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Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases

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A special issue of Nutrients (ISSN 2072-6643). This special issue belongs to the section "Nutritional Epidemiology".

Deadline for manuscript submissions: closed (20 December 2022) | Viewed by 33158

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Special Issue Editor

Prof. Dr. Peter E.H. Schwarz

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Department of Medicine, University of Dresden, Carl Gustav Carus, 01307 Dresden, Germany
Interests: digitalisation; nutrition; chronic care management; diabetes; type 2 diabetes; prevention
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Digitalization is progressing significantly at present, triggered by our experience with the pandemic but also by technical and software achievements, and attempts to address the individual needs of each patient through digital tools have become a growing field in the management of patients with chronic diseases, especially type 2 diabetes. There is significant potential for the use of digital tools in the care pathways of diabetes patients (and those with other chronic diseases) and to provide an autarkic impact to improve the outcome of our patients. There are various technologies focusing on documentation, feedback, motivation, messaging, and educational purposes, but especially supporting the behavior of patients for empowerment for better self-management of decision making. Furthermore, clinical decision support systems have been receiving growing attention in clinical care, as well as artificial-intelligence-based systems which can help to improve procedures and stratification of risk and to support professional decision making.

As is often the case in such a growing innovative environment, there is a lack of extensive evidence, and guidelines do not include information on this procedure due to a lack of studies with either positive or negative results from the clinical community, despite the speed with which this field is growing. It is for this reason that we have decided to establish this Special Issue on “Digitalization Supporting the Management of Type 2 Diabetes and Other Chronic Diseases”. Our aim is to provide a platform to communicate results of your research into digitalization, but also to offer an overview of the potential and barriers in the field, enabling to share research protocols and to gather information on the application of artificial intelligence in chronic disease management. Finally, we would like to collect insight into the development of guidelines for the introduction of digitalization into the management of chronic diseases.

There is growing evidence, both real-world and collected through studies, that digitally supported nutrition programs are more effective. Furthermore, digital health applications inform and support patients in enacting individualized nutritional behavior change. Apps that support multiple facets of patient behavior change, not only nutritional behavior but also physical activity and motivational aspects, are of particular interest. The strength of these applications is their scalability, whereas the biggest challenge is adherence and the effects of such apps on patients’ lives in the real world.

You are warmly invited if you are conducting research in this field, if you in the process of licensing digital products, or if you are involved in developing standard recommendations and guidelines in the field to publish your results and experiences in this Special Issue. We would like to make this a landmark issue for everyone working in the field of digitalization in chronic disease management, as well as the new field on the evaluation of digital tools for use in new and innovative research protocols.

I am very keen to read your manuscript and to publish together with you this Special Issue on a very innovative and important topic in medical care.

Prof. Dr. Peter E.H. Schwarz
Guest Editor

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Keywords

Digitalization
Type 2 Diabetes
Digital Intervention
Digital tools
Apps
Clinical decision support
systems
Navigation guidance
Chronic disease management
Artificial intelligence
Interoperability

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Published Papers (8 papers)

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Research

16 pages, 412 KiB

Open AccessArticle

Reversing Type 2 Diabetes in a Primary Care-Anchored eHealth Lifestyle Coaching Programme in Denmark: A Randomised Controlled Trial

by Jeanette Reffstrup Christensen, Ditte Hjorth Laursen, Jørgen Trankjær Lauridsen, Laura Hesseldal, Pernille Ravn Jakobsen, Jesper Bo Nielsen, Jens Søndergaard and Carl J. Brandt

Nutrients 2022, 14(16), 3424; https://doi.org/10.3390/nu14163424 - 19 Aug 2022

Cited by 11 | Viewed by 4116

Abstract

The goal of this trial was to investigate whether an eHealth lifestyle coaching programme led to significant weight loss and decreased Haemoglobin A1c (HbA1c) in patients with type 2 diabetes. In an RCT, 170 patients were enrolled from 2018 to 2019 for intervention or control. Inclusion criteria were diagnosed with type 2 diabetes, BMI 30–45 kg/m², and aged 18–70 years. Exclusion criteria were lacks internet access, pregnant or planning a pregnancy, or has a serious disease. Primary and secondary outcomes were a reduction in body weight and HbA1c. At six months, 75 (75%) patients in the intervention group and 53 (76%) patients in the control group remained in the trial. The mean body weight loss was 4.2 kg (95% CI, −5.49; −2.98) in the intervention group and 1.5 kg (95% CI, −2.57; −0.48) in the control group (p = 0.005). In the intervention group, 24 out of 62 patients with elevated HbA1c at baseline (39%) had a normalized HbA1c < 6.5% at six months, compared to 8 out of 40 patients with elevated HbA1c at baseline (20%) in the control group (p = 0.047). The eHealth lifestyle coaching programme can lead to significant weight loss and decreased HbA1c among patients with type 2 diabetes, compared to standard care. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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10 pages, 797 KiB

