Diabetes Management via Mobile Phones: A Systematic Review

Abstract Background: This study sought to understand the most common uses and functions of mobile phones in monitoring and managing diabetes, their potential role in a clinical setting, and the current state of research in this area. Methods: We identified peer-reviewed articles published between 2000 and 2010. Twenty-one articles were analyzed for this systematic literature review. Results: The majority of studies examined the use of mobile phones from the patient's perspective. Subjects with type 1 diabetes were enrolled exclusively in over 50% of the studies. Seventy-one percent of the studies used a study-specific application, which had supplemental features in addition to text messaging. The outcomes assessed varied considerably across studies, but some positive trends were noted, such as improved self-efficacy, hemoglobin A1c, and self-management behaviors. Conclusions: The studies evaluated showed promise in using mobile phones to help people with diabetes manage their condition effectively. However, many of these studies lacked sufficient sample sizes or intervention lengths to determine whether the results might be clinically or statistically significant. Future research should examine other key issues, such as provider perceptions, integration into a healthcare practice, and cost, which would provide important insight into the use of mobile phones for chronic disease management.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/98491/1/tmj%2E2011%2E0119.pd

Using the Technology Acceptance Model to Characterize Barriers and Opportunities of Telemedicine in Rural Populations: Survey and Interview Study

BackgroundHealth care access issues have long plagued rural Americans. One approach to alleviating the challenges and poor health outcomes for rural individuals is through the use of telemedicine, sometimes called telehealth. It is important to understand factors that may be related to telemedicine adoption or nonadoption, particularly in underserved rural settings. ObjectiveThis pilot study examines telemedicine perceptions among rural, underserved populations using the Technology Acceptance Model, which serves as a framework to explore the adoption of telemedicine services by those who have used it. This study also explores the differences between user and nonuser perceptions of telemedicine. MethodsPaper surveys and phone interviews were conducted in rural Northern Lower Michigan. ResultsPerceived usefulness and perceived ease of use explained 91% of the variability in attitude toward telemedicine (R2=0.91; F1,15=73.406; P<.001). Ease of use was a significant predictor (mean 2.36, SD 1.20; P<.001), but usefulness (mean 3.16, SD 0.81; P=.20) was not. Furthermore, there were significant differences in individual perception of telemedicine between users and nonusers. For example, nonusers believed they would receive better care in person (users: mean 3.30, SD 1.22; nonusers: mean 1.91, SD 1.14; F1,32=10.126; P=.003). The quantitative findings were reinforced by the qualitative results from the phone interviews. ConclusionsOverall, the Technology Acceptance Model is an appropriate model to understand the attitudes toward telemedicine that may lead to its adoption by rural Americans

Characteristics of patients with diabetes who accept referrals for care management services

Introduction: Patients with chronic conditions can improve their health through participation in self-care programs. However, awareness of and enrollment in these programs are generally low. Objective: We sought to identify factors influencing patients’ receptiveness to a referral for programs and services supporting chronic disease management. Methods: We analyzed data from 541 high-risk diabetic patients who completed an assessment between 2010 and 2013 from a computer-based, nurse-led Navigator referral program within a large primary care clinic. We compared patients who accepted a referral to those who declined. Results: A total of 318 patients (75%) accepted 583 referrals, of which 52% were for self-care programs. Patients who accepted a referral had more primary care visits in the previous year, were more likely to be enrolled in another program, expressed more interest in using the phone and family or friends for support, and were more likely to report recent pain than those who declined a referral. Discussion: Understanding what factors influence patients’ decisions to consider and participate in self-care programs has important implications for program design and development of strategies to connect patients to programs. This work informs outreach efforts to identify and engage patients who are likely to benefit from self-care activities

An mHealth-Based Intervention for Adolescents With Type 1 Diabetes and Their Parents: Pilot Feasibility and Efficacy Single-Arm Study

BackgroundType 1 diabetes (T1D) affects more than 165,000 individuals younger than 20 years in the United States of America. The transition from parent management to parent-child team management, with the child taking on increased levels of self-care, can be stressful and is associated with a deterioration in self-management behaviors. Therefore, a mobile app intervention, MyT1DHero, was designed to facilitate diabetes-specific positive parent-adolescent communication and improve diabetes-related outcomes. The MyT1DHero intervention links an adolescent with T1D and their parent through 2 separate app interfaces and is designed to promote positive communication regarding T1D management. ObjectiveThe aim of this pilot study was to determine (1) the initial efficacy of the MyT1DHero intervention in improving diabetes outcomes in adolescents, specifically the hemoglobin A1c (HbA1c) levels, diabetes care adherence, and quality of life, and (2) the adolescents’ overall satisfaction with this intervention. MethodsThis pilot study included 30 adolescent-parent pairs who used the MyT1DHero app in a 12-week single-arm clinical trial. Participants were recruited from the local pediatric endocrinology subspecialty clinic via snowball sampling. HbA1c levels, diabetes care adherence, quality of life, family conflict, and satisfaction levels were measured and analyzed using paired sample two-sided t tests and linear regression analyses. ResultsThe final analysis included 25 families. The mean age of the adolescents was 12.28 (SD 1.62) years. Half of the participants (13/25) reported a diabetes diagnosis of less than 5 years. After 12 weeks of the intervention, diabetes care adherence significantly improved (before the study: mean 3.87 [SD 0.59]; after the study: mean 4.19 [SD 0.65]; t21=–2.52, P=.02, d=0.52) as did quality of life (before the study: mean 4.02 [SD 0.84]; after the study: mean 4.27 [SD 0.73]; t24=2.48, P=.01, d=0.32). HbA1c levels (before the study: mean 8.94 [SD 1.46]; after the study: mean 8.87 [SD 1.29]; t24=0.67, P=.51, d=0.04) and family conflict (before the study: mean 2.45 [SD 0.55]; after the study: mean 2.61 [SD 0.45]; t23=0.55, P=.14, d=0.32) changed in the hypothesized direction, but the change was not significant. However, higher use of the mobile app was associated with more improvement in HbA1c levels (F1,20=9.74, P<.005; R2=0.33). Overall, the adolescents were satisfied with the app intervention. ConclusionsIn a 12-week pilot study of the mobile app intervention designed to facilitate parent-adolescent communication for improving diabetes outcomes, significant benefits were demonstrated in self-care adherence and quality of life. A randomized controlled trial with a longer intervention is needed to replicate these findings and to determine the stability of the intervention effects. Trial RegistrationClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT0343662