Feasibility of a mobile phone-based data service for functional insulin treatment of type 1 diabetes mellitus patients

Background: Patients with type 1 diabetes mellitus (DM1) have to be active participants in their treatment because they are inevitably responsible for their own day-to-day-care. Availability of mobile Internet access is advancing rapidly and mobile phones are now widely available at low cost. Thus, mobile phones have the potential to assist in daily diabetes management and to enable a telemedical interaction between patients and health care professionals. Objective: The aim of the study was to evaluate the feasibility and user acceptance of a mobile phone-based data service to assist DM1 patients on intensive insulin treatment. Methods: A software application called Diab-Memory (based on Java 2 Mobile Edition) has been developed to support patients when entering diabetes-related data with synchronization to the remote database at the monitoring center. The data were then processed to generate statistics and trends, which were provided for the patient and his/her health care professional via a Web portal. The system has been evaluated in the course of a clinical before-after pilot trial. Outcome measures focused on patients' adherence to the therapy, availability of the monitoring system, and the effects on metabolic status. General user acceptance of the system was evaluated using a questionnaire. Results: Ten patients (four female) with DM1 participated in the trial. Mean age was 36.6 years (+/- 11.0 years) and prestudy glycated hemoglobin (HbA(1c) was 7.9% (+/- 1.1%). A total of 3850 log-ins were registered during the 3 months of the study. The total number of received datasets was 13003, which equates to an average of 14 transmitted parameters per patient per day. The service was well accepted by the patients (no dropouts), and data transmission via mobile phone was successful on the first attempt in 96.5% of cases. Upon completion of the study, a statistically significant improvement in metabolic control was observed (HbA(1c) : prestudy 7.9% +/- 1.1% versus poststudy 7.5% +/- 0.9%; P=.02). While there was a slight decrease in average blood glucose level (prestudy 141.8 mg/dL +/- 22.5 mg/dL vs poststudy 141.2 mg/dL +/- 23.1 mg/dL; P=.69), the difference was not statistically significant. Conclusion: The results of the clinical pilot trial indicate that this proposed diabetes management system was well accepted by the patients and practical for daily usage. Thus, using the mobile phone as patient terminal seems to provide a ubiquitous, easy-to-use, and cost efficient solution for patient-centered data acquisition in the management of DM1. To confirm the promising results of the pilot trial further research has to be done to study long-term effects on glycemic control and cost-effectiveness.