title: A randomized controlled trial of Sweet Talk, a text-messaging system to support young people with diabetes. Effect of Home Blood Pressure Telemonitoring With Self-Care Support on Uncontrolled Systolic Hypertension in Diabetics Cluster-Randomized Trial of a Mobile Phone Personalized Behavioral Intervention for Blood Glucose Control Pilot study of a cell phone-based exercise persistence intervention post-rehabilitation for COPD Improved Glycemic Control Without Hypoglycemia in Elderly Diabetic Patients Using the Ubiquitous Healthcare Service, a New Medical Information System The impact of nurse short message services and telephone follow-ups on diabetic adherence: which one is more effective? Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial Blood pressure telemonitoring is useful to achieve blood pressure control in inadequately treated patients with arterial hypertension Qualitative evaluation of a mobile phone and web-based collaborative care intervention for patients with type 2 diabetes. The DAILY (Daily Automated Intensive Log for Youth) trial: a wireless, portable system to improve adherence and glycemic control in youth with diabetes. The in vivo adherence intervention for at risk adolescents with asthma: report of a randomized pilot trial. Diabetes Interactive Diary: A New Telemedicine System Enabling Flexible Diet and Insulin Therapy While Improving Quality of Life Blood pressure control during telemonitoring of home blood pressure. A randomized controlled trial during 6 months Impact of Patient–General Practitioner Short-Messages-Based Interaction on the Control of Hypertension in a Follow-up Service for Low-to-Medium Risk Hypertensive Patients: A Randomized Controlled Trial Reinforcement of adherence to prescription recommendations in Asian Indian diabetes patients using short message service (SMS)--a pilot study. Impact of Remote Telemedical Management on Mortality and Hospitalizations in Ambulatory Patients With Chronic Heart Failure: The Telemedical Interventional Monitoring in Heart Failure Study Patients’ Engagement With “Sweet Talk” – A Text Messaging Support System for Young People With Diabetes A mobile phone short message service improves perceived control of asthma: a randomized controlled trial. Mobile Phone-Based Telemonitoring for Heart Failure Management: A Randomized Controlled Trial A nurse short message service by cellular phone in type-2 diabetic patients for six months. Diabetes Self-Management Smartphone Application for Adults With Type 1 Diabetes: Randomized Controlled Trial A short message service by cellular phone in type 2 diabetic patients for 12 months. Development and Feasibility of a Text Messaging and Interactive Voice Response Intervention for Low-Income, Diverse Adults with Type 2 Diabetes Mellitus Effect of a reminder system using an automated short message service on medication adherence following acute coronary syndrome Managing diabetes care using an integrated regional e-health approach Mobile telemonitoring for achieving tighter targets of blood pressure control in patients with complicated diabetes: a pilot study. Mobile communication using a mobile phone with a glucometer for glucose control in Type 2 patients with diabetes: as effective as an Internet-based glucose monitoring system Pilot and Feasibility Test of Adolescent-Controlled Text Messaging Reminders A Ubiquitous Chronic Disease Care system using cellular phones and the internet. Stepwise Self-Titration of Oral Glucose-Lowering Medication Using a Mobile Telephone-Based Telehealth Platform in Type 2 Diabetes: A Feasibility Trial in Primary Care Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management. Mobile Phone-Based Video Messages for Diabetes Self-Care Support One-year efficacy and safety of Web-based follow-up using cellular phone in type 1 diabetic patients under insulin pump therapy: the PumpNet study. Gender Differences in Diabetes Self-Management: A Mixed-Methods Analysis of a Mobile Health Intervention for Inner-City Latino Patients Effect of mobile phone reminders on follow-up medical care of children exposed to or infected with HIV in Cameroon (MORE CARE): a multicentre, single-blind, factorial, randomised controlled trial. The use of text messaging to improve asthma control: a pilot study using the mobile phone short messaging service (SMS) Evaluating the impact of mobile telephone technology on type 2 diabetic patients' self-management: the NICHE pilot study. A text messaging intervention to promote medication adherence for patients with coronary heart disease: a randomized controlled trial. SMS reminders improve adherence to oral medication in type 2 diabetes patients who are real time electronically monitored Feasibility of Collecting Diary Data From Asthma Patients Through Mobile Phones and SMS (Short Message Service): Response Rate Analysis and Focus Group Evaluation From a Pilot Study Effect of Salt Reduction Intervention Program Using an Electronic Salt Sensor and Cellular Phone on Blood Pressure Among Hypertensive Workers Improving asthma control through telemedicine: a study of short-message service. A randomized, controlled trial of an automated wireless messaging system for diabetes. WellDoc mobile diabetes management randomized controlled trial: change in clinical and behavioral outcomes and patient and physician satisfaction. Mobile phone text messaging for promoting adherence to anti-tuberculosis treatment: a systematic review protocol A daily SMS reminder increases adherence to asthma treatment: a three-month follow-up study. Trial to examine text message-based mHealth in emergency department patients with diabetes (TExT-MED): a randomized controlled trial. Evaluation of a Telemedicine Service for the Secondary Prevention of Coronary Artery Disease Psychosocial factors and medication adherence among patients with coronary heart disease: A text messaging intervention Technical and compliance considerations for mobile health self-monitoring of glucose and blood pressure for patients with diabetes Evaluation of a mobile phone telemonitoring system for glycaemic control in patients with diabetes
abstract: AIMS To assess Sweet Talk , a text-messaging support system design ed to enhance self-efficacy , facilitate uptake of intensive insulin therapy and improve glycaemic control in paediatric patients with Type 1 diabetes . METHODS One hundred and twenty-six patients fulfilled the eligibility criteria ; Type 1 diabetes for > 1 year , on conventional insulin therapy , aged 8 - 18 years . Ninety-two patients were r and omized to conventional insulin therapy  ( n = 28 ) , conventional therapy and Sweet Talk ( n = 33 ) or  intensive insulin therapy and Sweet Talk ( n = 31 ) . Goal - setting at clinic visits was reinforced by daily text-messages from the Sweet Talk software system , containing personalized goal -specific prompts and messages tailored to patients ' age , sex and insulin regimen . RESULTS HbA(1c ) did not change in patients on conventional therapy without or with Sweet Talk ( 10.3 + /- 1.7 vs. 10.1 + /- 1.7 % ) , but improved in patients r and omized to intensive therapy and Sweet Talk ( 9.2 + /- 2.2 % , 95 % CI -1.9 , -0.5 , P < 0.001 ) . Sweet Talk was associated with improvement in diabetes self-efficacy  ( conventional therapy 56.0 + /- 13.7 , conventional therapy plus Sweet Talk 62.1 + /- 6.6 , 95 % CI + 2.6 , + 7.5 , P = 0.003 ) and self-reported adherence  ( conventional therapy 70.4 + /- 20.0 , conventional therapy plus Sweet Talk 77.2 + /- 16.1 , 95 % CI + 0.4 , + 17.4 , P = 0.042 ) . When surveyed , 82 % of patients felt that Sweet Talk had improved their diabetes self-management and 90 % wanted to continue receiving messages . CONCLUSIONS Sweet Talk was associated with improved self-efficacy and adherence ; engaging a classically difficult to reach group of young people . While Sweet Talk alone did not improve glycaemic control , it may have had a role in supporting the introduction of intensive insulin therapy . Scheduled , tailored text messaging offers an innovative means of supporting adolescents with diabetes and could be adapted for other health-care setting s and chronic diseases Lowering blood pressure reduces cardiovascular risk , yet hypertension is poorly controlled in diabetic patients . In a pilot study we demonstrated that a home blood pressure telemonitoring system , which provided self-care messages on the smartphone of hypertensive diabetic patients immediately after each reading , improved blood pressure control . Messages were based on care paths defined by running averages of transmitted readings . The present study tests the system 's effectiveness in a r and omized , controlled trial in diabetic patients with uncontrolled systolic hypertension . Of 244 subjects screened for eligibility , 110 ( 45 % ) were r and omly allocated to the intervention ( n=55 ) or control ( n=55 ) group , and 105 ( 95.5 % ) completed the 1-year outcome visit . In the intention-to-treat analysis , mean daytime ambulatory systolic blood pressure , the primary end point , decreased significantly only in the intervention group by 9.1±15.6 mmHg ( SD ; P<0.0001 ) , and the mean between-group difference was 7.1±2.3 mmHg ( SE ; P<0.005 ) . Furthermore , 51 % of intervention subjects achieved the guideline recommended target of < 130/80 mmHg compared with 31 % of control subjects ( P<0.05 ) . These improvements were obtained without the use of more or different antihypertensive medications or additional clinic visits to physicians . Providing self-care support did not affect anxiety but worsened depression on the Hospital Anxiety and Depression Scale ( baseline , 4.1±3.76 ; exit , 5.2±4.30 ; P=0.014 ) . This study demonstrated that home blood pressure telemonitoring combined with automated self-care support reduced the blood pressure of diabetic patients with uncontrolled systolic hypertension  and improved hypertension control . Home blood pressure monitoring alone had no effect on blood pressure . Promoting patient self-care may have negative psychological effects OBJECTIVE To test whether adding mobile application coaching and patient/provider web portals to community primary care compared with st and ard diabetes management would reduce glycated hemoglobin levels in patients with type 2 diabetes . RESEARCH DESIGN AND METHODS A cluster-r and omized clinical trial , the Mobile Diabetes Intervention Study , r and omly assigned 26 primary care practice s to one of three stepped treatment groups or a control group ( usual care ) . A total of 163 patients were enrolled and included in analysis . The primary outcome was change in glycated hemoglobin levels over a 1-year treatment period . Secondary outcomes were changes in patient-reported diabetes symptoms , diabetes distress , depression , and other clinical ( blood pressure ) and laboratory ( lipid ) values . Maximal treatment was a mobile- and web-based self-management patient coaching system and provider decision support . Patients received automated , real-time educational and behavioral messaging in response to individually analyzed blood glucose values , diabetes medications , and lifestyle behaviors communicated by mobile phone . Providers received quarterly reports summarizing patient ’s glycemic control , diabetes medication management , lifestyle behaviors , and evidence -based treatment options . RESULTS The mean declines in glycated hemoglobin were 1.9 % in the maximal treatment group and 0.7 % in the usual care group , a difference of 1.2 % ( P = 0.001 ) over 12 months . Appreciable differences were not observed between groups for patient-reported diabetes distress , depression , diabetes symptoms , or blood pressure and lipid levels ( all P > 0.05 ) . CONCLUSIONS The combination of behavioral mobile coaching with blood glucose data , lifestyle behaviors , and patient self-management data individually analyzed and presented with evidence -based guidelines to providers substantially reduced glycated hemoglobin levels over 1 year Objective To determine the feasibility and efficacy of a six-month , cell phone-based exercise persistence intervention for patients