Summary
The incidence of type 1 diabetes mellitus (T1DM) seems to be increasing globally. In fact, T1DM comprises 5-10% of all diabetes cases worldwide (Tauschmann & Hovorka, 2018). Hemoglobin A1c (HbA1c), glycated hemoglobin, is a long-term predictor of various complications that may develop in diabetic patients with poorly controlled glucose levels. Unfortunately, T1DM is still incurable; hence, supportive therapy and lifestyle adjustments are needed to delay these complications (Tauschmann & Hovorka, 2018). Since diabetic teenagers become independent, their self-care behaviors may not be favorable for them (McGill et al., 2019). Adolescents with type 1 diabetes mellitus are at greater risk for elevated HbA1c because they often want to eat fast food and snacks as their healthy counterparts. However, the consequence may be diabetic ketoacidosis (DKA), which is an acute complication. At the same time, long-term sequelae are high HbA1c and chronic damage to organs and tissues in the future (Cardona-Hernandez et al., 2021). Since not every patient’s family can afford insulin pumps, nurses can control these adolescents by communicating with them through social media and popular messaging apps to emphasize the danger of carbohydrate-rich meals for their health.
Research Question and Identified PICO Criteria
Does continuous glucose monitoring (CGM) and sending dietary reminders through social media and popular messaging apps to teenagers with T1DM reduce DKA incidence and HbA1c levels compared to those who do not receive these messages?
P (Problem): High incidence of DKA and elevated HbA1c in T1DM adolescents.
I (Intervention): Sending messages with dietary recommendations and long-term complications of high HbA1c to diabetic adolescents.
C (Comparator): Not sending messages.
O (Outcome): Lower incidence of DKA and better HbA1c levels.
I chose this research question because I encountered several cases of young patients hospitalized for DKA or developing early-onset diabetic retinopathy and nephropathy because they had poorly controlled glucose. Many of these patients did not have insulin pumps and had unbalanced nutrition. Although it is impossible to give automatic insulin injecting devices to all diabetic patients because of the high cost, insulin pens and CGMs are much cheaper. Moreover, a text-messaging strategy was found to be a practical strategy to help T1DM patients maintain normal blood glucose concentration (McGill et al., 2019). Thus, I would like to explore if communicating with these teenagers through messaging apps can help reduce DKA incidence and regulate their HbA1c levels by correcting their dietary choices.
Overview
I searched the articles in Google Scholar using specific keywords and the publication timeline within the last five years. The keywords I utilized were “DKA,” “adolescent patients,” “type 1 diabetes,” “remote monitoring,” and “sending reminders.” I considered including review papers, cohort studies, and clinical interventions to answer my research question. Papers that focused on the inclusion of pharmaceutical treatment were excluded. I selected manuscripts based on the presence of all codewords and the relevance of articles to my research question.
Article 1
Cardona-Hernandez, R., Schwandt, A., Alkandari, H., Bratke, H., Chobot, A., Coles, N., Corathers, S., Goksen, D., Goss, P., Imane, Z., Nagl, K., O’Riordan, S.M.P., & Jefferies, C. (2021). The glycemic outcome associated with an insulin pump and glucose sensor use in children and adolescents with type 1 diabetes. Data from the international pediatric registry SWEET. Diabetes Care, 44(5), 1176-1184. Web.
This retrospective cohort study strived to determine if insulin pumps and continuous glucose monitoring effectively maintain normal levels of HbA1c in pediatric patients with T1DM. The authors retrieved data from the SWEET registry, and after applying inclusion and exclusion criteria, 25,000 patient records remained for the final evaluation (Cardona-Hernandez et al., 2021). The results showed that 60% of the study participants used at least one device, and 44% of children had an insulin pump (Cardona-Hernandez et al., 2021). It appeared that those who wore both pump and sensor had better HbA1c control compared to those who had only one or no device. Still, children with remote monitors or pumps had better glycemic levels than the control group. This manuscript is applicable to my research because it demonstrates the effectiveness of wearable technology for T1DM patients.
Article 2
McGill, D. E., Volkening, L. K., Butler, D. A., Wasserman, R. M., Anderson, B. J., & Laffel, L. M. (2019). Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA1c benefits in teenagers with Type 1 diabetes. Diabetic Medicine, 36(5), 600-605. Web.
This article presents the results of an interventional study that involved adolescent diabetic patients who received text messages from clinicians about the need to check and report their blood glucose levels. The sample size was 147, and the age of the participants ranged from 13 to 17 (McGill et al., 2019). The results revealed that those who continuously sent their glycemic levels for 18 months had HbA1c below 7.5%, while low-responders did not have a significant improvement in this parameter (McGill et al., 2019). Notably, the authors excluded the possibility of no balance on the participants’ phones because teenagers were given $5 monthly to have an unlimited messaging option (McGill et al., 2019). This paper applies to my research because it shows that constant communication with T1DM adolescent patients can improve their long-term outcomes.
Article 3
Tauschmann, M., & Hovorka, R. (2018). Technology in the management of type 1 diabetes mellitus – Current status and future prospects. Nature Reviews Endocrinology, 14(8), 464-475. Web.
This review article focuses on modern technological devices that were developed for diabetic patients. The authors describe two types of insulin delivery apparatuses, pen and pump and glucose measuring tools, capillary blood glucose and CGMs (Tauschmann & Hovorka, 2018). Furthermore, the manuscript discusses various data-management apps that help clinicians remotely monitor T1DM patients’ glycemic levels (Tauschmann & Hovorka, 2018). Lastly, the paper talks about novel automated insulin-delivery methods tested in randomized clinical trials and approved in the United States (Tauschmann & Hovorka, 2018). This article applies to my research question because it provides an overview of available glucose monitoring and regulation techniques.