Open AccessArticle

Introducing zanadio—A Digitalized, Multimodal Program to Treat Obesity

by Katarina Forkmann, Lena Roth and Nora Mehl

Nutrients 2022, 14(15), 3172; https://doi.org/10.3390/nu14153172 - 1 Aug 2022

Cited by 11 | Viewed by 2872

Abstract

While the prevalence of overweight and obesity has been increasing annually, the accessibility of on-site treatment programs is not rising correspondingly. Digital, evidence-based obesity treatment programs could potentially alleviate this situation. The application zanadio has been developed to enable patients with obesity (BMI 30–45 kg/m²) to participate in a digital, multimodal weight reduction program based on current treatment guidelines. This article is divided into two parts: (I) it introduces zanadio, its aims and therapeutic concept, and (II) provides a first impression and demographic data on more than 11,000 patients from across the country who have used zanadio within the last 16 months, which demonstrates the demand for a digital obesity treatment. zanadio has the potential to partially close the current gap in obesity care. Future work should focus on identifying predictors of successful weight loss to further individualize digital obesity treatment, and an important next step would be to prevent obesity, i.e., to start the treatment at lower BMI levels, and to invent digital treatment programs for children and adolescents. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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10 pages, 932 KiB

Open AccessArticle

What Intervention Elements Drive Weight Loss in Blended-Care Behavior Change Interventions? A Real-World Data Analysis with 25,706 Patients

by Felix Schirmann, Philipp Kanehl and Lucy Jones

Nutrients 2022, 14(14), 2999; https://doi.org/10.3390/nu14142999 - 21 Jul 2022

Cited by 8 | Viewed by 4290

Abstract

Background: Blended-care behavior change interventions (BBCI) are a combination of digital care and coaching by health care professionals (HCP), which are proven effective for weight loss. However, it remains unclear what specific elements of BBCI drive weight loss. Objectives: This study aims to identify the distinct impact of HCP-elements (coaching) and digital elements (self-monitoring, self-management, and education) for weight loss in BBCI. Methods: Long-term data from 25,706 patients treated at a digital behavior change provider were analyzed retrospectively using a ridge regression model to predict weight loss at 3, 6, and 12 months. Results: Overall relative weight loss was −1.63 kg at 1 month, −3.61 kg at 3 months, −5.28 kg at 6 months, and −6.55 kg at 12 months. The four factors of BBCI analyzed here (coaching, self-monitoring, self-management, and education) predict weight loss with varying accuracy and degree. Coaching, self-monitoring, and self-management are positively correlated with weight losses at 3 and 6 months. Learn time (i.e., self-guided education) is clearly associated with a higher degree of weight loss. Number of appointments outside of app coaching with a dietitian (coach) was negatively associated with weight loss. Conclusions: The results testify to the efficacy of BBCI for weight loss-with particular positive associations per time point-and add to a growing body of research that characterizes the distinct impact of intervention elements in real-world settings, aiming to inform the design of future interventions for weight management. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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15 pages, 1465 KiB

Open AccessArticle

Personalised Nutritional Recommendations Based on Individual Post-Prandial Glycaemic Responses Improve Glycaemic Metrics and PROMs in Patients with Type 2 Diabetes: A Real-World Assessment

by Madlen Ungersboeck, Xiaowen Tang, Vanessa Neeff, Dominic Steele, Pascal Grimm and Matthew Fenech

