Feasibility of a Patient-Centered, Smartphone-Based, Diabetes Care System: A Pilot Study

다국어 초록 (Multilingual Abstract)

Background: We developed a patient-centered, smartphone-based, diabetes care system (PSDCS). This study aims to test the feasibility of glycosylated hemoglobin (HbA1c) reduction with the PSDCS.
Methods: This study was a single-arm pilot study. The participants with type 2 diabetes mellitus were instructed to use the PSDCS, which integrates a Bluetooth-connected glucometer, digital food diary, and wearable physical activity monitoring device.
The primary end point was the change in HbA1c from baseline after a 12-week intervention.
Results: Twenty-nine patients aged 53.9±9.1 years completed the study. HbA1c and fasting plasma glucose levels decreased significantly from baseline (7.7%±0.7% to 7.1%±0.6%, P<0.0001; 140.9±39.1 to 120.1±31.0 mg/dL, P=0.0088, respectively). The frequency of glucose monitoring correlated with the magnitude of HbA1c reduction (r=–0.57, P=0.0013). The components of the diabetes self-care activities, including diet, exercise, and glucose monitoring, were significantly improved, particularly in the upper tertile of HbA1c reduction. There were no severe adverse events during the intervention.
Conclusion: A 12-week application of the PSDCS to patients with inadequately controlled type 2 diabetes resulted in a significant HbA1c reduction with tolerable safety profiles; these findings require confirmation in a future randomized controlled trial.

참고문헌 (Reference)

1 eMarketer, "Worldwide smartphone usage to grow 25% in 2014"

2 Ralston JD, "Web-based collaborative care for type 2 diabetes: a pilot randomized trial" 32 : 234-239, 2009

3 Toobert DJ, "The summary of diabetes self-care activities measure: results from 7 studies and a revised scale" 23 : 943-950, 2000

4 Bond GE, "The effects of a web-based intervention on the physical outcomes associated with diabetes among adults age 60 and older: a randomized trial" 9 : 52-59, 2007

5 Khan S, "The effect of the Vermont Diabetes Information System on inpatient and emergency room use: results from a randomized trial" 1 : e61-e66, 2010

6 Maclean CD, "The Vermont diabetes information system: a cluster randomized trial of a population based decision support system" 24 : 1303-1310, 2009

7 Polonsky WH, "Structured self-monitoring of blood glucose significantly reduces A1C levels in poorly controlled, noninsulin-treated type 2 diabetes:results from the Structured Testing Program study" 34 : 262-267, 2011

8 American Diabetes Association, "Standards of medical care in diabetes: 2014" 37 (37): S14-S80, 2014

9 Karter AJ, "Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry" 111 : 1-9, 2001

10 Glasgow RE, "Randomized effectiveness trial of a computer-assisted intervention to improve diabetes care" 28 : 33-39, 2005

11 Grant RW, "Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial" 168 : 1776-1782, 2008

12 Glasgow RE, "Outcomes of minimal and moderate support versions of an internet-based diabetes self-management support program" 25 : 1315-1322, 2010

13 Lorig K, "Online diabetes self-management program: a randomized study" 33 : 1275-1281, 2010

14 Liu CT, "Observations on online services for diabetes management" 28 : 2807-2808, 2005

15 El-Gayar O, "Mobile applications for diabetes self-management: status and potential" 7 : 247-262, 2013

16 Cho JH, "Long-term effect of the Internet-based glucose monitoring system on HbA1c reduction and glucose stability: a 30-month follow-up study for diabetes management with a ubiquitous medical care system" 29 : 2625-2631, 2006

17 Holbrook A, "Individualized electronic decision support and reminders to improve diabetes care in the community: COMPETE II randomized trial" 181 : 37-44, 2009

18 Ilag LL, "Improving diabetes processes of care in managed care" 26 : 2722-2727, 2003

19 Peterson KA, "Improving diabetes care in practice:findings from the TRANSLATE trial" 31 : 2238-2243, 2008

20 Lim S, "Improved glycemic control without hypoglycemia in elderly diabetic patients using the ubiquitous healthcare service, a new medical information system" 34 : 308-313, 2011

21 O’Connor PJ, "Impact of electronic health record clinical decision support on diabetes care: a randomized trial" 9 : 12-21, 2011

22 Cho NH, "IDF diabetes atlas"

23 Bartlett EE, "Historical glimpses of patient education in the United States" 8 : 135-149, 1986

24 Saffari M, "Health education via mobile text messaging for glycemic control in adults with type 2 diabetes: a systematic review and meta-analysis" 8 : 275-285, 2014

25 International Diabetes Federation Guideline Development Group, "Global guideline for type 2 diabetes" 104 : 1-52, 2014

26 Norris SL, "Effectiveness of selfmanagement training in type 2 diabetes: a systematic review of randomized controlled trials" 24 : 561-587, 2001

27 Hussein WI, "Effectiveness of mobile phone short message service on diabetes mellitus management;the SMS-DM study" 94 : e24-e26, 2011

28 Kirkman MS, "Diabetes in older adults" 35 : 2650-2664, 2012

29 Cleveringa FG, "Computerized decision support systems in primary care for type 2 diabetes patients only improve patients’ outcomes when combined with feedback on performance and case management: a systematic review" 15 : 180-192, 2013

30 Pal K, "Computer-based interventions to improve self-management in adults with type 2 diabetes:a systematic review and meta-analysis" 37 : 1759-1766, 2014

31 Quinn CC, "Cluster-randomized trial of a mobile phone personalized behavioral intervention for blood glucose control" 34 : 1934-1942, 2011

32 Christian JG, "Clinic-based support to help overweight patients with type 2 diabetes increase physical activity and lose weight" 168 : 141-146, 2008

33 Ziemer DC, "An intervention to overcome clinical inertia and improve diabetes mellitus control in a primary care setting: Improving Primary Care of African Americans with Diabetes (IPCAAD) 8" 166 : 507-513, 2006

34 Yoo HJ, "A ubiquitous chronic disease care system using cellular phones and the internet" 26 : 628-635, 2009

35 Yoon KH, "A short message service by cellular phone in type 2 diabetic patients for 12 months" 79 : 256-261, 2008

36 Leu MG, "A randomized, controlled trial of an automated wireless messaging system for diabetes" 7 : 710-718, 2005

37 Sequist TD, "A randomized trial of electronic clinical reminders to improve quality of care for diabetes and coronary artery disease" 12 : 431-437, 2005

38 Hirsch IB, "A multifaceted intervention in support of diabetes treatment guidelines: a cont trial" 58 : 27-36, 2002

39 Meigs JB, "A controlled trial of web-based diabetes disease management: the MGH diabetes primary care improvement project" 26 : 750-757, 2003

40 고승현, "2011 Clinical Practice Guidelines for Type 2 Diabetes in Korea" 대한당뇨병학회 35 (35): 431-436, 2011