Building Competency in Diabetes Education THE ESSENTIALS

2-42 | CHAPTER 2

The Role of Technology in SMS With the recognition that contact time is a factor, more innovative methods are being used to educate and support our patients for long-term behaviour change. Technology interventions have been used effectively in many ways to support self-management behaviours. Telephone follow-up has proven to be cost-effective and clinically relevant for reducing a patient’s A1C (68,103,104,119,136,137). Other “consumer-facing” technologies, such as chat rooms, webinars, social media sites, eHealth media and a multitude of ‘apps’ for nutrition counselling, structured BG testing, and weight loss, have all proven to be of some benefit (105,138-141). Studies looking at text messaging, the use of the Internet and web-based applications have demonstrated improvement in A1C and increased motivation.

As suggested by one author, “when compared to face-to-face interaction and knowledge-based methods, alone, interactive media technologies that incorporate a specific theoretical base in their design are a more comprehensive and influential method of influencing people” (142).

However, we need to be vigilant as to the usability and real benefit technology can provide (143). The question we need to consider is: Are we confusing our patients with data overload? Are we integrating the technology into practice to augment our care or are we using it in lieu of contact? A recent review by the Agency for Healthcare Research and Quality (AHRQ) estimated that there were over 318,000 mobile health applications available with 16% of these directed to diabetes. Of these, the agency found only 11 apps which they felt had been properly evaluated (144). They reported that the majority of the apps are used for BG monitoring, tracking A1C, medications, physical activity and weight. Only two apps for type 1 diabetes and three for type 2 diabetes actually showed a reduction in the A1C when they were used for two to 12 months. Of interest, two apps showed benefit to the user in reducing hypoglycemia episodes in type 1 diabetes (144). Unfortunately, the use of the apps did not show any significant improvement in quality of life, blood pressure, weight or body mass index (BMI) (144). They conclude that “some apps for diabetes self-management may improve outcomes in the short-term, however, the effect cannot be distinguished from the concomitant effect of additional support from a health-care provider” (144). Holmen in her systematic review looking at apps for tailored feedback between patients and providers, also concluded that there were too few studies of high enough quality to prove the effectiveness of the apps (144).