**Empowering Diabetes Patient with Mobile Health Technologies**

Matjaž Krošel, Lana Švegl, Luka Vidmar and Dejan Dinevski

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/64620

#### **Abstract**

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Chronic diseases, especially diabetes mellitus, are huge public health burden. There‐ fore, new health care models for sharing the responsibility for care among health care providers and patients themselves are needed. The concept of empowerment pro‐ motes patient's active involvement and control over their own health. It can be achieved through education, self-management, and shared decision making. All these aspects can be covered by mobile health technologies, the so-called mHealth. This term comprises mobile phones, patient monitoring devices, tablets, personal digital assistants, other wireless devices, and numerous apps. Many challenges of diabetics can be addressed by mHealth, including glycemic control, nutrition control, physical activity, high blood pressure, medication adherence, obesity, education, diabetic retinopathy screening, diabetic foot screening, and psychosocial care. However, mHealth plays only minor role in diabetes management, despite numerous apps on the market. Namely, these apps have many shortcomings and the majority of them does not include important functions. Moreover, these apps lack the perceived additional benefit by the user and the ease of use, important factors for acceptance of mHealth. Studies of diabetes apps regarding usability and accessibility have shown moderate results. Beside improve‐ ments of apps usability, the future of diabetes mHealth lies probably in personalized education and self-management with the help of decision support systems. At the same time, work on artificial pancreas is in progress and smartphone could be used as user interface.

**Keywords:** mobile health, diabetes, empowerment, smartphone, chronic disease man‐ agement

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

## **1. Introduction**

Aging and chronic conditions represent a huge burden on the health care budgets. Moreover, in the future this burden will only increase [1]. At the same time, the patients require a better service, while there are fewer health care professionals and lesser resources. The states currently act mainly in two dimensions. On the one hand, they are strengthening their efforts on prevention. They develop or update existing programs, which promote healthy and active life styles. On the other hand, they are transforming the existing health care. Namely, the health care sys‐ tems as we know them were developed to treat the acute diseases. However, the chronic diseases spent more than 70% of the health care budgets [2, 3]. The prevention programs can prolong the healthy period of each individual, but some chronic diseases, such as diabetes, cannot elimi‐ nate. Therefore, there is a need for transformation of the existing health care whose goals are better health results, better quality of service and quality of patient life, and economic feasibil‐ ity. This transformation is as follows [2]:


The key enablers for such transformation are patient empowerment, use of information and communications technology (ICT), integrated care, and adopted business models.

This chapter explores the concept of empowerment of diabetes patients by presenting current and future possibilities of mobile health technology.

## **2. Diabetes mellitus**

Number of diabetes patients around the world has reached 415 million and it is predicted to climb up to 642 million by the year 2040. Diabetes can also be linked to around 5 million deaths each year and it is associated with high financial burden, since health spending on diabetes accounts for around 12% of total health expenditure worldwide. The costs include increase use of health services as well as loss of productivity or disability and are estimated to range from 673 billion USD to 1197 billion USD [4]. With such troubling predictions, we are obligated to look for new methods to facilitate patient care. Introduction of new methods should be done with the understanding that more than 95% of diabetes care is done by the patients themselves [5]. This is just one of several reasons why diabetes patients are excellent candidates for managing their disease with the help of mobile health technologies (mHealth) and why this may improve many aspects of personal and public health.

Diabetes is medically defined by the following criteria: patient fasting plasma glucose level ≥126 mg/dl (7.0 mmol/l) or HbA1c (glycated hemoglobin) ≥6.5% or patient plasma glucose level 2-h after OGTT (oral glucose tolerance test) ≥200 mg/dl (11.1 mmol/l) or patient random plasma glucose level ≥200 mg/dl (11.1 mmol/l) [6]. After the diagnosis, diabetes patients need to endure life-long management of their disease, which include medications and significant lifestyle changes. Disease progress should be monitored with the help of health care professionals in order to ensure prevention and quick diagnosis of long-term complications of hyperglycemia. Most commonly seen diabetes complications are retinopathy with a potential loss of vision, nephropathy that can result in renal failure, peripheral neuropathy leading to foot ulcers, Charcot foot and amputation, autonomic neuropathy that can causes gastrointestinal, genito‐ urinary, and cardiovascular symptoms. The patients with a chronically elevated glucose level have high incidence of atherosclerotic vascular changes, which cause development of periph‐ eral arterial disease, cerebrovascular, and cardiovascular complications [6, 7]. Number of complications can be reduced, if patients maintain good glycemic control. Every patient who reduces HbA1c level for 1% decreases the risk of microvascular complication for 37% and the risk for diabetes related deaths for 21% [8].

