title: Pilot study using mobile health to coordinate the diabetic patient, diabetologist, and ophthalmologist.
abstract: In the United States, more than 25 million adults have diabetes, 40% of diabetics have diabetic retinopathy, and diabetes is the leading cause of blindness in people 20 to 74 years of age. Clinical trials have shown that strict control of blood glucose level and other risk factors delays diabetic retinopathy onset, progression, and vision loss. Patients with Type 1 or Type 2 diabetes mellitus, access to an Apple iPhone or iPad, and no psychological or medical condition that would interfere with the study participated in a nonrandomized clinical trial using SightBook™, a free mobile app that enables self-measurement of visual function and creates a password-protected web account for each patient. Sixty patients enrolled in the clinical trial over a 6 month period. Twenty-six participants were men and 34 were women, with ages from 23 to 72 years (mean 45 ± 15) and diabetes duration of 1.5 to 50 years (mean 15.5 ± 11.5). Thirty-nine (65%) patients reported Type 1 diabetes and 21 (35%) patients reported Type 2 diabetes. Every patient established a personal web account on SightBook and invited participation of treating physicians; 51 (85%) patients completed the validated self-reported outcome assessments. Diabetologist examinations of 49 (82%) patients demonstrated systolic hypertension (≥140 mgHg) in 20% and hemoglobin A1c ≥ 7.0% in 56%. Ophthalmology examinations of 45 patients showed visual acuity in the worse-seeing eye of < 20/40 in 18% and diabetic retinopathy in 42% of patients. This clinical trial used a mobile health app to incorporate diabetic patient self-measurement of vision and coordinate the diabetic patient, diabetologist, and ophthalmologist for control of diabetes and diabetic retinopathy risk factors.
authors.affiliation: Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA itsui@jsei.ucla.edu.
authors.forename: Irena
authors.initials: I
authors.lastname: Tsui
authors.affiliation: Department of Medicine and the Gonda Diabetes Center, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Drexler
authors.affiliation: Departments of Psychology and Psychiatry/Biobehavioral Sciences, Center for Cancer Prevention and Control Research, University of California, Los Angeles, CA, USA.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Stanton
authors.affiliation: Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Jennie
authors.initials: J
authors.lastname: Kageyama
authors.affiliation: Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Ngo
authors.affiliation: Department of Ophthalmology and Jules Stein Eye Institute, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
authors.forename: Bradley R
authors.initials: BR
authors.lastname: Straatsma
mesh_terms: D000328:Adult; D000368:Aged; D003920:Diabetes Mellitus / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D003930:Diabetic Retinopathy / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008952:Mobile Health Units; D008991:Monitoring, Physiologic; D009885:Ophthalmology; D010820:Physicians; D010865:Pilot Projects; D011446:Prospective Studies; D057566:Self Report; D016896:Treatment Outcome; D014787:Vision Tests; D055815:Young Adult
keywords: app; coordinated care; diabetes; diabetic retinopathy; mHealth; mobile application