with chronic obstructive pulmonary disease ( COPD ) following pulmonary rehabilitation . Methods Participants who completed a two-week run-in were r and omly assigned to either MOBILE-Coached  ( n = 9 ) or MOBILE-Self-Monitored  ( n = 8) . All participants met with a nurse to develop an individualized exercise plan , were issued a pedometer and exercise booklet , and instructed to continue to log their daily exercise and symptoms . MOBILE-Coached also received weekly reinforcement text messages on their cell phones ; reports of worsening symptoms were automatically flagged for follow-up . Usability and satisfaction were assessed . Participants completed incremental cycle and six minute walk ( 6MW ) tests , wore an activity monitor for 14 days , and reported their health-related quality of life ( HRQL ) at baseline , three , and six months . Results The sample had a mean age of 68 ±11 and forced expiratory volume in one second 18 % predicted . Participants reported that logging their exercise and symptoms ( FEV1 ) of 40 ± was easy and that keeping track of their exercise helped them remain active . There were no differences between groups over time in maximal workload , 6MW distance , or HRQL ( p > 0.05 ) ; however , MOBILE-Self-Monitored increased total steps/day whereas MOBILE-Coached logged fewer steps over six months ( p = 0.04 ) . Conclusions We showed that it is feasible to deliver a cell phone-based exercise persistence intervention to patients with COPD post-rehabilitation and that the addition of coaching appeared to be no better than self-monitoring . The latter finding needs to be interpreted with caution since this was a purely exploratory study . Trial registration Clinical Trials.gov ( NCT00373932 ) OBJECTIVE To improve quality and efficiency of care for elderly patients with type 2 diabetes , we introduced elderly-friendly strategies to the clinical decision support system (CDSS)-based ubiquitous healthcare ( u-healthcare ) service , which is an individualized health management system using advanced medical information technology . RESEARCH DESIGN AND METHODS We conducted a 6-month r and omized , controlled clinical trial involving 144 patients aged > 60 years . Participants were r and omly assigned to receive routine care ( control , n = 48 ) , to the self-monitored blood glucose ( SMBG  , n = 47 ) group , or to the u-healthcare group ( n = 49 ) . The primary end point was the proportion of patients achieving A1C < 7 % without hypoglycemia at 6 months . U-healthcare system refers to an individualized medical service in which medical instructions are given through the patient ’s mobile phone . Patients receive a glucometer with a public switched telephone network-connected cradle that automatically transfers test results to a hospital-based server . Once the data are transferred to the server , an automated system , the CDSS rule engine , generates and sends patient-specific messages by mobile phone . RESULTS After 6 months of follow-up , the mean A1C level was significantly decreased from 7.8 ± 1.3 % to 7.4 ± 1.0 % ( P < 0.001 ) in the u-healthcare group and from 7.9 ± 1.0 % to 7.7 ± 1.0 % ( P = 0.020 ) in the SMBG group , compared with 7.9 ± 0.8 % to 7.8 ± 1.0 % ( P = 0.274 ) in the control group . The proportion of patients with A1C < 7 % without hypoglycemia was 30.6 % in the u-healthcare group , 23.4 % in the SMBG group ( 23.4 % ) , and 14.0 % in the control group ( P < 0.05 ) . CONCLUSIONS The CDSS-based u-healthcare service achieved better glycemic control with less hypoglycemia than SMBG and routine care and may provide effective and safe diabetes management in the elderly diabetic patients AIM To compare the effectiveness of two methods of follow-up : short message service and telephone follow-up on type 2 diabetes adherence for three months . BACKGROUND Using telemedicine approaches may preserve appropriate blood glucose levels and may improve adherence to diabetes control recommendations in diabetic patients . DESIGN A quasi-experimental , two-group , pretest and post-test design was used in this study to evaluate the effectiveness of nurse 's follow-up via cellular phones and telephones . METHODS The sample consisted of 77 patients with type 2 diabetes that r and omly were assigned to two groups : telephone follow-up ( n = 39 ) and short message service ( n = 38 ) . Telephone interventions were applied by a research er for three months ; twice a week for the first month and every week for the second and third month . For three successive months , the short message service group that received messages about adherence to therapeutic regimen was examined . The data gathering instrument included data sheets - to record glycosylated haemoglobin - and the question naire related to adherence therapeutic regimen . Data gathering was carried out at the beginning of the study and after three and six months . The data were analysed using descriptive and inferential statistic methods with SPSS version 11.5 . RESULTS Results showed that both interventions had significant mean changes in glycosylated haemoglobin . For the telephone group ( p < 0.001 ) , a mean change of -0.93 and for the short message service group ( p < 0.001 ) , a mean change of -1.01 . There was no significant difference in diet adherence ( p = 0.000 ) , physical exercise ( p = 0.000 ) and medication taking ( p = 0.000 ) adherence in either groups . CONCLUSION Intervention using short message services of cellular phones and nurse-led-telephone follow-up improved HbA1c levels and adherence to diabetes therapeutic regimen for three months in type 2 diabetic patients . RELEVANCE TO CLINICAL PRACTICE Both of follow-up intervention uses in this study can decrease HbA1c levels and escalate adherence to diabetes control recommendations in people with type 2 diabetes for three months Objective To determine whether mobile phone based monitoring improves asthma control compared with st and ard paper based monitoring strategies . Design Multicentre r and omised controlled trial with cost effectiveness analysis . Setting UK primary care . Participants 288 adolescents and adults with poorly controlled asthma ( asthma control question naire ( ACQ ) score ≥1.5 ) from 32 practice s. Intervention Participants were central ly r and omised to twice daily recording and mobile phone based transmission of symptoms , drug use , and peak flow with immediate feedback prompting action according to an agreed plan or paper based monitoring . Main outcome measures Changes in scores on asthma control question naire and self efficacy ( knowledge , attitude , and self efficacy asthma question naire ( KASE-AQ ) ) at six months after r and omisation . Assessment of outcomes was blinded . Analysis was on an intention to treat basis . Results There was no significant difference in the change in asthma control or self efficacy between the two groups ( ACQ : mean change 0.75 in mobile group v 0.73 in paper group , mean difference in change −0.02 ( 95 % confidence interval −0.23 to 0.19 ) ; KASE-AQ score : mean change −4.4 v −2.4 , mean difference 2.0 ( −0.3 to 4.2 ) ) . The numbers of patients who had acute exacerbations , steroid courses , and unscheduled consultations were similar in both groups , with similar healthcare costs . Overall , the mobile phone service was more expensive because of the expenses of telemonitoring . Conclusions Mobile technology does not improve asthma control or increase self efficacy compared with paper based monitoring when both groups received clinical care to guidelines st and ards . The mobile technology was not cost effective . Trial registration Clinical Trials NCT00512837 Failing to reach blood pressure ( BP ) goals is one of the main problems in hypertension management . Especially in high-risk patients , intensive monitoring including frequently office visits or new techniques to monitor home BP is required . A total of 60 patients with uncontrolled hypertension were included and r and omized into a group with  telemetric BP monitoring ( TBPM ) ( n=30 ) and a control group receiving st and ard care ( n=30 ) . During the 3-month study period , patients received in addition to their antihypertensive pre-treatment up to 2 × 300 mg irbesartan to achieve the required target BP . All patients were instructed to measure their BP once daily in the morning . In the TBPM group automatic alerts were generated by the central data base server using pre-defined algorithms and patients were subsequently contacted by the physician . At baseline mean 24-h ambulant BP monitoring ( ABPM ) was 143.3±11.1/82.6±9.9 mm Hg in the TBPM group and 141.4±12.6/82.1±6.5 mm Hg in the st and ard care group . During treatment mean systolic BP showed a more intensive decrease in the TBPM vs control group ( −17.0±11.1 mm Hg vs −9.8±13.7 mm Hg ; P=0.032 ) . Patients in the TBPM group had a more pronounced night dipping and a higher reduction of mean pulse pressure than controls ( −8.1±5.9 mm Hg vs −2.8±7.4 mm Hg , P=0.004 ) . After 3 months , TBPM-treated patients were given a higher mean daily dose of irbesartan ( 375±187 mg vs 222±147 mg in controls ; P=<0.001 ) . We demonstrated that with TBPM a more effective and faster titration of the antihypertensive agent is possible . The alarm criteria chosen were useful to improve BP control BACKGROUND Drawing on previous web-based diabetes management programs based on the Chronic Care Model , we exp and ed an intervention to include care management through mobile phones and a game console web browser . METHODS The pilot intervention enrolled eight diabetes patients from the University of Washington in Seattle into a collaborative care program : connecting them to a care provider specializing in diabetes , providing access to their full electronic medical record , allowing wireless glucose uploads and e-mail with providers , and connecting them to the program 's web services through a game system . To evaluate the study , we conducted qualitative thematic analysis of semistructured interviews . RESULTS Participants expressed frustrations with using the cell phones and the game system in their everyday lives , but liked the wireless system for collaborating with a provider on uploaded glucoses and receiving automatic feedback on their blood sugar trends . A majority of participants also expressed that their participation in the trial increased their health awareness . DISCUSSION Mobile communication technologies showed promise within a web-based collaborative care program for type 2 diabetes . Future intervention design should focus on integrating easy-to-use applications within mobile technologies already familiar to patients and ensure the system allows for sufficient collaboration with a care provider Blood glucose ( BG ) monitoring ( BGM ) is an important component of diabetes management . New wireless technologies may facilitate BGM and help to optimize glycemic control . We evaluated an integrated wireless approach with and without a motivational game in youth with diabetes . Forty youth , 8 - 18 years old , each received a h and held device fitted with a wireless modem and diabetes data management software , plus a wireless-enabled BG monitor . Half were r and omized to receive the new technologies along with an integrated motivational game in which the participants would guess a BG level following collection of three earlier readings ( Game Group ) . BG data , insulin doses , and carbohydrate intake were displayed graphically prior to the glucose estimation . The other group received the new technologies alone ( Control Group ) . Both groups were instructed to perform BGM four times daily and transmit their data to a central server via the wireless modem . Feasibility of implementation and outcomes were ascertained after 4 weeks . Ninety-three percent of participants successfully transmitted their data wirelessly to the server . The Game Group transmitted significantly more glucose values than the Control Group ( P < 0.001 ) . The Game Group also had significantly less hyperglycemia ( glucose > /=13.9 mmol/L or > /=250 mg/dL ) than the Control Group ( P < 0.001 ) . Youth in