Korean Diabetes J.  2009 Jun;33(3):232-240. 10.4093/kdj.2009.33.3.232.

The Effect of Cellular Phone-Based Telemedicine on Glycemic Control in Type 2 Diabetes Patients Using Insulin Therapy

• Lee YJ
• Jeong MH
• Kim JH
• Park J
• Kim HY
• Seo JA
• Kim SG
• Kim NH
• Choi KM
• Baik SH
• Choi DS

• KMID: 2222423
• DOI: http://doi.org/10.4093/kdj.2009.33.3.232

Abstract

BACKGROUND
Cellular phones are extremely prevalent in modern society and they enable appropriate feedback mechanisms through real time monitoring and short message services regarding blood glucose levels. We investigated whether cellular phone-based telemedicine support system could improve blood glucose control in type 2 diabetes patients who were in inadequate glycemic control regardless of insulin therapy. METHODS: A randomized, controlled clinical trial was conducted involving 74 type 2 diabetic patients with suboptimal glycemic control (HbA1c levels > 7%) regardless of insulin therapy. The intervention (cellular phone-based telemedicine) group managed their blood glucose using a cellular phone for 3 months, while the control (self monitoring of blood glucose) group managed their blood glucose with a standard glucometer for the same period. RESULTS: Three months later, HbA1c levels were decreased in both groups. However, the decrease in the control group from 8.37% to 8.20% was only 0.20% (P = 0.152) which was not significant. In contrast, the intervention group had a significant reduction of 0.61% from 8.77% to 8.16% (P < 0.001). Moreover, among patients with a baseline > or = 8%, the patients in the intervention group showed a significant reduction of 0.81% from 9.16% to 8.34% (P < 0.001). CONCLUSION: HbA1c levels were significantly decreased in the cellular phone-based telemedicine group compared with the control group after 3 months. This study suggests that cellular phone-based telemedicine is helpful for better glucose control in type 2 diabetes patients who previously were unable to control glucose levels adequately with insulin therapy.

Keyword

Cellular phone; Diabetes mellitus; Telemedicine

MeSH Terms

Blood Glucose
Cellular Phone
Diabetes Mellitus
Glucose
Humans
Insulin
Telemedicine
Blood Glucose
Glucose
Insulin

Reference

1. DCCT research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin dependent diabetes mellitus. New Engl J Med. 1989. 329:977–986.

2. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and the risk of complication in patients with type 2 diabetes (UKPD33). Lancet. 1988. 352:837–853.

3. Writing Team for the DCCT/Epidemiology of Diabetes Interventions and Complications Research Group. Effect of intensive therapy on the microvascular complications of type 1 diabetes mellitus. JAMA. 2002. 287:2563–2569.

4. Ohkubo Y, Kishikawa H, Araki E, Miyata T, Isami S, Motoyoshi S, Kojima Y, Furuyoshi N, Shichiri M. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995. 28:103–117.

5. Funnell MM, Haas LB. National Standards for Diabetes Self-Management Education Programs. Diabetes Care. 1995. 18:100–116.

6. National Standards for Diabetes Self-Management Education Programs and American Diabetes Association review criteria. Diabetes Care. 1995. 18:737–741.

7. King H, Aubert RE, Herman WH. Global burden of diabetes, 1995-2025: prevalence, numerical estimates, and projections. Diabetes Care. 1998. 21:1414–1431.

8. Boyle JP, Honeycutt AA, Narayan KM, Hoerger TJ, Geiss LS, Chen H, Thompson TJ. Projection of diabetes burden through 2050: impact of changing demography and disease prevalence in the U.S. Diabetes Care. 2001. 24:1936–1940.

9. Dunstan DW, Zimmet PZ, Welborn TA, De Courten MP, Cameron AJ, Sicree RA, Dwyer T, Colagiuri S, Jolley D, Knuiman M, Atkins R, Shaw JE. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care. 2002. 25:829–834.

10. Kim JS, Kim YJ, Park SI, Hong YP. Mean fasting blood glucose level and an estimated prevalence of diabetes mellitus among a representative adult Korea population. Korean J Prev Med. 1993. 26:311–320.

11. Shin CS, Kim HK, Kim WB, Park KS, Kim SY, Cho BY, Lee HK, Koh CS, Kim YI, Shin YS, Park HY, Oh TK, Park YS, Yang BK. Incidence of diabetes mellitus in Yonchon county, Korea. J Korean Diabetes Assoc. 1996. 30:87–95.

12. Levetan CS, Dawn KR, Robbins DC, Ratner RE. Impact of computer-generated personalized goals on HbA1c. Diabetes Care. 2002. 25:2–8.

13. Smith SA, Murphy ME, Huschka TR, Dinneen SF, Gorman CA, Zimmerman BR, Rizza RA, Naessens JM. Impact of a diabetes electronic management system on the care of patients seen in a subspecialty diabetes Clinic. Diabetes Care. 1998. 21:972–976.

14. Cho JH, Lee HC, Lim DJ, Kwon HS, Yoon KH. Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes : as effective as an Internet-based glucose monitoring system. J Telemed Telecare. 2009. 15:77–82.

15. Kwon HS, Cho JH, Kim HS, Song BR, Ko SH, Lee JM, Kim SR, Chang SA, Cha BY, Lee KW, Son HY, Lee JH, Lee WC, Yoon KH. Establishment of blood glucose monitoring system using the internet. Diabetes Care. 2004. 27:478–483.

16. Starren J, Hripcsak G, Sengupta S, Abbruscato CR, Knudson PE, Weinstock RS, Shea S. Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) project: technical implementation. J Am Med Inform Assoc. 2002. 9:25–36.

17. Shea S, Starren J, Weinstock RS, Knudson PE, Teresi J, Holmes D, Palmas W, Field L, Goland R, Tuck C, Hripcsak G, Capps L, Liss D. Columbia University's Informatics for Diabetes Education and Telemedicine (IDEATel) Project: rationale and design. J Am Med Inform Assoc. 2002. 9:49–62.

18. Farmer AJ, Gibson OJ, Dudley C, Bryden K, Hayton PM, Tarassenko L, Neil A. A randomized controlled trial of the effect of real-time telemedicine support on glycemic control in young adults with type 1 diabetes (ISRCTN 46889446). Diabetes Care. 2005. 28:2697–2702.

19. Montori VM, Helgemoe PK, Guyatt GH, Dean DS, Leung TW, Smith SA, Kudva YC. Telecare for patients with type 1 diabetes and inadequate glycemic control: a randomized controlled trial and meta-analysis. Diabetes Care. 2004. 27:1088–1094.

20. Gomez EJ, Hernando ME, Garcia A, Del Pozo F, Cermeno J, Corcoy R, Brugues E, De Leiva A. Telemedicine as a tool for intensive management of diabetes: the DIABTel experience. Comput Methods Programs Biomed. 2002. 69:163–177.

21. Yoon KH, Kim HS. A short message service by celluar phone in type 2 diabetic patients for 12 months. Diabetes Res Clin Pract. 2008. 79:256–261.