JMIR Publications

JMIR Diabetes

Emerging Technologies, Medical Devices, Apps, Sensors, and Informatics to Help People with Diabetes.


Journal Description

JMIR Diabetes (JD) is a new sister journal of JMIR (the leading open-access journal in health informatics (Impact Factor 2016: 5.175), focusing on technologies, medical devices, apps, engineering, informatics and patient education for diabetes prevention, self-management, care, and cure, to help people with diabetes. As open access journal we are read by clinicians and patients alike and have (as all JMIR journals) a focus on readable and applied science reporting the design and evaluation of health innovations and emerging technologies, as well as on diabetes epidemiology. We publish original research, viewpoints, and reviews (both literature reviews and medical device/technology/app reviews) covering for example wearable devices and trackers, mobile apps, glucose monitoring (including emerging technologies such as Google contact lens), medical devices for insulin and metabolic peptide delivery, closed loop systems and artificial pancreas, telemedicine, web-based diabetes education and elearning, innovations for patient self-management and "quantified self", diabetes-specific EHR improvements, clinical or consumer-focused software, diabetes epidemiology and surveillance, crowdsourcing and quantified self-based research data, new sensors and actuators to be applied to diabetes.


Recent Articles:

  • Source: The Authors; Copyright: Cheryl Conway; URL:; License: Creative Commons Attribution (CC-BY).

    Digital Health for Medication Adherence in Adult Diabetes or Hypertension: An Integrative Review


    Background: Optimal management of chronic diseases, such as type 2 diabetes and hypertension, often include prescription medications. Medication adherence (MA) is one component of self-management. Optimization through digital health—eHealth and mHealth—could enhance patient awareness and/or communication between the patient and provider. Objective: Medication adherence is a major issue that affects 50%-60% of chronically ill adults. Digital health refers to eHealth and mHealth, collectively, and as these technologies become more accessible, remote health delivery is increasingly available as an adjunct to improve medication adherence; communicate with patients and providers; and provide education to patients, families, and communities. The objective of this integrative review was to examine the types of digital health technologies that targeted medication adherence in the adult population with diabetes or hypertension. Methods: An integrative review was conducted using databases within EBSCOhost, PubMed, and Scopus. Eligible studies available as of September 2016 had to be written in English, had to contain digital health interventions to improve medication adherence to prescription medications in adults 18 years or older, and had to focus on diabetes or hypertension. Results: Of the 337 located studies, 13 (3.9%) used a digital health intervention for medication adherence to prescribed medications for diabetes or hypertension and were assessed according to the Chronic Care Model. Conclusions: The 13 studies included in this review found no conclusive evidence of improved medication adherence using digital health interventions such as interactive voice response (IVR), short message service (SMS) text messaging, telemonitoring, and interactive software technology. Among the 13 studies were digital health interventions that foster medication adherence via one-way communication to the patient or two-way communication between the patient and health care provider for adjunct medication adherence strategies. More research is needed to determine which digital health interventions are most beneficial for individuals with diabetes or hypertension.

  • TOC for JMIR website. Source: vividfix; Copyright: vividfix ( Copy approval# NACO/VFX/0217/0089; License: Licensed by the authors.

    Diabetes App-Related Text Messages From Health Care Professionals in Conjunction With a New Wireless Glucose Meter With a Color Range Indicator Improves...


