Diabetes Management Strategies

This assignment delves into diabetes management strategies, focusing on the Chronic Care Model and its application in managing chronic diseases like diabetes. Students are required to analyze research studies on various approaches, including home blood pressure telemonitoring with self-care support and chronic disease self-management programs. Furthermore, the assignment examines Saudi Arabia's efforts to combat diabetes through collaboration with Harvard University and explores the country's national health policies regarding diabetes.

Running head- CRITICAL ANALYSIS
Critical review of innovation in prevention of Diabetes in Saudi Arabia
Name of the Student
Name of the University
Author Note

1CRITICAL ANALYSIS
Executive Summary
Diabetes mellitus is a chronic disease that attracts huge attention globally, owing to the rapid
increase in its prevalence. The higher prevalence of the health abnormality also contributes to an
increase in the associated healthcare costs for the patients. It also creates a burden on the
healthcare professionals and the society as a whole. Therefore, the World Health Organisation
intends to increase the levels of awareness among all people on the global burden and potential
consequences of diabetes, while focusing particularly on developing countries. Unhealthy diet
patterns, reduction in overall energy expenditure and sedentary lifestyle are the major factors that
contribute to the higher prevalence of diabetes in the Kingdom of Saudi Arabia. This report aims
to focus on three innovations (SAED, MHERQ, SANAD) that are have been implemented for
improvement of chronic disease management and will critically discuss their effectiveness in
diabetes management in the target population.

2CRITICAL ANALYSIS
Table of Contents
Introduction......................................................................................................................................3
Discussion and evaluation...............................................................................................................3
Description of the innovation and the community......................................................................3
Need and rationale for the innovation.........................................................................................4
Addressing the core components of Chronic Care Model...........................................................5
Critical evaluation of the performance........................................................................................7
Implications.................................................................................................................................9
Opportunities for improvement.................................................................................................10
Conclusion.....................................................................................................................................10
References......................................................................................................................................12

3CRITICAL ANALYSIS
Introduction
Chronic diseases are health abnormalities that persist over a long period of time (3
months) (Bauer et al. 2014). Diabetes is regarded as a chronic diseases occurring due to
inefficiency of the pancreas to produce adequate insulin. The hormone insulin is responsible for
converting blood glucose. This results in an elevation in the blood sugar levels beyond the
threshold (Chiuve et al. 2012).
Regardless of the geography, age and socio-economic condition, diabetes mellitus has
become a major health concern. The incidence rates have reached an alarming level that calls for
the need to innovate healthcare delivery solutions in this digital age. Researchers expect the
youth to get empowered with their smart phones in near future, owing to which mobile health
(m-Health) innovations can be implemented to take responsibility of managing the chronic health
disorder. Healthcare professionals and clinicians will adorn the role of advisors and navigators,
in addition to acting as medical gatekeepers of the patients. This report will describe the m-
Health system and application for management and prevention of diabetes. It will also evaluate
clinical evidence of the impact and future implications of these innovations.
Discussion and evaluation
Description of the innovation and the community
SAED, a mobile diabetes management system was formulated with regards to the
residents of the community for the effective prevention and management of the chronic health
condition. The SAED encompasses a smart mobile based diabetes management system that is
made up of components such as, wireless technologies, sensors, GPS technologies and other

