The Role of Mobile Phones in Adolescent T1DM: A Review of the Literature
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UNCORRECTED PROOF 1 2 The Role of Mobile Phones in Adolescent T1DM: A 3 Review of the Literature 1 4 Brittany Q1 Barnaba BS ⁎ , Mary S. Burr MS, CPNP 5 University of Maryland School of Nursing, Baltimore, MD 6 7 Adolescents with type 1 diabetes mellitus (T1DM) often 8 struggle with the requirements of diabetes management and 9 treatment regimen adherence, leading to poor glycemic control 10 and self-management (Kovacs, Goldston, Obrosky, and 11 Iyengar, 1992; Rausch et al., 2012). Many interventions have 12 been proposed to help adolescents improve glycemic control 13 and self-management, but despite these interventions, optimal 14 control continues to be a challenge. Over the past decade, the 15 use of mobile phones to improve diabetes management among 16 adolescents has come to the forefront. More than three fourths of 17 teens have cell phones, almost half of which are smartphones 18 (Madden, Lenhart, Duggan, Cortesi, and Gasser, 2013). The 19 majority of teens have some type of mobile app on their phone, 20 and almost 90% use their phones to send and receive text 21 messages (Lenhart, Ling, Campbell, and Purcell, 2010; 22 Madden, Lenhart, Cortesi, and Gasser, 2013). With mobile 23 phone use becoming so widespread and common among 24 adolescents, mobile-phone-based interventions (MPBIs) could 25 address some of the challenges adolescents with T1DM face on 26 a daily basis. The purpose of this article is to review the literature 27 on MPBIs in adolescents with T1DM and determine their 28 efficacy in improving glycemic control and self-management. 29 Glycemic Control 30 Three studies found MPBIs to have a positive impact on 31 glycemic control, as demonstrated by a statistically significant 32 decrease in HbA1C (Carroll, Dimeglio, Stein, and Marrero, 33 2011; Franklin, Waller, Pagliari, and Greene, 2006; Rami, 34 Popow, Horn, Waldhoer, and Schober, 2006), though Franklin 35 et al. (2006) found an improvement only in adolescents 36 receiving insulin via an intensified regimen. The remaining 37 38 39 40 41 three articles included in the review found no statistically 42 significant changes in HbA1C (Cafazzo, Casselman, 43 Hamming, Katzman, and Palmert, 2012; Froisland, Arsand, 44 and Skarderud, 2012; Hanauer, Wentzell, Laffel, and 45 Laffel, 2009). 46 Self-Management 47 Although studies of adolescents using mobile phones for 48 diabetes management showed an increase in the frequency of 49 blood glucose monitoring (Cafazzo et al., 2012) and improved 50 adherence (Franklin et al., 2006), results were not consistent 51 (Cafazzo et al., 2012). Improved self-efficacy and feelings of 52 support, applied knowledge, and self-management as a whole 53 were also demonstrated (Carroll et al., 2011; Franklin et al., 54 2006; Froisland et al., 2012). 55 Participant Engagement 56 Two studies demonstrated difficulty engaging and 57 sustaining participants in the interventions (Hanauer et al., 58 2009; Rami et al., 2006). Rami et al. (2006) saw that about 59 one-fourth of the participants fail to send sufficient data. 60 Hanauer et al. (2009) demonstrated great difficulty with 61 participant engagement, as adherence to the intervention 62 steadily decreased over the course of the 3-month study, and 1 The Pediatric Endocrinology Nursing Society (PENS) is committed to the development and advancement of nurses in the art and science of pediatric endocrinology nursing and to improve the care of all children with endocrine disorders through the education of the pediatric healthcare community. To aid in achieving that goal, the purpose of the PENS department is to provide up-to-date reviews of topics relevant to the PENS membership and to the general readership of the Journal of Pediatric Nursing. ⁎ Corresponding author. E-mail address: [email protected]. Column Editor: Terri H. Lipman PhD, CRNP, FAAN http://dx.doi.org/10.1016/j.pedn.2014.04.009 0882-5963/© 2014 Published by Elsevier Inc. Journal of Pediatric Nursing (2014) xx, xxx–xxx YJPDN-01148; No of Pages 3
Transcript of The Role of Mobile Phones in Adolescent T1DM: A Review of the Literature
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Journal of Pediatric Nursing (2014) xx, xxx–xxx
YJPDN-01148; No of Pages 3
The Role of Mobile Phones in Adolescent T1DM: AReview of the Literature1
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Brittany Barnaba BS⁎, Mary S. Burr MS, CPNP
University of Maryland School of Nursing, Baltimore, MD
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RECAdolescents with type 1 diabetes mellitus (T1DM) oftenstruggle with the requirements of diabetes management andtreatment regimen adherence, leading to poor glycemic controland self-management (Kovacs, Goldston, Obrosky, andIyengar, 1992; Rausch et al., 2012). Many interventions havebeen proposed to help adolescents improve glycemic controland self-management, but despite these interventions, optimalcontrol continues to be a challenge. Over the past decade, theuse of mobile phones to improve diabetes management amongadolescents has come to the forefront.More than three fourths ofteens have cell phones, almost half of which are smartphones(Madden, Lenhart, Duggan, Cortesi, and Gasser, 2013). Themajority of teens have some type of mobile app on their phone,and almost 90% use their phones to send and receive textmessages (Lenhart, Ling, Campbell, and Purcell, 2010;Madden, Lenhart, Cortesi, and Gasser, 2013). With mobilephone use becoming so widespread and common amongadolescents, mobile-phone-based interventions (MPBIs) couldaddress some of the challenges adolescents with T1DM face ona daily basis. The purpose of this article is to review the literatureon MPBIs in adolescents with T1DM and determine theirefficacy in improving glycemic control and self-management.
