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BMJ Diabetes Day

27 Jun, 13 | by Dr Dean Jenkins

Yesterday at BMA House, the team from BMJ Informatica hosted a day dedicated to diabetes. It asked the question “How can we prevent diabetes from bankrupting the NHS?“.

The audience consisted of doctors and pharmacists  involved with the commissioning of diabetes care. There was a lively discussion on the challenges that diabetes, and obesity, present to the health service. The debate was informed by the a research update on screening and risk scores from Dr David Webb at the University of Leicester, the use of routine clinical data and risk scores from Dr Pete Green from Medway CCG, and an international perspective from Professor Henk Bilo of the Netherlands. There was also a presentation from Professor Kilm McPherson looking at updated models of future obesity rates, John Stewart describing the NHS Outcomes Frameworks, and Professor Stephen Bloom looking at the future therapeutic trends in the management of obesity.

The meeting was chaired by Professor Sir Charles George and myself. Although we didn’t come to any simple answer, plenty of interesting ideas shared. Prioritising patient reviews, using data to focus resources, virtual clinics, the efficient division of labour between primary and secondary care, strategies for local negotiation and methods for overcoming various forms of stakeholder resistance were all explored.

What I found the most fascinating was the data analysis that Paul Barbour from BMJ Informatica had prepared. Each delegate had an estimated prevalence and cost summary for their CCG derived from various data sources. There was also a screen with a Google Map of the UK overlaid with every GP practice so that the number of QOF-registered people with Type 2 Diabetes could be compared with the risk-score estimate of prevalence. The data made for a great focus of discussion when displayed on a large screen.

Map of GP practice data on people with diagnosed and undiagnosed Type 2 Diabetes.

BMJ Informatica map of GP practice data on people with diagnosed and undiagnosed Type 2 Diabetes.

 

Computer-based Type 2 Diabetes self-management

4 Apr, 13 | by Dr Dean Jenkins

A Cochrane systematic review of computer-based technology to support the self-management of people with Type 2 Diabetes has been published and it raises more questions than it answers. The authors concluded:

Two_Cell_Phones“Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control and the effect was larger in the mobile phone subgroup. There is no evidence to show benefits in other biological outcomes or any cognitive, behavioural or emotional outcomes.” [1]

Whilst there is a great potential for computer-based technologies to support people with diabetes – especially, perhaps, where there is connectivity through wireless internet connections – the authors point out that there remains uncertainty about which active components of these types of interventions actually work.

These computer-based interventions are complex and despite the enthusiasm of a number of mHealth, telemedicine, and telehealth supporters it is clear that technology in itself is not necessarily an effective tool. Aspects of the design around the use of theoretical models of behaviour change need to be explored.

I don’t see this review as negative as the summary reads. A small (albeit expensive) effect on blood glucose is to be welcomed. This is review that points out that the initial enthusiasm for mobile technologies show some promise but more rigorous research needs to be undertaken to see which aspects work. Designers of computer-based applications to support people with diabetes should work more closely across disciplines including human-computer-interface design and theoretical models of behaviour change.

 

1. Pal K, Eastwood SV, Michie S, Farmer AJ, Barnard ML, Peacock R, Wood B, Inniss JD, Murray E. Computer-based diabetes self-management interventions for adults with type 2 diabetes mellitus. In: Cochrane Database of Systematic Reviews. John Wiley & Sons, Ltd; 1996 Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD008776.pub2/abstract

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