4CRITICAL ANALYSIS
functional aspects (Alotaibi, Istepanian and Philip 2016). The primary objective of the system is
to provide optimal healthcare services to all patients. The cost-effectiveness of this system
enables it to be used by many people.
It facilitates remote monitoring of the blood level conditions and records and maintains a
medical history database, while enhancing patient knowledge on the disorder. Thus, the 2 major
components of SAED are commonly referred to as the mobile patient or healthcare provider
component, and the intelligent diabetes management component (Alotaibi, Istepanian and Philip
2016).
The other mobile health technology that acts as an innovation in diabetes management is
the Mobile Health Effect and Readiness Questionnaire (MHERQ). This questionnaire is a
modified version of the THREQ, translated into the Arabic language (Alenazia et al. 2017). It
encompasses three sections, namely, clinical data, demographics and a 5-point likert scale with
13 questions, based on the readiness of patients for use of m-Health technologies.
The primary objective of this questionnaire was to evaluate the effectiveness of health
monitoring services in controlling the rates of diabetes through the use of mobile devices.
Another objective was therefore related to determining whether the people of KSA have
technical literacy and are ready to make use of these services for improving their health (Alenazi
et al. 2017).
Need and rationale for the innovation
Diabetes mellitus is regarded as one of the fastest-growing chronic health disorder
globally (WHO 2016). The major factors that contribute to the ever-increasing rates of diabetes
in the world are sedentary lifestyle, lack of physical exercise, obesity, and unhealthy diet

5CRITICAL ANALYSIS
patterns. Research studies suggest that the socio-economic changes occurring in KSA over past 4
decades have created significant impacts on the lifestyle. These changes have resulted in less
healthful eating habits and a decline in physical activity levels (American Diabetes Association
2018). According to Guariguata et al. (2014) around 382 million people were suffer from
diabetes, of which 23.9% reside in Saudi Arabia. Another study assessed the burden of diabetes
in KSA and the prevalence rates were found to be 23.7%, and were more among males living in
urban areas (Alhowaish 2013). Research evidences also indicate that diabetes mellitus accounted
for 11% of the total healthcare expenses in the year 2011 (American Diabetes Association 2013).
Moreover, studies state that the estimated number of diabetic patients would reach 32% of the
adult population, by the year 2020 (Guariguata et al. 2014). The total annual medical costs for
diabetes were as high as $657 million in 2010 (UHO 2010). The rapidly increasing proportion of
diabetes in KSA accounts for the poor general health, low quality of life, high morbidity,
mortality and vascular complications. Therefore, there was a need to emphasise on screening for
pre-diabetes and diabetesin order to identify the risk factors that increase susceptibility to the
chronic health disorder (Al-Quwaidhi et al. 2014). This accounts for the need to implement the
SAED and MHERQ techniques to manage the incidence of type-2 diabetes among people living
in Saudi Arabia.
Addressing the core components of Chronic Care Model
The Chronic Care Model (CCM) refers to an organizational approach built with the aim
of caring for individuals who suffer from chronic health conditions, in a primary care setting.
The major elements of the care model includethe health-system, community, delivery system
design, self-management support, clinical information system and decision support (Nundy et al.

6CRITICAL ANALYSIS
2012). This eventually results in satisfied healthcare providers, healthier patients, and associated
cost savings.
Figure 1- The Chronic Care Model
Source- (Lovell et al. 2011)
The SAED mobile diabetes management intervention applied in the target population met
some objectives of the CCM in that its diabetes management component represented back end
operations that most commonly included data collection and storage in the database, such that it
could be used in the form of decision support system. Furthermore, the database stored
laboratory results, and records related to all patients, thereby offering clinical information
support (Ory et al. 2013). Upon implementation, it also acted as a cost-effective healthcare
solution that facilitated monitoring diabetes. Furthermore, it also facilitated self-monitoring of
the condition. Thus, most of the components of the care model were addressed by SAED. On the
other hand, the MHERQ when applied on the target population demonstrated an urge among the
participants for the usage of data technology to cope with their condition. Furthermore, most