Nutrients 2022, 14(10), 2123; https://doi.org/10.3390/nu14102123 - 19 May 2022

Cited by 8 | Viewed by 3688

Abstract

The recommended first-line therapy in type 2 diabetes (T2D) is lifestyle modification. In many patients, such interventions fail, and disease progresses inexorably to medication requirement. A potential reason for the failure of standard nutritional interventions is the use of generic dietary advice, with no personalisation to account for differences in the effect of food on blood glucose between different individuals. Another is the lack of instant feedback on the impact of dietary modification on glycaemic control, which supports sustained behaviour change. The use of continuous glucose monitoring (CGM) may help address both these shortcomings. We conducted an observational study to explore how personalised nutritional information impacts glycaemic control and patient-reported outcome measures (PROMs) of well-being. Free-living people with T2D eating their normal diet were provided with personalised nutritional recommendations by state-registered nutritionists based on the CGM-enabled analysis of individual post-prandial glycaemic responses (PPGRs). Participants demonstrated considerable inter-individual differences in PPGRs, reductions in post-prandial incremental area under the curve (iAUC) and daytime AUC, and improvements in energy levels, ability to concentrate, and other PROMs. These results suggest a role for personalised nutritional recommendations based on individual-level understanding of PPGRs in the non-pharmaceutical management of T2D. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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12 pages, 2240 KiB

Open AccessArticle

Opportunities of Digital Infrastructures for Disease Management—Exemplified on COVID-19-Related Change in Diagnosis Counts for Diabetes-Related Eye Diseases

by Franziska Bathelt, Ines Reinecke, Yuan Peng, Elisa Henke, Jens Weidner, Martin Bartos, Robert Gött, Dagmar Waltemath, Katrin Engelmann, Peter EH Schwarz and Martin Sedlmayr

Nutrients 2022, 14(10), 2016; https://doi.org/10.3390/nu14102016 - 11 May 2022

Cited by 6 | Viewed by 3132

Abstract

Background: Retrospective research on real-world data provides the ability to gain evidence on specific topics especially when running across different sites in research networks. Those research networks have become increasingly relevant in recent years; not least due to the special situation caused by the COVID-19 pandemic. An important requirement for those networks is the data harmonization by ensuring the semantic interoperability. Aims: In this paper we demonstrate (1) how to facilitate digital infrastructures to run a retrospective study in a research network spread across university and non-university hospital sites; and (2) to answer a medical question on COVID-19 related change in diagnostic counts for diabetes-related eye diseases. Materials and methods: The study is retrospective and non-interventional and runs on medical case data documented in routine care at the participating sites. The technical infrastructure consists of the OMOP CDM and other OHDSI tools that is provided in a transferable format. An ETL process to transfer and harmonize the data to the OMOP CDM has been utilized. Cohort definitions for each year in observation have been created centrally and applied locally against medical case data of all participating sites and analyzed with descriptive statistics. Results: The analyses showed an expectable drop of the total number of diagnoses and the diagnoses for diabetes in general; whereas the number of diagnoses for diabetes-related eye diseases surprisingly decreased stronger compared to non-eye diseases. Differences in relative changes of diagnoses counts between sites show an urgent need to process multi-centric studies rather than single-site studies to reduce bias in the data. Conclusions: This study has demonstrated the ability to utilize an existing portable and standardized infrastructure and ETL process from a university hospital setting and transfer it to non-university sites. From a medical perspective further activity is needed to evaluate data quality of the utilized real-world data documented in routine care and to investigate its eligibility of this data for research. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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14 pages, 2212 KiB

Open AccessArticle

Comparing Digital Therapeutic Intervention with an Intensive Obesity Management Program: Randomized Controlled Trial

by Katarína Moravcová, Martina Karbanová, Maxi Pia Bretschneider, Markéta Sovová, Jaromír Ožana and Eliška Sovová

Nutrients 2022, 14(10), 2005; https://doi.org/10.3390/nu14102005 - 10 May 2022

Cited by 21 | Viewed by 5039

Abstract

In this study, we evaluated whether the digital program Vitadio achieves comparable results to those of an intensive in-person lifestyle intervention in obesity management. This is a 12-month prospective, randomized controlled trial. Obese patients with insulin resistance, prediabetes or type 2 diabetes were included. The intervention group (IG) used Vitadio. The control group (CG) received a series of in-person consultations. Body weight and various metabolic parameters were observed and analyzed with ANOVA. The trial is ongoing and the presented findings are preliminary. Among 100 participants (29% men; mean age, 43 years; mean BMI, 40.1 kg/m²), 78 completed 3-month follow-up, and 51 have completed the 6-month follow-up so far. Participants significantly (p < 0.01) reduced body weight at 3 months (IG: −5.9 ± 5.0%; CG: −4.2 ± 5.0%) and 6 months (IG: −6.6±6.1%; CG: −7.1 ± 7.1%), and the difference between groups was not significant. The IG achieved favorable change in body composition; significant improvement in TAG (−0.6 ± 0.9 mmol/l, p < 0.01), HDL (0.1 ± 0.1%, p < 0.05), HbA1c (−0.2 ± 0.5%, p < 0.05) and FG (−0.5 ± 1.5 mmol/l, p < 0.05); and a superior (p = 0.02) HOMA-IR reduction (−2.5 ± 5.2, p < 0.01). The digital intervention achieved comparable results to those of the intensive obesity management program. The results suggest that Vitadio is an effective tool for supporting patients in obesity management and diabetes prevention. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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17 pages, 24893 KiB

