Ohio Nurse - June 2021

Page 20 Ohio Nurse June 2021
The Role of Technology and the Improvement of Compliance
with Diabetes Mellitus
Arica Jones
BSN, RN (MSN student, Troy University)
ajones175666@troy.edu
Reprinted with permission from
Alabama Nurse May 2021 issue
Scholarly, peer-reviewed articles and studies
published within the past five years were examined
to determine the current state of technology
for diabetes, as well as its effectiveness. The
research found that the combination of modern
technology and education has a profound effect
on glycemic control and is very promising for
improving the overall health of patients. Studies
have heavily incorporated cell phone usage and
mobile applications to enhance patient health
by encouraging personal involvement in their
care, which could ultimately lead to better patient
outcomes.
Dobson, R., Carter, K., Cutfield, R., Hulme, A.,
Hulme, R., McNamara, C., Maddison, R., Murphy,
R., Shepherd, M., Strydom, J., & Whittaker, R.
(2015). Diabetes text-message self-management
support program (SMS4BG): A pilot study. JMIR
Mhealth Uhealth, 3(1), 32. https://doi.org/10.2196/
mhealth.3988
Dobson et al. conducted a nonrandomized
pilot study designed to
implement a mobile health intervention
to control glycemic issues among the
population in Auckland, New Zealand. Fortytwo
consenting participants, with type 1 or
type 2 diabetes, participated over a threemonth
period. The self-management support
for blood glucose (SMS4BG) program was
created to offer mobile health solutions for
the complications of poor glycemic control.
In this study, poorly controlled diabetes
was defined as having a hemoglobin A1c of
8.6% or greater. Inclusion criteria included
possessing a mobile phone, being ages
17-69, and being able to read English. The
participants were referred from healthcare
providers at primary healthcare practices,
secondary care hospitals, and a community-
based organization.
The study affirmed that mobile health
would be beneficial to diabetes management
due to the high percentage of the
population that own a mobile device. The
study consisted of modules that could be
customized by the participant. They could
receive anywhere from 30 text messages
to 461 text messages during the study.
The core module sent two text messages
per month and covered topics such as
diabetes education and stress management.
Participants could also choose to receive
additional information, such as smoking
cessation tips and glucose check reminders.
Thirty-four of the 42 participants opted into
the glucose reminders, which ranged in
frequency from once per week to four times
per day. The glucose reminder messages
allowed participants to reply with their blood
glucose levels, which were then displayed on
a graph for tracking over time.
Thirty-nine of the 42 subjects participated
in the post-study follow-up. A telephone
interview showed that 100% of participants
felt the program was useful, and 97% stated
they would recommend the program to
others. The study resulted in an average
improvement of hemoglobin A1c to 7.1%.
Although this study consisted of a small
sample size, it is still beneficial due to its
patient satisfaction rating and overall patient
outcome.
Garg, S. K., Shah, V. N., Akturk, H. K., Beatson,
C., & Snell-Bergeon, J. K. (2017). Role of mobile
technology to improve diabetes care in adults with
type 1 diabetes: The remote-T1D study iBGStar®
in type 1 diabetes management. Diabetes Therapy,
8(4), 811-819. https://doi.org/10.1007/s13300-017-
0272-5
Garg et al. conducted a study to
determine if mobile technology could lower
the hemoglobin A1c in people with type 1
diabetes. The particular device that was
used in this study was the iBGStar®, which
is a blood glucose meter. This device is
unique because it attaches to a smartphone
and is able to report data directly to the
physician. This device can also be used in
conjunction with the Diabetes Manager app,
which enables it to function as a personal
glucometer. Garg et al. also assessed the
fear of hypoglycemia before and after the
study through a participant questionnaire.
