A short message service by cellular phone in type 2 diabetic patients for 12 months
Introduction
In Korea, the prevalence of diabetes mellitus is reached to 8–10% nowadays, and more than 95% of patients with diabetes belong to the type 2 diabetes mellitus group [1]. Many Korean people with diabetes do not effectively adhere to health care regimens including self-monitoring of blood glucose and therapeutic life-style changes, except for attending a physician several times per year [2].
Control of hyperglycaemia may prevent, reduce or retard the risks of diabetic chronic complications [3], [4]. All the interventions for tight glycemic control have been shown to reduce the risk of retinopathy, neuropathy, and nephropathy [5]. On the basis of those findings, the American Diabetes Association (ADA) has recommended that all individuals with diabetes should attempt to achieve near-normalisation of blood glucose levels [6].
Algorithms to achieve near-normalisation of blood glucose levels exist but may be complex and difficult for physicians to follow, to induce the patient's load and stress, lack of public education systems and time constraints. In addition, economic and technical barriers to providing the appropriate guidelines for the physician and diabetic patients in the community health system are recognised [7], [8]. Therefore, various alternatives have been studied such as systems for computerised decision support [9], [10], monitoring of lifestyle and compliance to the medication [11] and provided telephone advices [12], [13].
The Internet has established itself as a worldwide communication system that allows a person to contact other people – anywhere, at any time – and to exchange information online. In the website, patients with diabetes could find numerous online education, exercise and nutrition programs. Most of the Internet disease-management programs for diabetes evolved from focusing on emotional support, which provided more information to engage the patients and allowing self-management and counselling [14], [15]. So, whenever patients with diabetes want to contact their healthcare providers, the patients can reach to them at the real time and acquire the information using the Internet. However, a few computer-based or electronic-management systems have been reported to improve diabetes care [16], [17].
South Korea is one of the most developed countries in the fields of Internet networking. Nearly all families have their own computers and cellular phones and can access the Internet via modem or high-speed network systems. In our previous study, we introduced short-term effects of an Internet-based intervention for type 2 diabetes [18], [19] and its glycemic control effects in patients with obese type 2 diabetes [20], [21].
The present study evaluated whether an Internet-based intervention system and a short message service (SMS) using cellular phones could improve glycosylated haemoglobin (HbA1c) levels, fasting plasma glucose (FPG) levels and 2 h post-meal glucose (2HPMG) levels in patients with type 2 diabetes for 12 months.
Section snippets
Study design
A control group, pre-test/post-test, design was used in this study. Participants were recruited from the endocrinology outpatient department of a tertiary care hospital that was located in an urban city of South Korea. The hospital is a university-affiliated medical centre that has 800 beds.
Participants
The data were collected from January 2003 to August 2006. Diabetes was diagnosed according to the ADA criteria [22]. The selection criteria required that participants should be able to perform blood glucose
Results
The characteristics of the control and intervention group are shown in Table 1. The mean age of the control group was 47.5 years and that of the intervention group was 46.8 years. The mean BMI of the control group was 23.4 kg/m2 and that of the intervention group was 24.5 kg/m2. The mean duration of diabetes was 8.0 years in the control group and 5.2 years in the intervention group. There was no significant difference in age, sex, BMI, duration of diabetes, diabetes medication, blood pressure,
Discussion
New models of diabetes management systems using an Internet and cellular phone communication tool might be the one of the best cost-effective tool to improve the quality of care for patients with diabetes. This would enable patients with diabetes to communicate with physicians and nurses online at any time. This system would include the ability to ask questions and to receive a suitable recommendation from a physician or nurse at the appropriate time. The system would allow close communication
Conflict of interest
There are no financial and personal relationships with other people or organisations that could inappropriately influence (bias) in our work, all within 3 years of beginning the work submitted.
There are no conflicts of interest in our study.
Acknowledgements
This work was supported by grants from the Seoul R&BD Program (2006-10829).
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