7CRITICAL ANALYSIS
participants showed a willingness to use mobile health technologies for increasing their
awareness on the disease, and directly interacting with their healthcare professionals. Thus, the
MHERQ supported the need for the presence of certain components of the care model.
Critical evaluation of the performance
The study conducted by Alotaibi, Istepanian and Philip (2016) focused on developing an
SAED for the type-2 diabetes patients of KSA in order to determine the HbA1c levels and
diabetes awareness. Findings from the RCT suggested a significant reduction in HbA1c
outcomes, at the end of intervention period among participants in the SAED intervention group,
upon comparison with the control group. Furthermore, the mean baseline decreased from 8.76%
to 7.85% in the intervention group. The results also demonstrated a remarkable improvement in
knowledge and awareness of diabetes in the sample. Owing to the fact that diabetes is regarded
as a chronic disease faced by individuals of the aforementioned country, the researchers
illustrated the importance and effectiveness of the smart mobile management system on
improving the healthcare conditions of the future generations.
Furthermore, the increasing trend in the use of mobile health technology for making
healthcare services more efficient and better was also followed by the researchers. Another
advantage was related to determination of the effectiveness the determined the effectiveness and
results on lack of intervention in the control group as well. However, the major disadvantages
were related to small sample size (20 participants), lack of follow-up study and lack of
information on the area in which the study was conducted. According to the study conducted by
Alenazi et al. (2017) MEHRQ displayed a satisfactory response when implemented upon the
target population. The advantage of the study lies in the fact that it tried to assess the readiness
and levels of acceptance of mobile of telemonitoring facilities for improving diabetic status,

8CRITICAL ANALYSIS
based on a questionnaire. The study was effective in showing excellent internal consistency
among the sample. Additional advantages include the response of 77% participants showing
willingness to use mobile health services. Moreover, 60% displayed interest to use mobile
technology during holidays. Thus, the basic advantage was that most people identified the need
of mobile technologies for optimal health outcomes among the patients. However, the study had
its disadvantages that were associated with the presence of small sample size (30 diabetic
patients), and presence of near about half of the participants displaying a lack of willingness to
use telemonitoring for transferring values to other diabetic patients. Furthermore, the authors
failed to describe the kind of study that was conducted.
The effectiveness of SAED can be correlated with results of a systematic review that suggested
significant positive impacts of self-management interventions on regulations of HbA1c levels
among T-2-D patients in gulf cooperation council countries. Analysis of 8 articles, of which one
was an RCT showed a statistically significant improvement in the levels of HbA1c in 5 studies.
Improvements were also observed in the levels of physical activity in 4 studies. Thus, the
findings were in accordance with the SAED study (Al Slamah et al. 2017). In addition,
development of a mobile diabetes management system for Saudi Arabic diabetic patients, for
management of diabetes and social behavior demonstrated positive impacts on knowledge
promotion for diabetes and reflected positive outcomes in reducing levels of HbA1c among the
patients. Results from the study also showed an improved self-efficacy among the patients on use
of the SANAD (Alanzi 2014). Preliminary results suggested general acceptance in using m-
Health system with rating among T2D patients. Further investigation showed positive impact of
the SANAD in diabetic knowledge promotion and reduction of glycated hemoglobin. Thus, it

9CRITICAL ANALYSIS
can be concluded that use of self-management and mobile health technologies all over the world
have shown significant improvements in diabetes management.
Implications
Health equity refers to study and reasons for differences that arise in the quality of the
healthcare systems existing across different population (Bauer 2014). The major impact of the
SAED program is the fact that it provided data to establish the effectiveness of smart phone
interventions on T2D patients. The study had also made a consideration of the prevalence of
smart phone technologies and levels of its usage in the Kingdom.
The major impact on the providers includes self-management of the disease due to
incorporation of educational tool in the program. This holds extreme relevance in remote KSA
regions where lack of adequate healthcare facilities worsens the health condition of the residents.
Additionally, another benefit is related to enhancement of self-monitoring that eventually
reduces the mortality and morbidity rates (Logan et al. 2012). The healthcare providers are also
benefitted due to the integration of clinical information with the patients. This will create better
provisions for the providers to diagnose the health status and administer appropriate
interventions, by going through the previous health records of the patients (Aikens et al. 2015).
Similar benefits were also created by MHERQ that enabled patients to suggest that they
would like to use mobile health technologies for recording their blood glucose levels by self or
during holidays (Alenazia et al. 2017). This would directly benefit the doctors as they would be
able to directly implement treatment methods by interacting with the patients, while reviewing
the HbA1c records (Buysse, de Moor and De Maeseneer 2013). The equity implication is related
to the fact that the aforementioned strategies can be applied across all regions of the world

