DIABETES-SELF MANAGEMENT EDUCATION

17
Appendix A
Evaluation Table

Citation
Bell, A. M.,
Fonda, S. J.,
Walker, S.,
Scmidt, V., &
Vigersky, R. A.
(2012). Mobile
phone-based
video messages
for diabetes selfcare support.
Journal of
Diabetes Science
and Technology,
6(2), 310-319.
USA
F-Dept Defense
Franzetta, D.,
Willet, K., &
Fairchild, R.
(2012). A
systematic review
of smartphone
application use
for type 2 diabetic
patients. Online
Journal of
Nursing
Informatics
USA
F-Lilly
Endowment Fund

Conceptual
Framework
N.S.

N.S.

Design/Method

Sample/Setting

Design: RCT
Purpose:
Determine if daily
video messages of
tips on diabetes
management and
life-style support
improves glycemic
control.

n = 65

Design: SR
Purpose:
Evaluate
smartphone
technology for
management of
patients w/ DM2

n = 11
RCT = 7
Descriptive = 4
Inclusion Criteria
RCT, DM2, age>18,
cell phone
intervention, HbA1c

Inclusion Criteria
18+years, care from
NP at least 6 months,
A1C>8%
Exclusion Criteria
Pregnant, lactating,
planning to become
pregnant, using
glucocorticoids,
amphetamines,
anabolic or weight
reducing agents.
Setting
1 HCF

Major Variables
& Definitions
Dependent
HbA1c, BP,
SMBG data
Independent
IVG -SP Video
C- UT

Measurement
Baseline, 3, 6, 9,
12 months

Data Analysis
t-test
chi-square
using SAS

HbA1c
BP
SMBG data
#videos viewed

Findings
Δ base IVG
HbA1c = 1.2%,
1.1%, 1.2%, 1.3%

Decision for Use in
Practice/Application
to Practice
Challenge would be
to record daily video
tips, not likely a
sustainable model.

Δ base C HbA1c=
0.4%, 1.1%,
1.1%, 0.9%
Δ base at 3
months was SS
(p=0.02) between
the groups for
HbA1c favoring
IVG

Dependent
HbA1c
Independent
Cell phone
intervention

HbA1c

Variable by study

4/6 RCT showed
decrease HbA1c

Applicable to
practice. HbA1c is
reduced by using SP.

QS showed apps
that allow true
SM, providers
have security
concerns.

Δ- change, A – Asian, AA- African American, AGR – age range, AR – attrition rate, BP – blood pressure, BMI – body mass index, C – control group, CBSA –computer based software applications
CR – Caucasian race, CL – confidence limits, CI – confidence interval, CS – convenience sample CST – chi-squared test, CVD – cardiovascular diseases, DM1 – diabetes mellitus, type 1, DM2 –
diabetes mellitus, type 2, DV- dependent variable, ESRD – end stage renal disease, F – funding, FG – female gender, G – gender, HCF – health care facility, HDL –high density lipoprotein, HRQL –
health related quality of life, IBDSME – internet based diabetes self management education, IP – inpatient facilities, IV – independent variable, IVG – intervention group, LDL – low density
lipoprotein, LRA – linear regression analysis, MA – mean age, MG – male gender, MHI – mean household income, MTA – meta-analysis, N – sample size (people), n – sample size (studies), NA –
Native American, OR – other race, UT – usual treatment, RCT – randomized controlled trial, SM – self-management, SMS – short message service, SMSG – short message service texts generalized,
SMSS – short message service texts customized, SP –smartphone, SPA – smartphone application, SR – systematic review, SS- statistically significant, SMLA – single multi-level analysis, Trigs –
triglycerides, TT – t-test VM – voice message

DIABETES-SELF MANAGEMENT EDUCATION
Graziano, J. A., &
Gross, C. R.
(2009). A
randomized
controlled trial of
an automated
telephone
intervention to
improve glycemic
control in type 2
diabetes.
Advances in
Nursing Science

Health Belief
Model

Design:
experimental pretest-post-test
design, RCT
Purpose:
Determine impact
of daily automated
telephone
intervention on
HbA1c