The study was conducted over a six-month
period as a stratified block randomization
that consisted of 100 participants who were
divided into two groups: a control group and
an intervention group. The control group
was given an Accu-Chek Nano® meter,
while the intervention group was provided
with the iBGStar®, an iPhone, and the
Diabetes Manager app. Additionally, all of the
participants were provided with a Dexcom
Seven Plus CGM sensor. All participants
were educated on the use of their assigned
device and glucose logbooks. They were
instructed to check their blood glucose levels
at least three times per day during this sixmonth
period, and they were not allowed to
use their own CGMs or take acetaminophen,
as this would alter the analysis. The
intervention group’s device was set up to
send an alert to the patient’s provider if the
blood glucose level was below 60 or above
300 at any time.
The results of the study were measured
after three months and six months. Although
both groups showed a decrease in their
hemoglobin A1c, there was a substantial
decrease among the intervention group at
the six-month assessment. Garg et al. also
reassessed the fear of hypoglycemia at the
end of the study, but they saw no significant
difference between the initial scores and
the final ones. Over 85% of the participants
in the intervention group were pleased with
the iBGStar® apparatus. They found it to
be more convenient and user friendly than
traditional devices. This study shows how
mobile technology can improve compliance
among those with diabetes. A great deal of
non-compliance comes from not checking
blood glucose levels. This study implemented
routine checks of blood glucose levels, which
made the participants more conscientious of
their results. This, in turn, can promote the
start of healthy behaviors.
Gunawardena, K. C., Jackson, R., Robinett,
I., Dhaniska, L., Jayamanne, S., Kalpani, S.,
& Muthukuda, D. (2019). The influence of the
smart glucose manager mobile application on
diabetes management. Journal of Diabetes
Science and Technology, 13(1), 75-81. https://doi.
org/10.1177/1932296818804522
This randomized controlled study focused
on the population of Sri Lanka and its
prevalence of diabetes mellitus. The country
has seen a 13% increase in cell phone usage
among the population over the last five
years. This prompted Gunawardena et al. to
implement their innovative, technology-based
study to determine if a smartphone app could
positively impact those with diabetes. The
focus of the smart glucose manager (SMG)
app was to provide consistent feedback,
which was believed to have a profound effect
on lowering hemoglobin A1c. The features of
the app included daily reminders to perform
glucose checks, to administer insulin and
other medications, to eat, and to exercise.
The highlights of the app were the abilities
for users to store blood glucose levels to be
graphed over time and to receive feedback
from medical professionals.
The study consisted of 67 participants
between the ages of 18 and 80 years old
with a hemoglobin A1c of 8.0% or higher who
also possessed an Android phone. Exclusion
criteria included those who were pregnant,
on dialysis, had cognitive impairment, or with
steroid-induced diabetes. All participants
had their A1c and BMI checked after three
months and six months. The control group
consisted of 32 participants who were
encouraged to continue their daily diabetes
management routine. The intervention group
comprised 35 individuals with access to the
SMG app.
The study was deemed successful as both
groups showed a significant decrease in
A1c during the first three months. However,
only the intervention group continued to
show a reduction in A1c beyond that. This
study is beneficial because it shows the
positive effects of technology on the selfmanagement
of diabetes.
Hou, C., Carter, B., Hewitt, J., Francisa, T., &
Mayor, S. (2016). Do mobile phone applications
improve glycemic control (HbA1c) in the selfmanagement
of diabetes? A systematic review,
meta-analysis, and GRADE of 14 randomized
trials. Diabetes Care, 39(11), 2089-2095. https://
doi.org/10.2337/dc16-0346
The purpose of this study was to
determine if smartphone applications could
successfully lower and control hemoglobin
A1c and improve the self-management of
diabetes. Hou et al. reviewed 14 previous
studies that included 1,360 total participants.
The 14 studies were selected from five
databases using the keywords cellphones,
mobile applications, and diabetes mellitus.
The search was narrowed further to only
include those studies whose participants
were over the age of 18, had type 1 or type 2
diabetes, and did not already use an app for
diabetes management. Four of the studies
comprised 509 individuals and examined
type 1 diabetes, while the remainder focused
on type 2 diabetes in 851 people. A total of
12 apps were reviewed in the study: three
of which were used for type 1 diabetes, and