10CRITICAL ANALYSIS
regardless of the socio-economic status, gender, ethnic or racial disparities. Thus, it will be able
to enhance retention and attraction of health workers and will directly benefit people living in
areas that are inaccessible to urgent healthcare facilities (Farmer and Bukhman 2012). According
to recent news, the MOH has joined forces with Joslin Diabetes Centre that is associated with the
Harvard Medical School, for achieving healthcare facilities of international standards, by training
health workers on use of latest diabetes management techniques (Arab News Online 2016).
Opportunities for improvement
The Ministry of Health (MOH), Saudi Arabia recognises the need of implementing
treatment, prevention, and rehabilitation programs for ensuring inclusive health services for all
residents (Celler and Sparks 2015). This is further supplemented by its efforts of formulating a
National Executive Plan for 10 years (2010-2020). The plan will act as leverage for development
of other intervention programs. Furthermore, the establishment of 20 specialised centres for
diabetes treatment and work towards improving awareness on the disease would be beneficial
(Moh.gov.sa 2018). Furthermore, there is a need to conduct more high levels of study such as,
randomised control trials to determine the effectiveness of the m-Health strategies on diabetic
patients. RCTs will help to evaluate the efficacy and safety of the new interventions on human
health. Thus, the relevance of the innovations to patient care can be investigated accurately
(Kabisch et al. 2011).
Conclusion
The major strengths of healthcare technologies in the KSA are care management,
actionable health information, health insurance, consumer involvement and financial services.
These assets are paramount to improvement of healthcare for all citizens. Therefore, there is a

11CRITICAL ANALYSIS
need to develop partnership or collaboration between the primary stakeholders for prevention of
diabetes, a chronic health problem. Implementation of innovative strategies such as m-Helath,
which have already been applied in other countries, will help KSA achieve significant
management and prevention of diabetes by the year 2030.

12CRITICAL ANALYSIS
References
Aikens, J.E., Trivedi, R., Aron, D.C. and Piette, J.D., 2015. Integrating support persons into
diabetes telemonitoring to improve self-management and medication adherence. Journal of
general internal medicine, 30(3), pp.319-326.
Al Slamah, T., Nicholl, B.I., Alslail, F.Y. and Melville, C.A., 2017. Self-management of type 2
diabetes in gulf cooperation council countries: A systematic review. PloS one, 12(12),
p.e0189160.
Alanzi, T., 2014. Mobile diabetes management system for Saudi Arabia embedding social
networking and cognitive behavioral therapy modules (Doctoral dissertation, Kingston
University). Retrieved from- http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.702546
Alenazi, H., Alghamdi, M., Alradhi, S., Househ, M. and Zakaria, N., 2017. A Study on Saudi
Diabetic Patients' Readiness to Use Mobile Health. Studies in health technology and
informatics, 245, pp.1210-1210.
Alenazia, H., Alradhia, S., Alghamdia, M., Househb, M., Jamala, A. and Zakariaa, N., 2017.
Readiness to Use Mobile Health Features among Diabetic Patients in Saudi Arabia: Survey
Validation. Age, 18(35), pp.36-55.
Alhowaish, A.K., 2013. Economic costs of diabetes in Saudi Arabia. Journal of family &
community medicine, 20(1), p.1.
Alotaibi, M.M., Istepanian, R. and Philip, N., 2016. A mobile diabetes management and
educational system for type-2 diabetics in Saudi Arabia (SAED). mHealth, 2.

