Objective: To systematically review the effect of self-management education on diabetic control in type 2 diabetes Research design and methods: PubMed was searched for English-language articles published between 2010 and 2013. All the studies were original articles selected manually and used randomized control trials generating results of self-management education in people with type 2 diabetes referring to diabetic control. Relevant data were divided and tabulated into factors of population characteristics, interventions and outcomes. Interventions were classified into three sections as collaborative information intervention, lifestyle intervention, and skills teaching intervention based on the patterns of education. Outcomes were categorized into glycemic control, cardiovascular disease (CVD) risk factors and nephropathy risk factors. Results: A total of 24 studies were identified of initial 41 articles for this review. Effects of self-management education on glycemic control were demonstrated to be positive both in short-term (<10 months) and long-term (>10 months) follow-up, but more positive effects in short-term follow-up. The same effectiveness happens to CVD risk factors, including lipids, weight and blood pressure. On the other hand, with short-term follow-up, teaching skills intervention of self-management education is more effective than collaborative information intervention and lifestyle intervention on reducing glycemic control and CVD risk factors. Also with long-term follow-up, teaching skills intervention of self-management education had more effectiveness than collaborative information intervention and lifestyle intervention on reducing glycemic control. However, few studies including CVD risk factors in the long-term follow-up, so it is difficult to evaluate the effectiveness of on CVD risk factors with long-term follow-up. Conclusions: Evidences supports the positive effectiveness of self-management education with collaborative information intervention, lifestyle intervention and skills teaching intervention among type 2 diabetes patients on diabetic control, in both short-term follow-up and long-term follow-up, but short-term follow-up is more effective than long-term follow-up. Further research is needed to develop self-management interventions to maintain long-term follow-up effects on glycemic control, CVD risk factors and other diabetes complications. / published_or_final_version / Public Health / Master / Master of Public Health

Background Due to the aging of the population and the increasing prevalence of overweight and obesity, the global prevalence of diabetes had been steadily rising. The onset of depression among this diabetes population is a public health issue because of the negative impact on diabetes self-care, treatment adherence and increases in healthcare costs. Three previous meta-analyses have showed that diabetes patients are at an increased risk of developing depression when compared to their non-diabetes counterparts. However, none of these meta-analyses have included primary studies that consisted of primarily Chinese subjects or have considered studies published in Chinese. Thus, there is a knowledge gap for a meta-analysis to study the onset of depression among both Chinese and non-Chinese diabetes subjects. Methods Studies will be selected based on the pre-specified inclusion and exclusion criteria. Studies that are ambiguous to this study criterion will not be selected. Studies are retrieved from three electronic databases, PUBMED, Cochrane library and Wanfang databases. Keywords of “diabet*” and “depress*” where “*” indicated a truncated term were used to identify articles related to diabetes and depression. Only longitudinal studies are selected. Chinese and English articles that are published on or before 31 July 2013 are considered. Besides data collection, quality assessment are also performed based on a tool developed with reference to the Strengthening the Reporting of Observational studies in Epidemiology (STROBE) statement. Results 12 longitudinal studies are identified after the quality assessment procedures, with one study being a Chinese study from Taiwan. In this meta-analysis, the pooled unadjusted odds ratio was 1.26 [95% confidence interval: 1.09, 1.45]. The pooled adjusted hazards ratio is 1.26 [95% confidence interval: 1.12, 1.41]. Since both pooled unadjusted odds ratio and pooled adjusted hazards ratio estimates did not include 1, it may imply that the increases in risk of depression onset among diabetes subjects are significant, whether controlled for confounding factors or not. Conclusion This meta-analysis showed a significant increase in the risk of depression onset among Chinese and non-Chinese diabetes subjects, when compared to their non-diabetes counterparts. There are possible public health implications for depression screening needs for the diabetes population in Hong Kong. / published_or_final_version / Public Health / Master / Master of Public Health