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1 The Pediatric Endocrinology Nursing Society (PENS) is committed tothe development and advancement of nurses in the art and science ofpediatric endocrinology nursing and to improve the care of all children
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Three studies found MPBIs to have a positive impact onglycemic control, as demonstrated by a statistically significantdecrease in HbA1C (Carroll, Dimeglio, Stein, and Marrero,2011; Franklin, Waller, Pagliari, and Greene, 2006; Rami,Popow, Horn,Waldhoer, and Schober, 2006), though Franklinet al. (2006) found an improvement only in adolescentsreceiving insulin via an intensified regimen. The remaining
with endocrine disorders through the education of the pediatric healthcarecommunity. To aid in achieving that goal, the purpose of the PENSdepartment is to provide up-to-date reviews of topics relevant to thePENS membership and to the general readership of the Journal of
⁎ Corresponding author.E-mail address: [email protected].
Column Editor: Terri H. Lipman PhD, CRNP, FAANhttp://dx.doi.org/10.1016/j.pedn.2014.04.0090882-5963/© 2014 Published by Elsevier Inc.
OOthree articles included in the review found no statistically
significant changes in HbA1C (Cafazzo, Casselman,Hamming, Katzman, and Palmert, 2012; Froisland, Arsand,and Skarderud, 2012; Hanauer, Wentzell, Laffel, andLaffel, 2009).
ED PSelf-Management
Although studies of adolescents using mobile phones fordiabetes management showed an increase in the frequency ofblood glucose monitoring (Cafazzo et al., 2012) and improvedadherence (Franklin et al., 2006), results were not consistent(Cafazzo et al., 2012). Improved self-efficacy and feelings ofsupport, applied knowledge, and self-management as a wholewere also demonstrated (Carroll et al., 2011; Franklin et al.,2006; Froisland et al., 2012).
Participant Engagement
Two studies demonstrated difficulty engaging andsustaining participants in the interventions (Hanauer et al.,2009; Rami et al., 2006). Rami et al. (2006) saw that aboutone-fourth of the participants fail to send sufficient data.Hanauer et al. (2009) demonstrated great difficulty withparticipant engagement, as adherence to the interventionsteadily decreased over the course of the 3-month study, and
Pediatric Nursing.
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at completion, only five of the initial 22 participants (23%)still submitted blood glucose levels. Almost 20% of theparticipants in the text message intervention were considerednon-users who never submitted any blood glucose levels.
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Discussion
The results of this review show that MPBIs may play abeneficial role. Even though HbA1C was shown todecrease in only three studies, none showed HbA1C tosignificantly increase while using the interventions stud-ied. This suggests that, even if MPBIs do not conclusivelyimprove glycemic control in adolescents, they maymitigate the typical increase in HbA1C that is commonduring adolescence.
There is evidence that the method of mobile interventionplays a role in the impact on glycemic control. Two of thethree studies that demonstrated decreased HbA1C utilized anintervention where participants' blood glucose levels weresent directly to providers, who then sent advice via textmessage to make adjustments to the management regimen(Carroll et al., 2011; Rami et al., 2006). There was alsoevidence that simply reminding adolescents to check theirblood glucose levels had no impact on glycemic control(Froisland et al., 2012; Hanauer et al., 2009). These findingssuggest that highly interactive, supportive interventions maybe more effective.
Baseline participant characteristics may also play a role inthe effectiveness of the mobile intervention. Neither of thetwo studies that worked with older adolescents (averageage ≥ 16 years) showed improved glycemic control(Froisland et al., 2012; Hanauer et al., 2009). The averageage in the studies that showed decreased HbA1C was lessthan 16 years (Franklin et al., 2006; Rami et al., 2006),suggesting that younger adolescents may respond better toMPBIs. Baseline HbA1C may also be a determinant in howwell mobile interventions impact glycemic control. In two ofthe three studies with an average baseline HbA1C greater than9%, diabetes control was improved (Franklin et al., 2006;Rami et al., 2006). Therefore, poorer glycemic control maylead to increased effectiveness of MPBIs (Carroll et al., 2011).
