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. 2009 Nov;3(6):1460–1471. doi: 10.1177/193229680900300628

Table 4.

Health-Related Outcomes in Studies Using Cell Phones and Wireless Devices

Study detailsa Intervention Outcome measures Health outcomes resultsb Downs and Black scorec
Franklin et al.49 Scotland I RCT N = 92; assessment of SweetTalk, a text-messaging support system to improve self-efficacy and adherence to intensive insulin therapy for youth (10–15 years) with T1DM

  • HbA1c

  • Series of validated psychological measures: self-efficacy for diabetes, diabetes knowledge score, and diabetes social support interview

  • + HbA1c for patients allocated to intensive therapy and SweetTalk (p < .001)

  • ↔ HbA1c levels for conventional insulin therapy with or without SweetTalk

  • + Improved self-efficacy and self-reported adherence

  • + Diabetes self-management

 25
Benhamou et al.50 France I RCT N = 30; randomized crossover trial of telecare for adults with T1DM under continuous subcutaneous insulin infusion, cell phone for transmission of retrospective data, and SMS for immediate feedback

  • Assessment of metabolic efficacy

  • Safety (low blood glucose episodes < 70 mg/dl)

  • Quality of life

  • Adherence to performing SMBG

  • ↔ HbA1c (p < .10) and mean blood glucose values (p = .06) during 6-month SMS sequence, compared to no-SMS period

  • ↔ Safety issues (hypoglycemia and glucose variability)

  • ↔ Adherence to SMBG

  • + Diabetes quality of life global score and diabetes quality of life satisfaction with life subscale during SMS period

 23
Leu et al.51 USA I RCT N = 42; T1DM and T2DM; effectiveness of a two-way pager for management of diabetes through medication, blood glucose testing reminders, and exercise reinforcement

  • HbA1c levels (primary)

  • Blood pressure (secondary)

  • Patient attitudes and adherence to treatment plans via survey

  • ↔ HbA1c did not reach targeted goals of study

  • + More patients in pager group were normotensive and felt care was better at end of study

  • + 79% of participants enjoyed using pager and 68% desired to continue using system

 23
Kim and Jeong45 South Korea I RCT N = 51; diabetes management via nurse SMS by cellular phone and Internet for T2DM patients

  • HbA1c levels (pretest and 3 and 6 months)

  • 2 h postmeal glucose levels

  • + HbA1c (decreased at 3 and 6 months for intervention group)

  • + 2 HPMGd (decrease at 3 and 6 months for intervention group)

  • ↔ Fasting plasma glucose (between the two groups or over time)

 22
Kim and Kim46 South Korea I RCT N = 34; T2DM; decrease body weight and improve fasting plasma glucose levels through researcher recommendations via cell phone/SMS and Internet (Web site)

  • HbA1c levels

  • 2 h postprandial test

  • Measurements taken at 3, 6, 9, and 12 months

  • + HbA1c (decreased for intervention group at all time points, p < .05)

  • + HPPTd improved (decrease for intervention group at all time points, p < .05)

 22
Yoon and Kim47 South Korea I RCT N = 51; educational intervention using cellular phone with SMS and Internet for glycemic control (HbA1c < 7%) in patients with T2DM

  • Measures at pretest and 3, 6, 9, and 12 months:

  • HbA1c

  • Fasting plasma glucose

  • 2 HPMGd

  • Total cholesterol

  • Triglycerides

  • HDL-C

  • + HbA1c for intervention group, all time points (p < .05)

  • ↔ Fasting plasma glucose levels did not differ significantly between groups or over time

  • + 2 HPMGd for intervention group (p < .05)

  • ↔ Total cholesterol, triglycerides, and HDL-C did not differ significantly between two groups over time

 22
Kim48 South Korea I RCT N = 51; T2DM; weekly blood glucose based optimal recommendations via SMS

  • Group 1 <7% pre-post Group 2 ≥7%

  • HbA1c

  • Fasting plasma glucose

  • 2 HPMGd

  • + HbA1c (for patients with baseline < 7.0%, controls) showed good control, mean percentage change 0.43 (6.71% pretest to 7.14% post-test, p = .034)

  • ↔ HbA1c for intervention no change

  • ↔ Fasting plasma glucose: patients with baseline HbA1c <7.0% (intervention) pretest to posttest

  • + 2 HPGd: patients with baseline HbA1c <7.0% (intervention) improved

  • ↔ Control group showed no significant change

 21
Kumar et al.52USA I RCT N = 40; wireless, portable diabetes management system for youth with T1DM and T2DM; feasibility of system assessed in addition to clinical outcomes

  • HbA1c (baseline and 3 months)

  • Frequency of entering insulin dosage and carbohydrate data

  • Diabetes knowledge survey

  • Feasibility and use of the system

  • − Frequency of hyperglycemia (game group)

  • + HbA1c maintenance (game group)

  • + Number of transmitted blood glucose values (78% game group, 68% control group)

  • ↔ Insulin dosing and carbohydrate intake frequency (entered into PDA database)

  • + Median carbohydrate intake lower for game group

  • + Diabetes knowledge survey, improved knowledge scores (game group, p < .005; control group, p = .09)

  • + Satisfaction with technologies: glucose monitor with infrared data transmission and PDA software (youth and parents)

 21
Quinn et al.53 USA I RCT (pilot) N = 30; T2DM; impact on HbA1c levels via cell-phone-based diabetes management software system (Web-based data analytics and therapy optimization tools); examine health care provider adherence to prescribing guidelines and assessed health care provider's adoption of the technology

  • HbA1c levels

  • Summary of diabetes self-care activities questionnaire

  • + HbA1c for intervention group (p < .02)

  • + 84% of intervention patients had medications modified (titrated) by providers, compared to controls (p = .002)

  • + Physicians reported that the WellDoc system facilitated treatment decisions, reduced time to review logbooks, and organized data well

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a

Study details are listed according to level of evidence and in order of quality assessment score (Downs and Black). Study levels: I = RCT; II = cohort; III = case control; IV = case series.

b

↔ indicates no difference in health outcomes; + indicates improvements in health outcomes; and - indicates decline in health outcomes.

c

Downs and Black score ranges were given corresponding quality levels: excellent (26–28) and good (20–25). Studies that scored either in the fair (15–19) or poor (≤14) ranges were excluded, except where it was the only available evidence.

d

HPG - 2-hour plasma glucose, HPMG - 2-hour post-meal glucose, HPPT - 2-hour post-prandial test