Use of Computer-Based Diabetes Management System - Research Proposal Example

IMPROTANT NOTE 1. References: Your references should have been published during the last 5 years. Formatting: Times New Roman, Size 12 (Use this template) 2. Word limits: 3000-5000 words 3. Use this template file: Your report should include each of the items and sub-items below. Use this template file and fill in each paragraph and sub paragraph. 4. Failing to use this template will result in a 50% reduction in the mark. Table of Content 1Summary 1 2Introduction 2 3Literature Review 4 3.1Research Questions and perspectives 4 3.2Advantages 6 3.3Challenges and limitations 8 4New Research Perspective 10 4.1Perspective 10 4.2Applications and Scenarios 11 4.3Research disciplines needed for your proposed research project 11 5Conclusion 12 6References 14 1 Summary This paper reviewed the use of computer-based diabetes management system to establish its benefits and limitations in current applications and provide research options for improvement. The review established that computer-based diabetes management system has many benefits to the patient the healthcare system in general. For example, it was established that the system is useful in the management of diabetes in the absence of a doctor as it provides most of the information a doctor would. The system also helps the patient monitor glucose levels, leading to improved self-management. It is also cost effective in areas where access to the internet is affordable and electronic devices are cheap. However, it was found that it had limitations among older people who may not be technology savvy or can no longer use computer-based devices adequately due to old age. The system also lacks emotional and psychological support, which is a critical component of diabetes management. A suggestion was made to develop a device that allows peer-to-peer support through the system to fill the emotional and psychological gap that exists in the current system. 2 Introduction Chronic diseases, such as diabetes, cardiovascular diseases, HIV infection, lung cancer, and chronic obstructive pulmonary disease, kill millions of people every year. In fact, these diseases account for 40% of deaths in developed countries, and increasingly becoming an important factor of mortality in developing countries[Fre13]. There are various management interventions that can help people with these diseases live better and longer lives. Healthcare providers have a responsibility to help healthcare consumers manage certain aspects if their conditions. Studies have shown that the involvement of consumers in self-management of their health conditions such as adjusting medication dosage due to demand and monitoring disease progress can improve health outcomes [Fre13]. Therefore, healthcare providers have an important role to play in encouraging consumers to self-manage their chronic conditions. However, the number of primary health care givers in most countries is stretched and thus, they cannot adequately provide information, support, and encouragement directly through face-face consultations. In the last few decades, the development of mobile technologies in the management of chronic diseases has been on the rise. Mobile health interventions for people with chronic diseases are technologies designed to improve disease management through processes such as improving management of diabetes. Computer-based technologies can come in the form of personal digital assistants, mobile phones, enterprise digital assistants, handheld video-game consoles, portable media players, handheld ultra-portable computers, and most recently, smartphones[Fre13]. These devices can support a range of functions, including but not limited to, mobile cellular communication, software application support, and multi-media playback. The popularity of mobile technologies means that these devices can be used to deliver healthcare interventions remotely to a larger number of people than would be possible with face-to-face interactions. The mobility and popularity of computer technologies enable temporal synchronisation of health interventions and provide critical information at the most critical time[Fre13]. For example, using an online programme called “Diabeto”, delivered via the French national videotext network Minitel, healthcare providers are able to provide patients with electronic mail, decision support, and competent information. This ensures that all clients are able to receive critical information right from their homes and be able to interact individually with the programme [Yar10]. Someone with an acute asthma attack can easily get information on how to use inhalers when a health provider is not within reach [Fre13]. Considering the economies of scale, mobile technologies also medical interventions to be delivered at low cost. The interactivity of these technologies also allows users to acquire extra information whenever they need it and monitoring and motivational messages that would be issued via face-to-face interaction can be personalised depending on the needs of the patient. Patient and community awareness on diabetes can be increased through cost-effective online-based educational programs. Computer-based diabetes management system can help in the secure management, storage, and processing of diabetes-related, thus reducing the need to interact physically with physicians. 