title: Active assistance technology reduces glycosylated hemoglobin and weight in individuals with type 2 diabetes: results of a theory-based randomized trial.
abstract: BACKGROUND
  Type 2 diabetes is an individual health challenge requiring ongoing self-management. Remote patient reporting of relevant health parameters and linked automated feedback via mobile telephone have potential to strengthen self-management and improve outcomes. This research involved development and evaluation of a mobile telephone-based remote patient reporting and automated telephone feedback system, guided by health behavior change theory, aimed at improving self-management and health status in individuals with type 2 diabetes.
  
  
  METHODS
  This research comprised a randomized controlled trial. Inclusion criteria were diagnosis of type 2 diabetes, elevated glycosylated hemoglobin (HbA1c) levels (range, 6.5-11%) or use of oral diabetes medication, and 30-70 years of age. Intervention subjects (n=24) participated in remote patient reporting of health status parameters and linked health behavior change feedback. Control participants (n=24) received standard of care including diabetes education and healthcare provider counseling. Patients were followed for approximately 10 months.
  
  
  RESULTS
  Intervention participants achieved, compared with controls and controlling for baseline, a significantly greater mean reduction in HbA1c of -0.40% (95% confidence interval [CI] -0.67% to -0.14%) versus 0.036% (95% CI -0.23% to 0.30%) (P<0.03) and significantly greater weight reduction of -2.1 kg (95% CI -3.6 to -0.6 kg) versus 0.4 kg (95% CI -1.1 to 1.9 kg). Nonsignificant trends for greater intervention compared with control improvement in systolic and diastolic blood pressure were observed.
  
  
  CONCLUSIONS
  Sophisticated information technology platforms for remote patient reporting linked with theory-based health behavior change automated feedback have potential to improve patient outcomes in type 2 diabetes and merit scaled-up research efforts.
authors.affiliation: VTT Technical Research Centre of Finland, Helsinki, Finland.
authors.forename: Anna-Leena
authors.initials: AL
authors.lastname: Orsama
authors.forename: Jaakko
authors.initials: J
authors.lastname: Lähteenmäki
authors.forename: Kari
authors.initials: K
authors.lastname: Harno
authors.forename: Minna
authors.initials: M
authors.lastname: Kulju
authors.forename: Eva
authors.initials: E
authors.lastname: Wintergerst
authors.forename: Holly
authors.initials: H
authors.lastname: Schachner
authors.forename: Pat
authors.initials: P
authors.lastname: Stenger
authors.forename: Juha
authors.initials: J
authors.lastname: Leppänen
authors.forename: Hannu
authors.initials: H
authors.lastname: Kaijanranta
authors.forename: Ville
authors.initials: V
authors.lastname: Salaspuro
authors.forename: William A
authors.initials: WA
authors.lastname: Fisher
mesh_terms: D000368:Aged; D015992:Body Mass Index; D003131:Combined Modality Therapy / Q000295:instrumentation; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000628:therapy*; D030141:Feedback, Psychological; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D015438:Health Behavior; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D009042:Motivation; D009765:Obesity / Q000097:blood / Q000150:complications / Q000628:therapy*; D050177:Overweight / Q000097:blood / Q000150:complications / Q000628:therapy*; D011582:Psychological Theory; D012648:Self Care / Q000295:instrumentation*; D017216:Telemedicine / Q000379:methods*; D015431:Weight Loss
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human