    Background: Mobile diabetes apps enable health care professionals (HCPs) to monitor patient progress, offer remote consultations, and allow more effective and informed treatment decisions between patients and HCPs. The OneTouch Reveal app aggregates data from a blood glucose meter and provides analytics to help patients and HCPs visualize glycemic trends and patterns, enabling more informed treatment and lifestyle decisions. The app also allows patients and HCPs to keep connected by exchanging text messages (short message service [SMS]) or progress reports via email. Objective: The primary objective of our study was to assess changes in glycemic control and overall experiences of patients and HCPs using the app in conjunction with the wireless OneTouch Verio Flex blood glucose meter. Methods: We randomly assigned 137 adults with type 1 (T1DM) or type 2 diabetes mellitus (T2DM) and a glycated hemoglobin (HbA1c) level of ≥7.5% and ≤11.0% to use the glucose meter alone or glucose meter plus the app for 24 weeks. The meter + app group were scheduled to receive diabetes-related text messages from their HCP every 2 weeks (total of 12 texts). Clinical measures and self-reported outcomes were assessed during face-to-face clinic visits between the participant and a diabetes nurse at baseline, week 12, and week 24. Results: In 128 completed participants, HbA1c decreased after 12 and 24 weeks in both the meter-only (n=66) (0.56% and 0.55%, respectively) and meter + app groups (n=62) (0.78% and 0.67%, respectively) compared with baseline (each P<.001). The difference in HbA1c reduction between the 2 groups was not statistically significant at 12 or 24 weeks (P=.12 and P=.45, respectively). However, the decrease in HbA1c was greater in T2DM participants using the meter + app after 12 weeks (1.04%) than in T2DM participants using the meter alone (0.58%; P=.09). In addition, decrease in HbA1c in participants using the meter + app who received at least 10 diabetes-related text messages (1.05%) was significantly greater than in meter-only participants (P<.01). Conclusions: Use of the OneTouch Verio Flex glucose meter alone or in combination with the OneTouch Reveal diabetes app was associated with significant improvements in glycemic control after 12 and 24 weeks. Improvements using the app were greatest in participants with T2DM and those participants who received the highest number of HCP text messages. This study suggests that real-time availability of patient data and the ability to send personalized diabetes-related text messages can assist HCPs to improve glycemic control in patients between scheduled visits. Trial Registration: NCT02429024; (Archived by WebCite at

  • Source: Pixabay; Copyright: Alexandra / München; URL:; License: Public Domain (CC0).

    Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation


    Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings. Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes. Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation. Results: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018. Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months.

  • Source: Dreamstime; Copyright: Rawpixelimages; URL:; License: Public Domain (CC0).

    The Value of Children's Voices for a Video Game Development in the Context of Type 1 Diabetes: Focus Group Study


    Background: Children with type 1 diabetes mellitus (T1DM) face daily challenges performing self-care tasks, controlling symptoms, and dealing with psychosocial issues. The use of video games to improve health is a successful support for persons with chronic diseases, promoting adequate self-management through simulations of real life. Involving future users in the development of games is essential to generating innovative, creative, and effective programs. Objective: Our goal is to identify what children with T1DM need to know about their disease and their self-care tasks as well as their preferences in video games. Methods: Children with T1DM provided input about their learning needs, self-care tasks, and preferences in video games. Three categories were identified through qualitative content analysis: dealing with emotions and knowledge, practical skills and awareness, and game preferences. Results: Children expressed concerns about the difficulties of self-care, lack of knowledge about diabetes, and lack of awareness about the consequences of behaviors related to self-care, which contribute to inappropriate behaviors and significantly impact self-management of their disease. They expressed enthusiasm for a video game for children with diabetes that considered their needs and preferences. Conclusions: Findings support the potential benefits when children’s input is considered in game design. Consideration of customer needs and preferences is a powerful resource in the development of video games with enhanced learning experience.

  • Students in community health worker training program learning to use patient portals. Source: The Authors; Copyright: Amy Sheon; URL:; License: Creative Commons Attribution (CC-BY).

    Addressing Disparities in Diabetes Management Through Novel Approaches to Encourage Technology Adoption and Use


    Type 2 diabetes (T2D) is one of the nation’s leading drivers of disability and health care utilization, with elevated prevalence among individuals with lower education, income, and racial/ethnic minorities. Health information technology (HIT) holds vast potential for helping patients, providers, and payers to address T2D and the skyrocketing rates of chronic illness and associated health care costs. Patient portals to electronic health records (EHRs) serve as a gateway to consumer use of HIT. We found that disparities in portal use portend growing T2D disparities. Little progress has been made in addressing identified barriers to technology adoption, especially among populations with elevated risk of T2D. Patients often lack digital literacy skills and continuous connectivity and fear loss of the relationship with providers. Providers may experience structural disincentives to promoting patient use of HIT and apply hidden biases that inhibit portal use. Health care systems often provide inadequate training to patients and providers in use of HIT, and lack resources devoted to obtaining and optimizing use of data generated by HIT. Lastly, technology-related barriers include inadequate consideration of user perspectives, lack of evidence for patient-focused apps, and lack of features to enable providers and health care systems to readily obtain aggregate data to improve care and facilitate research. After discussing these barriers in detail, we propose possible solutions and areas where further research is needed to ensure that individuals and health care systems obtain the full benefit of the nation’s planned $38 billion HIT investment. A digital inclusion framework sheds new light on barriers posed for patients with social health inequalities. We have determined that partnerships with community organizations focused on digital inclusion could help health systems explore and study new approaches, such as universal screening and referral of patients for digital skills, health literacy, and Internet connectivity.