3 Literature Review 3.1 Research Questions and perspectives Despite the potential of computer-based diabetes management system to assist diabetic patients, questions have been raised over their impact in health outcomes. In a research conducted by [Pal14], computer-based diabetes self-management interventions used in the management of type-2 diabetes appeared to have dismal significance on the control of blood glucose, though significantly higher in those who used mobile phone-based interventions. However, the study showed that the interventions did not have a significant impact on behavioural, emotional, biological, or cognitive outcomes. Studies that have researched on the impact of the interventions on knowledge and comprehension have shown positive results, noting changes in self-efficacy[Lor10]. However, the effect on physical activities have produced mixed results but there has been no evidence showing that these interventions have a positive impact on the emotional wellbeing of the user[Pal14]. For example, diabetic patients also commonly suffer from depression as a result of decreased metabolic control. However, current studies have not produced any evidence to show that mobile interventions reduce depression. Moreover, generating such data may be difficult because people who are subjects in a study receive increased attention from the research team, which may be a contributing factor in their reduced depression levels[Cos09]. Thus, the current interventions do not appear to have a significant impact improving depression, weight, or quality of life of diabetic patients. Thus, while these mobile-based interventions might be effective in improving self-management practice among patients, existing evidence suggests that they do not offer a holistic support. Mobile-based interventions, however, have the ability to offer timely interactions with users, in which case, they can act as effective reminders for time to take medication or other action that needs to be taken. Studies have shown that these interventions have an impact on increased physical activity and proper diet. Via feedback and self-monitoring programs, a patient can be cautioned on his or her behaviour and strategies provided for acting on that information. Prompting behaviour and issuing feedback seems critical in initiating behaviour change. However, maximising their potential in improving patient outcomes require assistive interventions intended to change behaviour[Pal14]. Mobile-based interventions have also been faulted for their technicality as most of them require familiarity with IT. Some intervention programs may require patients to learn how to interact in online chat rooms, send emails, and navigate the internet. Studies show that natural ageing disease progression, and multiple co-morbidities may reduce the cognitive ability of the patient, rendering them incapable of using computer-based interventions. As type-2 diabetes is common in adults over the age of 60 years, computer-based interventions have proven a challenge. Studies have shown that older adults develop anxiety on the use of technology and lower confidence in using computers, leading to minimal use of computers[Cos09]. Another question has been on the competency of primary health providers to use technology. Primary healthcare providers who trained before the current technological age may be reluctant to apply mobile technologies in the delivery of healthcare services. This computer anxiety may impact negatively on the use of online interactions on the part of healthcare providers[Cos09]. 3.2 Advantages Computer-based technologies are indeed an innovative way to care for and manage diabetic conditions. These technologies enable diabetic patients to self-control their medical data using online-based applications or their mobile devices. Mobil Diab system, for example, help healthcare providers access patient data via a secure web portal. The disease module in rooted in this platform, which has a user hierarchical model that enables hospital, administration, patient, and doctor interactivity. This concept empowers diabetic patients to self-manage their condition by enabling them to personally monitor their blood sugar levels over a long time period and even make certain actionable conclusions. This is one system that highlights the benefits of computer-based diabetes management system[Tak14]. One of the main benefits of these technologies is unimpeded patient mobility[Tak14]. These technologies allow people at risk of or those already suffering from diabetes gain valuable knowledge to modify their behaviour even when they are not in close proximity with a primary healthcare provider and successfully manage their conditions to improve health outcomes. Computer-based diabetes management system allows for self-monitoring of blood sugar, healthy eating, complications risk reduction behaviour, and medication adherence among others, depending on the design of the programme. the patient has a direct control over the management of the disease and the patient makes key daily decisions on the control of the disease[Sha15]. Computer-based diabetes management system also enables the