Open AccessArticle

Impact of a Digital Lifestyle Intervention on Diabetes Self-Management: A Pilot Study

by Maxi Pia Bretschneider, Jan Klásek, Martina Karbanová, Patrick Timpel, Sandra Herrmann and Peter E. H. Schwarz

Nutrients 2022, 14(9), 1810; https://doi.org/10.3390/nu14091810 - 26 Apr 2022

Cited by 19 | Viewed by 6541

Abstract

The aim of this study was to provide preliminary evidence on the impact of the digital health application Vitadio on improving glycemic control in patients with type 2 diabetes mellitus. This was a 3-month, prospective, multicenter, open-label trial with an intraindividual control group. Participants received a digital lifestyle intervention. HbA1c levels were observed at 3 time points: retrospectively, at 3 months before app use; at baseline, at the start of usage; and 3 months after the start of use. In addition, changes in other metabolic parameters (fasting glucose, body weight, and waist circumference), patient reported outcomes (quality of life, self-efficacy, and depression), and data generated within the app (frequency of use, steps, and photos of meals) were evaluated. Repeated measures analysis of variance with the Bonferroni correction was used to assess the overall difference in HbA1c values between the intervention and the intraindividual control group, with p < 0.05 considered significant. Participants (n = 42) were 57 ± 7.4 years old, 55% male, and with a mean baseline HbA1c of 7.9 ± 1.0%. An average HbA1c reduction of −0.9 ± 1.1% (p < 0.001) was achieved. The digital health application was effective in significantly reducing body weight (−4.3 ± 4.5 kg), body mass index (−1.4 ± 1.5 kg/m²), waist circumference (−5.7 ± 15 cm), and fasting glucose (−0.6 ± 1.3 mmol/L). The digital therapy achieved a clinically meaningful and significant HbA1c reduction as well as a positive effect on metabolic parameters. These results provide preliminary evidence that Vitadio may be effective in supporting patient diabetes management by motivating patients to adopt healthier lifestyles and improving their self-management. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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29 pages, 1230 KiB

Open AccessArticle

Long-Term Effects of a Video-Based Smartphone App (“VIDEA Bewegt”) to Increase the Physical Activity of German Adults: A Single-Armed Observational Follow-Up Study

by Gesine Reinhardt, Patrick Timpel, Peter E. H. Schwarz and Lorenz Harst

Nutrients 2021, 13(12), 4215; https://doi.org/10.3390/nu13124215 - 24 Nov 2021

Cited by 5 | Viewed by 2091

Abstract

As physical inactivity is one of the four leading risk factors for mortality, it should be intensively treated. Therefore, this one-year follow-up study aimed to evaluate the long-term effects of a preventive app to increase physical activity in German adults under real-life circumstances. Data collection took place from July 2019 to July 2021 and included six online questionnaires. Physical activity was studied as the primary outcome based on MET-minutes per week (metabolic equivalent). Secondary outcomes included health-related quality of life based on a mental (MCS) and physical health component summary score (PCS). At the time of publication, 46/65 participants completed the study (median 52 years, 81.5% women). A significant increase of physical activity was observed in people with a low/moderate baseline activity during the first four months of follow-up (median increase by 490 MET-minutes per week, p < 0.001, r = 0.649). Both MCS (median increase by 2.8, p = 0.006, r = 0.344) and PCS (median increase by 2.6, p < 0.001, r = 0.521) significantly increased during the first two months and the BMI significantly decreased during the first six months after the intervention (median decrease by 0.96 kg/m², p < 0.001, r = 0.465). Thus, this study provides evidence for the medium-term impact of the app, since the effects decreased over time. However, due to the chosen study design and a sizeable loss to follow-up, the validity of these findings is limited. Full article

(This article belongs to the Special Issue Digitalization Supporting Management of Type 2 Diabetes and Other Chronic Diseases)

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