  • Good data? Source: istock; Copyright: ©; URL:; License: Licensed by the authors.

    Assessing Diabetes-Relevant Data Provided by Undergraduate and Crowdsourced Web-Based Survey Participants for Honesty and Accuracy


    Background: To eliminate health disparities, research will depend on our ability to reach select groups of people (eg, samples of a particular racial or ethnic group with a particular disease); unfortunately, researchers often experience difficulty obtaining high-quality data from samples of sufficient size. Objective: Past studies utilizing MTurk applaud its diversity, so our initial objective was to capitalize on MTurk’s diversity to investigate psychosocial factors related to diabetes self-care. Methods: In Study 1, a “Health Survey” was posted on MTurk to examine diabetes-relevant psychosocial factors. The survey was restricted to individuals who were 18 years of age or older with diabetes. Detection of irregularities in the data, however, prompted an evaluation of the quality of MTurk health-relevant data. This ultimately led to Study 2, which utilized an alert statement to improve conscientious behavior, or the likelihood that participants would be thorough and diligent in their responses. Trap questions were also embedded to assess conscientious behavior. Results: In Study 1, of 4165 responses, 1246 were generated from 533 unique IP addresses completing the survey multiple times within close temporal proximity. Ultimately, only 252 responses were found to be acceptable. Further analyses indicated additional quality concerns with this subsample. In Study 2, as compared with the MTurk sample (N=316), the undergraduate sample (N=300) included more females, and fewer individuals who were married. The samples did not differ with respect to race. Although the presence of an alert resulted in fewer trap failures (mean=0.07) than when no alert was present (mean=0.11), this difference failed to reach significance: F1,604=2.5, P=.11, ƞ²=.004, power=.35. The modal trap failure response was zero, while the mean was 0.092 (SD=0.32). There were a total of 60 trap failures in a context where the potential could have exceeded 16,000. Conclusions: Published studies that utilize MTurk participants are rapidly appearing in the health domain. While MTurk may have the potential to be more diverse than an undergraduate sample, our efforts did not meet the criteria for what would constitute a diverse sample in and of itself. Because some researchers have experienced successful data collection on MTurk, while others report disastrous results, Kees et al recently identified that one essential area of research is of the types and magnitude of cheating behavior occurring on Web-based platforms. The present studies can contribute to this dialogue, and alternately provide evidence of disaster and success. Moving forward, it is recommended that researchers employ best practices in survey design and deliberately embed trap questions to assess participant behavior. We would strongly suggest that standards be in place for publishing the results of Web-based surveys—standards that protect against publication unless there are suitable quality assurance tests built into the survey design, distribution, and analysis.

  • Woman with iPhone showing a diabetes management app (montage). Source: The Authors /; Copyright: JMIR Publications; URL:; License: Creative Commons Attribution (CC-BY).

    iOS Appstore-Based Phone Apps for Diabetes Management: Potential for Use in Medication Adherence


