title: Using mobile phones to measure adolescent diabetes adherence.
abstract: OBJECTIVE
  1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA.
  
  
  METHODS
  Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent.
  
  
  RESULTS
  The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59-74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control.
  
  
  CONCLUSIONS
  Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions.
authors.affiliation: School of Nursing, Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37240, USA. shelagh.mulvaney@vanderbilt.edu
authors.forename: Shelagh A
authors.initials: SA
authors.lastname: Mulvaney
authors.forename: Russell L
authors.initials: RL
authors.lastname: Rothman
authors.forename: Mary S
authors.initials: MS
authors.lastname: Dietrich
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Wallston
authors.forename: Elena
authors.initials: E
authors.lastname: Grove
authors.forename: Tom A
authors.initials: TA
authors.lastname: Elasy
authors.forename: Kevin B
authors.initials: KB
authors.lastname: Johnson
mesh_terms: D000293:Adolescent; D001786:Blood Glucose / Q000032:analysis; D015190:Blood Glucose Self-Monitoring; D040421:Cell Phone; D002648:Child; D003625:Data Collection / Q000379:methods; D003920:Diabetes Mellitus; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D012648:Self Care; D014894:Weights and Measures; D016903:Drug Monitoring
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin