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The global rise in the prevalence of diabetes significantly impacts the quality of life of both patients and their families. Despite advances in diabetes care, numerous challenges remain in its management. In recent years, digital tools have been increasingly integrated into diabetes care, demonstrating some positive outcomes. However, the long-term effectiveness and associated challenges of these tools in diabetes management remain areas for future research. This study aims to assess the types and current usage of digital tools in diabetes management, analyze their benefits and limitations, and provide recommendations for optimizing their future application in diabetes care. This scoping review followed the 5-stage framework proposed by Arksey and O'Malley. A comprehensive literature search was conducted across 9 electronic databases (CNKI, Wanfang Database, VIP, Sinomed, PubMed, Embase, Web of Science, CINAHL, and Cochrane Library) from their inception to July 31, 2024. Study selection was independently performed by 2 reviewers, descriptive analysis was conducted, and findings were presented narratively, key study characteristics-including first author, publication date, country or region, study type, sample size, type of digital tools, intervention methods, intervention duration, limitations, and outcome indicators-were independently extracted and cross-checked by 2 investigators. A total of 6263 articles were initially retrieved. After deduplication and a 2-stage screening process (initial screening based on titles and abstracts followed by full-text assessment), 45 studies meeting the predefined inclusion criteria were ultimately included for analysis, originating from 7 countries. The included studies demonstrated marked heterogeneity in research designs: randomized controlled trials (RCTs; n=26, 57.8%), non-RCTs (n=15, 33.3%), quasi-RCTs (n=1, 2.2%), observational studies (n=1, 2.2%), mixed-methods studies (n=1, 2.2%), and qualitative studies (n=1, 2.2%). The digital tools primarily included mobile health apps, integrated management information platforms, Diabetes Online Community (DOC), specialized monitoring and analytics tools, blood glucose information management systems, and remote monitoring and follow-up systems, among others. These tools were applied across home, hospital, and community settings. Outcome measures were primarily focused on evaluating glycemic control efficacy (eg, fasting blood glucose, postprandial blood glucose, and glycated hemoglobin), blood lipid levels, BMI, self-management capacity, quality of life, patient satisfaction, and diabetes knowledge. This review highlights the diversity and potential value of digital tools in diabetes care, particularly in supporting patient self-management and extending care across multiple settings. From a nursing perspective, digital interventions offer opportunities for individualized care, patient engagement, and continuity of services. However, challenges such as technology acceptance remain. Future studies should address gaps related to long-term effectiveness, economic evaluation, and tool adaptation for aging populations, while incorporating interdisciplinary approaches and real-world evidence to inform sustainable digital health strategies.

Gestational diabetes mellitus (GDM) is associated with an elevated risk of adverse maternal and neonatal outcomes. Dietary management is a cornerstone of GDM treatment due to its beneficial effects on metabolic control. However, suboptimal adherence to dietary recommendations has diminished its potential benefits in achieving optimal glycemic outcomes. Cognitive behavioral therapy (CBT)-based interventions have emerged as a promising approach to enhance dietary compliance and glycemic control in patients with GDM. This study aims to investigate the effects of a CBT-based digital dietary intervention on glycemic control and pregnancy outcomes in patients with GDM. The intervention group received standard care plus a digital dietary intervention based on CBT principles, delivered via a customized WeChat (Tencent Inc) mini program. This intervention included structured dietary education and behavioral strategies focused on appropriate food selection and meal sequencing. The control group received standard care alone. The primary outcome was the glycemic qualification rate, and secondary outcomes included fasting blood glucose, postprandial blood glucose (PBG), General Self-Efficacy Scale scores, and incidence of macrosomia. Self-monitored blood glucose data were collected and analyzed at biweekly follow-up visits from enrollment until delivery. Of the 200 participants, 171 completed the study. The average age was 31.2 (SD 4) years, and the average gestational age at enrollment was 26.3 (SD 1.6) weeks. Baseline HbA1c levels were similar between groups (5.2% vs 5.1%; P=.97). The glycemic qualification rate was significantly higher in the intervention group than in the control group at follow-up 3 (mean 87.9%, SD 14.9% vs 81.9%, SD 17.8%; P=.02), follow-up 4 (mean 91.0%, SD 9.9% vs 87.2%, SD 14.4 %; P=.04), follow-up 5 (mean 94.0%, SD 7.4% vs 91.5%, SD 9.5%; P=.04), and follow-up 6 (mean 94.3%, SD 6.7% vs 91.8%, SD 8.9%). PBG levels were significantly lower in the intervention group after lunch (1 h: mean 5.9, SD 0.7 vs 6.0, SD 0.7 mmol/L; P=.0 2 h2h: 5.1, SD 0.7 vs 5.3, SD 0.8 mmol/L; P=.03) and dinner (1 h: mean 6.0, SD 0.5 vs 6.2, SD 0.6; 2 h: 5.5, SD 0.7 vs 5.7, SD 0.8 mmol/L). However, no significant differences were observed in fasting blood glucose or PBG after breakfast between the groups. The intervention group showed significantly higher General Self-Efficacy Scale scores than the control group (mean 195.4, SD 6.9 vs 192.9, SD 5.8). The incidence of macrosomia was significantly lower in the intervention group than in the control group (5% vs 15%; P=.04). The findings of this randomized controlled trial suggest that a CBT-based digital dietary intervention can significantly enhance glycemic control, particularly PBG levels, and may contribute to improved pregnancy outcomes with a reduced incidence of macrosomia in women with GDM.