N = 120
IVG= 62
C = 58

Dependent
HbA1c
HRQL

Inclusion Criteria
DM2 for >12 months,
age>50 years,
HbA1c>7.0%,
English speaking,
access to cell or
landline, ability to
hear phone
commands,
responsible for own
care, glucose meter
w/ 3 month storage,
daily SMBG routine
Exclusion Criteria
Unable to give
informed consent or
too ill to participate
Setting
Midwest HCF

Independent
Usual care

Design:
2 group crossover, repeated
measures, RCT
Purpose:
Determine if iPad
DSME improves
self-efficacy,
increases
participation in
monitoring
behaviors,
improves HbA1c

N= 17
iPad
Journal

Dependent
HbA1c
HRQL
Self Monitoring
Independent
IVG -iPad
C- Journaling

USA
F- Nova Nordisk

Hunt, C. W., &
Sanderson, B. K.
(2014). Support
for diabetes using
technology: A
pilot study to
improve selfmanagement.
Medsurg Nursing
USA
F- Gatson
Grindell EBP
research grant

SelfDetermination
Theory

18

Male = 41.2%
Caucasian = 76.5%
Inclusion Criteria
DM2, age>19 years,
read & write English

HbA1c
HRQL
#BGSM

2 sided TT
independent
sample TT
Mann-Whitney U
test

Study effect 1.0%
decrease in both
groups HbA1c

Pre-recorded VM
difficult to sustain for
practice, but possible.
No significant
reduction in HbA1c.
Improvement in
HRQL.

Patients had
positive feedback
on utilizing the
application.

Possibly applicable
due to positive
feedback on
utilization. Lack of
data makes it
challenging to verify
if HbA1c is
impacted.

Used SPSS
Pre-recorded voice
message daily

Baseline, 3
months, 6 months
for crossover
HbA1c
HRQL

Descriptive
statistics
Mixed model
analysis of
variance

HbA1c draw was
not done due to
site starting
glycemic control
of patients

Δ- change, A – Asian, AA- African American, AGR – age range, AR – attrition rate, BP – blood pressure, BMI – body mass index, C – control group, CBSA –computer based software applications
CR – Caucasian race, CL – confidence limits, CI – confidence interval, CS – convenience sample CST – chi-squared test, CVD – cardiovascular diseases, DM1 – diabetes mellitus, type 1, DM2 –
diabetes mellitus, type 2, DV- dependent variable, ESRD – end stage renal disease, F – funding, FG – female gender, G – gender, HCF – health care facility, HDL –high density lipoprotein, HRQL –
health related quality of life, IBDSME – internet based diabetes self management education, IP – inpatient facilities, IV – independent variable, IVG – intervention group, LDL – low density
lipoprotein, LRA – linear regression analysis, MA – mean age, MG – male gender, MHI – mean household income, MTA – meta-analysis, N – sample size (people), n – sample size (studies), NA –
Native American, OR – other race, UT – usual treatment, RCT – randomized controlled trial, SM – self-management, SMS – short message service, SMSG – short message service texts generalized,
SMSS – short message service texts customized, SP –smartphone, SPA – smartphone application, SR – systematic review, SS- statistically significant, SMLA – single multi-level analysis, Trigs –
triglycerides, TT – t-test VM – voice message

DIABETES-SELF MANAGEMENT EDUCATION
Pal, K.,
Eastwood, S. V.,
Michie, S.,
Farmer, A. J.,
Barnard, M. L.,
Peacock, R., ...
Murray, E.
(2013).
Computer-based
diabetes selfmanagement
interventions for
adults with type 2
diabetes mellitus
(Cochrane
Review)

N.S.
(likely Lorig’s
self-management)

Kim, H. S., &
Jeong, H. S.
(2006). A nurse
short message
service by cellular
phone in type-2
diabetic patients
for six months.
Journal of
Clinical Nursing,
16(6), 1082-1087.