the Game Group displayed a significant increase in diabetes knowledge over the 4-week trial ( P < 0.005 ) . Finally , there was a trend for more youth in the Game Group to maintain hemoglobin A1C values < /=8 % ( P = 0.06 ) . Thus a pediatric population with diabetes can successfully implement new technologies to facilitate BGM . Use of a motivational game appears to increase the frequency of monitoring , reduce the frequency of hyperglycemia , and improve diabetes knowledge , and may help to optimize glycemic control OBJECTIVE Low-income and minority adolescents are at high risk for poor asthma outcomes , due in part to adherence . We tested acceptability , feasibility , and effect sizes of an adherence intervention for low socioeconomic status ( SES ) minority youth with moderate- and severe-persistent asthma . Design and Methods Single-site r and omized pilot trial : intervention ( n = 12 ; asthma education , motivational interviewing , problem-solving skills training , 1 month cell-phone with tailored text messaging ) versus control ( n = 14 ; asthma education ; cell-phone without tailored messaging ) . Calculated effect-sizes of relative change from baseline ( 1 and 3 months ) . RESULTS Intervention was judged acceptable and feasible by participants . Participants ( 12 - 18 years , mean = 15.1 , SD = 1.67 ) were 76.9 % African-American , 80.7 % public/no insurance . At 1 and 3 months , asthma symptoms ( Cohen 's d 's = 0.40 , 0.96 ) and HRQOL ( PedsQL ™ ; Cohen 's d 's = 0.23 , 1.25 ) had clinical ly meaningful medium to large effect sizes . CONCLUSIONS This intervention appears promising for at-risk youth with moderate- and severe-persistent asthma OBJECTIVE Widespread use of carbohydrate counting is limited by its complex education . In this study we compared a Diabetes Interactive Diary ( DID ) with st and ard carbohydrate counting in terms of metabolic and weight control , time required for education , quality of life , and treatment satisfaction . RESEARCH DESIGN AND METHODS Adults with type 1 diabetes were r and omly assigned to DID ( group A , n = 67 ) or st and ard education ( group B , n = 63 ) and followed for 6 months . A subgroup also completed the  SF-36 Health Survey ( SF-36 ) and World Health Organization-Diabetes Treatment Satisfaction Question naire ( WHO-DTSQ ) at each visit . RESULTS Of 130 patients ( aged 35.7 ± 9.4 years ; diabetes duration 16.5 ± 10.5 years ) , 11 dropped out .  Time for education was 6 h ( range 2–15 h ) in group A and 12 h ( 2.5–25 h ) in group B ( P = 0.07 ) . A1C reduction was similar in both groups ( group A from 8.2 ± 0.8 to 7.8 ± 0.8 % and group B from 8.4 ± 0.7 to 7.9 ± 1.1 % ; P = 0.68 ) . Nonsignificant differences in favor of group A were documented for fasting blood glucose and body weight . No severe hypoglycemic episode occurred . WHO-DTSQ scores increased significantly more in group A ( from 26.7 ± 4.4 to 30.3 ± 4.5 ) than in group B ( from 27.5 ± 4.8 to 28.6 ± 5.1 ) ( P = 0.04 ) . Role Physical , General Health , Vitality , and Role Emotional SF-36 scores improved significantly more in group A than in group B. CONCLUSIONS DID is at least as effective as traditional carbohydrate counting education , allowing dietary freedom for a larger proportion of type 1 diabetic patients . DID is safe , requires less time for education , and is associated with lower weight gain . DID significantly improved treatment satisfaction and several quality -of-life dimensions Aim . To compare the effectiveness of antihypertensive treatment based on telemonitoring of home blood pressure ( BP ) and conventional monitoring of office BP . Methods . Hypertensive patients ( n = 236 ) participated in a r and omized , controlled study . In the intervention group , antihypertensive treatment was based on home BP monitoring . BP readings were registered by a PDA and automatically transmitted to a server , by which the patient and doctor could communicate . In the control group , patients received usual care with office visits to adjust antihypertensive treatment as needed . Primary outcome was difference in systolic daytime ambulatory BP monitoring ( ABPM ) change between baseline and 6 months . Results . In both groups , systolic daytime ABPM decreased significantly from baseline to follow‐up . The decrease in systolic daytime ABPM was −11.9 mmHg in the intervention group and −9.6 mmHg in the control group ( mean difference −2.3 [ 95 % CI −6.1 to −1.5 ] , p = 0.225 ) . The likelihood of daytime ABPM normalization was similar in the two groups [ 32/113 ( 28 % ) vs 46/123 ( 37 % ) , p = 0.139 ] . Conclusion . Antihypertensive treatment based on telemonitoring of home BP was as effective as usual monitoring of office BP with regards to reduction of BP . Trial registration : Clinical Trials.gov identifier : NCT00282334 The evaluation in real-life setting s of services for the follow-up and control of hypertensive patients is a complex intervention , which still needs analysis of the roles , tasks , and re sources involved in the basic items : patient , healthcare professional , and the interaction between the two . To evaluate the impact of patient-general practitioner ( GP ) short-messages-based interaction , isolated from other items , on the degree of hypertension control in the follow-up of medium-to-low-risk patients in primary care , a r and omized controlled trial has been performed : 38 GPs enrolled 285 hypertensive patients who recorded the results of self-blood-pressure ( BP ) monitoring , heart rate , and body weight , and completed an optional question naire in an identical manner over a six-month period . The telemedicine group ( TmG ) sent the data to a telemedicine-based system that enabled patient-GP interaction ; the control group ( CG ) recorded the data on paper and could only deliver it to their GP personally in the routine visits . In the TmG , the results were better , but not significantly so , for : 1 ) degree of hypertension control , in terms of the percentage of uncontrolled hypertensives at the final visit ( TmG versus CG : 31.7 % versus 35.6 % ; p = 0.47 ) ; 2 ) reduction in hypertension during follow-up , comparing measurements ( performed by a professional ) at the initial and final visits of systolic BP ( 15.5 versus 11.9 ; p = 0.13 ) and diastolic BP ( 9.6 versus 4.4 ; p = 0.40 ) ; and 3 ) adherence to the protocol within compliance levels of interest in a real-life follow-up service : Gt50 % ( 84.8 % versus 73.3 % ) and Gt25 % ( 92.4.8 % versus 75.4 % ) ( p = 0.053 ) . Other factors such as average values of self-measured systolic BP , diastolic BP and heart rate , acceptability of the protocol , and median number of consultations and hospital admissions were similar in both groups . Outcomes show that , taken alone , the patient-GP short-messages-based interaction has very little impact on the degree of hypertension control in patients with this profile . In complex interventions , to discriminate the impact of each of its components in isolation will enable us to design an efficient follow-up service , little dem and ing in terms of healthcare professional dedication , and optimized in other basic aspects OBJECTIVES To investigate the acceptability and feasibility of using short message services ( SMS ) via cell phones to ensure adherence to management prescriptions by diabetic patients . METHODS Type 2 diabetic patients with 5 or more years of diabetes and having HbA1c between 7.0 % to 10 % were r and omized to the control arm ( n = 105 ) to receive st and ard care and to the intervention arm ( SMS , n = 110 ) . Messages in English on principles of diabetes management were sent once in 3 days , the contents and frequencies varied as per the patients ' preferences . The study duration was 1 year . All participants were advised to report for quarterly clinic visits . A comparative assessment of the clinical , biochemical and anthropometric outcomes was made among the groups at the annual visit . RESULTS Annual review was possible in 71 % of intervention group and 63 % of control group . SMS was acceptable to the patients and the median number requested was 2 per week . HbA1c and plasma lipids improved significantly in the SMS group . CONCLUSIONS The pilot study showed that frequent communication via SMS was acceptable to diabetic patients and it helped to improve the health outcomes Background — This study was design ed to determine whether physician-led remote telemedical management ( RTM ) compared with usual care would result in reduced mortality in ambulatory patients with chronic heart failure ( HF ) . Methods and Results — We enrolled 710 stable chronic HF patients in New York Heart Association functional class II or III with a left ventricular ejection fraction ⩽35 % and a history of HF decompensation within the previous 2 years or with a left ventricular ejection fraction ⩽25 % . Patients were r and omly assigned ( 1:1 ) to RTM or usual care . Remote telemedical management used portable devices for ECG , blood pressure , and body weight measurements connected to a personal digital assistant that sent automated encrypted transmission via cell phones to the telemedical centers . The primary end point was death from any cause . The first secondary end point was a composite of cardiovascular death and hospitalization for HF . Baseline characteristics were similar between the RTM ( n=354 ) and control ( n=356 ) groups . Of the patients assigned to RTM , 287 ( 81 % ) were at least 70 % compliant with daily data transfers and no break for > 30 days ( except during hospitalizations ) . The median follow-up was 26 months ( minimum 12 ) , and was 99.9 % complete . Compared with usual care , RTM had no significant effect on all-cause mortality ( hazard ratio , 0.97 ; 95 % confidence interval , 0.67 to 1.41 ; P=0.87 ) or on cardiovascular death or HF hospitalization ( hazard ratio , 0.89 ; 95 % confidence interval , 0.67 to 1.19 ; P=0.44 ) . Conclusions — In ambulatory patients with chronic HF  , RTM compared with usual care was not associated with a reduction in all-cause mortality . Clinical Trial Registration : — URL : http://www . Clinical Trials.gov . Unique identifier : NCT00543881 Background Guidelines for optimizing type 1 diabetes in young people advocate intensive insulin therapy coupled with personal support from the health care team . “ Sweet Talk ” is a novel intervention design ed to support patients between clinic visits using text messages sent to a mobile phone . Scheduled messages are tailored to patient profiles and diabetes self-management goals , and generic messages include topical “ newsletters ” and anonymized tips from other participants . The system also allows patients to su bmi t data and questions to the diabetes care team . Objectives The aim was to explore how patients with type 1 diabetes interact with the Sweet Talk system in order to underst and its utility to this user group . Methods Subjects were 64 young people with diabetes who were participating in the intervention arms of a r and omized controlled trial . All text messages su bmi tted to Sweet Talk during a 12-month period were recorded . Messaging patterns and content were analyzed using mixed quantitative and qualitative methods . Results Patients su bmi tted 1180 messages during the observation period ( mean 18.4 , median 6 ) . Messaging frequency ranged widely between participants ( 0 - 240 ) with a subset of 5 high users contributing 52 % of the total . Patients ’ clinical and sociodemographic characteristics were not associated with total messaging frequency , although girls sent significantly more messages unrelated to diabetes than did boys ( P = .002 ) . The content of patients ’ messages fell into 8 main categories : blood glucose readings , diabetes questions , diabetes information , personal health administration , social messages , technical messages , message errors , and message responses . Unprompted su bmi ssion of blood glucose values was the most frequent incoming message type ( 35 % of total ) . Responses to requests for personal experiences and tips generated 40 % of all the incoming messages , while topical