A 3-Month Randomized Controlled Pilot Trial of a Patient-Centered, Computer-Based Self-Monitoring System for the Care of Type 2 Diabetes Mellitus and Hypertension

This study was performed to evaluate the effects of a patient-centered, tablet computer-based self-monitoring system for chronic disease care. A 3-month randomized controlled pilot trial was conducted to compare the use of a computer-based self-monitoring system in disease self-care (intervention group; n = 33) with a conventional self-monitoring method (control group; n = 30) in patients with type 2 diabetes mellitus and/or hypertension. The system was equipped with a 2-in-1 blood glucose and blood pressure monitor, a reminder feature, and video-based educational materials for the care of the two chronic diseases. The control patients were given only the 2-in-1 monitor for self-monitoring. The outcomes reported here included the glycated hemoglobin (HbA1c) level, fasting blood glucose level, systolic blood pressure, diastolic blood pressure, chronic disease knowledge, and frequency of self-monitoring. The data were collected at baseline and at 1-, 2-, and 3-month follow-up visits. The patients in the intervention group had a significant decrease in mean systolic blood pressure from baseline to 1 month (p < 0.001) and from baseline to 3 months (p = 0.043) compared with the control group. Significant improvements in the mean diastolic blood pressure were seen in the intervention group compared with the control group after 1 month (p < 0.001) and after 2 months (p = 0.028), but the change was not significant after 3 months. No significant differences were observed between the groups in the fasting blood glucose level, the HbA1c level, or chronic disease knowledge. The frequency of self-monitoring of blood glucose level and blood pressure was similar in both groups. The performances of the tablet computer-assisted and conventional disease self-monitoring appear to be useful to support/maintain blood pressure and diabetes control. The beneficial effects of the use of electronic self-care resources and support provided via mobile technologies require further confirmation in longer-term, larger trials.

[1]  Ernest L Carter,et al.  A patient-centric, provider-assisted diabetes telehealth self-management intervention for urban minorities. , 2011, Perspectives in health information management.

[2]  Rong-Rong Chen,et al.  Developing a Web 2.0 Diabetes Care Support System with Evaluation from Care Provider Perspectives , 2012, Journal of Medical Systems.

[3]  Elif Derya Übeyli.  Medical Informatics: A Model Developed for Diabetes Education Via Telemedicine , 2008, Journal of Medical Systems.

[4]  Russell E. Glasgow,et al.  Twelve-month outcomes of an Internet-based diabetes self-management support program. , 2012, Patient education and counseling.

[5]  Margus Viigimaa,et al.  Daily usage and efficiency of remote home monitoring in hypertensive patients over a one-year period , 2005, Journal of telemedicine and telecare.

[6]  Richard J. Holden,et al.  Human Factors and ergonomics of health information technology implementation , 2012 .

[7]  Patricia Flatley Brennan,et al.  Factors affecting home care patients' acceptance of a web-based interactive self-management technology , 2011, J. Am. Medical Informatics Assoc..

[8]  G. Paré,et al.  Clinical Effects of Home Telemonitoring in the Context of Diabetes, Asthma, Heart Failure and Hypertension: A Systematic Review , 2010, Journal of medical Internet research.

[9]  Sakib Jalil,et al.  A Meta-Synthesis of Behavioral Outcomes from Telemedicine Clinical Trials for Type 2 Diabetes and the Clinical User-Experience Evaluation (CUE) , 2015, Journal of Medical Systems.

[10]  Robert M Hamer,et al.  Last observation carried forward versus mixed models in the analysis of psychiatric clinical trials. , 2009, The American journal of psychiatry.

[11]  Lionel Tarassenko,et al.  Using a mobile health application to support self-management in COPD: a qualitative study. , 2014, The British journal of general practice : the journal of the Royal College of General Practitioners.

[12]  Ben-Tzion Karsh,et al.  Review Paper: A Systematic Review of Patient Acceptance of Consumer Health Information Technology , 2009, J. Am. Medical Informatics Assoc..

[13]  C. Lloyd,et al.  Modification and validation of the Revised Diabetes Knowledge Scale , 2010, Diabetic medicine : a journal of the British Diabetic Association.

[14]  Heather J Ross,et al.  Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial , 2012, Journal of medical Internet research.

[15]  Richard J McManus,et al.  Telemonitoring and self-management in the control of hypertension (TASMINH2): a randomised controlled trial , 2010, The Lancet.

[16]  Siamak Noorbaloochi,et al.  Validation of Screening Questions for Limited Health Literacy in a Large VA Outpatient Population , 2008, Journal of General Internal Medicine.

[17]  Calvin K. L. Or,et al.  The Influence of Computer Experience and Screen Size on Use Performance and Perceptions of a Tablet-Based Chronic Illness Self-Management System for Older Adults , 2014 .

[18]  Fiona Simpson,et al.  Randomization and allocation concealment: a practical guide for researchers. , 2005, Journal of critical care.

[19]  Da Tao,et al.  Effects of Self-Management Health Information Technology on Glycaemic Control for Patients with Diabetes: A Meta-Analysis of Randomized Controlled Trials , 2013 .

[20]  J. Polisena,et al.  Home telehealth for diabetes management: a systematic review and meta‐analysis , 2009, Diabetes, obesity & metabolism.

[21]  Gianfranco Parati,et al.  Clinical usefulness and cost effectiveness of home blood pressure telemonitoring: meta-analysis of randomized controlled studies , 2013, Journal of hypertension.

[22]  T. Bodenheimer,et al.  Patient self-management of chronic disease in primary care. , 2002, JAMA.

[23]  Aviva Zyskind,et al.  Exploring the use of computer based patient education resources to enable diabetic patients from underserved populations to self-manage their disease , 2009, Inf. Serv. Use.

[24]  J Biehn,et al.  Patients' knowledge of hypertension. , 1984, Canadian family physician Medecin de famille canadien.

[25]  Joseph A Cafazzo,et al.  MOBILE PHONE-BASED REMOTE PATIENT MONITORING IMPROVES HEART FAILURE MANAGEMENT AND OUTCOMES: A RANDOMIZED CONTROLLED TRIAL , 2011 .

[26]  Da Tao,et al.  Does the use of consumer health information technology improve outcomes in the patient self-management of diabetes? A meta-analysis and narrative review of randomized controlled trials , 2014, Int. J. Medical Informatics.

[27]  Valarie Blue Bird Jernigan,et al.  Online Diabetes Self-Management Program , 2010, Diabetes Care.

[28]  Da Tao,et al.  Usability Study of a Computer-Based Self-Management System for Older Adults with Chronic Diseases , 2012, JMIR research protocols.

[29]  J. Chiasson,et al.  The use of information technology for the management of intensive insulin therapy in type 1 diabetes mellitus. , 2003, Diabetes & metabolism.

[30]  Susan S. Woods,et al.  Barriers and drivers of health information technology use for the elderly, chronically ill, and underserved. , 2008, Evidence report/technology assessment.

[31]  A. Pentland,et al.  The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. , 2004, Diabetes technology & therapeutics.

[32]  Tugrul U. Daim,et al.  Determining Patient Preferences for Remote Monitoring , 2012, Journal of Medical Systems.

[33]  Fabrizio Bert,et al.  Smartphones and Health Promotion: A Review of the Evidence , 2013, Journal of Medical Systems.

[34]  Irl B Hirsch,et al.  Web-based collaborative care for type 1 diabetes: a pilot randomized trial. , 2009, Diabetes technology & therapeutics.

[35]  Rupa S. Valdez,et al.  Human factors and ergonomics in home care: Current concerns and future considerations for health information technology. , 2009, Work.