The purpose of this review was to evaluate the contribution of cell phone interventions in the control and management of diabetes. In this review, most studies provided standard diabetes care utilizing face-to-face communication during clinic visits. In addition, the intervention group participants received care through cell phones using one or more of their functional aspects (e.g., SMS, voice mail, Internet, or email). Cell phones were used as a management tool to enable information to flow between patients and providers. In a chronic disease such as diabetes, maintaining blood sugar levels and related clinical and physiological measurements to acceptable levels requires monitoring and management through regular self-care behaviors. In some studies, cell phones and text messaging facilitated regular treatment advice and support in between clinic visits. In other studies, cell phones and text messaging proved to be good tools to deliver regular alerts and reminders to achieve desired goals. Nine out of 10 studies that used cell phone technology and measured hemoglobin A1c showed significant decreases in hemoglobin A1c values. Results of our study indicate that educational interventions providing personalized advice and support delivered through a cell phone can help avoid diabetes symptoms by providing timely treatment adjustments and can lead to improved health outcomes.
The concept of using interactive voice mail messages to deliver information or education in disease management and control is not new.37
Computer and communication technology-based education and support are becoming vital components of quality diabetes care.38
Diabetes education and diabetes management support through automated telephone reminders and support have been shown to increase knowledge, increase frequency of self-care behaviors among persons with diabetes, and improve health outcomes for patients who need regular care and monitoring and self-care management.39
Because monitoring and support from a health care provider play important roles in achieving the desired clinical goals, the use of cell phones, especially text messaging, is a step further in achieving the health and quality of life for persons with diabetes. Using cell phones and text messaging offers great opportunities to improve patient self-management by facilitating education, monitoring, and feedback between scheduled clinic visits. The ubiquitous nature of cell phones provides the mobility and flexibility so that care can be provided wherever a patient may be.40
A potential implication of this is licensure issues if a health care provider is licensed in one state and the patient is receiving treatment in another state. As more and more people own cell phones, text messaging may even provide cost-effective alternatives to regular phone communication when combined with other methods of education and support.41,42
Unfortunately, only one study in this review provided information on the costs of running the system.32
Results of this systematic review should be interpreted with limitations in mind. The studies did not provide the reliability and validity of the information that patients entered into the cell phones; however, two studies provided examples of how a automated system could be programmed to check if the value entered was within a predefined range.16,17
The heterogeneity of the studies prevented a meta-analysis, which could have allowed for a quantitative assessment. We attempted to search comprehensively; however, we may have unknowingly left out some work that was eligible for inclusion. Regardless, the benefits offered or limitations involved in the use of cell phones in diabetes care are estimated to be the same.