13CRITICAL ANALYSIS
Al-Quwaidhi, A.J., Pearce, M.S., Sobngwi, E., Critchley, J.A. and O’Flaherty, M., 2014.
Comparison of type 2 diabetes prevalence estimates in Saudi Arabia from a validated Markov
model against the International Diabetes Federation and other modelling studies. Diabetes
research and clinical practice, 103(3), pp.496-503.
American Diabetes Association, 2013. Economic costs of diabetes in the US in 2012. Diabetes
care, 36(4), pp.1033-1046.
American Diabetes Association, 2018. 4. Lifestyle Management: Standards of Medical Care in
Diabetes—2018. Diabetes care, 41(Supplement 1), pp.S38-S50.
Bauer, G.R., 2014. Incorporating intersectionality theory into population health research
methodology: challenges and the potential to advance health equity. Social Science &
Medicine, 110, pp.10-17.
Buysse, H.E., de Moor, G.J. and De Maeseneer, J., 2013. Introducing a telemonitoring platform
for diabetic patients in primary care: Will it increase the socio-digital divide?. Primary care
diabetes, 7(2), pp.119-127.
Celler, B.G. and Sparks, R.S., 2015. Home telemonitoring of vital signs—Technical challenges
and future directions. IEEE journal of biomedical and health informatics, 19(1), pp.82-91.
Chiuve, S.E., Fung, T.T., Rimm, E.B., Hu, F.B., McCullough, M.L., Wang, M., Stampfer, M.J.
and Willett, W.C., 2012. Alternative dietary indices both strongly predict risk of chronic
disease. The Journal of nutrition, pp.jn-111.
Farmer, P. and Bukhman, G., 2012. Reuse of medical devices and global health equity. Annals of
internal medicine, 157(8), pp.591-592.

14CRITICAL ANALYSIS
Guariguata, L., Whiting, D.R., Hambleton, I., Beagley, J., Linnenkamp, U. and Shaw, J.E., 2014.
Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research
and clinical practice, 103(2), pp.137-149.
Kabisch, M., Ruckes, C., Seibert-Grafe, M. and Blettner, M., 2011. Randomized controlled
trials: part 17 of a series on evaluation of scientific publications. Deutsches Ärzteblatt
International, 108(39), p.663.
Logan, A.G., Irvine, M.J., McIsaac, W.J., Tisler, A., Rossos, P.G., Easty, A., Feig, D.S. and
Cafazzo, J.A., 2012. Effect of Home Blood Pressure Telemonitoring With Self-Care Support on
Uncontrolled Systolic Hypertension in DiabeticsNovelty and Significance. Hypertension, 60(1),
pp.51-57.
Lovell, M., Myers, K., Forbes, T.L., Dresser, G. and Weiss, E., 2011. Peripheral arterial disease:
application of the chronic care model. Journal of Vascular Nursing, 29(4), pp.147-152.
Moh.gov.sa (2018). Kingdom of Saudi Arabia - Ministry of Health Portal. [online] Moh.gov.sa.
Available at: https://www.moh.gov.sa/en/Ministry/MediaCenter/Publications/Pages/
Publications-2013-11-12-001.aspx [Accessed 25 Jan. 2018].
Nundy, S., Dick, J.J., Goddu, A.P., Hogan, P., Lu, C.Y.E., Solomon, M.C., Bussie, A., Chin,
M.H. and Peek, M.E., 2012. Using mobile health to support the chronic care model: developing
an institutional initiative. International journal of telemedicine and applications, 2012, p.18.
Ory, M.G., Ahn, S., Jiang, L., Smith, M.L., Ritter, P.L., Whitelaw, N. and Lorig, K., 2013.
Successes of a national study of the chronic disease self-management program: meeting the triple
aim of health care reform. Medical care, 51(11), pp.992-998.

15CRITICAL ANALYSIS
Saudi Arabia and Harvard join forces to fight diabetes Mohammed Rasooldeen. Published —
Thursday 15 December 2016 Retrieved from- http://www.arabnews.com/node/1024461/saudi-
arabia
United Health Group., 2010. Diabetes in the United Arab Emirates: Crisis or Opportunity?
Retrieved from-
http://www.unitedhealthgroup.com/~/media/UHG/PDF/2010/UNH_WorkingPaperDiabetesUAE
.ashx?la=en
World Health Organization, 2016. Global report on diabetes. World Health Organization.
Retreived from- http://apps.who.int/iris/bitstream/10665/204871/1/9789241565257_eng.pdf