news items also generated good responses . Patients also used the service to ask questions , su bmi t information about their self-management , and order supplies . No patients nominated supporters to receive text messages about their self-management goals . Another option that was not used was the birthday reminder service . Conclusions Automated , scheduled text messaging successfully engaged young people with diabetes . While the system was primarily design ed to provide “ push ” support to patients , su bmi ssion of clinical data and queries illustrates that it was seen as a trusted medium for communicating with care providers . Responses to the newsletters and su bmi ssion of personal experiences and tips for circulation to other participants also illustrate the potential value of such interventions for establishing a sense of community . Although participants su bmi tted relatively few messages , positive responses to the system suggest that most derived passive support from reading the messages . The Sweet Talk system could be readily adapted to suit other chronic disease models and age groups , and the results of this study may help to inform the design of future text message support interventions OBJECTIVE Mobile phone short message service ( SMS ) has been suggested as a potentially powerful tool to improve asthma outcomes , and it can overcome external barriers such as time and distance to participate education programs . We wanted to know whether SMS can help to overcome intrinsic barriers such as perceived control of asthma ( PCA ) . SUBJECTS AND METHODS One hundred fifty out patients with asthma were r and omly assigned to the control , traditional , and SMS groups . Patients in all groups received verbal education based on the Global Initiative for Asthma , and patients in the traditional group received additional individualized asthma action plan for self-management with peak expiratory flow monitoring and recording asthma diary , while patients in the SMS group received additional daily SMS reminders on their mobile phone . The six-item PCA Question naire ( PCAQ-6 ) , St and ard Asthma-Specific Quality of Life [ AQLQ(S ) ] , spirometry , blood and induced sputum cell count , follow-up compliance rate , medicine compliance rate , and emergency department ( ED ) visits data were collected at the initial visit and at 12 weeks . RESULTS In total , 71 participants completed the trial for analysis .  Patients ' PCAQ-6 score was significantly increased in the SMS and traditional groups ( p<0.001 ) after 12 weeks , and the change of patients ' PCAQ-6 score in the SMS group was higher than in the traditional group ( p=0.018 ) . Patients in the SMS group had the highest AQLQ(S ) score and follow-up rate after 12 weeks . The change in PCAQ-6 score was associated with change in AQLQ(S ) score ( r=0.442 ) . Patients in all groups had better forced expiratory volume in 1 s ( FEV1 % ) and fewer ED visits after 12 weeks , but no significant differences were found among the three groups in the changes of FEV1 % and blood and induced sputum eosinophil counts and neutrophil counts . CONCLUSIONS SMS can improve PCA , and it has a greater advantage in improving follow-up rate and asthma-specific quality of life than traditional programs Background Previous trials of telemonitoring for heart failure management have reported inconsistent results , largely due to diverse intervention and study design s. Mobile phones are becoming ubiquitous and economical , but the feasibility and efficacy of a mobile phone-based telemonitoring system have not been determined . Objective The objective of this trial was to investigate the effects of a mobile phone-based telemonitoring system on heart failure management and outcomes . Methods One hundred patients were recruited from a heart function clinic and r and omized into telemonitoring and control groups . The telemonitoring group ( N = 50 ) took daily weight and blood pressure readings and weekly single-lead ECGs , and answered daily symptom questions on a mobile phone over 6 months . Readings were automatically transmitted wirelessly to the mobile phone and then to data servers . Instructions were sent to the patients ’ mobile phones and alerts to a cardiologist ’s mobile phone as required . Results Baseline question naires were completed and returned by 94 patients , and 84 patients returned post- study question naires . About 70 % of telemonitoring patients completed at least 80 % of their possible daily readings . The change in quality of life from baseline to post- study , as measured with the Minnesota Living with Heart Failure Question naire , was significantly greater for the telemonitoring group compared to the control group ( P = .05 ) . A between-group analysis also found greater post- study self-care maintenance ( measured with the Self-Care of Heart Failure Index ) for the telemonitoring group ( P = .03 ) . Brain natriuretic peptide ( BNP ) levels , self-care management , and left ventricular ejection fraction ( LVEF ) improved significantly for both groups from baseline to post- study , but did not show a between-group difference . However , a subgroup within-group analysis using the data from the 63 patients who had attended the heart function clinic for more than 6 months revealed the telemonitoring group had significant improvements from baseline to post- study in BNP ( decreased by 150 pg/mL , P = .02 ) , LVEF ( increased by 7.4 % , P = .005 ) and self-care maintenance ( increased by 7 points , P = .05 ) and management ( increased by 14 points , P = .03 ) , while the control group did not . No differences were found between the telemonitoring and control groups in terms of hospitalization , mortality , or emergency department visits , but the trial was underpowered to detect differences in these metrics . Conclusions Our findings provide evidence of improved quality of life through improved self-care and clinical management from a mobile phone-based telemonitoring system . The use of the mobile phone-based system had high adherence and was  feasible for patients , including the elderly and those with no experience with mobile phones . Trial Registration Clinical Trials.gov AIM To investigate the effectiveness of a nurse short message service ( SMS ) by cellular phone and wire Internet on plasma glucose levels in people with diabetes for six months . BACKGROUND Blood glucose management system using telemedicine approaches may maintain the appropriate blood glucose levels in type-2 diabetic patients . DESIGN A control group pre-test-post-test design was used to assess the effectiveness of nurse 's education . METHODS Twenty-five patients were r and omly assigned to an intervention group and 26 to a control group . The intervention was applied for six months . The goal of the intervention was to keep blood glucose concentrations close to the normal range . Participants were requested to input their  blood glucose level , diet and exercise diary everyday in the website by cellular phone or wire Internet . The research er sends optimal recommendations to each patient using SMS by cellular phone and wire Internet weekly . RESULTS Glycosylated hemoglobin ( HbA(1)c ) decreased 1.15 % points at three months and 1.05 % points at six months compared with baseline in the intervention group . Patients in the intervention group had a decrease of two hours post meal glucose ( 2HPMG ) of 85.1 mg/dl at three months and 63.1 mg/dl at six months compared with baseline . CONCLUSION This web-based intervention using SMS of cellular phone improved HbA(1)c and 2HPMG for six months in type-2 diabetic patients . RELEVANCE TO CLINICAL PRACTICE An SMS of cellular phone intervention by a nurse can reduce HbA(1)c and 2HPMG for six months in type-2 diabetic patients Background Persistently poor glycemic control in adult type 1 diabetes patients is a common , complex , and serious problem initiating significant damage to the cardiovascular , renal , neural , and visual systems . Currently , there is a plethora of low-cost and free diabetes self-management smartphone applications available in online stores . Objective The aim of this study was to examine the effectiveness of a freely available smartphone application combined with text-message feedback from a certified diabetes educator to improve glycemic control and other diabetes-related outcomes in adult patients with type 1 diabetes in a two-group r and omized controlled trial . Methods Patients were recruited through an online type 1 diabetes support group and letters mailed to adults with type 1 diabetes throughout Australia . In a 6-month intervention , followed by a three-month follow-up , patients ( n=72 ) were r and omized to usual care ( control group ) or usual care and the use of a smartphone application ( Glucose Buddy ) with weekly text-message feedback from a Certified Diabetes Educator ( intervention group ) . All outcome measures were collected at baseline and every three months over the study period . Patients ’ glycosylated hemoglobin levels ( HbA1c ) were measured with a blood test and diabetes-related self-efficacy , self-care activities , and quality of life were measured with online question naires . Results The mean age of patients was 35.20 years ( SD 10.43 ) ( 28 male , 44 female ) , 39 % ( 28/72 ) were male , and patients had been diagnosed with type 1 diabetes for a mean of 18.94 years ( SD 9.66 ) . Of the initial 72 patients , 53 completed the study ( 25 intervention , 28 control group ) . The intervention group significantly improved glycemic control ( HbA1c ) from baseline ( mean 9.08 % , SD 1.18 ) to 9-month follow-up ( mean 7.80 % , SD 0.75 ) , compared to the control group ( baseline : mean 8.47 % , SD 0.86 , follow-up : mean 8.58 % , SD 1.16 ) . No significant change over time was found in either group in relation to self-efficacy , self-care activities , and quality of life . Conclusions In adjunct to usual care , the use of a diabetes-related smartphone application combined with weekly text-message support from a health care professional can significantly improve glycemic control in adults with type 1 diabetes . Trial Registration Australian New Zeal and Clinical Trials Registry : ACTRN12612000132842 ; https://www.anzctr.org.au/Trial/ Registration /Trial Review .aspx?ACTRN=12612000132842 ( Archived by WebCite at http://www.webcitation.org/6Kl4jqn5u ) OBJECTIVE Investigate the effectiveness of an educational intervention that used both the cellular phone with a short messaging service ( SMS ) and the Internet on the glycemic control of the patients with type 2 diabetes mellitus . METHODS Twenty-five patients were r and omly assigned to an  intervention  group and twenty-six to a  control group . The intervention was applied for 12 months . The goal of the intervention was to keep blood glucose concentrations close to the normal range ( HbA(1)c<7 % ) . Patients in the intervention group were asked to access a website by using a cellular phone or to wiring the Internet and input their blood glucose levels weekly . Participants were sent the optimal recommendations by both cellular phone and the Internet weekly . RESULTS Participants in the intervention group had lower HbA(1)c over 12 months when compared with the control group . At 12 months the change from baseline in HbA(1)c was -1.32 in the intervention group versus + 0.81 in the control group . Two hours post-meal glucose ( 2HPMG ) had a significantly greater decline in the intervention group after 12 months when compared with the control group ( -100.0 versus + 18.1mg/dl ) . CONCLUSION This educational intervention using the Internet and a SMS by cellular phone rapidly improved and stably maintained the glycemic control of the patients with type 2 diabetes mellitus Low-income , racial/ethnic minorities are often nonadherent to diabetes medications , have uncontrolled glycemia , and have high rates of diabetes-related morbidity . Cell phones provide a viable modality to support medication adherence , but few cell phone-based interventions have been design ed for low-income persons , a population with more feature phone