Type 2 diabetes (T2D) is a complex, chronic condition that requires ongoing management. An important aspect of effective diabetes management is shared decision-making between the person with diabetes and the health care professionals (HCPs) to tailor individual treatment plans. Personal health technologies can play a crucial role in this collaborative effort by providing tools for monitoring, communication, and education. This study aims to test the clinical feasibility of DiaFocus, a mobile health system developed for adults with T2D. This was a single-arm, prospective, 6-month pilot study in a clinical outpatient setting at Steno Diabetes Center Copenhagen, Denmark. The DiaFocus system includes an app for the participants and a web portal for the HCPs. The system collects diabetes-related data, including participant-reported lifestyle surveys, sensor-based measures on physical activity, and participant-selected focus areas, aiming to support communication and shared decision-making at clinical visits. Participants were eligible if they were ≥18 years old, diagnosed with T2D≥12 months, spoke Danish, and had a smartphone (iOS 13+ or Android 8.0+). For each participant, 3 visits and 1 telephone call were scheduled during the 6-month study period. The DiaFocus system's acceptability and feasibility were assessed through retention rates, app usage, participant feedback, and by the CACHET Unified Method for Assessment of Clinical Feasibility (CUMACF) questionnaire. The clinical outcomes were assessed by the following questionnaires: Diabetes Distress Scale (DDS), Perceived Competence for Diabetes (PCDS), Diabetes Treatment Satisfaction Questionnaire (DTSQs+c), hemoglobin A1c levels, and body weight. A total of 17 participants with T2D were included in the study, 15 completed the study, and data were analyzed on an intention-to-treat basis. The median age was 68 (IQR 56-72) years, 12 (71%) were males, the median diabetes duration was 18 (IQR 11-21) years, and the median hemoglobin A1c was 59 (IQR 49-68) mmol/mol. Participants found the DiaFocus system feasible to support diabetes management despite technical problems, and they valued the ability to set focus areas. The most common focus areas were \"blood glucose\" (n=10, 59%) and \"exercise\" (n=9, 53%), but areas such as \"sleep\" and \"mood\" were also used. The CUMACF questionnaire showed that 90% (9/10) of the participants had very favorable views of how easy the system is to understand, learn, and use, and 80% (8/10) of the participants agreed or strongly agreed that the system was useful. Feedback was generally positive, indicating participants would use a refined version. Despite these findings, no statistically significant changes in clinical outcomes were observed throughout the study period using the DiaFocus system. This pilot study demonstrated that the DiaFocus system is clinically feasible and acceptable for users with T2D, although there is a need for optimization of app functionality and stability.

