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      Health Care Professionals’ Clinical Perspectives and Acceptance of a Blood Glucose Meter and Mobile App Featuring a Dynamic Color Range Indicator and Blood Sugar Mentor: Online Evaluation in Seven Countries

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          Abstract

          Background

          Despite many new therapies and technologies becoming available in the last decade, people with diabetes continue to struggle to achieve good glycemic control. Innovative and affordable solutions are needed to support health care professionals (HCPs) to improve patient outcomes.

          Objective

          To gather current self-management perceptions of HCPs in seven countries and investigate HCP satisfaction with a new glucose meter and mobile app featuring a dynamic color range indicator and a blood sugar mentor.

          Methods

          A total of 355 HCPs, including 142 endocrinologists (40.0%), 108 primary care physicians (30.4%), and 105 diabetes nurses (29.6%), were recruited from the United Kingdom (n=50), France (n=50), Germany (n=50), India (n=54), Algeria (50), Canada (n=51), and the United States (n=50). HCPs experienced the OneTouch Verio Reflect glucose meter and the OneTouch Reveal mobile app online from their own office computers using interactive demonstrations via webpages and multiple animations. After providing demographic and clinical practice insights, HCPs responded to statements about the utility of the system.

          Results

          Concerning current practice, 83.1% (295/355) of HCPs agreed that poor numeracy or health literacy was a barrier for their patients. A total of 85.9% (305/355) and 92.1% (327/355) of HCPs responded that type 2 diabetes (T2D) and type 1 diabetes (T1D) patients were aware of what represented a low, in-range, or high blood glucose result. Only 62.0% (220/355) felt current glucose meters made it easy for patients to understand if results were in range. A total of 50.1% (178/355) and 78.0% (277/355) of HCPs were confident that T1D and T2D patients took action for low or high results. A total of 87.0% (309/355) agreed that the ColorSure Dynamic Range Indicator could help them teach patients how to interpret results and 88.7% (315/355) agreed it made them more aware of hyper- and hypoglycemic results so they could take action. A total of 83.7% (297/355) of HCPs agreed that the Blood Sugar Mentor feature gave personalized guidance, insight, and encouragement so patients could take action. A total of 82.8% (294/355) of HCPs also agreed that the Blood Sugar Mentor provided real-time guidance to reinforce the goals HCPs had set so patients could take steps to manage their diabetes between office visits. After experiencing the full system, 85.9% (305/355) of HCPs agreed it was beneficial for patients with lower numeracy or health literacy; 96.1% (341/355) agreed that it helped patients understand when results were low, in range, or high; and 91.0% (323/355) agreed that the way it displayed diabetes information would make patients more inclined to act upon results. A total of 89.0% (316/355) of HCPs agreed that it would be helpful for agreeing upon appropriate in-range goals for their patients for their next clinic visit.

          Conclusions

          This multi-country online study provides evidence that HCPs were highly satisfied with the OneTouch Verio Reflect meter and the OneTouch Reveal mobile app. Each of these use color-coded information and the Blood Sugar Mentor feature to assist patients with interpreting, analyzing, and acting upon their blood glucose results, which is particularly beneficial to keep patients on track between scheduled office visits.

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          Most cited references15

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          Achievement of goals in U.S. diabetes care, 1999-2010.

          Tracking national progress in diabetes care may aid in the evaluation of past efforts and identify residual gaps in care. We analyzed data for adults with self-reported diabetes from the National Health and Nutrition Examination Survey and the Behavioral Risk Factor Surveillance System to examine risk-factor control, preventive practices, and risk scores for coronary heart disease over the 1999-2010 period. From 1999 through 2010, the weighted proportion of survey participants who met recommended goals for diabetes care increased, by 7.9 percentage points (95% confidence interval [CI], 0.8 to 15.0) for glycemic control (glycated hemoglobin level <7.0%), 9.4 percentage points (95% CI, 3.0 to 15.8) for individualized glycemic targets, 11.7 percentage points (95% CI, 5.7 to 17.7) for blood pressure (target, <130/80 mm Hg), and 20.8 percentage points (95% CI, 11.6 to 30.0) for lipid levels (target level of low-density lipoprotein [LDL] cholesterol, <100 mg per deciliter [2.6 mmol per liter]). Tobacco use did not change significantly, but the 10-year probability of coronary heart disease decreased by 2.8 to 3.7 percentage points. However, 33.4 to 48.7% of persons with diabetes still did not meet the targets for glycemic control, blood pressure, or LDL cholesterol level. Only 14.3% met the targets for all three of these measures and for tobacco use. Adherence to the recommendations for annual eye and dental examinations was unchanged, but annual lipid-level measurement and foot examination increased by 5.5 percentage points (95% CI, 1.6 to 9.4) and 6.8 percentage points (95% CI, 4.8 to 8.8), respectively. Annual vaccination for influenza and receipt of pneumococcal vaccination for participants 65 years of age or older rose by 4.5 percentage points (95% CI, 0.8 to 8.2) and 6.9 percentage points (95% CI, 3.4 to 10.4), respectively, and daily glucose monitoring increased by 12.7 percentage points (95% CI, 10.3 to 15.1). Although there were improvements in risk-factor control and adherence to preventive practices from 1999 to 2010, tobacco use remained high, and almost half of U.S. adults with diabetes did not meet the recommended goals for diabetes care.
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            Association of numeracy and diabetes control.