N.S.
(possibly Health
Education)

F- Alumni
Research Fund,
Catholic U or
Korea
Kirwan, M.,
Vandelanotte, C.,
Fenning, A., &
Duncan, M. J.
(2013). Diabetes
self-management
smartphone
application for

Design:
SR
Purpose
Review using
computer based
interventions for
DSME and
reduction of
HbA1C

n = 16 RCT
3578 participants
mean age = 46-67

Dependent
HbA1C
HRQL

intervention time = 112 months
Inclusion Criteria
RCT, age >18, DM2,
CBSA
Exclusion Criteria
CBSA targeting
DM1, age<18

Independent
CBSA
DSME
UT
CP

Design:
RCT, control
group pre-testpost-test design

N=51
IVG = 25
C=26

Dependent
HbA1c
FPG
Independent
SMS texting by
nurse.
UT (office visits)

Baseline, 3, 6
month HbA1c &
FPG

n = 72
IVG = 36
C = 36

Dependent
HbA1c
HRQL

HbA1c at
baseline, 3, 6, 9
months

Inclusion Criteria
DM1>6 months, age
18-65, HbA1c>7.5%,
multiple daily

Independent
SP app –Glucose
Buddy

HRQL

Purpose:
To evaluate
whether an
Internet-based
intervention using
SMS by a nurse
could improve
HbA1c in patients
with DM2.

South Korea

N.S.
(likely Individual
and Family SelfManagement)

19

Design:
RCT
Purpose:
Examine the
effectiveness of a
freely available SP
application
combined with

Inclusion Criteria
Able to self test BG,
inject insulin, own a
cell phone.
Exclusion Criteria
Renal insufficiency
w/ creatinine >1.5,
using insulin pump
Setting
Endocrinology clinic,
remote education,
HCF

HbA1c
HRQL

CST

0.2% reduction in
HbA1c overall
0.5% reduction in
HbA1c in trials
utilizing cellular
phones

CST
TT
Fisher’s exact
tests
ANOVA

1.15% decrease in
HbA1c in IVG
which was SS

Linear mixed
models analysis

1.1% decrease in
HbA1c in IVG

Type III Wald test

no difference in
HRQL

LRA

Applicable to
practice, SP
technology shows
reduction in HbA1c.
Easy to implement.

Applicable to
practice. Portal that
allows texting is in
place.

no Δ in FPG

Applicable to
practice. Portal
allows texting. May
not relate as well to
DM2 patients who do
not use insulin.

Δ- change, A – Asian, AA- African American, AGR – age range, AR – attrition rate, BP – blood pressure, BMI – body mass index, C – control group, CBSA –computer based software applications
CR – Caucasian race, CL – confidence limits, CI – confidence interval, CS – convenience sample CST – chi-squared test, CVD – cardiovascular diseases, DM1 – diabetes mellitus, type 1, DM2 –
diabetes mellitus, type 2, DV- dependent variable, ESRD – end stage renal disease, F – funding, FG – female gender, G – gender, HCF – health care facility, HDL –high density lipoprotein, HRQL –
health related quality of life, IBDSME – internet based diabetes self management education, IP – inpatient facilities, IV – independent variable, IVG – intervention group, LDL – low density
lipoprotein, LRA – linear regression analysis, MA – mean age, MG – male gender, MHI – mean household income, MTA – meta-analysis, N – sample size (people), n – sample size (studies), NA –
Native American, OR – other race, UT – usual treatment, RCT – randomized controlled trial, SM – self-management, SMS – short message service, SMSG – short message service texts generalized,
SMSS – short message service texts customized, SP –smartphone, SPA – smartphone application, SR – systematic review, SS- statistically significant, SMLA – single multi-level analysis, Trigs –
triglycerides, TT – t-test VM – voice message

DIABETES-SELF MANAGEMENT EDUCATION
adults with type 1
diabetes:
Randomized
controlled trial.
Journal of
medical Internet
research, 15(11),

SMS feedback to
improve glycemic
control in adults
with DM1

injections or insulin
pump
Exclusion Criteria
Pregnant or already
using a SP app
Setting
HCF, single clinic,
remote education

Design
RCT
Purpose
To evaluate the
effect of a webbased
comprehensive
information
system consisting
of internet and
cellular phone use
on BG.

