JMIR Diabetes

Group-based diabetes care, both technology-enabled and in-person, can improve diabetes outcomes in low-income minority women, but the mechanism remains unclear.

Federally Qualified Health Centers (FQHCs) provide service to medically underserved areas and communities, providing care to over 32 million patients annually. The burden of diabetes is increasing, but often, the vulnerable communities served by FQHCs lag in the management of the disease due to limited resources and related social determinants of health. With the increasing adoption of technologies in health care delivery, digital tools for continuous glucose monitoring (CGM) are being used to improve disease management and increase patient engagement. In this viewpoint, we share insights on the implementation of a CGM program at an FQHC, the Community-University Health Care Center (CUHCC) in Minneapolis, Minnesota. Our intent is to improve diabetes management through better monitoring of glucose and to ensure that the CGM program enables our organization’s overarching digital strategy. Given the resource limitations of our population, we provided Libre Pro devices to uninsured patients through grants to improve health care equity. We used an interdisciplinary approach involving pharmacists, nurses, and clinicians and used hemoglobin A1c (HbA1c) levels as a measure of diabetes management. We assessed the CGM program and noted key aspects to guide future implementation and scalability. We recruited 148 participants with a mean age of 54 years; 39.8% (59/148) self-identified their race as non-White, 9.5% (14/148) self-identified their ethnicity as Hispanic or Latino, and one-third (53/148, 35.8%) were uninsured. Participants had diverse language preferences, with Spanish (54/148, 36.5%), English (52/148, 35.1%), Somali (21/148, 14.2%), and other languages (21/148, 14.2%). Their clinical characteristics included an average BMI of 29.91 kg/m2 and a mean baseline HbA1c level of 9.73%. Results indicate that the CGM program reduced HbA1c levels significantly from baseline to first follow-up (P<.001) and second follow-up (P<.001), but no significant difference between the first and second follow-up (P=.94). We share key lessons learned on cultural and language barriers, the digital divide, technical issues, and interoperability needs. These key lessons are generalizable for improving implementation at FQHCs and refining digital strategies for future scalability.

Beyond physical health, managing type 1 diabetes (T1D) also encompasses a psychological component, including diabetes distress, that is, the worries, fears, and frustrations associated with meeting self-care demands over the lifetime. While digital health solutions have been increasingly used to address emotional health in diabetes, these technologies may not uniformly meet the unique concerns and technological savvy across all age groups.

Food choices play a significant role in achieving glycemic goals and optimizing overall health for people with type 2 diabetes (T2D). Continuous glucose monitoring (CGM) can provide a comprehensive look at the impact of foods and other behaviors on glucose in real time and over the course of time. The impact of using a nutrition-focused approach (NFA) when initiating CGM in people with T2D is unknown.

Type 2 Diabetes affects nearly 34.2 million adults and is the seventh leading cause of death in the United States. Online health communities have emerged as avenues to provide social support to individuals engaging in diabetes self-management (DSM). The analysis of online peer interactions and social connections can improve our understanding of the factors underlying behavior change, which can inform the development of personalized DSM interventions.

The prevalence of type 2 diabetes in adults worldwide is increasing. Low levels of physical activity and sedentary behaviour are major risk factors of developing the disease. Physical activity interventions incorporating activity trackers can reduce blood glucose levels in adults diagnosed with type 2 diabetes. The My Diabetes My Way website is a support and educational platform for people diagnosed with diabetes and health care professionals. Users of the My Diabetes My Way website can upload their Fitbit activity data onto the system but this is not presently being analysed and used routinely within clinical care. Developers of the My Diabetes My Way system are planning to allow different makes of activity trackers to be integrated with the platform.

Technologies evolve at a breakneck pace, and the success of mobile health (mHealth) for people with type 2 diabetes mellitus (T2DM) depends on whether health care professionals, care management, government regulators, and consumers will adopt the technology as a viable solution to enhance patient self-management.

Gestational diabetes mellitus (GDM) is an increasingly common high-risk pregnancy condition requiring intensive daily self-management, placing the burden of care directly on the patient. Understanding personal and cultural differences among patients is critical for delivering optimal support for GDM self-management, particularly in high-risk populations. Although mobile apps for GDM self-management are being used, limited research has been done on the personalized and culturally tailored features of these apps and their impact on patient self-management.

Diabetes is a significant health concern in sub-Saharan Africa, emphasising the importance of assessing the health literacy and eHealth skills of hospitalised diabetic patients. This study evaluated the health literacy and eHealth literacy of diabetic patients at Donka Hospital in Guinea and Sanou Sourou Hospital in Burkina Faso, providing insights for targeted interventions and mHealth solutions to improve self-management and treatment outcomes.

Wearable devices can simultaneously collect data on multiple items in real time and are used for disease detection, prediction, diagnosis, and treatment decision-making. Several factors, such as diet and exercise, influence blood glucose levels; however, the relationship between blood glucose and these factors has yet to be evaluated in real practice.

One in eleven people receive primary care from a federally qualified health center (FQHC) in the U.S. Text-messaging interventions (TMI) are accessible ways to deliver health information, engage patients, and improve health outcomes in the health center setting.

The management of type 2 diabetes mellitus (T2DM) includes mastery of complex care activities, self-management skills, and routine health care encounters to optimize glucose control and achieve good health. Given the lifelong course of T2DM, patients are faced with navigating complex medical and disease-specific information. This health-seeking behavior is a driver of health disparities and is associated with hospitalization and readmission. Given that health-seeking behavior is a potentially intervenable social determinant of health, a better understanding of how people navigate these complex systems is warranted.