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Smartphone Role in Type 2 Diabetes Self-Management

The 2010 factsheet by the Centers for Disease Control (CDC) reveals that 10.9 million Americans of 65 years and above are suffering from type 2 diabetes mellitus. The same report estimates that in 2010, some 79 million Americans over the age of 20 years have pre-diabetes (Centers for Disease Control and Prevention, 2011).

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Diabetes complications can be very costly to be managed as diabetic patients incur more than twice the medical expenses non-diabetic patients need. Eonta et al (2011) contend that smartphones can be used in searching for valuable health information and educational materials on the management of diabetes. The current scholarly paper is an attempt of examining the role of smartphones in type 2 diabetes mellitus self-management.

The dramatic rise in the number of individuals living with type 2 diabetes coupled with the escalation in the cost of managing this chronic condition shows that primary care practices are overwhelmed by the demand for diabetes services. Much of the diabetes management takes place outside the healthcare facilities, but still, patients are increasingly reliant on healthcare providers for support and counseling. Due to limitations in reimbursement and staffing exercise, counseling patients on diet and other crucial self-management behaviors rarely get accomplished as part of the routine primary care (King et al. 2012).

Research indicates that the use of in-person interventions may enhance biological and behavioral outcomes although it is still unclear whether the use of technology would help minimize the associated high cost without reducing their effectiveness. However, the use of well-designed patient-centered e-health technologies would be useful in promoting the dissemination and improving patients’ access to efficient and effective self-management programs.

Estimates by the American Diabetes Association revealed that the United States is faced with an annual economic burden to be spent on managing diabetes mellitus, which amounts to $ 174 billion (American Diabetes Association 2008). Further, the American Diabetes Association has advocated for the use of seven self-care behaviors that persons with diabetes mellitus need to practice to attain integrated management of this chronic condition.

One of these self-care behaviors is the periodic self-monitoring of the patient’s blood glucose levels. Bresnick (2012) has noted that patients’ self-monitoring of blood glucose levels was linked to crucially important improvements in glycemic control among patients with type 2 diabetes mellitus.

Data management tools are important since they facilitate in logging self-management blood glucose data, thereby enabling healthcare providers to easily recommend the most appropriate exercise, diet, as well as medication interventions. The final objective of data management is effective to facilitate the management of a patient’s diabetes conditions, controlling or minimizing glycated hemoglobin as well as delaying or preventing the complications that normally accompany it.

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In a study conducted by Azar and Gabbay (2009), the researchers noted that those patients who shared self-management blood glucose data with their healthcare providers via Web-based tools, such as smartphones, both reduced the long-term costs of managing the chronic conditions and saved time as well.

Moreover, patients with type 2 diabetes mellitus demonstrated significant improvements in their HbA1c levels, unlike those with type 1diabates. Patients were supposed to log in to their accounts and upload their self-management results. Thereafter, healthcare providers would respond to the patients through text messages, via the internet, or their mobile phones (Bergenstal, 2005).

A regression trial study by Sevick et al (2008) revealed that the use of self-management blood glucose aided by a portable digital assistant (PDA) was both promising and useful in the management of diabetes mellitus. Forjuoh et al (2008) revealed that even as the use of PDA-assisted care was quite challenging, nonetheless, it resulted in a significant reduction in HbA1c. Azar and Gabbay (2009) discovered that patients who shared their self-management blood glucose data via the internet or mobile phones, along with the resultant feedback via in-person appointments, email, or text led to a decline in the number of hospitalizations while at the same time improving glycemic control.

Furthermore, the adoption of any kind of technology is reliant on the associated learning curve of the software or gadget, along with its underlying architectural and technical design (Årsand, Tatara & Hartvigsen, 2011). For instance, diabetes patients suffering from vision problems could find it hard to operate the mini-keyboard interface used in most smartphones.

Notwithstanding that, the push for the application of smartphone-based solutions in the self-management of type 2 diabetes gains prominence from a demographic point of view. Currently, the larger majority of individuals who own and use smartphones are between 25 and 44 years old (Nielsen Wire 2009).

These statistics are further supported by a factsheet released by the Centers for Disease Control and Prevention (2008) showing that individuals between 40 and 59 years of age have a higher chance (50%) of being diagnosed with diabetes for the first time. If we consider diabetes-risk and smartphone-using demographics remain constant, it means that majority of the current smartphone users are likely candidates for diabetes mellitus in the next decade.

