Mike Masding

Ideas and enhancements related to mobile applications to support type 1 diabetes

Background Mobile devices have become increasingly important to young people who now use them to access a wide variety of health-related information. Research and policy related to the integration of health information and support with this technology do not effectively consider the viewpoint of a younger patient. Views of young people with type 1 diabetes are vital in developing quality services and improving their own health-related quality of life (HRQOL), yet research on their lifestyle and use of Web and mobile technology to support their condition and in non–health-related areas is sparse. Objective To develop insight into young people with type 1 diabetes and their current use of Web and mobile technology and its potential impact on HRQOL. This can be achieved by constructing an in-depth picture of their day-to-day experiences from qualitative interviewing and exploring how they make use of technology in their lives and in relation to their condition and treatment. The goal was then to build something to help them, using the researcher’s technical expertise and seeking users’ opinions during the design and build, utilizing sociotechnical design principles. Methods Data were collected by semistructured, in-depth qualitative interviews (N=9) of young people with type 1 diabetes aged 18-21. Interviews were transcribed and loaded onto NVivo for theme identification. Data analysis was undertaken during initial interviews (n=4) to locate potential ideas and enhancements for technical development. Latter interviews (n=5) assisted in the iterative sociotechnical design process of the development and provided additional developmental ideas. Results Six themes were identified providing an understanding of how participants lived with and experienced their condition and how they used technology. Four technological suggestions for improvement were taken forward for prototyping. One prototype was developed as a clinically approved app. A number of ideas for new mobile apps and enhancements to currently existing apps that did not satisfactorily cater to this age group’s requirements for use in terms of design and functionality were suggested by interviewees but were not prototyped. Conclusions This paper outlines the nonprototyped suggestions from interviewees and argues that young people with type 1 diabetes have a key role to play in the design and implementation of new technology to support them and improve HRQOL. It is vital to include and reflect on their suggestions as they have a radically different view of technology than either their parents or practitioners. We need to consider the relationship to technology that young people with type 1 diabetes have, and then reflect on how this might make a difference to them and when it might not be a suitable mechanism to use.

Innovative mobile technology alcohol education for young people with type 1 diabetes

Views of young people with type 1 diabetes are vital in developing quality services and improving health‐related quality of life (HRQoL), yet research on their lifestyle and use of web and mobile technology to support their condition and in non‐health related areas is sparse. The aim of this research was to develop an insight into young peoples current use of web and mobile technology and its potential impact on HRQoL by constructing an in‐depth picture of their day‐to‐day experiences, exploring how they made use of technology in their lives and in relation to their condition and treatment – then, building something to help them.

Early postpartum glycaemic assessment in patients with gestational diabetes

Uptake of postpartum glycaemic assessment in women with gestational diabetes (GDM) has been shown to be low, with six weeks postpartum testing (as recommended by the UK National Institute for Health and Care Excellence) inconvenient for new mothers who prioritise their new baby over their own health at this time. As pregnancy‐related insulin resistance returns to pre‐pregnancy levels immediately after placental delivery, we hypothesised that early postpartum fasting blood glucose testing, while the mother is likely to be still in hospital, would increase uptake of postpartum glycaemic assessment.

An Unusual Case of Recurrent Severe Hypoglycemia in a Woman With Type 1 Diabetes Undergoing Medically Assisted Abortion

A 32-year-old woman developed severe recurrent hypoglycemia after a medically assisted, first-trimester abortion. She had had type 1 diabetes since 1988, and the pregnancy was her first and planned. The patient’s glycemic control had been good, with a preconception A1C of 6.3%. She was on a multiple daily injection insulin regimen and routinely counted carbohydrate. Unfortunately, she had a missed miscarriage at 11 weeks’ gestation and opted for medical management. She was given mifepristone 800 μg. After taking mifepristone, the patient noticed that she had numerous episodes of unexplained prolonged hypoglycemia. She had a significant and sudden drop in capillary glucose levels with no obvious trigger and very little warning within about 2 hours after taking mifepristone. Over the next 2–4 days, she continued to have multiple hypoglycemic episodes, mostly attributable to her rapid-acting insulin. However, her glycemic control started to settle down after 5 days, and her blood glucose levels subsequently stabilized in her target range with no hypoglycemia. She was seen in the diabetes clinic after this episode, when she reported the effects of the medical miscarriage treatment on her glycemic control. Her glycemic control has remained stable since, without any further episodes of unexplained hypoglycemia. 1. What is the most likely cause for severe, prolonged hypoglycemic episodes after undergoing medically triggered abortion? …

Cardiovascular risk intervention in patients with type 2 diabetes

The risk of developing vascular disease is greatly increased in people with type 2 diabetes. The use of risk assessment tools is considered. The use of cardiovascular risk tables can underestimate risk by up to 30%. However, multiple risk factor intervention is recognised to be of benefit in reducing vascular risk and treatment strategies should include antiplatelet therapy, a statin and antihypertensive medication. Br J Diabetes Vasc Dis 2004;4:414‐16

Diabetes and the new GMS contract — a secondary care perspective

Drs Masding and Gatling consider the potential of the new GMS contract in the standardisation of diabetes investigations and treatments in primary care in the light of a 78 practice audit in Dorset. Glycaemic control in patients treated by diet alone and hypertension control were selected as aspects of clinical care where audit could be used to influence outcome.