penetration than smartphone penetration . In an effort to reach the broadest range of patients , we leveraged the voice and text messaging capabilities shared by all cell phones to design the MEssaging for Diabetes intervention . We specifically advanced and adapted an existing tailored text messaging system to include interactive voice response functionality and support the medication adherence barriers of low-income , diverse adults with type 2 diabetes mellitus . We report on the design process and feasibility testing results ( i.e. , technical use patterns and subjective user experiences ) from patients from the target population who used the intervention in one of three user-centered design iterations . The types of challenges encountered in design were related to providing text message content with valued information and support that engages patients . The design process also highlighted the value of obtaining mixed methods data to provide insight into legitimate versus illegitimate missing data , patterns of use , and subjective user experiences . The iterative testing process and results outlined here provide a potential template for other teams seeking to design technology-based self-care support solutions for comparable patient population Background : Medication non-adherence leads to a vast range of negative outcomes in patients with coronary artery disease . An automated web-based system managing short message service ( SMS ) reminders is a telemedicine approach to optimise adherence among patients who frequently forget to take their medications or miss the timing . Aim : This paper sought to investigate the effect of automated SMS-based reminders on medication adherence in patients after hospital discharge following acute coronary syndrome ( ACS ) . Methods : An interventional study was conducted at a tertiary teaching hospital in Malaysia . A total of 62 patients with ACS were equally r and omised to receive either automated SMS reminders before every intake of cardiac medications or only usual care within eight weeks after discharge . The primary outcome was adherence to cardiac medications . Secondary outcomes were the heart functional status , and ACS-related hospital readmission and death rates . Results : There was a higher medication adherence level in the intervention group rather than the usual care group , ( χ2 (2)=18.614 , p<0.001 ) . The risk of being low adherent among the control group was 4.09 times greater than the intervention group ( relative risk = 4.09 , 95 % confidence interval ( CI ) 1.82–9.18 ) . A meaningful difference was found in heart functional status between the two study groups with better results among patients who received SMS reminders , ( χ2 ( 1 ) = 16.957 , p<0.001 ) . Conclusion : An automated SMS-based reminder system can potentially enhance medication adherence in ACS patients during the early post-discharge period A total of 175 patients with Types 1 and 2 diabetes in primary care and university hospital outpatient departments were r and omized into a study group ( n = 101 ) or usual care ( n = 74 ) . The study group used an e-health application with a diabetes management system and a home care link . Usual care did not involve e-health , i.e. the patients made regular general practitioner visits about every three months . After 12 months HbA1c decreased significantly in both groups of patients . The differences were small , but HbA1c was significantly lower in the study group than the controls . Diastolic blood pressure , fasting plasma glucose , serum total cholesterol , serum LDL-cholesterol and serum triglycerides were significantly lower in the study than in the control group . This was achieved with fewer visits by study patients to doctors and nurses . Use of e-health in diabetes care for 12 months was able to provide equivalent diabetic control to usual care , and improved cardiovascular risk factors BACKGROUND Hypertension is a major risk factor for the long-term complications of diabetes . Mobile , self-measurement of blood pressure is emerging as a method to manage blood pressure in general , but its impact in patients with diabetes is unclear . METHODS We r and omized 137 patients with diabetes and hypertension to either  mobile telemonitoring  ( n = 72 ) or usual care ( n = 65 ) . Clinic blood pressure was recorded at baseline and after 6 months . Patients in the intervention arm transmitted weekly blood pressure readings wirelessly , using adapted sensors via mobile phones to a central server . Clinicians received the data in real-time and using a web-based application provided management advice to the patient and their physicians . RESULTS Systolic blood pressure fell significantly in the patients in the intervention group ( mean [ 95 % confidence interval ] , -6.5 [ -0.8 to -12.2 ] mm Hg ; P = 0.027 ) and remained unchanged in the control group ( 2.1 [ 9.3 to -5.0 ] mm Hg ; P = 0.57 ) . Patients within the intervention arm of African origin seemed to benefit more from the intervention . In addition , those who achieved a systolic blood pressure of < 120 mm Hg had lower average blood sugars than those with higher readings ( 7.8 [ SD 1.6 ] vs. 8.9 [ SD 2.2 ] mmol/L ; P = 0.02 ) . CONCLUSIONS In patients with diabetes , mobile telemonitoring has potential for delivering intensified care to improve blood pressure control , and its use may be associated with reduced exposure to hyperglycemia A mobile phone with a glucometer integrated into the battery pack ( the ‘ Diabetes Phone ’ ) was launched in Korea in 2003 . We compared its effect on management of type 2 diabetes to the Internet-based glucose monitoring system ( IBGMS ) , which had been studied previously . We conducted a r and omized trial involving 69 patients for three months . Participants were assigned to an Internet group or a phone group . The phone group communicated with medical staff through the mobile phone only . Their glucose-monitoring data were automatically transferred to individual , web-based charts and they received medical recommendations by short message service . The Internet group used the IBGMS . There were no significant differences between the groups at baseline . After three months ' intervention , HbA1c levels of both groups had decreased significantly , from 7.6 % to 6.9 % for the Internet group and from 8.3 % to 7.1 % for the phone group ( P < 0.01 ) . Levels of patient satisfaction and adherence to medical advice were similar . Mobile , bidirectional communication between doctors and patients using the diabetes phone was as effective for glucose control as the previously-studied Internet-based monitoring system and it was good for patient satisfaction and adherence Purpose . This pilot study assessed the feasibility , acceptability , and utility of a text messaging system that allowed teenagers with asthma to generate and control medical reminders sent to their mobile phones . Methods . The 12 teens in the study group were able to create their own reminder text messages , add or change reminders , and determine when and how often the messages were sent to their cell phone . Results . In total , 18 of the 21 unique messages created were reminders to take medication . No teen made changes to their original text messages or delivery schedule on their own . They gave high ratings on the usefulness , acceptability , and ease of use of the text messaging system . Self-reported asthma control at baseline was similar for both the study and comparison groups and did not change significantly . Conclusions . Allowing teens to control the timing and content of reminder text messages may support self-management of chronic disease AIMS The rapidly increasing prevalence of chronic diseases is an important challenge to healthcare systems worldwide . To improve the quality and efficiency of chronic disease care , we investigated the effectiveness and applicability of the Ubiquitous Chronic Disease Care ( UCDC ) system using cellular phones and the internet for overweight patients with both Type 2 diabetes and hypertension . METHODS We conducted a r and omized , controlled clinical trial over 3 months that included 123 patients at a university hospital and a community public health centre . RESULTS After 12 weeks , there were significant improvements in HbA(1c ) in the intervention group ( 7.6 + /- 0.9 % to 7.1 + /- 0.8 % , P < 0.001 ) compared with the control group ( 7.4 + /- 0.9 % to 7.6 + /- 1.0 % , P = 0.03 ) . Furthermore , we observed a significant reduction in systolic and diastolic blood pressure , as well as improvements in total cholesterol , low-density lipoprotein-cholesterol and triglyceride levels in the intervention group . Furthermore , there was a significant increase in adiponectin levels in the intervention group compared with the control group , although high-sensitivity C-reactive protein and interleukin-6 levels did not change in either group . CONCLUSIONS The novel UCDC system presented in this paper improved multiple metabolic parameters simultaneously in overweight patients with both Type 2 diabetes and hypertension Background : Telehealth-supported clinical interventions may improve diabetes self-management . We explored the feasibility of stepwise self-titration of oral glucose-lowering medication guided by a mobile telephone-based telehealth platform for improving glycemic control in type 2 diabetes . Methods : We recruited 14 type 2 diabetes patients to a one-year feasibility study with 1:1 r and omization . Intervention group patients followed a stepwise treatment plan for titration of oral glucose-lowering medication with self-monitoring of glycemia using real-time graphical feedback on a mobile telephone and remote nurse monitoring using a Web-based tool . We carried out an interim analysis at 6 months . Results : We screened 3476 type 2 diabetes patients ; 94 % of the ineligible did not meet the eligibility criteria for hemoglobin A1c ( HbA1c ) or current treatment . Mean ( st and ard deviation ) patient age at baseline was 58 ( 11 ) years , HbA1c was 65 ( 12 ) mmol/mol ( 8.1 % [ 1.1 % ] ) , body mass index was 32.9 ( 6.4 ) kg/m2 , median [ interquartile  range ( IQR ) ] diabetes duration  was 2.6 ( 0.6 to 4.7 ) years , and 10 ( 71 % ) were men . The median ( IQR ) change in HbA1c from baseline to six months was −10 ( −21 to 3 ) mmol/mol ( −0.9 % [ -1.9 % to 0 % ] ) in the intervention group and −5 ( −13 to 6 ) mmol/mol ( −0.5 % [ -1.2 % to 0.6 % ] ) in the control group . Six out of seven intervention group patients and four out of seven control group patients changed their oral glucose-lowering medication ( p = .24 ) . Conclusions : Self-titration of oral glucose-lowering medication in type 2 diabetes with self-monitoring and remote monitoring of glycemia is feasible , and further studies using adapted recruitment strategies are required to evaluate whether it improves clinical outcomes BACKGROUND Cell phone text messaging , via the Short Messaging Service ( SMS ) , offers the promise of a highly portable , well-accepted , and inexpensive modality for engaging youth and young adults in the management of their diabetes . This pilot and feasibility study compared two-way SMS cell phone messaging with e-mail reminders that were directed at encouraging blood glucose ( BG ) monitoring . METHODS Forty insulin-treated adolescents and young adults with diabetes were r and omized to receive  electronic reminders  to check their BG levels  via cell phone text messaging or e-mail reminders for a 3-month pilot study . Electronic messages were automatically generated , and participant replies with BG results were processed by the locally developed Computerized Automated Reminder Diabetes System ( CARDS ) . Participants set their schedule for reminders on the secure CARDS website where they could also enter and review BG data . RESULTS Of the 40 participants , 22 were r and omized to receive cell phone text message reminders and 18 to receive e-mail reminders ; 18 in the cell phone group and 11 in the e-mail group used the system . Compared to the e-mail group , users in the cell phone group received more reminders ( 