title: Improvements in illness self-management and psychological distress associated with telemonitoring support for adults with diabetes.
abstract: OBJECTIVE
  The objective of this observational open label trial was to characterize changes in diabetes self-management and psychological distress associated with a mobile health (mHealth) interactive voice response (IVR) self-management support program.
  
  
  METHODS
  For 3-6 months, 301 patients with diabetes received weekly IVR calls assessing health status and self-care and providing tailored pre-recorded self-management support messages. Patients could participate together with an informal caregiver who received suggestions on self-management support, and patients' clinicians were notified automatically when patients reported significant problems.
  
  
  RESULTS
  Patients completed 84% of weekly calls, providing 5682 patient-weeks of data. Thirty-nine percent participated with an informal caregiver. Outcome analyses adjusted for study design factors and sociodemographics indicated significant pre-post improvement in medication adherence, physical functioning, depressive symptoms, and diabetes-related distress (all p values <0.001). Analyses of self-management problems indicated that as the intervention proceeded, there were significant improvements in patients' IVR-reported frequency of weekly medication adherence, SMBG performance, checking feet, and frequency of abnormal self-monitored blood glucose readings (all p values <0.001).
  
  
  CONCLUSIONS
  We conclude that the combined program of automated telemonitoring, clinician notification, and informal caregiver involvement was associated with consistent improvements in medication adherence, diabetes self-management behaviors, physical functioning, and psychological distress. A randomized controlled trial is needed to verify these encouraging findings.
authors: Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address: aikensj@umich.edu.
authors: James E
authors: JE
authors: Aikens
authors: Division of General Internal Medicine, University of Michigan, Ann Arbor, MI, USA; VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA.
authors: Ann-Marie
authors: AM
authors: Rosland
authors: VA Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
authors: John D
authors: JD
authors: Piette
mesh_terms: D000368:Aged; D015190:Blood Glucose Self-Monitoring; D017028:Caregivers / Q000523:psychology; D017281:Cost of Illness; D003376:Counseling; D003863:Depression / Q000209:etiology / Q000517:prevention & control / Q000523:psychology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D012648:Self Care; D057566:Self Report; D016353:Self-Examination; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D017216:Telemedicine; D013689:Telephone; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D007004:Hypoglycemic Agents
keywords: Care management; Diabetes; Primary care; mHealth