Diabetes Interactive Diary: A New Telemedicine System Enabling Flexible Diet and Insulin Therapy While Improving Quality of Life

Abstract

OBJECTIVEWidespread use of carbohydrate counting is limited by its complex education. In this study we compared a Diabetes Interactive Diary (DID) with standard carbohydrate counting in terms of metabolic and weight control, time required for education, quality of life, and treatment satisfaction.RESEARCH DESIGN AND METHODSAdults with type 1 diabetes were randomly assigned to DID (group A, n = 67) or standard education (group B, n = 63) and followed for 6 months. A subgroup also completed the SF-36 Health Survey (SF-36) and World Health Organization-Diabetes Treatment Satisfaction Questionnaire (WHO-DTSQ) at each visit.RESULTSOf 130 patients (aged 35.7 ± 9.4 years; diabetes duration 16.5 ± 10.5 years), 11 dropped out. Time for education was 6 h (range 2–15 h) in group A and 12 h (2.5–25 h) in group B (P = 0.07). A1C reduction was similar in both groups (group A from 8.2 ± 0.8 to 7.8 ± 0.8% and group B from 8.4 ± 0.7 to 7.9 ± 1.1%; P = 0.68). Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight. No severe hypoglycemic episode occurred. WHO-DTSQ scores increased significantly more in group A (from 26.7 ± 4.4 to 30.3 ± 4.5) than in group B (from 27.5 ± 4.8 to 28.6 ± 5.1) (P = 0.04). Role Physical, General Health, Vitality, and Role Emotional SF-36 scores improved significantly more in group A than in group B.CONCLUSIONSDID is at least as effective as traditional carbohydrate counting education, allowing dietary freedom for a larger proportion of type 1 diabetic patients. DID is safe, requires less time for education, and is associated with lower weight gain. DID significantly improved treatment satisfaction and several quality-of-life dimensions.

A Meta-Analysis of Mobile Health and Risk Reduction in Patients with Diabetes Mellitus: Challenge and Opportunity

“…Moreover, the question remains as to who will be responsible for covering the attributable costs of this innovation in the real world. Unfortunately, only three studies 24,28,30 in this review had cost/benefit analysis information, in which they reported that selfmonitoring and management of diabetes via mobile phone technology would be cost-effective at approximately €4/month, 2 pence/text, and €1.4/month respectively. Nevertheless, the applicability of mobile technology in low resources settings is still questionable in terms of its overall cost (phone, internet and operation).…”

“…The minimum difference reported at the end of the study period in the intervention group was -0.1 (6.4% pretest to 6.3% at 3 months) while the maximum difference was -2.4 (9.8% pretest to 7.4% at 3 months). Ten studies showed lower HbA1c levels among participants in the intervention group at the end of the intervention, although only seven 17,19,20,25,27,28,30 reported significant reduction in HbA1c levels (p < 0.05). Meta-analysis suggests that during an average followup of 6.3 years, an overall net effect of HbA1c reduction of the 12 studies in intervention groups was 0.39% (95%CI: -0.067, -0.72, p=0.018) after taking off the reduction in control groups.…”

“…After excluding studies that did not meet the eligibility criteria, 15 studies were reviewed intensively. 30 . Patients were recruited from primary clinics, tertiary hospitals and community settings.…”

Actionable Self-Monitoring of Blood Glucose: Redefining the Role for Patients Using Multiple Daily Injection Therapy

“…Teaching patients about carbohydrate counting via a mobile phone has been shown to reduce hemoglobin A1c levels similar to that achieved by "traditional" structured patient education programs but requires significantly less health care provider resource. 28 In a meta-analysis assessing the impact of mobile phone interventions on glycemic control, Liang and colleagues 29 assessed 22 studies involving more than 1600 participants and reported that this type of intervention led to a reduction in hemoglobin A1c of the order of 0.5% and that mobile phone interventions are especially valuable for patients with type 2 diabetes.…”

A mobile feedback system for integrated E-health platforms to improve self-care and compliance of diabetes mellitus patients

“…There are existing mobile feedback solutions for diabetes patients, such as the DID by Rossi et al [6], yet they are not platform based and thus isolated solutions. METABO is meant to be much more integrative.…”