180.4 vs. 106.6 per user ) and responded with BG results significantly more often ( 30.0 vs. 6.9 per user , P = 0.04 ) . During the first month cell phone users su bmi tted twice as many BGs as e-mail users ( 27.2 vs. 13.8 per user ) ; by month 3 , usage waned . CONCLUSIONS Cell phone text messaging to promote BG monitoring is a viable and acceptable option in adolescents and young adults with diabetes . However , maintaining interest levels for prolonged intervals remains a challenge Background : This study examined whether mobile phone-based , one-way video messages about diabetes self-care improve hemoglobin A1c ( A1C ) and self-monitoring of blood glucose ( SMBG ) . Methods : This was a 1-year prospect i ve r and omized trial with two groups . The active intervention lasted 6 months . The study enrolled 65 people with A1C > 8.0 % who were established ( > 6 months ) patients in the endocrinology clinics of the Walter Reed Health Care System . Participants were r and omized to receive “ usual care ” or self-care video messages from their diabetes nurse practitioner . Video messages were sent daily to cell phones of study participants . Hemoglobin A1c and SMBG data were collected at 0 , 3 , 6 , 9 , and 12 months . Results : Participants who received the messages had a larger rate of decline in A1C than people who received usual care ( 0.2 % difference over 12 months , adjusting for covariates ; p = .002 and p = .004 for the interaction between time and group and for the quadratic effect of time by group , respectively ) . Hemoglobin A1c decline was greatest among participants who received video messages and viewed > 10 a month ( 0.6 % difference over 12 months , adjusting for covariates ; p < .001 for the interaction between time and group and the quadratic effect ) . Self-monitoring of blood glucose metrics were not related to the intervention . Conclusions : A one-way intervention using mobile phone-based video messages about diabetes self-care can improve A1C . Engagement with the technology is an important predictor of its success . This intervention is simple to implement and sustain AIM Conventional follow-up of type 1 diabetic patients treated with continuous subcutaneous insulin infusion ( CSII ) was compared with intensive coaching using the Web and the cellular phone network for retrospective data transmission and short message service ( SMS ) . METHODS Thirty poorly controlled patients ( HbA1c 7.5 - 10 % ) were enrolled in a bicenter , open-label , r and omized , 12-month , two-period , crossover study . After a 1-month run-in period , 15 patients were r and omly assigned to receive weekly medical support through SMS based upon weekly review of glucose values , while 15 patients continued to download self-monitored blood glucose ( SMBG ) values on a weekly basis without receiving SMS . After 6 months , patients crossed over to the alternate sequence for 6 additional months . Visits at the clinic were maintained every 3 months . RESULTS Patients with long-st and ing inadequately controlled diabetes ( 24 + /- 13 years ) were included . A non-significant trend to reduction in HbA(1c ) ( -0.25+/-0.94 % , P<0.10 ) and mean glucose values ( -9.2+/-25 mg/dl , P=0.06 ) during the 6-month SMS sequence was observed as compared with the no-SMS period . No safety issue ( hypoglycemia , glucose variability ) was reported . Adherence to SMBG was not affected by the trial . Quality of life analysis suggests a significant improvement in DQOL global score , as well as the DQOL satisfaction with life subscale , during the SMS sequence . CONCLUSIONS Long-term telemedical follow-up of insulin pump-treated patients using a cellular phone- , SMS- and Web-based platform is feasible , safe , does not alter quality of life and associated with a trend toward improved metabolic control Background : The benefit of mobile health ( mHealth ) on diabetes management among low-income , inner-city patients is largely unknown , particularly for Latino patients .  TExT-MED ( Trial to Examine Text Message for Emergency Department Patients with Diabetes ) is a text message-based program design ed to improve disease knowledge , self-efficacy , and glycemic control among low-income , inner-city Latinos . In phase I , 23 patients participated in an acceptability and feasibility study . Contrary to our model , there was no increase in knowledge despite increases in self-efficacy and healthy behaviors . In phase II , we performed a mixed- methods analysis to underst and how TExT-MED achieved these seemingly contradictory findings . Method : We performed a qualitative analysis of focus groups with patients from phase I. We explored patients ' receipt of health information from TExT-MED and other information sources . We used these qualitative findings to perform a mixed- methods analysis of the outcomes from phase I , reanalyzing the quantitative measures of self-efficacy , diabetes knowledge , and healthy behaviors . Results : We conducted two focus groups , one in English and one in Spanish . Through qualitative analysis , we found gender differences in information sources , dietary self-efficacy , and desired educational content . Applying this knowledge , we re-stratified phase I outcomes by gender and found differential changes in diabetes knowledge , self-efficacy , and behaviors . Men had increased self-efficacy while women showed increased knowledge . Conclusions : The efficacy of mHealth on diabetes management was affected by gender . Specifically , men and women differ in their dietary self-efficacy , information sources , and desired topics in future mHealth interventions . To achieve maximal impact , future mHealth interventions should be mindful of this gender difference BACKGROUND Missed scheduled HIV appointments lead to increased mortality , resistance to antiretroviral therapy , and suboptimum virological response . We aim ed to assess whether reminders sent to carers by text message , mobile phone call , or concomitant text message and mobile phone call increase attendance at medical appointments for HIV care in a population of children infected with or exposed to HIV in Cameroon . We also aim ed to ascertain the most cost-effective method of mobile-phone-based reminder . METHODS MORE CARE was a multicentre , single-blind , factorial , r and omised controlled trial in urban , semi-urban , and rural setting s in Cameroon . Carers of children who were infected with or had been exposed to HIV were r and omly assigned electronically in blocks of four and allocated ( 1:1:1:1 ) sequentially to receive a text message and a call , a text message only , a call only , or no reminder ( control ) . Investigators were masked to group assignment . Text messages were sent and calls made 2 or 3 days before a scheduled follow-up appointment . The primary outcomes were efficacy ( the proportion of patients attending a previously scheduled appointment ) and efficiency ( attendance/ [ measures of staff working time × cost of the reminders ] ) , as a measure of cost-effectiveness . The primary analysis was by intention to treat . This study is registered with the Pan African Clinical Trials Register , number PACTR201304000528276 . FINDINGS The study took place between Jan 28 and May 24 , 2013 . We r and omly assigned 242 adult-child ( carer-patient ) pairs into four groups : text message plus call ( n=61 ) , call ( n=60 ) , text message ( n=60 ) , and control ( n=61 ) . 54 participants ( 89 % ) in the text message plus call group , 51 ( 85 % ) in the call group , 45 ( 75 % ) in the text message group , and 31 ( 51 % ) in the control group attended their scheduled appointment . Compared with control , the odds ratios for improvement in the primary efficacy outcome were 7·5 ( 95 % CI 2·9 - 19·0 ; p<0·0001 ) for text message plus call , 5·5 ( 2·3 - 13·1 ; p=0·0002 ) for call , and 2·9 ( 1·3 - 6·3 ; p=0·012 ) for text message . No significant differences were seen in comparisons of the three intervention groups with each other , and there was no synergism between text messages and calls . For the primary efficiency outcome , the mean difference for text message versus text message plus call was 1·5 ( 95 % CI 0·7 to 2·4 ; p=0·002 ) , for call versus text message plus call was 1·2 ( 0·7 to 1·6 ; p<0·0001 ) , and for call versus text message was 0·4 ( -1·3 to 0·6 ; p=0·47 ) . INTERPRETATION Mobile-phone-based reminders of scheduled HIV appointments for carers of paediatric patients in low-re source setting s can increase attendance . The most effective method of reminder was text message plus phone call , but text messaging alone was the most efficient ( ie , cost-effective ) method . FUNDING No external funding We have evaluated the feasibility of using the mobile phone short message service ( SMS ) for symptom monitoring in patients with asthma . All consecutive patients admitted to hospital for asthma during an 11-month period were considered for enrolment ( n = 497 ) . Those meeting the inclusion criteria were r and omized into a control ( n = 60 ) and intervention group ( n = 60 ) . Patients in the intervention group received SMS messages according to a structured workflow , while patients in the control group had no SMS support . In the intervention group , the mean response rate to the messages was 82 % . There was an improvement in the Asthma Control Test ( ACT ) scores in 36 subjects in the intervention group compared to 28 subjects in the control group . There were reductions in the number of nebulizations in 54 subjects in the control group compared to 50 subjects in the intervention group , and reductions in emergency department visits in 57 subjects in the control group compared to 51 subjects in the intervention group . However , none of these differences were significant . There was no reduction in admission rates in either group ( P = 0.5 ) . The service was accepted by most patients , but its long-term effectiveness on the management of asthma remains to be determined RATIONALE , AIMS AND OBJECTIVES Utilizing information technology , such as Internet and cellphones , holds great promise in enhancing diabetic care . Yet few studies have examined the impact of cellphone technology on type 2 diabetics ' self-care . The primary aim of the study is to examine the feasibility of utilizing this technology to assist with diabetes self-care in a clinic population as well as its impact on clinical outcomes . METHODS Thirty patients with a diagnosis of type 2 diabetes at two Community Health Centers were r and omized to intervention or control . Intervention patients participated in a brief intervention and received tailored daily messages via cellphone prompting them to enhance their diabetic self-care behaviour .  Patients at the control site continued with their st and ard diabetes self-management .  RESULTS A mean improvement in HbA1c levels was apparent ( -0.1 , SD = 0.3 % ; P = 0.1534 ) in the intervention group , compared with a mean deterioration in the control ( 0.3 , SD = 1.0 % ; P = 0.3813 ) , yet without statistical significance . Self-efficacy scores improved significantly in the intervention group ( -0.5 , SD = 0.6 ; P = 0.0080 ) compared with no improvement in the control ( 0.0 , SD = 1.0 ; P = 0.9060 ) . Participants encountered numerous technological barriers when attempting to adhere to the intervention protocol . CONCLUSION The results indicate the intervention had a positive impact on some clinical outcome and self-efficacy . Although the technology appears feasible in a clinical setting technology must be made more user-friendly before a larger phase II trial is conducted OBJECTIVE Pharmacologic treatment for secondary prevention of coronary heart disease ( CHD ) is critical to prevent adverse clinical outcomes . In a r and omized controlled trial , we compared antiplatelet and statin adherence among patients with CHD who received : ( 1 ) text messages ( TM ) for medication reminders and education , ( 2 ) educational TM only , or ( 3 ) No TM .  