    Background: Currently, various phone apps have been developed to assist patients. Many of these apps are developed to assist patients in the self-management of chronic diseases such as diabetes. It is essential to analyze these various apps to understand the key features that would potentially be instrumental in helping patients successfully achieve goals in disease self-management. Objective: The objective of this study was to conduct a review of all the available diabetes-related apps in the iOS App Store to evaluate which diabetic app is more interactive and offers a wide variety of operations such as monitoring glucose, water, carbohydrate intake, weight, body mass index (BMI), medication, blood pressure (BP) levels, reminders or push notifications, food database, charts, exercise management, email, sync between devices, syncing data directly to the prescribers, and other miscellaneous functions such as (Twitter integration, password protection, retina display, barcode scanner, apple watch functionality, and cloud syncing). Methods: Data was gathered using the iOS App Store on an iPad. The search term “diabetes” resulted in 1209 results. Many of the results obtained were remotely related to diabetes and focused mainly on diet, exercise, emergency services, refill reminders, providing general diabetes information, and other nontherapeutic options. We reviewed each app description and only included apps that were meant for tracking blood glucose levels. All data were obtained in one sitting by one person on the same device, as we found that carrying out the search at different times or on different devices (iPhones) resulted in varying results. Apps that did not have a feature for tracking glucose levels were excluded from the study. Results: The search resulted in 1209 results; 85 apps were retained based on the inclusion criteria mentioned above. All the apps were reviewed for average customer ratings, number of reviews, price, and functions. Of all the apps surveyed, 18 apps with the highest number of user ratings were used for in-depth analysis. Of these 18 apps, 50% (9/18) also had a medication adherence function. Our analysis revealed that the Diabetes logbook used by the mySugr app was one of the best; it differentiated itself by introducing fun as a method of increasing adherence. Conclusions: A large variation was seen in patient ratings of app features. Many patient reviewers desired simplicity of app functions. Glucose level tracking and email features potentially helped patients and health care providers manage the disease more efficiently. However, none of the apps could sync data directly to the prescribers. Additional features such as graph customization, availability of data backup, and recording previous entries were also requested by many users. Thus, the use of apps in disease management and patient and health-care provider involvement in future app refinement and development should be encouraged.

  • My Dietitian web-based weight loss intervention study logo. Source: Image created by the authors; Copyright: The authors; License: Creative Commons Attribution (CC-BY).

    Web-Based Weight Loss Intervention for Men With Type 2 Diabetes: Pilot Randomized Controlled Trial


    Background: Rising obesity levels remain a major public health concern due to the clear link with several comorbidities such as diabetes. Diabetes now affects 6% of the UK population. Modest weight loss of 5% to 10% has been shown to be associated with significant reductions in blood sugar, lipid, and blood pressure levels. Men have been shown to be attracted to programs that do not require extensive face-to-face time commitments, illustrating the potential audience available for health behavior change via the Web. Objective: The objective of our study was to evaluate the feasibility and acceptability of a Web-based weight loss intervention in men with type 2 diabetes. Methods: We conducted a pilot, parallel 2-arm, individually randomized controlled trial with embedded process evaluation. Participants were randomly assigned in a one-to-one ratio to the usual care group or the 12-month Web-based weight loss intervention, including dietitian and exercise expert feedback. Face-to-face recruitment and assessment were performed by the researcher unblinded. Data collected included weight, height, body mass index (BMI), and waist circumference, together with an audit trail of eligibility, recruitment, retention, and adherence rates. A process evaluation (website use data and qualitative interviews) monitored adherence, acceptability, and feasibility of the intervention. Results: General practice database searches achieved the recruitment target (n=61) for the population of men with type 2 diabetes, of whom 66% (40/61) completed 3-month follow-up measurements. By 12 months, the retention rate was 52% (32/61), with 12 of the 33 men allocated to the intervention group still active on the website. The intervention was seen as acceptable by the majority of participants. We gained insights about acceptability and use of the website from the parallel process evaluation. Conclusions: Recruitment to the Web-based weight loss intervention was successful. Results are descriptive, but there were positive indications of increased weight loss (in kilograms and as a percentage), and reduced waist circumference and BMI for the intervention group from 3 to 12 months, in comparison with control. This research adds to the evidence base in relation to incorporating a Web-based weight loss intervention within the UK National Health Service (NHS). NHS weight loss services are struggling to provide sufficient referrals. Therefore, alternative modes of delivery, with the potential to reduce health professional input and time per patient while still enabling individual and tailored care, need to be investigated to identify whether they can be effective and thus benefit the NHS. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN): 48086713; (Archived by WebCite at

  • Source: Joseph Keller/; Copyright: iMore; URL:; License: Creative Commons Attribution (CC-BY).

    Machine or Human? Evaluating the Quality of a Language Translation Mobile App for Diabetes Education Material


