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Diabetes and Self-management-Learning to Cope Digitally


07 January 2010

Diabetes and Self-management-Learning to Cope Digitally

After all the reports on the Johnson family tragedy, I started to wonder what kinds of support tools might be available in the future for Type 1's, and I chose to focus on the digital market.  After all, technology has proved to enhance diabetes care over the past twenty years.  There is a caveat however.   I am not looking for 1. new devises for the administration of insulin (pumps, pens) or 2. blood glucose monitors or 3. blood glucose record software programs for ipod or iphone or even my friend, CGMS -- they are all old news for the most part AND, although they are helpful - I am looking for new ways that technology can be utilized for diabetes (emotional) support.

I was immediately struck by what I read to find that most studies focus on adolescence. It makes good business sense. Today it is children and teenagers who are responsible for successful trends in the digital market; they spend a great deal of time on social networking sites or online games, some of their favorite programs are fundamentally (and even globally) educational. My daughter has been competing with children all over the world in maths to see who can come up with the right answer for a problem the most quickly. And that's just the point! Digital education is teaching our children to be better problem solvers (OK, there are other ways of teaching them, but they ENJOY being online). The 8-18 set make up the real digital market these days; they will be the force behind how it evolves over the next fifty years. Who do you think James Cameron made Avatar for anyway?

So, shake the image of the Na'vi out of your mind and refocus back to what I am in search of... What is in development which uses technology to help better self-manage T1 diabetes?

I found a few things out there (let's face it most programs support T2 diabetes and frankly with nearly 7% of the US population struggling with the metabolic disorder - it makes sense); the most impressive is a program called YourWay which is an internet-based self management intervention for adolescents with Type 1 diabetes

The YourWay study ran from July 09 - November 09.  In fact, the findings have just been printed online.

What the study did
A group of 72 adolescents with T1 ages 13-17 were randomized to usual care plus internet support or a usual care group (control group).  The internet support system was designed to enhance problem solving barriers to self-management.  The media program offered the following content:

Interactive multimedia stories depicting (pyschosocial) barriers to self-management, such as peer pressure, time contraints (no time to eat!), and embarrassment - and what approaches for coping and resolving the issues would work best in the opinion of the user.  Other content features included:
Personalized homepage
Social networking/peer forum
Social comparison of their responses to problem solving versus other users
Help from problem-solving experts
Emails encouraging participation and encouragement
Participants HAD NO interactions with clinicians or parents through the YourWay website.

Smart, very smart.

What they found
The adolescents in the internet support treatment group showed significant improvement in self-management.  Although A1Cs remained unchanged for the treatment group (they stayed the same) - the treatment as usual groups' A1Cs actually rose.  Over 60% of the participants gave YourWay an A rating - the rest a B.  A larger more randomized trial is necessary to establish efficacy.

What I think
I like it.  I don't know if YourWay will be the big winner (I have since come to learn that this is a Pfizer program that they are currently using as a new treatment and support plan for patients with an overactive bladder - which sucks the coolness out of the whole business for the teen market) but it may certainly be one of many early prototype designs.  I believe that this is one aspect of the future with diabetes, and I fully support it.  I like it because it utilizes self-determination for change, and requires no additional clinical effort.

Although different in certain design components and methodology,  Juvenation, a social network created by the Juvenile Diabetes Research Foundation (JDRF), is especially for people with Type 1 diabetes, and has already taken the lead in developing this type of social networking site.  It will be interesting to see how successful this program is and what other similar types of networks follow.


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