In a yearlong study, researchers from the department of epidemiology and public health at the University of Maryland school of medicine in Baltimore found that patients who had access to the mobile system for treatment and behavioral coaching were able to lower their glycated hemoglobin (A1c)--a measure of long-term blood glucose control--significantly more than those who only received care during occasional doctor visits and through self-management. This was true regardless of how high the patient's A1c level was at the start of the study.
The research team, supported by disease management application developer WellDoc, health insurer CareFirst BlueCross BlueShield of Maryland, medical device manufacturer LifeScan, and telecommunications company Sprint, reported their findings in an article published in the September issue of the journal Diabetes Care.
"To our knowledge, this is the first cluster-randomized study of a mobile diabetes-coaching intervention conducted in a community setting over a one-year treatment period. Few previous studies of electronic or mobile communication interventions for diabetes were randomized, included a control group, or covered one year," the Maryland epidemiologists wrote.
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The researchers tracked 163 patients with type 2 diabetes at 26 primary care practices across Maryland over a one-year period. All were covered by commercial insurance. Patients were divided into four groups: a control group with traditional, office-based care; a group given WellDoc coaching and a secure Web portal so they could communicate with their physicians; a group with the WellDoc system whose doctors could see patient self-entered data; and a group whose physicians had clinical decision support that linked data to standards of care and evidence-based care guidelines.
All patients were supplied with LifeScan's One Touch Ultra 2 glucose meters. Those in the three study groups also received mobile phones with service and data plans, plus the WellDoc mobile diabetes management software that delivered more than 1,000 self-management messages, as specified by an algorithm that considered such factors as blood-glucose levels, medications, and carbohydrate consumption. The Web portal included personal health records for reporting diabetes-related information such as test results and whether the patients had had regular foot and eye exams.
Patients could communicate by phone or secure portal with diabetes educators acting as "virtual case managers," though they were encouraged to choose electronic messaging. Patients received an "action plan" through the portal every 2.5 months that helped with self-management and served as clinical summaries prior to doctor visits.
The researchers found that the group whose doctors had access to clinical decision support saw their A1c levels decline by 1.9 percentage points, while patients in the control group had a median reduction of just 0.7 points. The control group saw improvements simply from having proper education, according to the study. The Maryland team cited earlier studies showing that merely 55% of people with type 2 diabetes received diabetes education and that only 16% followed recommended self-management regimens.
However, there were no "convincing" changes in other indicators of diabetes control, including blurred vision, pain, depression, and worrisome blood pressure and lipid readings. The researchers recommended that follow-up studies look at how mobile technologies can affect behaviors related to medication adherence, physical activity, and patient-physician communications.
"These may be important mechanisms to explain change in glycated hemoglobin but were not primary or secondary analyses planned for this study. Future studies of mobile health should address more specific characterization of patient and provider behaviors that support change in clinical health parameters," the article said.
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