The self-management concepts investigated varied ineach study. As with glycemic control, there is evidence thatthe method of intervention impacts self-management.Franklin et al. (2006) used daily text message reminders tomonitor blood glucose levels and found improved adherenceamong participants. A study that did not use text messagereminders did not find improved adherence (Cafazzo et al.,2012). It is worth noting that of five studies that showedimprovement in self-management, only two also showedimprovement in glycemic control (Carroll et al., 2011;Franklin et al., 2006). Further investigation is needed todetermine if this improvement in self-management improveslong-term glycemic control.
Participant engagement and retention in research isessential when interpreting results. Age and baselineHbA1C varied across the studies that showed no problemswith engagement and those that did. Interventions thatrequired adolescents to actively send information to asystem/provider were likely to have problems with engage-ment (Hanauer et al., 2009; Rami et al., 2006). Studies whereinformation exchange was automatic and required no extradaily work by the adolescent (Carroll et al., 2011; Franklinet al., 2006) had no apparent problems with participantengagement and intervention use, suggesting mobile inter-ventions that require minimal effort may achieve higherlevels of use and engagement.
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OImplications for Practice
Although the results of this review showed that MPBIscan improve glycemic control and self-management inadolescents with T1DM, there was not sufficient evidencefor the immediate implementation of any one system. Whilemany studies presented in this article did show benefits to thevarious MPBIs, the results were based mostly on small, non-randomized, uncontrolled trials. Large-scale, randomizedcontrolled trials are needed to improve the strength of theevidence and provide support for implementation.
Further research into MPBIs for T1DM must beconducted to better understand the best use of the technologyin adolescent populations. Many intervention methods werefound during this review, though no comparison acrossmethods was made. Such a comparison would identify themost successful method. The current research suggests thatmobile interventions may work better for some adolescentswith T1DM than others, so additional analysis of the impactthat age and baseline diabetes control have on theeffectiveness of the mobile interventions is needed. Theissues with participant engagement must also be addressedbefore implementation in the general population.
This review of the current literature found MPBIs to havepromise in improving outcomes for adolescents with T1DM,but more research is necessary before definitive conclusionscan be made. More research is needed to better understandhow teens use technology so interventions that best meet themanagement needs and desires of adolescents with T1DMcan be developed and tested.
ReferencesCafazzo, J., Casselman,M., Hamming, N., Katzman, D., & Palmert,M. (2012).
Design of an mHealth app for the self-management of adolescent type 1diabetes: A pilot study. Journal of Medical Internet Research, 14, e70,http://dx.doi.org/10.2196/jmir.2058.
Carroll, A., Dimeglio, L., Stein, S., & Marrero, D. (2011). Contracting andmonitoring relationships for adolescents with type 1 diabetes: A pilotstudy.Diabetes Technol Ther, 13, 543–549, http://dx.doi.org/10.1089/dia.2010.0181.
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Franklin, V. L., Waller, A. A., Pagliari, C. C., & Greene, S. A. (2006). Arandomized controlled trial of Sweet Talk, a text-messaging system tosupport young people with diabetes. Diabet Med, 23, 1332–1338,http://dx.doi.org/10.1111/j.1464-5491.2006.01989.x.
Froisland, D., Arsand, E., & Skarderud, F. (2012). Improving diabetes care foryoung peoplewith type 1 diabetes through visual learning onmobile phones:Mixed-methods study. Journal of Medical Internet Research, 14, 113–125.
Hanauer, D., Wentzell, K., Laffel, N., & Laffel, L. (2009). Computerizedautomated reminder diabetes system (CARDS): E-mail and SMS cellphone text messaging reminders to support diabetes management.Diabetes Technol Ther, 11, 99–106.
Kovacs, M., Goldston, D., Obrosky, D., & Iyengar, S. (1992). Prevalenceand predictors of pervasive noncompliance with medical treatmentamong youths with insulin-dependent diabetes mellitus. Journal of theAmerican Academy of Child and Adolescent Psychiatry, 31, 1112–1119.
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Lenhart, A., Ling, R., Campbell, S., & Purcell, K. (2010). Teens and mobilephones. Pew Internet & American Life Project.
Madden, M., Lenhart, A., Cortesi, S., & Gasser, U. (2013). Teens andmobile apps privacy. Pew Internet and American Life Project.
Madden, M., Lenhart, A., Duggan, M., Cortesi, S., & Gasser, U.(2013). Teens and technology 2013. Pew Internet & AmericanLife Project.
Rami, B., Popow, C., Horn, W., Waldhoer, T., & Schober, E. (2006).Telemedical support to improve glycemic control in adolescents withtype 1 diabetes mellitus. European Journal of Pediatrics, 165,701–705, http://dx.doi.org/10.1007/s00431-006-0156-6.
Rausch, J., Hood, K., Delamater, A., Shroff Pendley, J., Rohan, J., Reeves,G., et al. (2012). Changes in treatment adherence and glycemic controlduring the transition to adolescence in type 1 diabetes. Diabetes Care,35, 1219–1224.
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