    Background: Diabetes is a major health crisis for Hispanics and Asian Americans. Moreover, Spanish and Chinese speakers are more likely to have limited English proficiency in the United States. One potential tool for facilitating language communication between diabetes patients and health care providers is technology, specifically mobile phones. Objective: Previous studies have assessed machine translation quality using only writing inputs. To bridge such a research gap, we conducted a pilot study to evaluate the quality of a mobile language translation app (iTranslate) with a voice recognition feature for translating diabetes patient education material. Methods: The pamphlet, “You are the heart of your family…take care of it,” is a health education sheet for diabetes patients that outlines three recommended questions for patients to ask their clinicians. Two professional translators translated the original English sentences into Spanish and Chinese. We recruited six certified medical translators (three Spanish and three Chinese) to conduct blinded evaluations of the following versions: (1) sentences interpreted by iTranslate, and (2) sentences interpreted by the professional human translators. Evaluators rated the sentences (ranging from 1-5) on four scales: Fluency, Adequacy, Meaning, and Severity. We performed descriptive analyses to examine the differences between these two versions. Results: Cronbach alpha values exhibited high degrees of agreement on the rating outcomes of both evaluator groups: .920 for the Spanish raters and .971 for the Chinese raters. The readability scores generated using MS Word’s Flesch-Kincaid Grade Level for these sentences were 0.0, 1.0, and 7.1. We found iTranslate generally provided translation accuracy comparable to human translators on simple sentences. However, iTranslate made more errors when translating difficult sentences. Conclusions: Although the evidence from our study supports iTranslate’s potential for supplementing professional human translators, further evidence is needed. For this reason, mobile language translation apps should be used with caution.

  • Videoconsultation between a patient in his home  and the physcian at the healthcare center. Source: The Authors; Copyright: Renewing Health Norrbotten; URL:; License: Public Domain (CC0).

    Telemonitoring and Health Counseling for Self-Management Support of Patients With Type 2 Diabetes: A Randomized Controlled Trial


    Background: The prevalence of diabetes is increasing among adults globally, and there is a need for new models of health care delivery. Research has shown that self-management approaches encourage persons with chronic conditions to take a primary role in managing their daily care. Objective: The objective of this study was to investigate whether the introduction of a health technology-supported self-management program involving telemonitoring and health counseling had beneficial effects on glycated hemoglobin (HbA1c), other clinical variables (height, weight, body mass index, blood pressure, blood lipid profile), and health-related quality of life (HRQoL), as measured using the Short Form Health Survey (SF-36) version 2 in patients with type 2 diabetes. Methods: This was a pragmatic randomized controlled trial of patients with type 2 diabetes. Both the control and intervention groups received usual care. The intervention group also participated in additional health promotion activities with the use of the Prescribed Healthcare Web application for self-monitoring of blood glucose and blood pressure. About every second month or when needed, the general practitioner or the diabetes nurse reviewed the results and the health care activity plan. Results: A total of 166 patients with type 2 diabetes were randomly assigned to the intervention (n=87) or control (n=79) groups. From the baseline to follow-up, 36 patients in the intervention group and 5 patients in the control group were lost to follow-up, and 2 patients died. Additionally, HbA1c was not available at baseline in one patient in the intervention group. A total of 122 patients were included in the final analysis after 19 months. There were no significant differences between the groups in the primary outcome HbA1c level (P=.33), and in the secondary outcome HRQoL as measured using SF-36. A total of 80% (67/87) of the patients in the intervention group at the baseline, and 98% (47/50) of the responders after 19-month intervention were familiar with using a personal computer (P=.001). After 19 months, nonresponders (ie, data from baseline) reported significantly poorer mental health in social functioning and role emotional subscales on the SF-36 (P=.03, and P=.01, respectively). Conclusions: The primary outcome HbA1c level and the secondary outcome HRQoL did not differ between groups after the 19-month follow-up. Those lost to follow-up reported significantly poorer mental health than did the responders in the intervention group. Trial Registration: NCT01478672; (Archived by WebCite at

  • Diabetes children share experience. Source: Image created by the authors; Copyright: Goran Petrovski; URL:; License: Creative Commons Attribution (CC-BY).

    Impact of Facebook on Glucose Control in Type 1 Diabetes: A Three-Year Cohort Study


