Paul Allan P. Cenabre AAHN3 (DM)MSN IRosalia R. Caazares, MSN

Support for Diabetes Using Technology: A Pilot Study to Improve Self- Management

Technology is a tool used today to assist people in daily living. The potential for technological advances as adjuncts to clinical care should be explored. More so, current studies indicate technology can have a positive impact on the diabetes self-management.

The people with diabetes find it difficult to sustain adequate self-management behavior. Self-Management Support strategies, including the use of mobile technology, have shown potential benefit. This study evaluates the effectiveness of tablet (iPhone iPad) support intervention to improve health outcomes, access to care and enablement of people with diabetes.

The main purpose of the study was to determine if the use of application (Diabetes Buddy) on Apple Ipad technology that support diabetes self-management will increase self-efficacy for self-management, increase participation in self-management behaviours and improve diabetes outcomes in persons with type 2 diabetes mellitus.

The experimental pilot study used a two- group, crossover, repeated-measures design, in which a total of 17 adults (19 and older) with type 2 diabetes joined the research study. The researchers limit the pilot study to a small convenience sample. During the pre-intervention phase, research obtained data that may limit the effectiveness of the intervention. Paticipants has a good glycemic control and have high self-efficacy scores. It is stated in the demographic information that 13 out of the 17 participants were previously diagnose with type 2 diabetes mellitus for more than 10 years. Given the length of time of diagnosis and their management, this would be a main reason why most of the participants had high self-efficacy scores during the pre- intervention measure.

Another limitation of the study was the complexity of using the tablet (Apple Ipad), participants had hard time in navigating the application, they have to answer and follow multiple steps to enter a consumed food and allocating food was difficult. Given the fact that out of 17 participants in the intervention where 51 and older, this would mean frustration on the participants part. Some may not previously use a tablet and had difficulty with basic operation.

Result revealed that Self-efficacy scores for the first iPad group (n= 6) remained relatively the same scores from the pre-intervention phase to post- intervention phase. On the other hand, the second group (n=8) self-efficacy scores were decreased from pre-intervention to mid-intervention after logging using the journal and increases after using the iPads. Using a t-test, analysis of the data revealed that there is no significant difference in the self-efficacy scores between the iPad and journal study groups. However, self-efficacy scores were too high at the baseline, making it too difficult to identify improvement. Given its limited sample, a larger and more varied sample size is needed for further evaluation. It was stated that the researchers in the future would explore and should identify which technologies are most effective for the improvement of self-management and diabetes outcome. Furthermore, other potential uses of the technology for self-management should be explored.

In general, a growing number of people have the capability and access to smartphone like tablet and internet (Brenner, 2013 et. Al). As the technology devices become more accessible, the option for using it for health particularly in disease management increases. Technology plays integral part in health care providers. It can be used to supplement education and support when resources, including time are limited. Nurses should be knowledgeable about the technological advancement and should assist patient s to identify technology that can be used to facilitate management of chronic diseases like diabetes mellitus.