Evidence is lacking on interventions that are implemented to meet the needs of older adults with diabetes. Among many age groups of adults, mobile phone interventions have been shown to improve diabetes management. To determine whether the impact of such interventions is dependent upon age, Charlene C. Quinn, PhD, RN, and colleagues had a study published in the Journal of Applied Gerontology in which they assessed differences in the impact of a mobile intervention among adults younger than 55 and those aged 55 to 64.
Testing an Intervention
For the study, patients with type 2 diabetes were treated by physicians who had been randomized to provide usual care (control group) or to provide a patient coaching system (PCS) and provider clinical decision support (intervention group). The PCS included a mobile diabetes management software application that allowed patients to enter diabetes self-care data on their mobile phones. The application also sent patients selections from about 1,000 automated messages that were secure and offered real-time educational, behavioral, and motivational messages based on the data that was entered.
Self-care data were intermittently reviewed by diabetes educators who could supplement the secure mobile phone messages with messages that were sent electronically to a patient web portal that was part of the PCS. “The portal included a diabetes management library, a secure message center, and an individualized personal health record where patients could keep track of various metrics,” explains Dr. Quinn.
For patients in both age groups that were studied, the intervention group experienced greater reductions in A1C than the control group. “Among older patients, A1C decreased 1.8% in the intervention group, compared with a 0.3% decrease in the control group,” says Dr. Quinn. Younger patients in the intervention group experienced a 2.0% decrease in A1C, compared with a 1.0% decrease among those in the control group. “Our finding that older patients in the intervention group did nearly as well as younger patients breaks the myth that older adults are either unwilling or unable to use mobile technologies,” adds Dr. Quinn.
As mobile technology and patient-centered care both become more ubiquitous, it is important for physicians to understand and explain to their patients that very few mobile apps have any scientific evidence to support their use. “Clinicians should assess the effectiveness and evidence behind the mobile health apps their patients are using and be willing to work with them to determine which mobile health approaches might be best suited to them,” Dr. Quinn says. “Older patients with diabetes are a heterogeneous population, and mobile health interventions may allow for a personalized intervention for each patient.”
Quinn C, Shardell M, Terrin M, et al. Mobile diabetes intervention for glycemic control in 45- to 64-year-old persons with type 2 diabetes. J Appl Gerontol. 2014 Aug 6. [Epub ahead of print]. Available at: http://jag.sagepub.com/content/early/2014/07/21/0733464814542611.abstract.
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