    Background: As the world is changing, traditional health care services should be adapted for the new era of technology and the Internet. One of the possible ways for communication between health care providers and patients is social media. There are several benefits of social media in health: increased interactions with others; more available and shared information; increased accessibility; social or emotional support. Objective: The aim of this study was to evaluate the results of Facebook and CareLink software as a possible Internet tool to improve diabetes control in type 1 diabetes patients using a sensor augmented pump. Methods: A total of 67 adolescents with type 1 diabetes and in the age range of 14-23 years were randomized in 2 groups: (1) Traditional group and (2) Internet group. In the traditional group, 34 patients were treated using standard medical protocol with regular clinic visits, where data were uploaded at the clinic and interventions (pump settings-basal bolus insulin and education) were delivered to the patient. In the Internet group, 33 patients were treated using Facebook and CareLink software (Medtronic Diabetes) on a monthly basis, where the data were uploaded by the patient at home and interventions (same as traditional group) were delivered via Facebook (written reports and chats). Both the traditional and Internet group had regular visits every 3 months with standard medical protocol. Glycosylated hemoglobin (HbA1c) was obtained before and every 3 months during the study for a 3-year-period. Results: The improvement in glucose control was found in both groups: 7.9% (SD 1.4) [62.8 mmol/mol (SD 12.9)] to 6.9% (SD 1.2) [51.9 mmol/mol (SD 10.8)] in the traditional group, and 7.8% (SD 1.8) [61.7 mmol/mol (SD 17.2)] to 6.7% (SD 1.8) [49.7 mmol/mol (SD 17.3)] in the Internet group). Significant improvement of HbA1c (P<.05) was found in favor of the Internet group. Conclusions: Social media such as Facebook as a tool can assist in standard medical care to improve glucose control in a long term period in adolescents with type 1 diabetes using insulin pump therapy.

  • Source: iStock by Getty Images; Copyright: monkeybusinessimages; URL:; License: Licensed by the authors.

    Phone Messaging to Prompt Physical Activity and Social Support Among Low-Income Latino Patients With Type 2 Diabetes: A Randomized Pilot Study


    Background: Given disparities in diabetes prevalence, receipt of diabetes education, diabetes knowledge, and self-management behaviors among Latinos, there is a need to provide education and ongoing support to this population. Phone-based interventions have the potential to reach and engage both patients and their family members and friends. Objective: The aim of this study was to investigate the feasibility, perceived usefulness, and potential effectiveness of a short text or voice message (STVM) intervention to activate (1) physical activity (PA) behavior change among urban, low-income Latino adults with type 2 diabetes and (2) supportive behaviors by their family members and friends. Methods: A 12-week pilot study randomized 42 participants recruited in person from a safety-net ambulatory care clinic in Los Angeles into one of the 3 study arms: control, phone messaging (PM), and phone messaging plus social support from family members and friends (PM+FF). All participants were prompted to set PA goals and to self-monitor PA behavior using pedometers and walking logs. PM and PM+FF participants received STVMs with reminders to review goals and self-monitor, PA behavior change education, and feedback on performance. Participants in the PM+FF arm also had their family members and friends receiving STVMs with suggestions for how they could support the participant’s PA behavior change efforts. Participants completed semistructured assessments in person at baseline, 6 weeks, and 12 weeks. Outcomes were PA (steps/day) and perceived social support from family members and friends. Results: Among PM and PM+FF participants, those who opted to receive text messages (short message service, SMS) responded to 62.7% (128/204) of SMS text messages requiring a response while those who opted to receive voice messages responded 30% (12/40) of the time. Participants perceived guidance in self-regulation as useful, particularly self-monitoring, goal setting, self-instruction, feedback, and social support. All participants increased PA at 6 weeks, but only the PM and PM+FF arms increased PA at 12 weeks. All study arms experienced an increase in perceived social support from family members and friends at 6 weeks, but only those in the PM+FF arm had an increase in the perception of social support at 12 weeks. Conclusion: Designing an STVM intervention based on self-regulation techniques is feasible and perceived as useful by participants. The STVM intervention has the potential to improve PA in terms of daily steps and perceived social support from family members and friends. Trial Registration: NCT02850770; (Archived by WebCite at

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  • Engagement in the Diabetes Online Community Is Associated with Better Glycemic Control, Self-Care and Quality of Life

    Date Submitted: Jul 29, 2017

    Open Peer Review Period: Jul 29, 2017 - Sep 23, 2017

    Background: Successful diabetes management, usually measured by glycosalyted hemoglobin (A1c) levels, requires ongoing lifelong self-care, and can reqire that individuals with diabetes become experts...