right care to be provided at the right time[Tak14]. Structured online educational materials, in addition to web portals and blogs, are continually being used to supplement traditional diabetes education through mobile-based interactions. These online platforms can be individualised for self-management and they are easy to learn and use anywhere at any time, cost-effective, and convenient in providing reliable information on diabetes and its complications[Sha15]. Technology also makes it easy for various stakeholders to come together in the management of diabetes. For example, government agencies, professional diabetes organisations, non-profit organisations, and pharmaceutical industries provide online information on diabetes education that can be incorporated into these systems easily. Involvement of the patient in the therapy process also encourages the patient and leads to improved behaviour and healthier lifestyles[Tak14]. Studies have shown that tracking apps lead to greater weight loss than conventional physical activities. These systems are able to communicate with the use and even remind them when it is time to exercise. They can also detect when the user has been sedentary longer than the recommended period and remind them to become active. Computer-based systems are able to record intensity, time, type, and frequency of activity. They can also guide the user on exercise routine by providing demonstrations and feedback. The user can also input their daily diet and the computer can help generate a healthy daily diet[Sha15]. Devices worn on the body can also count calories and inform the user of the progress and the impact of the physical activity on health. 3.3 Challenges and limitations The use of computer-based diabetes management systems is only effective when the user understands the process of using appropriate technologies for monitoring of glucose levels and medication compliance. The patient must also understand complex treatment strategies[Sha15]. This limits the usability of these technologies among individuals who are not competent with the use of computer technology. For such interventions to be useful in such scenarios, individuals must first be trained, which may affect the efficacy of the technology. Another potential barrier to the use of computer-based technologies is cost. Most of these interventions are delivered via smartphones that also require the use of internet data plans. Most healthcare providers only cover the cost of content and materials delivered to the device, leading the cost of the device and other recurring charges to the consumer. Hence, while diabetes might be a major challenge all over the world, the application of these interventions has remained limited due to the high cost of associated devices such as smartphones. In addition, internet accessibility is still a problem in rural areas even in developed countries such as the United States[Smi13]. There is much enthusiasm about new digital technologies in diabetes management, however, evidence on their safety and efficacy is still limited[Pal14]. The information provided on nutrition and exercise have also not been evaluated to determine reliability and accuracy ad may thus, mislead the user [Ram13]. For those that have been tested, the trials have only been short term; hence, the long-term effects of the materials remain unknown. In addition, due to the language and technicality of these applications, they may not be applicable in certain populations. For example, the elderly, who are the most affected by type-2 diabetes may not use these interventions appropriately. Other populations that may be left out include people with lower socio-economical status, the physically challenged, and non-English speakers, as most interventions are delivered using English[Sha15]. The use of computer-based technologies also presents the challenge of data security. Certain devices required to monitor the condition of the patient, such as blood glucose meter, use wireless connectivity and as such, can be attacked by hackers. Moreover, they may also face interferences from electromagnetic devices. Such challenges pose a significant risk to the user[Sha15]. Digital technologies also can result in severe side effects if not used properly. For example, diabetic people can use insulin dose calculator software to calculate bolus insulin doses. However, in the case of malfunction, it can provide higher insulin doses, which can cause severe hypoglycemia. Given that digital technologies are increasingly becoming popular, the potential harms of these technologies could have clinical significance[Sha15]. 4 New Research Perspective 4.1 Perspective The biggest challenge that digital diabetes management technologies face is the lack of promotion of the patient’s psychological wellbeing. Traditionally, a diabetic patient can go to a doctor and discuss his or her problems with the physician and in the process, the psychological burdens of the disease will be lifted. Hence, if technology could fill this psychological gap, it would go a long way in the management of diabetes. However, this challenge could be addressed by a peer-to-peer connection for individuals with diabetes. Through such a medium, patients can connect with each other and offer support through the technology and become each other’s coach. Combined with the technical interaction of computer-based diabetes management tools, this level of human interaction can significantly improve the psychological and emotional wellbeing of diabetic patients. Studies have shown that while insulin remains the strongest medication tool for diabetic people, the emotional and mental health is nourished by connecting to people experiencing the same condition, making the debilitating burden of the disease much lighter[deV14]. Many diabetic patients suffer from depression because of the burden of the disease on daily life [Cos09]. However, with support from people with the same condition, research shows that managing the disease becomes rather easier[deV14]. 4.2 Applications and Scenarios The peer-to-peer support platform will be used mainly by patients but doctors will also have access to the information so that there can be control of useful information. It must be understood that, the peer connection is only meant to offer emotional and psychological support and not medical advice. Therefore, the role of the doctor would be a supervisory on to monitor the platform occasionally to ensure that peers are not sharing medical information that could jeopardise the health of the patient. Treatment regiments are different for all patients, hence, the need to protect patients from sharing medical information. The platform will apply the use of interactive voice response (IVR) to ensure efficient and reliable communication. The system will also have reminders for those who contact each other frequently so that they can stay in touch constantly. The system will also allow peer conferencing so that group communications are also possible for both chat options and voice calls. Peers will be able to know the routine of their peers as indicated in the system if the user has shared that information. This way, peers can also act as reminders when they notice that the other person has not taken insulin, adhered to other medications, or exercise routine. 4.3 Research disciplines needed for your proposed research project A research on the use computer-based diabetes management system to offer emotional and phycological support to patients requires various stakeholders. the main collaborators, however, will be patients. As this programme will be designed for patients, they will be used in identifying their needs explicitly. Diabetic patients who are currently using Computer-based diabetes management system will be the main focus of the research as they already know the gaps that arise from using the technology. Consumers such as doctors, medical centres and hospitals are also critical for the success of the research as they hold a key role in the delivery of health services. Healthcare providers will be critical in assisting with information on information delivery as the system will link non-healthcare providers with healthcare providers all under one platform. Other collaborators will include government agencies, such as policy developers and regulatory authorities, who are critical in the approval process and institutions and organisations that deal with diabetes management. 5 Conclusion Diabetes is a major health problem, both for developing and developed countries. Currently, treatment of diabetes involves the use of insulin, which patients can easily inject themselves with. Thus, self-management among people with diabetes is a common phenomenon. Technologies such as computer-based diabetes management system have stepped in in recent years to assist patients with managing their conditions. These systems can help patients monitor their glucose levels and direct them when to inject insulin. Patients can also interact remotely with their physicians and get valuable information without face-to-face interaction. These systems also provide additional disease management assistance such as exercise, measuring calories and so on. However, these systems still face a fundamental challenge in the management of chronic diseases because they do not fulfil an emotional and psychological need as do healthcare providers. Depression is a condition that is normally co-morbid with diabetes and studies have shown that computer-based diabetes management systems have no clinical significance in the reduction of diabetic-associated stress. This gap can, however, be met by incorporating peer-to-peer support in computer-based diabetes management systems. According to recent research as discussed above, peer support can significantly reduce the levels of depression among diabetic patients. Developing such a system is a collaborative initiative that will require the input of patients, healthcare providers, policy makers, regulatory agencies, and private organisations among others. 6 References Fre13: , (Free, et al., 2013), Fre13: , (Free, et al., 2013), Yar10: , (Yardley, Morrison, Andreou, Joseph, & Little, 2010), Pal14: , (Pal, et al., 2014), Lor10: , (Lorig, et al., 2010), Pal14: , (Pal, et al., 2014), Cos09: , (Costa, Fitzgerald, Jones, & Dunning, 2009), Tak14: , (Takenga, et al., 2014 ), Sha15: , (Shah & Garg, 2015), Smi13: , (Smith, 2013), Ram13: , (Ramachandran, et al., 2013), deV14: , (de Vries, et al., 2014), Cos09: , (Costa, Fitzgerald, Jones, & Dunning, 2009), 1 Read More