Effectiveness of mobile and internet intervention in patients with obese type 2 diabetes

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Abstract

Purpose

The present study evaluated whether an intervention using the SMS by personal cellular phone and internet would improve the levels of plasma glucose of obese type 2 diabetes at 3, 6, 9, and 12 months.

Methods

This is a quasi-experimental design with pre- and follow-up tests. Participants were recruited from the endocrinology outpatient department of tertiary care hospital located in an urban city of South Korea. Eighteen patients were randomly assigned to an intervention group and 16 to a control group. The goal of the intervention was to decrease body weight and keep blood glucose concentrations close to the normal range. Patients were requested to record their blood glucose level in a weekly diary on the website by personal cellular phones or computer internet. The researcher sent optimal recommendations to each patient, by both the cellular phone and the Internet weekly. The intervention was applied for 1 year.

Results

Glycosylated hemoglobin (HbA1c) decreased 1.22 percentage points at 3 months, 1.09 percentage points at 6 months, 1.47 percentage points at 9 months, and 1.49 percentage points at 12 months compared with baseline in the intervention group (all time points, p < 0.05). The percentage change in the control group was, however, not significant. Patients in the intervention group had a decrease of 2-h post-prandial test (2HPPT) of 120.1 mg/dl at 3 months, 58.9 mg/dl at 6 months, 62.0 mg/dl at 9 months, and 102.9 mg/dl at 12 months compared with baseline (all time points, p < 0.05). The mean change in the control group was, however, not significant.

Conclusion

This web-based intervention using SMS of personal cellular phone and Internet improved HbA1c and 2HPPT at 3, 6, 9, and 12 months in patients with obese type 2 diabetes.

Introduction

The majority of type 2 diabetic patients are non-obese in Korea, which is in contrast to Caucasians but similar to those of other Asian countries. Thirty-five percent of Korean type 2 diabetic patients have a body mass index (BMI) of 25 kg/m2 or above [1]. However BMI is the most determining factor for the insulin resistance in type 2 diabetic patients in Korea [2]. It is conceivable that Koreans with a BMI > 23 kg/m2 have a body composition whose percentage body fat is comparable to Causians with BMI > 25 kg/m2. This explains the associated increased risk for insulin resistance in this patient group [2]. Obesity complicates the management of type 2 diabetes by increasing insulin resistance and blood glucose concentrations [3].

Diabetes care is facilitated by the patient engaging in a self management program with the advice and counsel of physicians and allied health professionals [4]. More than most chronic diseases, diabetes often requires behavioral and medication changes supported by frequent feedback and support from care providers [5].

Recently, the Internet has established itself as a worldwide communication system that allows a person to contact other people anywhere at any time and exchange information on line. Patients are accessing medical content on the Internet with increasing frequency [6]. Fifty-four percent of the 512 patients who returned the survey stated that they used the Internet for medical information. And sixty percent felt that the information on the Internet was the “same as” or “better than” information from their doctors [6].

Kwon et al. demonstrated the effects of web-based interventions that provide an interactive component and its short-term effects over three months in patients with diabetes [7]. In our previous study [8], we introduced an Internet-based intervention and its short-term effects over 6 months for obese type 2 diabetes. No study has been made to test the direct efficacy of the Internet-based system on controlling plasma glucose levels in people with obese type 2 diabetes for 1 year.

The present study evaluated whether an intervention using the SMS by personal cellular phone and internet would improve the levels of plasma glucose of obese type 2 diabetes at 3, 6, 9, and 12 months for longer term effects.

Section snippets

Study design

This is a quasi-experimental design with pre- and follow-up tests for 12 months. Participants were recruited from the endocrinology outpatient department of tertiary care hospital located in an urban city of South Korea. The hospital is a university-affiliated medical center that has 800 beds.

Outcome measures

Before the intervention, demographic variables, glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and 2-h post-prandial test (2HPPT) were measured as pre-test data. The HbA1c, FPG, and 2HPPT

Samples’ characteristics

The researcher sent optimal recommendations to each patient in the intervention group weekly. The researcher spent 5 min per week to send the optimal recommendations to each intervention patient. The characteristics of the intervention and control group are shown in Table 1. The mean age of the control group was 48.5 years and that of intervention group was 45.5 years. Slightly more than half (56.2%) of the individuals were women in the control group, half (50.0%) of the intervention group were

Discussion

Obesity is one most important risk factor for Koreans with type 2 diabetes. The relative risks for diabetes mellitus in those with a BMI ≥ 23 kg/m2 were higher than those with a BMI < 23 kg/m2 [10]. The number of insulin-resistant patients with a BMI above 23 kg/m2 sharply increased. In Korea, an increasing BMI is directly related to insulin resistance and type 2 diabetes, even in non-obese subjects [2].

In this study, we evaluated whether an intervention using the SMS by personal cellular phone and

Acknowledgements

This work was supported by the Korea Research Grant funded by the Korean Government (MOEHRD) (KRF-2005-015- E00232).

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