A short message service by cellular phone in type 2 diabetic patients for 12 months

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Abstract

Objective

Investigate the effectiveness of an educational intervention that used both the cellular phone with a short messaging service (SMS) and the Internet on the glycemic control of the patients with type 2 diabetes mellitus.

Methods

Twenty-five patients were randomly assigned to an intervention group and twenty-six to a control group. The intervention was applied for 12 months. The goal of the intervention was to keep blood glucose concentrations close to the normal range (HbA1c < 7%). Patients in the intervention group were asked to access a website by using a cellular phone or to wiring the Internet and input their blood glucose levels weekly. Participants were sent the optimal recommendations by both cellular phone and the Internet weekly.

Results

Participants in the intervention group had lower HbA1c over 12 months when compared with the control group. At 12 months the change from baseline in HbA1c was −1.32 in the intervention group versus +0.81 in the control group. Two hours post-meal glucose (2HPMG) had a significantly greater decline in the intervention group after 12 months when compared with the control group (−100.0 versus +18.1 mg/dl).

Conclusion

This educational intervention using the Internet and a SMS by cellular phone rapidly improved and stably maintained the glycemic control of the patients with type 2 diabetes mellitus.

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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