phenomenon and night‐time glucose) in Type 2 diabetes.

The Relationship Between Sedentary Bout Duration And Glucose In Adults With Type 2 Diabetes: 3581 Board #28 June 3 8

Physical activity is important for blood glucose management in people with Type 2 diabetes (T2D). Little research has explored the relationship between sedentary behaviour and mean glucose and glucose variability in people with T2D using objective and continuous measurements. Aims: To explore the relationship between sedentary bout duration and mean glucose and glucose variability in people with T2D using objective continuous measurement. Methods: 16 participants with T2D managed with diet, Metformin or DPP4 inhibitors were recruited (mean age 64.1±10.9 yr & BMI 29.4±6.9 kg/m2). Participants completed a demographic questionnaire and wore an activPAL accelerometer and FreeStyle Libre continuous glucose monitor for 3-14 days whilst documenting sleep, food and medication. Average proportion of time spent sitting/lying, during the waking day were calculated. Bouts of wake time sedentary behaviour were identified and defined as a period of at least 30 minutes continuous, uninterrupted sitting/lying during the waking day. Correlation analysis was conducted to investigate the relationships between sedentary bout duration and mean glucose, glucose range and glucose coefficient of variation. Results: On average, participants spent 65% of their day sitting/lying, 76% of sedentary bouts were ≥30minutes and 29% of bouts were ≥60minutes. Mean glucose was negatively (r = -0.08, p <0.01) associated with sedentary bout duration. Glucose range (r =0.47, p <0.001) and glucose coefficient of variation (r = 0.26, p <0.001) both positively correlated with sedentary bout duration. Participant characteristics such as age, gender and BMI appear to influence the relationship between sedentary bout duration and glucose response. Conclusions: Results indicate increased sedentary time leads to improved mean glucose and increased glucose variability.