## **3. Adherence to treatment**

**1. Introduction**

ity. This transformation is as follows [2]:

32 Mobile Health Technologies - Theories and Applications

and future possibilities of mobile health technology.

of chronic patients,

and

as homes.

**2. Diabetes mellitus**

Aging and chronic conditions represent a huge burden on the health care budgets. Moreover, in the future this burden will only increase [1]. At the same time, the patients require a better service, while there are fewer health care professionals and lesser resources. The states currently act mainly in two dimensions. On the one hand, they are strengthening their efforts on prevention. They develop or update existing programs, which promote healthy and active life styles. On the other hand, they are transforming the existing health care. Namely, the health care sys‐ tems as we know them were developed to treat the acute diseases. However, the chronic diseases spent more than 70% of the health care budgets [2, 3]. The prevention programs can prolong the healthy period of each individual, but some chronic diseases, such as diabetes, cannot elimi‐ nate. Therefore, there is a need for transformation of the existing health care whose goals are better health results, better quality of service and quality of patient life, and economic feasibil‐

**•** from the health care model centered on acute medical care to the model adopted to the needs

**•** from reactive model to proactive model to cure, care for and prevent based on risk factors,

**•** from passive patients to a model with a patient in the center, actively managing his disease,

**•** from a fragmented model with lack of coordination to a model enabling continuity of care,

**•** from activities primarily in acute hospitals to activities in more suitable environments, such

The key enablers for such transformation are patient empowerment, use of information and

This chapter explores the concept of empowerment of diabetes patients by presenting current

Number of diabetes patients around the world has reached 415 million and it is predicted to climb up to 642 million by the year 2040. Diabetes can also be linked to around 5 million deaths each year and it is associated with high financial burden, since health spending on diabetes accounts for around 12% of total health expenditure worldwide. The costs include increase use of health services as well as loss of productivity or disability and are estimated to range from 673 billion USD to 1197 billion USD [4]. With such troubling predictions, we are obligated to look for new methods to facilitate patient care. Introduction of new methods should be done with the understanding that more than 95% of diabetes care is done by the patients themselves [5]. This is just one of several reasons why diabetes patients are excellent candidates for

communications technology (ICT), integrated care, and adopted business models.

World Health Organization defines adherence as an extent to which a person's behavior: taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider [9]. One of the key challenges in diabetes management is a lack of adherence to medication regime and lack of lifestyle changes. Adherence to oral hypoglycemic agents is between 36 and 93% for the first 9–24 months of treatment and adherence to insulin treatment for type 2 diabetes patients is between 62 and 64%. Patients even less complain when it comes to dietary and other lifestyle recommenda‐ tions [10, 11]. Regardless of the type of treatment, it was proven that introduction of selfmonitoring of blood glucose level is associated with better glycemic control [12], but there are still around 29% patients treated with insulin, 65% patients treated with oral hypoglycemic agents, and 80% patients treated with dietary restriction, who do not practice self-monitor‐ ing or they do it less than once a month [13]. Poor adherence is also a public health issue. For every 10% increase in adherence, there is 8.6% decrease in annual health care cost. Further‐ more, there is evidently a link between number of hospitalizations and adherence to medica‐ tion therapy, which is reduced by 23.3% when adherence had increased from 50 to 100%. Even more evident reduction of 46.2% is seen in number of emergency department visits. Both events, i.e., number of hospitalization and emergency department visits are associated with lower costs [14, 15]. When dealing with nonadherence, it is valuable to consider various reasons why this phenomenon occurs. It can be attributed to demographic factors, psycho‐ logical factors, social factors, medical system factors, disease and treatment characteristic, but

mostly it is a result of combinations of multiple factors [11, 16]. For example, glycemic control and treatment outcomes are less promising among racial minorities, men and people with depression or anxiety disorders [17, 18]. Those differences emphasize the importance of individualized and patient-centered care.