N= 40
IVG=20
C=20

Design
SR
Purpose
Determine the
strength of
evidence for the
effectiveness of

n= 18 RCT

20

New Zealand
F-Central
Queensland
University
Noh, J. H., Cho,
Y. J., Nam, H.
W., Kim, J. H.,
Kim, D. J., Yoo,
H. S., ... Yoo, M.
J. (2010). Webbased
comprehensive
information
system for selfmanagement of
diabetes mellitus.
Diabetes
Technology &
Therapeutics,
12(5), 333-337.

N.S. (possibly
chronic care
model)

Inclusion Criteria
Age 18-80, HbA1c
7%-10%, drug naïve
or prior drug therapy,
stable glycemic
control – no Δ in
therapy for 3 months,
internet access, and
cellular phone
Exclusion Criteria
Severe medical
illness- cirrhosis,
ESRD, cancer.

Dependent
HbA1c, BP, FPG,
BMI, LDL, HDL,
Trigs

HbA1c, BMI, BP,
FPG, LDL, HDL,
Trigs at baseline,
6 months

Independent
IVG- eMOD
system of online
education
C-diabetes
education books

Frequency of
accessing via
internet or SP

Dependent
HbA1c n=17
HRQL

HbA1c, total steps
HRQL

Student’s TT
Pearson’s x2 test
Wilcoxon Sign
Rank test
LRA

SS reduction in
HbA1c 1.53%,
and post prandial
of -54.58 all other
were not SS

Applicable to
practice, easy to
implement. Patient
portal allows texting.

SMBG devices
demonstrate a
decrease in
HbA1c in both
insulin dependent
and noninsulin
forms.

Applicable to
practice, devices
show reduction in
HbA1c.

P=0.05

Republic of Korea
F-Korean
Diabetes
Association
Russell-Minda,
E., Jutai, J.,
Speechley, M.,
Bradley, K.,
Chudyk, A., &
Petrella, R.
(2009). Health

N.S. (possibly
chronic care
model)

Inclusion Criteria
Age > 14 and youth
7-14 years with DM1
or DM2,

Independent

Variable by study

Δ- change, A – Asian, AA- African American, AGR – age range, AR – attrition rate, BP – blood pressure, BMI – body mass index, C – control group, CBSA –computer based software applications
CR – Caucasian race, CL – confidence limits, CI – confidence interval, CS – convenience sample CST – chi-squared test, CVD – cardiovascular diseases, DM1 – diabetes mellitus, type 1, DM2 –
diabetes mellitus, type 2, DV- dependent variable, ESRD – end stage renal disease, F – funding, FG – female gender, G – gender, HCF – health care facility, HDL –high density lipoprotein, HRQL –
health related quality of life, IBDSME – internet based diabetes self management education, IP – inpatient facilities, IV – independent variable, IVG – intervention group, LDL – low density
lipoprotein, LRA – linear regression analysis, MA – mean age, MG – male gender, MHI – mean household income, MTA – meta-analysis, N – sample size (people), n – sample size (studies), NA –
Native American, OR – other race, UT – usual treatment, RCT – randomized controlled trial, SM – self-management, SMS – short message service, SMSG – short message service texts generalized,
SMSS – short message service texts customized, SP –smartphone, SPA – smartphone application, SR – systematic review, SS- statistically significant, SMLA – single multi-level analysis, Trigs –
triglycerides, TT – t-test VM – voice message

DIABETES-SELF MANAGEMENT EDUCATION
technologies for
monitoring and
managing
diabetes: A
systematic
review. Journal of
Diabetes Science
and Technology,
3(6), 1460-1471.

self-monitoring
devices and
technologies for
individuals with
DM1 or DM2.

F-Canadian
Institute of Health
Research

interventions w/ selfmonitoring device,
clinical outcomes
with device, English,
1985-2008, RCT &
observational studies
Exclusion Criteria
N<10, cross-sectional
data, primary
interventions with
medications, studies
assessing accuracy of
devices, telemedicine
applications, CGM
devices

21
SMBG n=5
SMS n= 7
Activity n=4
SP app n=2

Mixed results on
pedometers for
demonstrating a
increase in steps,
no evidence for
improvement in
metabolic
parameters.
SMS/internet
interventions
showed decrease
in HbA1c
SP based app may
decrease HbA1c.