A novel mobile health (mHealth) app \"acT1ve,\" developed using a co-design model, provides real-time support during exercise for young people with type 1 diabetes (T1D). This study aimed to demonstrate the noninferiority of acT1ve compared with \"treatment as usual\" with regard to hypoglycemic events. Thirty-nine participants living with T1D (age: 17.2, SD 3.3 years; HbA1c: 64, SD 6.0 mmol/mol) completed a 12-week single-arm, pre-post noninferiority study with a follow-up qualitative component. During the intervention, continuous glucose monitoring (CGM) and physical activity were monitored while participants used acT1ve to manage exercise. CGM data were used to assess the number of hypoglycemic events (<3.9 mmol/L for ≥15 minutes) in each phase. Using a mixed effects negative binomial regression, the difference in the rates of hypoglycemia between the preapp and app-use phases was analyzed. Participants completed both a semistructured interview and the user Mobile Application Rating Scale (uMARS) questionnaire postintervention. All interviews were audio-recorded for transcription, and a deductive content analysis approach was used to analyze the participant interviews. The uMARS Likert scores for each subscale (engagement, functionality, esthetics, and information) were calculated and reported as medians with IQRs. The rates of hypoglycemia were similar for both the preapp and app-use phases (0.79 and 0.83 hypoglycemia events per day, respectively). The upper bound of the CI of the hypoglycemia rate ratio met the prespecified criteria for noninferiority (rate ratio=1.06; 95% CI 0.91-1.22). The uMARS analysis showed a high rating (≥4 out of 5) of acT1ve by 80% of participants for both functionality and information, 72% for esthetics, and 63% for overall uMARS rating. Content analysis of the interview transcripts identified 3 main themes: \"Provision of information,\" \"Exercising with the App,\" and \"Targeted Population.\" The mHealth app \"acT1ve,\" which was developed in collaboration with young people with T1D, is functional, acceptable, and safe for diabetes management around exercise. The study supports the noninferiority of acT1ve compared with \"treatment as usual\" with regards to hypoglycemic events.

The use of mobile health interventions, such as apps, are proposed to meet the challenges faced by preventive health care services due to the increasing prevalence of type 2 diabetes (T2D). Thus, we developed and conducted initial feasibility testing of the Plunde app for promoting and monitoring individual goals related to lifestyle change for people at risk of T2D. The primary aim of this study was to assess the feasibility of an app for promoting lifestyle change in people at risk of T2D. The secondary aim was to assess recruitment rate, resource requirements, and change in potential outcomes for a full scale randomized controlled trial (RCT) study . A 3-arm feasibility RCT lasting 12 weeks was designed. Participants were recruited from 9 general practitioners in Norway. Eligible participants were randomized to either (1) app follow-up; (2) app follow-up and referral to care as usual in Healthy Life Centers; or (3) referral to care as usual in a Healthy Life Center, only. The primary outcome was feasibility and was measured by app adherence (actual usage of the app), the System Usability Scale, and app motivation score gained from a questionnaire designed for this study. Criteria for success were preset based on these measures. Secondary outcomes included recruitment rate, resource requirements, and potential primary outcomes of a full-scale RCT. This included change in body weight, waist circumference, and self-evaluated functional health status, assessed with the Dartmouth Primary Care Cooperative Research Network/World Organization of Family Doctors (COOP/WONCA) functional health assessment chart. Within 8 months, 9 general practitioners recruited a total of 54 participants, of which 45 were eligble for participation in the study. Mean age was 61 (SD 13) years and 53% (n=24) were female. App adherence was 86%, the mean System Usability Scale score was 87.3 (SD 11.9), and the mean app motivation score was 74.8 (SD 30.3). Throughout the intervention period, health care professionals spent on average 3.0 (SD 1.0) minutes per participant per week providing follow-up. Statistically significant reduction in body weight and waist circumference was shown in group 1 and 3. Based on the preset criteria for success, the Plunde app is feasible in providing support for lifestyle change. The Plunde app had excellent user satisfaction. The amount of time spent on monitoring and promoting lifestyle change through the app was low; however, the recruitment was slow. Results from this study will guide the development of further research within this field.