METHODS A mobile health intervention delivered customized TM for 30 days . We assessed and analyzed medication adherence with electronic monitoring devices [ Medication Event Monitoring System ( MEMS ) ] by one-way ANOVA and Welch tests , two-way TM response rates by t-tests , and self-reported adherence ( Morisky Medication Adherence Scale ) by Repeated Measures ANOVA . RESULTS Among 90 patients ( 76 % male , mean age 59.2 years ) , MEMS revealed patients who received TM for antiplatelets had a higher percentage of correct doses taken ( p=0.02 ) , percentage number of doses taken ( p=0.01 ) , and percentage of prescribed doses taken on schedule ( p=0.01 ) .  TM response rates were higher for antiplatelets than statins ( p=0.005 ) . Self-reported adherence revealed no significant differences among groups . CONCLUSION TM increased adherence to antiplatelet therapy demonstrated by MEMS and TM responses . PRACTICE IMPLICATION S Feasibility and high satisfaction were established . Mobile health interventions show promise in promoting medication adherence BACKGROUND Poor adherence to oral antidiabetics has a negative influence on glycaemic control in type 2 diabetes patients .  Real Time Medication Monitoring ( RTMM ) combines real time monitoring of patients ' medication use with SMS reminders sent only if patients forget their medication , aim ing to improve adherence . This study aim ed to investigate the effect of these SMS reminders on adherence to oral antidiabetics in patients using RTMM  and investigate patients ' experiences with RTMM . METHODS Data were collected in a RCT involving 104 type 2 diabetes patients with suboptimal adherence to oral antidiabetics . Fifty-six patients were r and omised to receive SMS reminders if they forgot their medication , 48 patients received no reminders . Primary outcome measure was adherence to oral antidiabetics registered with RTMM , measured as : ( 1 ) days without dosing ; ( 2 ) missed doses ; ( 3 ) doses taken within predefined st and ardized time windows . Patients ' experiences were assessed with written question naires . RESULTS Over the six-month study period , patients receiving SMS reminders took significantly more doses within predefined time windows than patients receiving no reminders : 50 % vs. 39 % within a 1-h window ( p=0.003 ) up to 81 % vs. 70 % within a 4-h window ( p=0.007 ) . Reminded patients tended to miss doses less frequently than patients not reminded ( 15 % vs. 19 % , p=0.065 ) . Days without dosing were not significantly different between the groups . The majority of patients reported positive experiences with RTMM and SMS reminders . CONCLUSION RTMM with SMS reminders improves adherence of type 2 diabetes patients , especially the precision with which patients follow their prescribed regimen , and is well accepted by patients . TRIAL REGISTRATION Netherl and s Trial Register NTR1882 Background Self-management of asthma may improve asthma outcomes . The Internet has been suggested as a tool for the monitoring and self-management of asthma . However , in a recent study we found that a Web interface had some disadvantages and that users stopped using the application after a short while . Objective The primary objective of this study was to evaluate , from a user perspective , the feasibility of using short message service ( SMS ) for asthma diary data collection through mobile phones . The secondary objective was to investigate patient compliance with an  SMS diary  , as measured by response rates over time . Methods The study included quantitative response rate data , based on SMS collection , and qualitative data from a traditional focus group setting . In a period of 2 months , the participants received 4 SMS messages each day , including a medication reminder , a request to enter peak flow , data on sleep loss , and medication dosage . Participants were asked to reply to a minimum of 3 of the messages per day . Diary inputs were collected in a data base and the response rate per patient was expressed as the number of diary inputs ( SMS replies ) divided by diary requests ( product of number of days in the study and the number of diary questions per day ) for each participant . After the study period , the participants were invited to a focus group interview addressing the participants ' attitudes to their disease , their experience with the SMS asthma diary , and their future expectations from the SMS asthma diary . Results Twelve patients with asthma ( 6 males , 6 females ) participated in the data collection study . The median age was 38.5 ( range : 13 – 57 ) years . The median response rate per patient was 0.69 ( range : 0.03 – 0.98 ) , ie , half the participants reported more than about two thirds of the requested diary data . Furthermore , response rates were relatively steady during the study period with no signs of decreasing usage over time . From the subsequent focus group interview with 9 users we learned that , in general , the participants were enthusiastic about the SMS diary – it became an integrated part of their everyday life . However , the participants wished for a simpler diary with only one SMS message to respond to and a system with a Web interface for system customization and graphical display of diary data history . Conclusion This study suggests that SMS collection of asthma diary data is feasible , and that SMS may be a tool for supporting the self-management of asthma ( and possibly other chronic diseases ) in motivated and self-efficacious patients because mobile phones are a part of people 's everyday lives and enable active requests for data wherever the patient is . The combination of SMS data collection and a traditional Web page for data display and system customization may be a better and more usable tool for patients than the use of Web-based asthma diaries which suffer from high attrition rates Abstract We investigated the effectiveness of a workplace intervention program that utilized self-monitoring of daily salt excretion by an electronic salt sensor and sent personalized e-mail advice via cellular phone .  Forty-one hypertensive male workers were assigned to intervention and control groups , then counseled together . Intervention group members were asked to measure daily salt excretion and received e-mail advice . After 4 weeks , a greater decrease of blood pressure ( BP ) was observed in the intervention group , with significant reductions to daily salt excretion and home BP . The new intervention program is considered useful for BP control among hypertensive workers Home peak expiratory flow ( PEF ) measurement is recommended by asthma guidelines . In a 16-week r and omized controlled study on 16 subjects with asthma ( 24.6 6.5 years old , asthma duration small ze , Cyrillic 6 months ) , we examined Global System for Mobile Communications ( GSM ) mobile telephone short-message service ( SMS ) as a novel means of telemedicine in PEF monitoring . All subjects received asthma education , self-management plan , and st and ard treatment . All measured PEF three times daily and kept a symptom diary . In the study group , therapy was adjusted weekly by an asthma specialist according to PEF values received daily from the patients . There was no significant difference between the groups in absolute PEF , but PEF variability was significantly smaller in the study group ( 16.12 + /- 6.93 % vs. 27.24 + /- 10.01 % , p = 0.049 ) . forced expiratory flow in 1 second ( FEV1 ; % predicted ) in the study group was slightly but significantly increased ( 81.25 + /- 17.31 vs. 77.63 + /- 14.80 , p = 0.014 ) and in the control group , unchanged ( 78.25 + /- 21.09 vs. 78.88 + /- 22.02 , p = 0.497 ) . Mean FEV1 was similar in the two groups both before and after the study . Controls had significantly higher scores for cough ( 1.85 + /- 0.43 vs. 1.42 + /- 0.28 , p < 0.05 ) and night symptoms ( 1.22 + /- 0.23 vs. 0.85 + /- 0.32 , p < 0.05 ) . There was no significant difference between the groups in daily consumption of inhaled medicine , forced vital capacity , or compliance . Per patient , per week , the additional cost of follow-up by SMS was Euros 1.67 ( equivalent to approximately $ 1.30 per 1 Euro ) , and SMS transmission required 11.5 minutes . Although a study group of 40 patients is needed for the follow-up study to achieve the power of 80 % within the 95 % confidence interval , we conclude that SMS is a convenient , reliable , affordable , and secure means of telemedicine that may improve asthma control when added to a written action plan and st and ard follow-up BACKGROUND Aggressive management of blood glucose reduces future diabetes-related complications , but this is difficult to achieve . METHODS This r and omized , controlled study tested the effect of using a wireless two-way pager-based automated messaging system to improve diabetes control through facilitated self-management . The system sent health-related messages to patients , with automatic forwarding of urgent patient responses to the health care team . RESULTS Participants in both the experimental ( pager ) and the control groups experienced an average hemoglobin A1c decrease of 0.1 - 0.3 % . More patients in the pager group were  normotensive  , and more felt that their health care was better by the end of the study . A total of 79 % of participants enjoyed using the pager , and 68 % wanted to continue using the system . CONCLUSIONS Utilizing a wireless , automated messaging system in clinical practice is a feasible , low-cost , interactive way to facilitate diabetes self-management , which is acceptable to patients . While providing a convenient way for patients and providers to communicate , this system can support automated recording and ready retrieval of these real-time interactions BACKGROUND Less than 63 % of individuals with diabetes meet professional guidelines target of hemoglobin A1c < 7.0 % , and only 7 % meet combined glycemic , lipid , and blood pressure goals . The primary study aim was to assess the impact on A1c of a cell phone-based diabetes management software system used with web-based data analytics and therapy optimization tools . Secondary aims examined health care provider ( HCP ) adherence to prescribing guidelines and assessed HCPs ' adoption of the technology . METHODS Thirty patients with type 2 diabetes were recruited from three community physician practice s for a 3-month study and evenly r and omized . The intervention group received cell phone-based software design ed by endocrinologists and CDEs ( WellDoc Communications , Inc. , Baltimore , MD ) . The software provided real-time feedback on patients ' blood glucose levels , displayed patients ' medication regimens , incorporated hypo- and hyperglycemia treatment algorithms , and requested additional data needed to evaluate diabetes management . Patient data captured and transferred to secure servers were analyzed by proprietary statistical algorithms . The system sent computer-generated logbooks ( with suggested treatment plans ) to intervention patients ' HCPs . RESULTS The average decrease in A1c for intervention patients was 2.03 % , compared to 0.68 % ( P < 0.02 , one-tailed ) for control patients . Of the intervention patients , 84 % had medications titrated or changed by their HCP compared to controls ( 23 % , P = 0.002 ) . Intervention patients ' HCPs reported the system facilitated treatment decisions , provided organized data , and reduced logbook review time . CONCLUSIONS Adults with type 2 diabetes using WellDoc 's software achieved statistically significant improvements in A1c . HCP and patient satisfaction with the system was clinical ly and statistically significant Background In 2010 , there were approximately 8.8 million incident cases of tuberculosis ( TB ) worldwide . The treatment of TB is at least six months long and may be complicated by a high pill burden . In addition , TB patients often do not take their medication on schedule simply because they forget . Mobile phone text messaging has the potential to help promote TB treatment adherence . We , therefore , propose to conduct a review of current best evidence for the use of mobile phone text messaging to promote patient adherence to TB treatment . Methods This is a systematic review of the literature . We