Introduction: The market for chronic disease management apps for patients is growing from year to year. However, policy and regulation of app use for medical purposes in Asia Pacific are not developed. Methods: 1) A systematic review of randomized-controlled trials of diabetes management apps for patients are assessed as to determine whether using the app (intervention group) leads to significant reductions in HbA1c levels ; 2) A comparison of paid and free apps based on number of group functions between Apple iTunes App Store and Google Play for Android. Results: 1) A reduction in HbA1c in both the intervention (m-Health) and control (usual care) group, although two studies identified the changes as statistically insignificant; 2) Apple iTunes App store included 95 free diabetes management apps for patients and 86 paid apps at an average cost of $19.91. Google Play offered 80 free apps and 31 paid apps at an average cost of $4.31. The largest HbA1c reductions could be found when clinical, social, behavioural, and affective factors are taken into account in the app’s supporting system (e.g. WellDoc™ System (WDS). Discussion: There is some evidence to suggest that mobile apps for diabetes management for patients show reductions in HbA1c similar to usual care. In Hong Kong, some progress has been made regarding the promotion of the use of m-Health for the elderly and disabled, but policies on app development, approval, and regulation are absent. Future expansion of ICT may consider m-Health for chronic disease management based on international lessons on medical device and medical apps guidelines. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Type 2 diabetes mellitus is one of the most prevalent chronic diseases worldwide, currently affecting about 3 million global populations. The incidence of Type 2 diabetes has been increasing particularly in recently developed Asian settings including Hong Kong. Dairy product, as a part of dietary guidelines, has been hypothesized to help reduce risks of Type 2 diabetes. However different types of dairy product might have different effects on Type 2 diabetes given their varying content in fat, sugar and vitamins. Objective: To review literature on the examination of the association between consumption of different types of dairy products (total dairy, high-fat dairy, low-fat dairy and fermented dairy) and the risk of type 2 diabetes Methods Relevant studies were searched and identified through database of PubMed and Google Scholar using combination of keywords. Studies examining the association between consumption of total dairy and subtypes of dairy products and the risk of type 2 diabetes were included. Results: Of the 163 papers identified, 10 studies were finally included in this systematic review. All studies were prospective cohort study from Western countries. Findings for different kinds of dairy products varied. For high-fat dairy products consumption, nine out of the ten studies found there was no association with type 2 diabetes risks. For low-fat dairy products, six out of ten studies found an inverse association after adjusted for confounders like age, sex and total energy intake; among these six studies, three still reported an inverse association after further adjusted for confounders like education level, smoking status and alcohol intake, physical activities and family history of type 2 diabetes. For fermented dairy products (mainly yoghurt), among seven studies which examined this, three studies found an inverse association between yogurt consumption and Type 2 diabetes risk before and after adjusted for multivariate confounders (age ,sex, total energy drink, education level, social class, physical activities, smoking status, alcohol intake and family history of type 2 diabetes, etc) . One of the three studies also found that, other than yogurt, there was an inverse association between low-fat fermented dairy and total fermented dairy consumption and type 2 diabetes risks after adjusted for age and sex. However, after further adjustment, the association became null for total fermented dairy products while it remained for low-fat fermented dairy products. All of the 10 studies that examined subtypes of dairy product also reported total dairy product consumption. For total dairy product, six out of ten studies found an inverse association. Conclusion: Overall, total dairy consumption might be associated with lower risks of type 2 diabetes, but the associations may be varied by subtypes of dairy products. Across different types of dairy products, low-fat dairy consumption was associated with lower risk of type 2 diabetes while high-fat dairy consumption was clearly not associated with type 2 diabetes risk. Results for subtypes of fermented dairy consumption remain unclear. Further prospective cohort study in other non-Western populations may provide are required. / published_or_final_version / Public Health / Master / Master of Public Health

Background: Lifestyle intervention is recommended as one important approach for Diabetes Mellitus management. Type 2 Diabetes Mellitus could be controlled and maintained by lifestyle intervention with no or less medications. It can delay the onset of diabetes related complications. Meal Replacement is one important lifestyle intervention. It modifies the composition and amount of nutrition intake, through daily meal, in order to control body weight and other metabolic indices. Effectiveness of meal replacement was examined by randomized controlled trials. Reviewing these studies systematically would demonstrate the clinical implication and other benefit of meal replacement, further more to guide the implementation in practice. Method: Search the online literature databases for related Randomized Controlled Trials. Analyze and compare different strategies of these interventions, as well as the outcomes. The effect of MR would be categorized into on body weight, on blood glucose, on serum lipid and on hypoglycemic medication and prognosis. The economic benefit would also be one important objective. Result: MR intervention achieved body weight reduction, and considerable controlling effect on glucose and lipid. Majority of studies also reduced the hypoglycemic medication and improved prognosis. Conclusion: MR is one considerable intervention for T2DM and Intermediate Hyperglycemia patients. It could be integrated into structured lifestyle intervention for prevention and treatment. It also brings economic benefit so that reduce health care burden. Further research is needed for better effectiveness in practice. / published_or_final_version / Public Health / Master / Master of Public Health