Saffari, M.,
Ghanizadeh, G.,
& Koenig, H. G.
(2014). Health
education via
mobile text
messaging for
glycemic control
in adults with type
2 diabetes: A
systematic review
and metaanalysis. Primary
Care Diabetes

Health Education

Design:
SR and metaanalysis
Purpose
Review all
published articles
that have reported
the effects of
health education
by text
intervention on
glycemic control

n = 10 RCT

Dependent
HbA1C

N= 960
Inclusion Criteria
Educational
intervention using
SMS, DM2
diagnosis, HbA1c
measurement, age<18
years, RCT
Exclusion Criteria
Other chronic
disorders like CVD,
pregnant patients

Independent
SMS texting
UT

HbA1c

CST
Data analysis
through
Comprehensive
Meta-analysis
Software

50% greater
reduction in
HbA1c in IVG
compared to UT
from metaanalysis

Applicable to
practice, patient
portal allows texting,
shows reduction in
HbA1c.

(Korea, Taiwan,
USA)
F- Baqiyatallh
Univeristy of
Medical Sciences

Δ- change, A – Asian, AA- African American, AGR – age range, AR – attrition rate, BP – blood pressure, BMI – body mass index, C – control group, CBSA –computer based software applications
CR – Caucasian race, CL – confidence limits, CI – confidence interval, CS – convenience sample CST – chi-squared test, CVD – cardiovascular diseases, DM1 – diabetes mellitus, type 1, DM2 –
diabetes mellitus, type 2, DV- dependent variable, ESRD – end stage renal disease, F – funding, FG – female gender, G – gender, HCF – health care facility, HDL –high density lipoprotein, HRQL –
health related quality of life, IBDSME – internet based diabetes self management education, IP – inpatient facilities, IV – independent variable, IVG – intervention group, LDL – low density
lipoprotein, LRA – linear regression analysis, MA – mean age, MG – male gender, MHI – mean household income, MTA – meta-analysis, N – sample size (people), n – sample size (studies), NA –
Native American, OR – other race, UT – usual treatment, RCT – randomized controlled trial, SM – self-management, SMS – short message service, SMSG – short message service texts generalized,
SMSS – short message service texts customized, SP –smartphone, SPA – smartphone application, SR – systematic review, SS- statistically significant, SMLA – single multi-level analysis, Trigs –
triglycerides, TT – t-test VM – voice message

DIABETES-SELF MANAGEMENT EDUCATION

22

Appendix B
Synthesis Table

Trial type
DM1 %
DM2 %
HbA1c
HRQL
SMSG
SMSS
IBDSME
PC
VM
SPA

Bell
(2012)
RCT
8%
92%
ê
N

Frazetta
(2012)
SR
0
100%
ê
N
Y
Y
Y

Y

Graziano
(2009)
RCT
0
100%
Ø
Y

Hunt
(2014)
RCT
0
100%
Ø
Y

Pal
(2013)
SR
0
100%
ê
Y
Y
Y
Y

Kim
(2006)
RCT
0
100%
ê
N

Kirwan
(2013)
RCT
100%
0
ê
Y

Y

Y

Noh
(2010)
RCT

Russell
(2009)
SR

ê
N

ê
Y
Y
Y
Y
Y
Y
Y

Y

Y
Y

Y

Y

Y

Y

Saffari
(2014)
SR
0
100%
ê
N

DM1 – diabetes mellitus, type 1, DM2 – diabetes mellitus, type 2, HbA1c – glycolated hemoglobin, HRQL – health related quality of life, IBDSME – internet based diabetes self management
education, PC –phone call, RCT – randomized controlled trial, SMSG – short message service texts generalized, SMSS – short message service texts customized, SP –smartphone, SPA – smartphone
application, SR – systematic review, VM– voice message, Ø – no change, ê- decrease