will preferably include r and omized controlled trials ( RCTs ) . However , non-r and omized studies ( NRS ) will be considered if there is an inadequate number of RCTs .We will search PubMed , EMBASE , CINAHL , CENTRAL , Science Citation Index , Africa-Wide Information , and WHOLIS electronic data bases for eligible studies available by 30 November 2012 regardless of language or publication status . We will also check reference lists for additional studies , identify abstract s from conference proceedings and communicate with authors for any relevant material .At least two authors will independently screen search outputs , select studies , extract data and assess the risk of bias ( using separate criteria for RCTs and NRS ) ; resolving discrepancies by discussion and consensus . We will assess clinical heterogeneity by examining the types of participants , interventions and outcomes in each study and pool studies judged to be clinical ly homogenous . We will also assess statistical heterogeneity using the chi-square test of homogeneity and quantify it using the I-square statistic . If study results are found to be statistically homogeneous ( that is heterogeneity P > 0.1 ) , we will pool them using the fixed-effect meta- analysis . Otherwise , we will use r and om-effects meta- analysis . We will calculate risk ratios and their corresponding 95 % confidence intervals for dichotomous outcomes , and mean differences for continuous outcomes . For other outcomes without quantitative data , a descriptive analysis will be used . Discussion Our results can be used by research ers and policy-makers to help inform them of the efficacy of mobile phone text messaging interventions to promote patient adherence to TB treatment BACKGROUND Poor adherence to asthma treatment is a well-recognised challenge and is associated with increased morbidity , mortality and consumption of health care re sources . This study examined the impact of receiving a daily text message reminder on one 's cell phone on adherence to asthma treatment . METHODS A total of 26 subjects aged 18 - 45 years , with a clinical history of asthma and a positive methacholine challenge test ( PD(20)<or=4micromol ) were r and omised to receive , or to not receive , a daily short message service ( SMS ) reminder on their cell phone to take their anti-asthmatic medication . Inhaled corticosteroids to last for eight weeks and a prescription for four additional weeks were given to the subjects . The primary outcome was adherence to asthma treatment . Secondary outcomes were reimbursement of asthma medication , and change in exhaled nitric oxide levels , lung function , and airway responsiveness . RESULTS The absolute difference in mean adherence rate between the two groups after 12 weeks was 17.8 % , 95 % CI ( 3.2 - 32.3 % ) , p=0.019 . No significant differences were observed between the two r and omisation groups for the secondary outcomes . CONCLUSION Daily text message reminders are already after a short period of observation associated with increased adherence to anti-asthmatic medication STUDY OBJECTIVE Increasingly , low-income inner-city patients with diabetes utilize emergency departments ( EDs ) for acute and chronic care . We seek to determine whether a scalable , low-cost , unidirectional , text message-based mobile health intervention ( TExT-MED ) improves clinical outcomes , increases healthy behaviors , and decreases ED utilization in a safety net population . METHODS We conducted an r and omized controlled trial of 128 adult patients with poorly controlled diabetes ( glycosylated hemoglobin [ Hb A1C ] level ≥8 % ) in an urban , public ED .  The TExT-MED group received 2 daily text messages for 6 months in English or Spanish . The primary outcome was change in Hb A1C level . Secondary outcomes included changes in medication adherence , self-efficacy , performance of self-care tasks , quality of life , diabetes-specific knowledge , ED utilization , and patient satisfaction . RESULTS Hb A1C level decreased by 1.05 % in the TExT-MED group compared with 0.60 % in the controls ( Δ0.45 ; 95 % confidence interval [ CI ] -0.27 to 1.17 ) at 6 months . Secondary outcomes favored the TExT-MED group , with the most sizable change observed in self-reported medication adherence ( as measured by the Morisky Medication Adherence Scale , an 8-point vali date d scale with higher scores representing better adherence ) , which improved from 4.5 to 5.4 in the TExT-MED group compared with a net decrease of -0.1 in the controls ( Δ1.1 [ 95 % CI 0.1 to 2.1 ] ) . Effects were larger among Spanish speakers for both medication adherence ( 1.1 versus -0.3 ; Δ1.4 ; 95 % CI 0.2 to 2.7 ) and Hb A1C ( -1.2 % versus -0.4 % ) in the TExT-MED group . The proportion of patients who used emergency services trended lower in the TExT-MED group ( 35.9 % versus 51.6 % ; Δ15.7 % ; 95 % CI 9.4 % to 22 % ) . Overall , 93.6 % of respondents enjoyed TExT-MED and 100 % would recommend it to family/friends . CONCLUSION The TExT-MED program did not result in a statistically significant improvement in Hb A1C . However , trends toward improvement in the primary outcome of Hb A1C and other secondary outcomes , including quality of life , were observed , the most pronounced being improved medication adherence . TExT-MED also decreased ED utilization . These findings were magnified in the Spanish-speaking subgroup .  Technologies such as TExT-MED represent highly scalable , low-cost , and widely accessible solutions for safety-net ED population PURPOSE : Efficient ways are needed to implement the secondary prevention ( SP ) of coronary heart disease . Because few studies have investigated Web-based SP programs , our aim was to determine the usefulness of a new Web-based telemonitoring system , connecting patients provided with self-measurement devices and care managers via mobile phone text messages , as a tool for SP . METHODS : A single-blind , r and omized controlled , clinical trial of 203 acute coronary syndrome ( ACS ) survivors , was conducted at a hospital in Madrid , Spain . All patients received lifestyle counseling and usual-care treatment . Patients in the telemonitoring group ( TMG ) sent , through mobile phones , weight , heart rate , and blood pressure ( BP ) weekly , and capillary plasma lipid profile and glucose monthly . A cardiologist accessed these data through a Web interface and sent recommendations via short message service . Main outcome measures were BP , body mass index ( BMI ) , smoking status , low-density lipoprotein-cholesterol ( LDL-c ) , and glycated hemoglobin A1c ( HbA1c ) . RESULTS : At 12-month followup , TMG patients were more likely ( RR = 1.4 ; 95 % CI = 1.1−1.7 ) to experience improvement in cardiovascular risk factors profile than control patients ( 69.6 % vs 50.5 % , P = .010 ) . More TMG patients achieved treatment goals for BP ( 62.1 % vs 42.9 % , P = .012 ) and HbA1c ( 86.4 % vs 54.2 % , P = .018 ) , with no differences in smoking cessation or LDL-c . Body mass index was significantly lower in TMG ( −0.77 kg/m2 vs + 0.29 kg/m2 , P = .005 ) . CONCLUSIONS : A telemonitoring program , via mobile phone messages , appears to be useful for improving the risk profile in ACS survivors and can be an effective tool for secondary prevention , especially for overweight patients Objective : Medication adherence is a complex behavior that is influenced by numerous factors . Applying self-efficacy theory , the primary aim of this r and omized controlled trial was to compare medication self-efficacy among patients with coronary heart disease who received : ( a ) text messages ( TMs ) for medication reminders and education , ( b ) TMs for education , or ( c ) no TMs .  The second aim was to identify the personal ( sociodemographic and clinical characteristics ) and psychosocial factors that were associated with and predicted medication adherence . Methods : Customized TMs were delivered over 30 days . Repeated measures analysis of variance was used to analyze medication self-efficacy . A multiple regression analysis was performed at baseline and follow-up to determine variables that were associated with and predicted self-reported medication adherence . Results : Among 90 subjects with mean age 59.2 years ( st and ard deviation ( SD ) 9.4 , range 35–83 ) , total scores for medication self-efficacy improved over 30 days ; however , there was no significant difference in this improvement as a function of the different treatment groups ( p=0.64 ) . Controlling for other variables in the model ( age , education , depression , and social support ) , less depression ( p=0.004 ) and higher social support ( p=0.02 ) positively predicted higher medication adherence in the final model . Conclusions : TM medication reminders and /or health education did not improve medication self-efficacy . Further theory testing of current and future models and interventions are required to underst and variables related to self-efficacy and medication adherence . Addressing psychosocial factors such as depression and social support should be a priority to improve medication adherence among patients with coronary heart disease Self-monitoring of blood glucose is an integral part of diabetes care which may be extended to other biometrics . Cellular and short range communication technologies will be important for the routine usage of these systems . However , the issues of follow-up and patient compliance with these emerging systems have not been yet studied evaluated but could be critical to the adoption of these technologies . We evaluated the impact of mobile telemonitoring on the intensification of care on blood pressure control and exposure to hyperglycaemia in patients with diabetes . We r and omised 137 patients with diabetes to either mobile telemonitoring  ( n = 3D72 ) or usual care patients ( n = 3D65 ) for 9 months . In this paper we present some of the clinical results with focus on blood pressure control hypertension and highlight some of the technical and compliance issues that were encountered We conducted a r and omized controlled trial using mobile health technology in an ethnically diverse sample of 137 patients with complicated diabetes . Patients in the intervention group ( n = 72 ) were trained to measure their blood glucose with a sensor which transmitted the readings to a mobile phone via a Bluetooth wireless link . Clinicians were then able to examine and respond to the readings which were viewed with a web-based application . Patients in the control arm of the study ( n = 65 )  did not transmit their readings and received care with their usual doctor in the outpatient and /or primary care setting . The mean follow-up period was 9 months in each group . The default rate was higher in the patients in the intervention arm due to technical problems . In an intention-to-treat analysis there were no differences in HbA1c between the intervention and control groups . In a sub-group analysis of the patients who completed the study , the telemonitoring group had a lower HbA1c than those in the control group : 7.76 % and 8.40 % , respectively ( P = 0.06 )
target: There is potential for mHealth tools to better facilitate adherence to chronic disease management , but the evidence supporting its current effectiveness is mixed .
background: BACKGROUND Adherence to chronic disease management is critical to achieving improved health outcomes , quality of life , and cost-effective health care .
  As the burden of chronic diseases continues to grow globally , so does the impact of non-adherence .
  Mobile technologies are increasingly being used in health care and public health practice ( mHealth ) for patient communication , monitoring , and education , and to facilitate adherence to chronic diseases management .
  OBJECTIVE We conducted a systematic review of the literature to evaluate the effectiveness of mHealth in supporting the adherence of patients to chronic diseases management ( " mAdherence " ) , and the usability , feasibility , and acceptability of mAdherence tools and platforms in chronic disease management among patients and health care providers .