Research findings by several quantitative studies reveal that the use of smartphones could be a valuable strategy in enabling type 2 diabetes patients to manage the condition. Arsand and Demiris (2008) have underscored the importance of mobile phone-based self-management of type 2 diabetes mellitus, have argued that in such endeavors, the patient ought to be an active player.

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The researchers further revealed that the use of mobile phone-based self-management of type 2 diabetes results in enhanced lipids and glycemic control, not to mention improvements in lifestyle and self-care behaviors due to increased physical activity and improved dietary habits.

Based on the foregoing arguments, Arsand and Demiris (2008) contended that the use of mobile phones in the self-management of type 2 diabetes mellitus would result in a minimization of the overall risk for type 2 diabetes complications, such as a reduction in the prevalence of metabolic syndrome and absolute risk for coronary heart diseases. Type 2 diabetes mellitus requires sustainable and sufficient patient-initiated self-management (Piette, 2007).

On the other hand, it is not unusual to have poor adherence to type 2 diabetes mellitus (Sabaté, 2003). Therefore, several researchers considered the use of mobile phones a promising intervention strategy in supporting self-management of type 2 diabetes mellitus due to their ubiquity and pervasiveness (Blake 2008). The emergence of smartphones has led to a dramatic increase in the number of free as well as commercial self-management tools for type 2 diabetes mellitus (Chomutare et al., 2011).

The rapid increase in lifestyle-related conditions, such as type 2 diabetes mellitus, has seen many players designing tailored and low-cost information and communication technology (ICT) tools to aid in disease management as well as lifestyle changes. There is ample evidence in the literature to show that there is a growing importance to using an electronic tool in the management of type 2 diabetes mellitus, along with enhanced disease-related outcomes. Between 2001 and 2008, there had been a rise in publications on the use of mobile self-help tools, especially in the management of type 2 diabetes.

A study conducted by the University of Maryland revealed that mobile phone technology applications could result in tremendous improvements in control of blood sugar by type 2 diabetes mellitus patients (Quinn et al 2011). The researchers revealed that the use of an interactive computer software program mounted onto a mobile phone resulted in a 1.9 percent reduction in hemoglobin A1C levels over the 1 year period that the patients were monitored. Hemoglobin A1C is an important indicator of blood glucose control. The A1C test is a useful indicator of the average everyday blood glucose levels of a patient spread across 2-3 months.

According to the American Diabetes Association, an individual should ideally have an A1C level of below 7 percent. The majority of Americans diagnosed with type 2 diabetes report an average A1C level of 9 percent. Considering that this level of A1C increases the risk of the patients developing diabetes-related complications, we can then should value the crucial role of mobile phone applications in the management of type 2 diabetes mellitus.

The kind of technology applied in the study by Quinn et al (2011) along with other related works indicates the growing application of information and communication technologies (for example, mobile phones, the internet, as well as Bluetooth) is not only tracking, but also facilitating the transmission of blood glucose results to adult patients diagnosed with type 2 diabetes mellitus.

In the past, patient education programs have played a crucial role in reducing type-2 diabetes-related complications. However, it is important to note that not many individuals with type 2 diabetes mellitus were able to attend structured or formal education programs where they could learn more on how to take care of themselves, using self-management strategies. A better application of smartphone technology could give benefits to individuals with type 2 diabetes mellitus as far as self-management is concerned.

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The California-based Palo Alto Medical Foundation conducted a randomized control trial and revealed that individuals proven hard to control type 2 diabetes benefited enormously from an online disease management program that entailed the use of a smartphone and a wireless blood glucose tool (Bresnick, 2012).

Some 415 patients took part in this trial that was conducted for slightly over a year. Of the 415 patients taking part in the trial, 193 of them were beneficiaries of a wireless home glucometer implemented in a smartphone where it related to the patient’s diabetes readings. This enabled patients to see the diabetes information online. Moreover, the device also allowed them to view valuable information on diabetes management, such as blood pressure, insulin management, and tips on diet, weight control, and exercise, among others.