            The influence of a patient's quantitative skills (numeracy) on the management of diabetes is only partially understood. To examine the association between diabetes-related numeracy and glycemic control and other diabetes measurements. Cross-sectional survey. 2 primary care and 2 diabetes clinics at 3 medical centers. 398 adult patients with type 1 or type 2 diabetes mellitus enrolled between March 2004 and November 2005. Health literacy, general numeracy, and diabetes-related numeracy assessed by using the Rapid Estimate of Adult Literacy in Medicine; the Wide Range Achievement Test, 3rd edition; and the Diabetes Numeracy Test (DNT), respectively. The primary outcome was most recent level of hemoglobin A1c. Additional measurements were diabetes knowledge, perceived self-efficacy of diabetes self-management, and self-management behaviors. The median DNT score was 65% (interquartile range, 42% to 81%). Common errors included misinterpreting glucose meter readings and miscalculating carbohydrate intake and medication dosages. Lower DNT scores were associated with older age, nonwhite race, fewer years of education, lower reported income, lower literacy and general numeracy skills, lower perceived self-efficacy, and selected self-management behaviors. Patients scoring in the lowest DNT quartile (score <42%) had a median hemoglobin A1c level of 7.6% (interquartile range, 6.5% to 9.0%) compared with 7.1% (interquartile range, 6.3% to 8.1%) in those scoring in the highest quartile (P = 0.119 for trend). A regression analysis adjusted for age, sex, race, income, and other factors found a modest association between DNT score and hemoglobin A1c level. Causality cannot be determined in this cross-sectional study, especially with its risk for unmeasured confounding variables. Poor numeracy skills were common in patients with diabetes. Low diabetes-related numeracy skills were associated with worse perceived self-efficacy, fewer self-management behaviors, and possibly poorer glycemic control.
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              Achievement of Glycated Hemoglobin Goals in the US Remains Unchanged Through 2014

              Introduction Previous research has found that the percentage of US adults with diabetes achieving a glycated hemoglobin (HbA1c) target of 9.0% increased from 12.6% (95% CI 10.5–14.8%) to 15.5% (95% CI 12.9–18.2%). Achievement of individualized targets varied by age group and presence of comorbidities, but exhibited similar trends as general target achievement. Conclusions Despite the development of many new medications to treat diabetes during the past decade, the proportion of patients achieving glycemic control targets has not improved. Funding Intarcia Therapeutics. Electronic supplementary material The online version of this article (doi:10.1007/s13300-017-0280-5) contains supplementary material, which is available to authorized users.
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                Author and article information

                Contributors
                Journal
                JMIR Hum Factors
                JMIR Hum Factors
                JMIR Human Factors
                JMIR Human Factors
                JMIR Publications (Toronto, Canada )
                2292-9495
                Jul-Sep 2019
                03 July 2019
                : 6
                : 3
                : e13847
                Affiliations
                [1 ] LifeScan Scotland Inverness United Kingdom
                [2 ] LifeScan Europe GmbH Zug Switzerland
                [3 ] LifeScan Global Corporation Wayne, PA United States
                [4 ] Forschergruppe Diabetes eV München-Neuherberg Germany
                Author notes
                Corresponding Author: Mike Grady mgrady@ 123456lifescan.com
                Author information
                http://orcid.org/0000-0002-8006-1844
                http://orcid.org/0000-0001-8011-7732
                http://orcid.org/0000-0002-4717-5241
                http://orcid.org/0000-0002-8860-3871
                http://orcid.org/0000-0003-4968-2367
                Article
                v6i3e13847
                10.2196/13847
                6636235
                31271146
                bc2a829a-caaf-481b-932d-cfdefb00cef8
                ©Mike Grady, Usha Venugopal, Katia Robert, Graham Hurrell, Oliver Schnell. Originally published in JMIR Human Factors (http://humanfactors.jmir.org), 03.07.2019.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in JMIR Human Factors, is properly cited. The complete bibliographic information, a link to the original publication on http://humanfactors.jmir.org.as well as this copyright and license information must be included.

                History
                : 28 February 2019
                : 16 April 2019
                : 30 May 2019
                : 4 June 2019
                Categories
                Original Paper
                Original Paper

                colorsure dynamic range indicator,blood sugar mentor,mobile app,blood glucose meter,self-monitoring of blood glucose,health care professionals

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