title: Evaluating self-management behaviors of diabetic patients in a telehealthcare program: longitudinal study over 18 months.
abstract: BACKGROUND
  Self-management is an important skill for patients with diabetes, and it involves frequent monitoring of glucose levels and behavior modification. Techniques to enhance the behavior changes of diabetic patients have been developed, such as diabetes self-management education and telehealthcare. Although the patients are engaged in self-management activities, barriers to behavior changes remain and additional work is necessary to address the impact of electronic media and telehealthcare on patient self-care behaviors.
  
  
  OBJECTIVE
  The aims of this study were to (1) explore the behaviors of diabetic patients interacting with online applications, (2) determine the impact of a telehealthcare program among 7 self-care behaviors of the patients, and (3) determine the changes in glycosylated hemoglobin (HbA1c) levels.
  
  
  METHODS
  A telehealthcare program was conducted to assist the patients with 7 self-care activities. The telehealthcare program lasted for 18 months and included the use of a third-generation mobile telecommunications glucometer, an online diabetes self-management system, and a teleconsultant service. We analyzed the data of 59 patients who participated in the telehealthcare program and 103 who did not. The behavioral assessments and the HbA1c data were collected and statistically analyzed to determine whether the telehealthcare services had an impact on the patients. We divided the 18-month period into 3 6-month intervals and analyzed the parameters of patients assisted by the telehealthcare service at different time points. We also compared the results of those who were assisted by the telehealthcare service with those who were not.
  
  
  RESULTS
  There was a significant difference in monitoring blood glucose between the beginning and the end of the patient participation (P=.046) and between the overall period and the end of patient participation (P<.001). Five behaviors were significantly different between the intervention and control patients: being active (P<.001), healthy eating (P<.001), taking medication (P<.001), healthy coping (P=.02), and problem solving (P<.001). Monitoring of blood glucose was significantly different (P=.02) during the 6-12 month stage of patient participation between the intervention and control patients. A significant difference between the beginning and the 6-12 month stage of patient participation was observed for the mean value of HbA1c level (P=.02), and the differences between the overall HbA1c variability and the variability of each 6-month interval was also significant.
  
  
  CONCLUSIONS
  Telehealthcare had a positive effect on diabetic patients. This study had enhanced blood glucose monitoring, and the patients in the program showed improvements in glycemic control. The self-care behaviors affect patient outcomes, and the changes of behavior require time to show the effects.
authors: Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan. d98945012@ntu.edu.tw.
authors: Lichin
authors: L
authors: Chen
authors: Lee-Ming
authors: LM
authors: Chuang
authors: Chia-Hsiun
authors: CH
authors: Chang
authors: Chiou-Shiang
authors: CS
authors: Wang
authors: I-Ching
authors: IC
authors: Wang
authors: Yufang
authors: Y
authors: Chung
authors: Hui-Yu
authors: HY
authors: Peng
authors: Hui-Chuen
authors: HC
authors: Chen
authors: Yu-Ling
authors: YL
authors: Hsu
authors: Yu-Sheng
authors: YS
authors: Lin
authors: Huang-Jen
authors: HJ
authors: Chen
authors: Tieng-Chun
authors: TC
authors: Chang
authors: Yi-Der
authors: YD
authors: Jiang
authors: Hung-Chang
authors: HC
authors: Lee
authors: Ching-Ting
authors: CT
authors: Tan
authors: Hsin-Lu
authors: HL
authors: Chang
authors: Feipei
authors: F
authors: Lai
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000523:psychology* / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D015438:Health Behavior; D006785:Hospitals, University; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010358:Patient Participation; D010865:Pilot Projects; D012648:Self Care; D013624:Taiwan; D017216:Telemedicine / Q000379:methods*
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human
keywords: Internet; diabetes mellitus; online systems; patient access to records; personal health record; self-care; telemedicine