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

Aim and objectives: 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. Design: 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. Conclusion: 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. Relevance to clinical practice: 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. © 2014 John Wiley & Sons Ltd.