In the United States, diabetes affects 25.8 million people, for whom the costs of care exceed $100 billion annually. Clinical trials suggest that improved self-care and lifestyle changes can lead to better diabetes-related outcomes. Unfortunately, other studies indicate that just 55% of patients with type 2 diabetes receive diabetes education, and only 16% report adhering to recommended self-care practices. Part of the problem behind the poor dissemination of and adherence to behavioral interventions is that patients with diabetes are generally limited to 15-minute office visits with their primary care providers. In that short period, it’s often challenging for physicians and healthcare providers to thoroughly educate patients on their disease. Further complicating the issue is that many patients do not have access to one-on-one or group interventions that can enhance adherence to important self-care practices.
Testing a Mobile Apps on Glucose Control
In a study published in the September 2011 issue of Diabetes Care, my colleagues and I tested a diabetes coaching system for patients with type 2 diabetes. The system uses mobile phone applications and patient/provider portals to provide feedback on self-management and blood glucose results. It also collects data on lifestyle behaviors and clinical management. The hope was that this program could reduce A1C levels over 1 year.
In our analysis, three intervention groups consisting of patients and physicians received different amounts of information. Maximal treatment consisted of automated, real-time education and behavioral messaging in response to individually analyzed blood glucose values, diabetes medications, and lifestyle behaviors communicated by cell phone. Quarterly reports were given to providers that summarized patients’ glycemic control, medication management, lifestyle behaviors, and evidence-based treatment options.
“The widespread distribution of electronic communications like smartphone apps and web portals is making it easier to process and share data in real time.”
For patients who participated in the maximal intervention group, we found an average decline in A1C of 1.9%, compared with a 0.7% decline for those receiving usual care. Although no differences were seen between groups in blood pressure, lipid levels, diabetes distress, or depression, these areas were not specifically addressed by the intervention. In order to influence these other important aspects of diabetes care, it’s clear that smartphone apps and/or website portals need to be created specifically to address known behavioral interventions that are effective for each condition.
Addressing Applicability to Patients with Diabetes
Practicing physicians can apply our results to patients with diabetes who are well managed with the exception of their A1C levels. However, smartphone apps and website portals that emerge in the future will need to address other important behavioral interventions to maximize their potential in the care of patients with diabetes.
A Promising Future for Mobile Apps in Diabetes
In the U.S., the number of mobile phone users increased from 34 million in 1995 to 290 million in 2010. Mobile phone and internet users are also becoming more diverse in age and race. The widespread distribution of electronic communications like smartphone apps and web portals is making it easier to process and share data in real time, making these modalities ideal for the development of simple, effective, diabetes management platforms and programs. The mobile phone and web portal communication strategy we used in our study is likely to be one of many that will be developed, tested, and used as we strive to improve how we manage patients with diabetes in the future.
Readings & Resources (click to view)
Quinn C, Shardell M, Terrin M, et al. Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control. Diabetes Care. 2011;34:1934-1942.
Katsiki N, Papanas N, Mikhailidis D, Fonseca V. Glycated hemoglobin A1c (HbA1c) and diabetes. A new era? Curr Med Res Opin. 2011 Sep 14. [Epub ahead of print]. Available at http://informahealthcare.com/doi/abs/10.1185/03007995.2011.618179.
Silbernagel G, Kleber M, Grammer T, et al. Additional use of glycated hemoglobin for diagnosis of type 2 diabetes in people undergoing coronary angiography reveals a subgroup at increased cardiovascular risk. Diabetes Care. 2011 Sep 12. [Epub ahead of print]. Available at http://care.diabetesjournals.org/content/early/2011/09/07/dc11-1046.abstract.
Roush G, Salonga A, Bajaj N. A longitudinal study of sociodemographic predictors of hemoglobin A1c. Conn Med. 2011;75:325-328.
Plotnikoff R, Pickering M, Glenn N, et al. The effects of a supplemental, theory-based physical activity counseling intervention for adults with type 2 diabetes. J Phys Act Health. 2011;9:944-954.
Unick J, Beavers D, Jakicic J, et al. Effectiveness of lifestyle interventions for individuals with severe obesity and type 2 diabetes: Results from the Look AHEAD trial. Diabetes Care. 2011 Aug 11. [Epub ahead of print]. Available at http://care.diabetesjournals.org/content/early/2011/08/05/dc11-0874.abstract.
Handelsman Y, Jellinger P. Overcoming obstacles in risk factor management in type 2 diabetes mellitus. J Clin Hypertens (Greenwich). 2011;13:613-620.