Title: Teaching diabetes self-management 'basic survival skills'

From the September ACP Internist, copyright © 2012 by the American College of Physicians


By Stacey Butterfield

There’s a cost-efficient, effective treatment for diabetes that is significantly underused in the United States today, both in and outside of the hospital.


“We know that it can dramatically improve hemoglobin A1c. In fact, the reduction shown in meta-analysis is far greater than what’s required to approve a drug by the FDA,” endocrinologist and ACP Member Robert Gabbay, MD, PhD, told attendees at the American Diabetes Association (ADA) annual meeting, held in Philadelphia in June.

Dr. Gabbay, who is director of the Penn State Hershey Diabetes Institute in Pennsylvania, was talking about diabetes self-management education, an intervention that can range from the basics of how to test blood sugar to assistance with reshaping a whole diet and lifestyle.


Teaching diabetes on the phone


A room, a desk, a book—these are the typical tools of education. But the latest in diabetes self-management education requires none of these accoutrements.


“Cell phones are emerging as a fantastic platform for personal health and wellness applications,” Lena Mamykina, PhD, assistant professor of biomedical informatics at Columbia University in New York, told American Diabetes Association meeting attendees.


To help manage diabetes, today’s smartphones can keep records (of blood glucose measurements or food consumed, for example) input by the patient, or even track data on their own, such as sensing movement when a person is exercising. They can also provide social support and communication.


The last of these was the focus of a recent study led by Dr. Mamykina. A group of diabetic patients under age 65 were enrolled in in-person diabetes education classes and given smartphones. Using the phones, they were encouraged to send data frequently to a diabetes educator, including blood glucose results (measured and transmitted via a Bluetooth attachment) and meals (photographed or described in e-mail or voice notes).


The educator remotely provided advice to the patients, on what might be a good choice for breakfast, for example, and answered specific questions. After five months, the researchers compared the smartphone patients to a group that had received only the diabetes education classes.


The smartphone group was significantly more likely to think that diabetes was theirs to control (as opposed to having an external locus of control). “When they had a chance to very clearly see how their behaviors impact their glucose readings, it put them more in a position of asserting themselves and taking responsibility,” said Dr. Mamykina. “Interestingly, the quality of life [for those patients] went down...The fact that you are in charge of your health is not always a very positive discovery.”

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