Controlling glycated hemoglobin (HbA1c) levels can be challenging for patients with type 2 diabetes mellitus (T2DM). Peer support promotes HbA1c control, and a digital peer-supported app designed for group interactions may enable patients with T2DM to encourage one another to achieve better HbA1c outcomes. However, no studies have investigated the use of digital peer-supported apps to control HbA1c levels in patients with T2DM. This pilot study aimed to explore the effects of a digital peer-supported app on HbA1c control in patients with T2DM. This prospective single-arm pilot study enrolled patients with T2DM who owned smartphones and visited medical institutions in Japan. During the 3-month intervention, participants used a digital peer-supported app in addition to receiving standard care. This app allowed participants to share activity logs and concerns via a chat function to improve HbA1c levels through mutual engagement and encouragement. The primary outcome was the change in HbA1c levels, measured at health care facilities at baseline and after 3 months. The secondary outcomes were body weight and blood pressure, with the most recent data obtained from hospitals and clinics. Physical activity (≥1 hour/day) was assessed at the same time points using a self-reported questionnaire. The study included 21 participants with a median age of 56 (IQR 51-61) years, of which 13 (61.9%) were female. After using the digital peer-supported app for 3 months, the participants' HbA1c levels significantly decreased from 7.1% (SD 0.6%) at baseline to 6.9% (SD 0.1%) (P=.04). Similarly, participants' body weight decreased from 70.7 (SD 12.7) kg to 69.9 (SD 12.4) kg (P =.004) through app use. Although blood pressure decreased slightly from 128.2 (SD 12.5) mm Hg to 126.0 (SD 12.9) mm Hg, this change was not statistically significant (P=.20). Additionally, the proportion of participants engaged in ≥1 hour of daily physical activity significantly increased from 23.5% (n=4) to 58.5% (n=10) (P=.03). In addition to receiving standard clinical care, the use of a digital peer-supported app may significantly lower HbA1c levels in patients with T2DM by promoting healthy behaviors.

The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behavior are major risk factors for developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit (Google Inc) activity data into the system but this is not presently being analyzed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform. This qualitative study aimed to explore (through the RE-AIM [reach, effectiveness, adoption, implementation, and maintenance] framework) views from adults diagnosed with type 2 diabetes and health care professionals on the integration of activity trackers into type 2 diabetes care. Overall, 12 adults diagnosed with type 2 diabetes and 9 health care professionals (4 general practitioners, 1 consultant, 2 diabetes nurses, 1 practice nurse, and 1 physical activity advisor) were recruited through social media and professional contacts. Semistructured one-to-one interviews were conducted. Abductive thematic analysis was undertaken, and main themes and subthemes were identified. The RE-AIM framework was used to evaluate the themes with respect to the wider use of activity trackers and the My Diabetes My Way platform within type 2 diabetes clinical care. Overall, 6 main themes (awareness, access, cost, promotion, support, and technology and data) and 20 subthemes were identified. Evaluation using the 5 RE-AIM dimensions found that reach could be improved by raising awareness of the My Diabetes My Way platform and the ability to upload activity tracker data into the system. Effectiveness could be improved by implementing appropriate personalized measures of health benefits and providing appropriate support for patients and health care staff. Adoption could be improved by better promotion of the intervention among stakeholders and the development of joint procedures. Implementation could be improved through the development of an agreed protocol, staff training, and introducing measurements of costs. Maintenance could be improved by supporting all patients for long-term engagement and measuring improvements to patients' health. Through this study, we identified how the reach, effectiveness, adoption, implementation, and maintenance of integrating activity trackers into adult type 2 diabetes care could be improved.

Type 2 diabetes mellitus (T2DM) is a metabolic disease that affects over 38 million adults in the United States, who are disproportionately Hispanic. This study describes the development and implementation of Salud Paso por Paso, a culturally tailored and linguistically appropriate intervention to increase engagement in physical activity (PA) for Hispanic adults living with T2DM. Participants were enrolled in a 6-week pre-post pilot test of a culturally tailored intervention that included sessions covering different aspects of PA and T2DM. Participants were recruited at a local free clinic. Nonparametric paired-sample Wilcoxon signed-rank tests were used to examine differences between pre- and postintervention measures. Twenty-one participants were recruited, and 19 (90.5%) completed the intervention. Participants significantly increased average hours spent in moderate PA, by 3.16 hours (from 4.73, SD 3.79 minutes to 9.63, SD 6.39 minutes; Z=-3.52; P<.001), average steps per week (from 23,006.38, SD 14,357.13 steps to 43,000.81, SD 30,237.17 steps; Z=-2.79; P=.005), and minutes per week of PA (from 105.94, SD 72.23 minutes to 224.19, SD 167.85 minutes; Z=-3.36; P<.001). Developing effective culturally tailored interventions that can ameliorate the deleterious effects of T2DM in Hispanic adults is an important strategy to promote health equity. The Salud Paso por Paso intervention is an effective way to promote PA in Hispanic adults living with T2DM.