    Background: Successful diabetes management, usually measured by glycosalyted hemoglobin (A1c) levels, requires ongoing lifelong self-care, and can reqire that individuals with diabetes become experts in translating care recommendations into real-life day-to-day diabetes management strategies. The diabetes online community (DOC) comprises multiple websites that include social media sites, blogs, and discussion groups for people with diabetes to chat and exchange information. Online communities can provide disease-specific practical advice, emotional support, allow users to share experiences, and encourage self-advocacy and patient empowerment. However, there has been little research about whether DOC use is associated with better diabetes self-management. Objective: This study surveyed adults with diabetes who participated in a DOC to better understand and describe who is using the DOC, how they are using it, and whether use of a DOC was associated with health indicators. Methods: We recruited, over a 7-month period, adults diagnosed with diabetes who used at least one of four different diabetes-related online communities to complete an online cross-sectional survey. Participants demographics, reported glycosylated hemoglobin (A1c), health-related quality of life (SF-12v2), level of diabetes self-care (Self-Care Inventory Revised), and DOC use (level of intensity and engagement) were collected. We examined the relationships between demographics, DOC use engagement and health indicators (HRQOL, self-care, and A1c levels).We used binary logistic regression to determine the extent to which DOC use predicted an A1C < 7% or ≥ 7% after controlling statistically for other variables in the model. Results: A total of 183 adults participated in this study. Participants were mostly female (71.6%; N=131/183) with a mean age of 44.7 years (SD=14) and diabetes duration of 18.2 years (SD=14.6). Participants had higher diabetes self-care (p<.001, M=72.4, SD=12.1) and better health-related quality of life (physical component summary p<.001, M= 64.8, SD=19; mental component summary p<.001, M= 66.6, SD=21.6) when compared to norms for diabetes. DOC engagement was a strong predictor of A1c, reducing the odds of having an A1c ≥7% by 33.8% for every point increase in DOC engagement (0-5). Our data also indicated that study participants are oftentimes (67.2%; N=123/183) not informing their healthcare providers about their DOC use even though most (91.2%; N=169/183) are seeing their healthcare provider on a regular basis. Conclusions: Our results suggest that individuals highly engaged with the DOC are more likely to have better glycemic control than those with lower engagement. Furthermore, DOC users have high health-related quality of life and diabetes self-care levels. Supplementing usual healthcare activities with DOC use may encourage knowledge and support among a population who need to optimize their diabetes self-management. Further studies are needed to determine how DOC use may affect health outcomes.

  • Behavioral and medical mechanisms that link diabetes to disability depend on the intersection of place and gender

    Date Submitted: Jun 23, 2017

    Open Peer Review Period: Jun 25, 2017 - Aug 20, 2017

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind...

    Background: The mechanisms that link diabetes to disability may vary across populations. Objective: This study investigated gender by place differences in the behavioral and medical mechanisms behind the link between diabetes (DM) and disability in eight countries. Methods: We borrowed data from Research on Early Life and Aging Trends and Effects (RELATE). This analysis included adults from eight countries including Barbados, Brazil, Costa Rica, Chile, Cuba, Puerto Rico, Mexico, and Uruguay. Diabetes was the independent variable, disability (activities of daily living) was the dependent variable, socioeconomics, obesity, health behaviors, and comorbidities were covariates, and gender was the moderator. We used country by gender specific- logistic regressions to test the effect of DM on disability after adjusting for socioeconomics (Model 1), socioeconomics, health behaviors, and obesity (Model 2), and socioeconomics, obesity, health behaviors, and medical comorbid conditions (Model 3). Results: Gender by country specific patterns of association between DM and disability were observed in Puerto Rico, Mexico, Brazil, Chile, and Cuba. In Puerto Rico, in men, DM – ADL could be explained by health behaviors and obesity, for women, however, the impact of DM on ADL was above all confounders for women. In Mexico, for men, DM was not associated with disability, however, for women, there was a link which could be explained by health behaviors and obesity. In Brazil, for men, DM – ADL limitation link could be fully explained by health behaviors and obesity, for women, however, DM was not associated with ADL at all. In Chile, for men, DM was not associated with ADL limitation, for women, however, there was an association between DM and ADL limitation which could not be explained by health behaviors, obesity, or comorbid medical conditions. In Cuba, for men, health behaviors and obesity fully mediated the effect of DM on ADL, for women, however, this link was mediated by comorbid medical conditions. Conclusions: Gender by place differences exist in the link between DM and disability, as well as behavioral and medical mechanisms behind such link. These findings advocate for the intersectionality approach in studying burden of illnesses such as DM.