Bakgrund: Ny teknik förändrar förutsättningar för hur information sprids och används i samhället. Den enskilde individen kan i stor utsträckning samla data om sig själv och sin omgivning. I vården kan denna förändring medföra en förskjutning av roller där patienten intar en roll som söker partnerskap och delaktighet snarare än undervisning och riktade beslut. Parallellt med en snabb teknisk utveckling har idag även livsstils relaterade sjukdomar växt fram, däribland diabetes.  Sjukdomen kräver en hög grad av egenvård och information. Stöd för patienten erbjuds idag via ett flertal mobila applikationer, specifikt riktade till patienter med Diabetes. Syfte: Syftet med studien var att beskriva likheter och skillnader mellan mobila egenvårdsstöd för patienter med diabetes. Fokus riktades även mot förändring av HBA1c (metabol balans) knutet till användandet av mobila egenvårdstöd. Metod: Litteraturstudie, där åtta vetenskapliga artiklar med kvantitativ ansats granskades. Databaserna CINAHL, PubMed och PsychInfo användes. Resultat: Analysen resulterade i två kategorier och två sub-kategorier. Den första kategorin var Likheter och skillnader mellan applikationer och den andra var HbA1c. Konklusion: Forskning pekar på positiva trender gällande metabol balans vid användning av mobila applikationer vid diabetes. Dock saknar dessa applikationer ofta viktiga komponenter. Mer studier krävs inom området då forskningen inom fältet är begränsad.

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The appropriate intensity of exercise needed to reduce the risk of hypoglycemia (≤3.9 mmol/L) in persons with type 1 diabetes (T1D) is not known. Ten participants with T1D performed four exercise sessions on a treadmill lasting 45 minutes: a control condition at 45-55% of heart rate reserve and three high intensity sessions at 70, 80, and 90% of heart rate reserve. A blinded continuous glucose monitor was used to measure time spent ≤3.9 mmol/L and glucose variability in the 12 hours following exercise. There were no significant changes in the percentage of time spent ≤3.9 mmol/L (p=0.58) and glucose variability as measured by mean absolute glucose change (p=0.53) and continuous overall net glycemic action (CONGA1: p=0.95; CONGA2: p=0.90; CONGA4: p=0.72) between the sessions. High intensity exercise at 70, 80, and 90% of HRR does not significantly reduce the amount of time spent ≤3.9 mmol/L or glucose variability compared to the 45-55% session alone. / October 2015

The prevalence of Type 2 diabetes mellitus is increasing worldwide and with it, the demands on heath service resources. As the long-term outcomes of this disease are dependent upon reducing lifestyle risk factors, together with effective treatment and screening strategies, much of the responsibility for diabetes management ultimately resides with the patient. Therefore patient education is a key part of the care of this population. A trial of an empowerment based health education programme was underpinned by the theories associated with health protective behaviour and those associated with adult learning. These align patient education to an experiential learning process within which beliefs about self-efficacy and the effects of social-environmental influences are central to outcomes. This view was compatible with current health care policies which see patients taking a more active and informed role in their disease management. The trial utilised a randomised controlled wait-list design to allow for the ethical limitations of excluding patients from educational treatment, and permitted collection of data over a short- and long-term period. A qualitative approach to data collection, using symbolic interactionism, was also integrated into the clinical trial. The two types of data were treated as complementary so that the outcomes of the trial relied upon detailed exploration of how they complemented each other. Eighty-nine patients were recruited from three diabetes centres. All patients recruited were blindly randomised to a 'Look After Yourself education programme. Clinical, behavioural and psychological outcomes were measured at six and twelve months. The relationship between these, the content of the intervention and participants' perspectives was assessed through ten focus group interviews. The combined results showed that the educational intervention had modified participants' personal models of diabetes by increasing their knowledge and understanding, by clarifying their beliefs and by changing their attitudes toward the disease and its management. It facilitated the acquisition of skills and prompted movement into the behaviour change cycle for the majority of those taking part, regardless of socio-economic status. The impact of these changes upon clinical outcomes was most effective where participants perceived their risk factors to be greatest. These findings supported the production of a framework for guiding nursing intervention to enhance patient self-management of diabetes. To adhere to such a model of care, however, the trial highlighted the need to expand the biomedical orientation to patient education so that it allows for patients' self-perceived needs. This demands integration of the medical and behavioural sciences into the practice of diabetes care and recognition of the need to support patients in their lifelong task of maintaining their own health. It recognises that care for chronic illness is an inherently different social enterprise than is care for acute illness. The findings have therefore highlighted the training needs for health professionals so that they can develop the skills that can enhance this process. Whilst these conclusions acknowledge the importance of continuing education and support for patients, such clinical practice will rely upon tailoring nursing intervention to the outcomes of a diabetes-specific assessment instrument. In this way, educational referral can become an integral part of a patient's treatment profile. Only then might health professionals authenticate a culture that supports patient choice so that they can take greater control over their health.