Gestational diabetes mellitus (GDM), a type of blood glucose intolerance or hyperglycemia that occurs during pregnancy, is a common condition increasing in prevalence both globally and in Australia. Mobile health apps have been shown to be a useful resource for women with type 1 diabetes and could successfully contribute to GDM management by facilitating healthy behaviors. This study aimed to seek the perspectives of health care consumers (HCCs) and health professionals (HPs) regarding the development of a smartphone app for women living with GDM. A co-design process with 4 distinct phases underpinned the development of SugarMumma. Phase 1 involved a nonsystematic literature search followed by the creation of an app functions wish list. In phase 2, semistructured interviews with HCCs and HPs were undertaken and then thematically analyzed. In phase 3, a prototype was designed based on social cognitive theory and stakeholder recommendations. Agile project management methodology was used, followed by \"user acceptance testing.\" During phase 4, a second round of individual interviews was undertaken with HCCs and HPs. The same qualitative methods outlined in phase 2 were used. In phase 2, individual and didactic interviews were undertaken with HCCs (n=2) and HPs (n=6). Two overarching themes encompassing recommendations for app development emerged: (1) functionality and (2) individualized care. SugarMumma was created in phase 3. Phase 4 involved a second round of individual interviews with HCCs (n=1) and HPs (n=5), resulting in the final theme (3) future directions. With increasing numbers of people using smartphones, mobile health apps can help manage chronic conditions such as GDM. SugarMumma was designed following extensive stakeholder input. Good functionality, regular notifications, appealing visual aids, positive feedback, relevant dietary advice, and exporting information to HPs are important features to include.

Mobile health (mHealth) interventions offer a promising way to support healthy lifestyle habits, but effectiveness depends on user engagement. Maintaining high user engagement in app-based interventions is important, yet challenging. We aimed to examine the association between user engagement with an app-based dietary education for people with type 2 diabetes and changes in diet quality, dietary intake, and clinical measures. In this randomized clinical trial, people with type 2 diabetes were recruited within primary care and randomized 1:1 to a 12-week smartphone-delivered app-based dietary education or control group. Participants were followed up after 3, 6, and 12 months. Dietary intake was assessed using a food frequency questionnaire. The control group received the app at the 3-month follow-up. User engagement was analyzed among all participants. Categories of high (100%), moderate (50%-99.9%), and low (<50%) user engagement were created based on the percentage of activities completed in the app. We used paired t tests to compare mean changes in diet quality, dietary intake, and clinical markers within user engagement groups, and fitted linear regression models to analyze differences in change between groups. Data from 119 participants (60.5%, 72/119 men) were analyzed. The mean age at baseline was 63.2 (SD 10.3) years and mean BMI was 30.1 (SD 5.1) kg/m2. User engagement was high with an average of 77.1% of app activities completed. More than half (53.8%, 64/119) of the users showed high user engagement, 21.8% (26/119) moderate, and 24.4% (29/119) low. Directly following the app-based education, a significant difference in change was seen for whole grains (β=20.4, 95%CI 0.57-40.3) in participants with high user engagement compared to the low user engagement group who decreased their intake (P=.03). At follow-up after 6 to 9 months after completed education, significant differences in change were seen for fiber, wholegrains, carbohydrates, saturated fat, sodium, and total energy in the moderate compared with the low engagement group, and a significant difference in change was seen for carbohydrates in the high, compared with the low, user engagement group. User engagement was generally high for the smartphone-based dietary education, suggesting that an app targeting dietary habits is feasible to use. Those with higher user engagement seem to maintain healthier dietary behaviours over time, compared to those with low user engagement. Future mHealth interventions should focus on ways to engage those with low interest.