title: Using mobile phone text messages to improve insulin injection technique and glycaemic control in patients with diabetes mellitus: a multi-centre study in Turkey.
abstract: OBJECTIVE
  To improve the knowledge and skills of diabetic patients on insulin injections using mobile phone short message services and to evaluate the association of this intervention with metabolic outcomes.
  
  
  BACKGROUND
  Mobile communication technologies are widely used in Turkey, which maintains a diabetic population of more than 6·5 million. However, there are a limited number of studies using mobile technologies in the challenging and complicated management of diabetes.
  
  
  METHODS
  A one group pretest-posttest design was used in this study.
  
  
  METHODS
  The study sample consisted of 221 people with type 1 and type 2 Diabetes Mellitus from eight outpatient clinics in six cities in Turkey. The 'Demographic and diabetes-related information Form' and 'Insulin Injection Technique and Knowledge Form' were used in the initial interview. Subsequently, 12 short messages related to insulin administration were sent to patients twice a week for six months. Each patient's level of knowledge and skills regarding both the insulin injection technique and glycaemic control (glycated haemoglobin A1c) levels were measured at three months and six months during the text messaging period and six months later (12 months total) when text messaging was stopped.
  
  
  RESULTS
  The mean age of the patients with diabetes was 39·8 ± 16·2 years (min: 18; max: 75). More than half of the patients were females with a mean duration of diabetes of 11·01 ± 7·22 years (min 1; max: 32). Following the text message reminders, the patients' level of knowledge and skills regarding the insulin injection technique improved at month 3 and 6 (p < 0·05). The patients' A1c levels statistically significantly decreased at the end of month 3, 6 and 12 compared to the baseline values (p < 0·05). The number of insulin injection sites and the frequency of rotation of skin sites for insulin injections also increased.
  
  
  CONCLUSIONS
  This study demonstrated that a short message services-based information and reminder system on insulin injection administration provided to insulin-dependent patients with diabetes by nurses resulted in improved self-administration of insulin and metabolic control.
  
  
  CONCLUSIONS
  Today, with the increased use of mobile communication technologies, it is possible for nurses to facilitate diabetes management by using these technologies. We believe that mobile technologies, which are not only easy to use and to follow-up with by healthcare providers, are associated with positive clinical outcomes for patients and should be more commonly used in the daily practice of diabetes management.
authors.affiliation: Istanbul University, Istanbul Faculty of Medicine Hospital, Istanbul, Turkey.
authors.forename: Selda
authors.initials: S
authors.lastname: Celik
authors.affiliation: İstanbul University, Florence Nightingale Nursing Faculty, Istanbul, Turkey.
authors.forename: Gulhan
authors.initials: G
authors.lastname: Cosansu
authors.affiliation: İstanbul University, Florence Nightingale Nursing Faculty, Istanbul, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Erdogan
authors.affiliation: Istanbul University, Cerrahpaşa Faculty of Medicine Hospital, Istanbul, Turkey.
authors.forename: Alev
authors.initials: A
authors.lastname: Kahraman
authors.affiliation: Istanbul Dr Lutfi Kirdar Kartal Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sengul
authors.initials: S
authors.lastname: Isik
authors.affiliation: Faculty of Medicine Hospital, Ondokuz Mayis University, Samsun, Turkey.
authors.forename: Gulay
authors.initials: G
authors.lastname: Bayrak
authors.affiliation: Faculty of Medicine Hospital, Dokuz Eylul University, Izmir, Turkey.
authors.forename: Belgin
authors.initials: B
authors.lastname: Bektas
authors.affiliation: Faculty of Health Science, Acıbadem University, Istanbul, Turkey.
authors.forename: Nermin
authors.initials: N
authors.lastname: Olgun
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001786:Blood Glucose; D040421:Cell Phone; D003695:Delivery of Health Care; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy* / Q000451:nursing; D005260:Female; D006801:Humans; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D017010:Reminder Systems; D055817:Telenursing; D060145:Text Messaging; D014421:Turkey; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin
keywords: diabetes; information technology; metabolic control; nurse