In addition, nurse managers and dieticians also made regular contact with the test group via secure messaging. On the other hand, participants benefitted from regular updates regarding the progress they were making. After six months, the researchers noted a significant improvement in the participants in their control of glycosylated hemoglobin levels as compared with the control group. Within 12 months, the overall A1C levels of the participants have significantly decreased.

The prevalence and incidence of Type 2 diabetes mellitus are increasing very fast, and this is putting a lot of strain on the existing primary healthcare providers (Boutati & Raptis 2009). As such, it would be worth embracing technology in the self-management of type 2 diabetes mellitus as a way of increasing adherence to the treatment regimens and also reducing the associated costs. Over the past several years, we have witnessed that such technologies as computers and mobile phones are not only educating the patients about the condition but also helping them monitor their glucose levels.

Several meta-analysis studies that have been conducted on this topic reveal that the use of smartphones allows patients to view important information on diabetes management, including insulin management, blood pressure, weight control, diet tips, as well as exercise. They also get important feedback from healthcare providers. The studies have also shown that such patients tend to have improved glycemic control and glycosylated hemoglobin levels as compared with the control group.

Reference List

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Arsand, E., & Demiris, G. (2008). User-centered methods for designing patient-centric self-help tools. Inform Health Soc Care, 33(3),158-69.

Årsand, E., Tatara, N., & Hartvigsen, G. (2011). Wireless Mobile Technologies Improving Diabetes Self-Management. Handbook of Research on Mobility and Computing: Information Science Reference, 136-156.

Azar, M., & Gabbay R. (2009). Web-based management of diabetes through glucose uploads: has the time come for telemedicine? Diabetes Res Clin Pract., 83(1), 9 -17.

Bergenstal, R. M., Anderson, R. L., Bina, D. M., Johnson, M. L., Davidson, J. L., Solarz Johnson, B., & Kendall, D. M. (2005). Impact of modem-transferred blood glucose data on clinician work efficiency and patient glycemic control. Diabetes Technol Ther., 7(2),241–247.

Blake, H. (2008). Mobile phone technology in chronic disease management. Nurs Stand., 23(12),43-46.

Boutati, E., & Raptis, S. (2009). Self-monitoring of blood glucose as part of integral care of type 2 diabetes. Diabetes Care, 32(2), 205-210.

Bresnick, J. (2012). Type 2 diabetics benefit from smartphone disease management. Web.

Centers for Disease Control and Prevention. (2008). National diabetes fact sheet: general information and national estimates on diabetes in the United States 2007. Atlanta: U.S. Department of Health and Human Services Centers for Disease Control and Prevention.

Centers for Disease Control and Prevention. (2011). National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention.

Chomutare, T., Fernandez-Luque, L., Arsand, E., & Hartvigsen, G. (2011). Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res., 13(3), e65.

Eonta, A., Christon, L., Houriga, S., Ravinran, N., Vrana, S. & Southam-Gerow (2011). Using everyday technology to enhance evidence-based treatments. Professional Psychology:Research and Practice, 42(6), 513-520.

Forjuoh, S. N., & Reis, M. D., Couchman, G. R., & Ory, M. G. (2008). Improving diabetes self-care with a PDA in ambulatory care. Telemed J E Health, 14(3),273-279.

King, D. K., Toobert, D. J., Portz, J. D., Stycker, L. A., Doty, A., Martin, C., Boggs, J. M., Faber, A. J., Geno, C. R., & Glasgow, R. E. (2012). What patients want: relevant health information technology for diabetes self-management. Health and Technology, 2(3), 147-157.

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Piette, J. D. (2007). Interactive behavior change technology to support diabetes self management: where do we stand? Diabetes Care, 30(10), 2425-2432.

Quinn, C. C., Shartdell, M. D., Terrin, M. L., Barr, E. A., Ballew, S. H., & Gruber-Baldini, L. (2011). Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control. Diabetes Care, 34(9), 1934-42.

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Sevick, M. A., Zickmund, S., Korytkowski, M., Piraino, B., Sereika, S., Mihalko, S., Snetselaar, L., Stumbo, P., Hausmann, L., Ren, D., Marsh, R., Sakraida, T., Gibson, J., Safaien, M., Starrett, T. J., & Burke, L. E. (2008). Design, feasibility, and acceptability of an intervention using personal digital assistant-based self monitoring in managing type 2 diabetes. Contemp Clin Trials. 29(3),396–409.

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