Effect of a Ten-Week Short Message Service-Based Intervention on Self-Management of Type-2 Diabetes Patients in Bali, Indonesia

Abstract

Background: Diabetes mellitus is a chronic disease that may pose serious complications if poorly managed. The application of mobile technology (m-health) ranging from simple to more complex programs in diabetes management has the potential to foster patients’ active involvement in their care. However, the evidence of m-health effectiveness on the self-management of type-2 diabetes patients in low- and middle-income countries is still mixed.Purpose: To evaluate the effect of a ten-week short message system (SMS)-based intervention (Tweek SMSDM) on self-management of type-2 diabetes patients.Methods: A quasi-experimental study was performed in two groups. The intervention group (n=30) received additional daily automated messages to enhance their diabetic self-care practice, while the control group (n=30) continued to follow the standard program only. Pre- and post-intervention data were measured in both groups using the Indonesian version of the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire. T-test, Mann-Whitney, Wilcoxon Signed-Ranks, McNemar and Fisher exact tests were carried out to analyze the data.Results: After ten weeks, the intervention group showed significant mean changes in the domains of general diet (0.42±1.08; p=0.034), specific diet (1.75±1.42; p=0.0001), exercise (1.02±1.85; p=0.005), blood-glucose testing (0.53±1.67; p=0.009), and foot care (4.75±2.51; p=0.001) before and after the intervention, while the control group did not. This study also found significant differences in the mean scores for each domain of the SDSCA between the intervention and the control groups (p<0.05).Conclusion: The Tweek SMSDM program can improve the self-management of type-2 diabetes patients and positively affect each domain in the SDSCA. The findings of this study recommend that nurses integrate the program into patient treatment regimes in primary healthcare centers; therefore, patients and their significant others can play more proactive roles in their diabetic care.

A Meta-Analysis of the Effectiveness of Telemedicine in Glycemic Management among Patients with Type 2 Diabetes in Primary Care

“…Among the 32 included studies [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 ], 14 were from the United States, 3 from China, 2 from Spain, 2 from Australia, 2 from India, and 1 each from Australia, Iran, the United Kingdom, Slovenia, Sub-Saharan Africa, Canada, Belgium, Norway, Poland, and Italy. The studies ranged from 3 to 24 months of intervention between 2009 and 2021.…”

“…Because there was no apparent allocation concealment, five [ 29 , 37 , 44 , 51 , 52 ] studies were rated as high risk. Twenty [ 23 , 24 , 25 , 27 , 28 , 29 , 31 , 33 , 34 , 35 , 36 , 37 , 44 , 45 , 46 , 47 , 50 , 51 , 52 , 53 ] studies were also rated as unclear bias because they were not blinded to interventionists or subjects. One [ 42 ] study was rated as high risk because it was not blinded to the outcome evaluator.…”

Analyzing the Effectiveness of mHealth to Manage Diabetes Mellitus Among Adults Over 50: A Systematic Literature Review

“…Slightly less than half originated in the United States (14/30, 47%). Studies are listed in chronological order and alphabetically: 2020 (n=19), 29–47 2021 (n=8), 48–55 2022 (n=3). 56–58 For each study, we extracted the following data fields: participants, intervention, comparison (to control or other group), medical outcomes, study design, sample size, bias within study, country of origin, statistics used, patient satisfaction, quality associated with intervention, barriers to adoption, strength of evidence, and quality of evidence.…”

“… Significant improvement in diet, exercise, smoking cessation, and BGL control. RCT Damayanti et al 47 Older adults, average age 61, 50% male, SMS Improved diet, exercise, blood-glucose testing, and foot care Improved blood-glucose testing, and foot care Quasi-experimental Fu et al 48 Older adults mHealth apps and SMS Improved self-management behaviors Improved self-management behaviors Qualitative Jia et al 49 Older adults mHealth enabled hierarchical diabetes management Overall improvement of HbA1C, but no statistically significant differences in weight changes. Improved HbA1C RCT Lee et al 50 Older adults mHealth apps and coaching Improved self-management behaviors Improved HbA1C RCT Lewinski et al 51 Older adults mHealth No control group Not reported Qualitative Li et al 52 Older adults mHealth app and wearable sensor Intervention group showed larger increase in cardiopulmonary endurance, larger decrease in body fat percentage Increase in cardiopulmonary endurance, decrease in body fat percentage RCT Montero et al 53 Older adults, average age 56.1, 81% Black, 62% female Cellular remote monitoring, Biotel system dashboard + telemedicine visits Statistically significant difference in HbA1C levels between groups as well as user confidence in self-management Improvement in HbA1C True ex...…”

“…This theme appeared in 15/107 (14%) of the occurrences. 29 , 32 , 37–39 , 41 , 43 , 45 , 47 , 48 , 50 , 51 , 54 , 56 , 58 The theme “improved exercise” appeared in 10/107 (9%) of the occurrences. The themes “improved diet” 36–39 , 47 , 48 and “improved weight loss” 34 , 39 , 41 , 42 , 58 each appeared in 6/107 (6%) of the occurrences.…”