Computerized Automated Reminder Diabetes System (CARDS) : using web and wireless phone technology to improve diabetes compliance

Abstract

Automated computer technologies utilizing e-mail or SMS text messaging reminders can help overcome adherence barriers to optimal glycemic control in patients with diabetes. Text messaging on cellular phones, in particular, has become a popular communications tool among adolescents and young adults. We have created an automated computer system that provides reminders to check blood sugars by e-mail or text messaging on a cellular phone. The reminder schedule is set on a password-protected web site by the user according to his or her preferences. Users can respond to the reminders with their blood sugars, which are time and date stamped and then stored in a database. Text parsing rules allow users to override the time and date and to attach a comment as well. The blood sugar log can later be viewed and edited on the web site. Positive feedback is provided for every blood sugar entered and users also have the option to have both general and diabetes facts sent to them daily at random times via e-mail or text messaging. A randomized, controlled trial comparing e-mail with text messaging is underway at the time of this writing to test the feasibility and utility of this system in patients with diabetes. Preliminary results from 10 users (mean age 18.9 [plus-minus] 2.0 years) indicate that the system appeals to a subset of the study population. Two of the ten subjects have been using the system consistently, each submitting an average of 1.3 and 2.7 blood sugars per day, respectively. Only 4 of the 51 blood sugars submitted have been via the website, suggesting that submission via e-mail or cell phone is more appealing. Final results will not be obtained until all patients have been enrolled and have completed their three month trial period.