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Development of DM EduCorner as a Smartphone-based DSME Application for Diabetes Mellitus patients in Indonesia
Abstract
Background: The prevalence of DM in Indonesia, the fourth most populous country in the world, has increased by more than 50% in the past 5 years, from 6,9% in 2013 to 10,9% in 2018, of which most of the were Type-2 (T2DM). Furthermore, >70% of cases were undiagnosed and among those receiving treatment, only <30% achieved the blood glucose target. These factors lead high rates of complications and health cost which further complicates the problem of DM in Indonesia. Diabetes Self-Management Education (DSME) is one of strategy to overcome this problem and well-known to give good positive outcome. In past few years, many smartphone applications are developed to support DSME-behavior among DM patients. However, none of these applications/approach are specifically designed for DM patients in Indonesia.
Aims: The aim of this research is to develop and validate DM EduCorner as a standardized smartphone-based application for facilitating diabetes education among DM patients in Indonesia.
Method: Development of DM EduCorner application is carried out based on Android operating system (minimum SDK 23). Diabetes education material selections are based on National consensus on DM management and suggestions from experts and clinicians at the Endocrinology and Metabolism Division, Dr. Cipto Mangunkusumo National General Hospital. Education materials are then divided into 2 group of topics: Basic and Advance. All educational contents are delivered in Bahasa. Validation is then carried out by 7-days trial on at least 15 T2DM patients. Questionnaire-based assessment is provided after trial periods to assess its basic function as a standardized smartphone-based DSME application.
Results: We already released the application and can be downloaded through Google Play Store, with "DM EduCorner" keyword. The application can run start from Android 6.0 (SDK 23), with minimum support as low as Android 5.0 (SDK 21). Diabetes educational contents within application are delivered in form of articles, infographics, and videos, of which have been made based on National consensus on DM management criteria.
Discussion: The application can work well. Continuous updating is needed to keep the contents are up to date. We hope this application is out starting point to transforming standard conventional diabetes education into mobile-phone based diabetes education in the future!
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OBJECTIVE
This study evaluated the efficacy of a smartphone-based, patient-centered diabetes care system (mDiabetes) for type 2 diabetes that contains comprehensive modules for glucose monitoring, diet, physical activity, and a clinical decision support system.
RESEARCH DESIGN AND METHODS
We conducted a 24-week, multicenter, randomized controlled trial with adult patients with inadequately controlled type 2 diabetes. The patients were randomly assigned to the mDiabetes group or the paper logbook (pLogbook) group. The primary end point was the difference of the change in HbA1c from baseline between the two groups.
RESULTS
HbA1c reduction from baseline was greater in the mDiabetes group (−0.40 ± 0.09%, n = 90) than in the pLogbook group (−0.06 ± 0.10%, n = 82). The difference of adjusted mean changes was 0.35% (95% CI 0.14–0.55, P = 0.001). The proportion of patients whose HbA1c fell below 7.0% (53 mmol/mol) was 41.1% for the mDiabetes group and 20.7% for the pLogbook group (odds ratio [OR] 2.01, 95% CI 1.24–3.25, P = 0.003). The percentage of patients who attained HbA1c levels below 7.0% (53 mmol/mol) without hypoglycemia was 31.1% in the mDiabetes group and 17.1% in the pLogbook group (OR 1.82, 95% CI 1.03–3.21, P = 0.024). There was no difference in the event numbers of severe hyperglycemia and hypoglycemia between the two groups.
CONCLUSIONS
The implementation of the mDiabetes for patients with inadequately controlled type 2 diabetes resulted in a significant reduction in HbA1c levels, with tolerable safety profiles.
Diabetes mellitus (DM) is a chronic progressive metabolic disorder characterized by hyperglycemia mainly due to absolute (Type 1 DM) or relative (Type 2 DM) deficiency of insulin hormone. World Health Organization estimates that more than 346 million people worldwide have DM. This number is likely to more than double by 2030 without any intervention. The needs of diabetic patients are not only limited to adequate glycemic control but also correspond with preventing complications; disability limitation and rehabilitation. There are seven essential self-care behaviors in people with diabetes which predict good outcomes namely healthy eating, being physically active, monitoring of blood sugar, compliant with medications, good problem-solving skills, healthy coping skills and risk-reduction behaviors. All these seven behaviors have been found to be positively correlated with good glycemic control, reduction of complications and improvement in quality of life. Individuals with diabetes have been shown to make a dramatic impact on the progression and development of their disease by participating in their own care. Despite this fact, compliance or adherence to these activities has been found to be low, especially when looking at long-term changes. Though multiple demographic, socio-economic and social support factors can be considered as positive contributors in facilitating self-care activities in diabetic patients, role of clinicians in promoting self-care is vital and has to be emphasized. Realizing the multi-faceted nature of the problem, a systematic, multi-pronged and an integrated approach is required for promoting self-care practices among diabetic patients to avert any long-term complications.
Jakarta: Badan Penelitian dan Pengembangan Kesehatan Kementerian Kesehatan Republik Indonesia
- Riskesdas Hasil Utama
Hasil utama Riskesdas 2018 [Powerpoint]. Jakarta: Badan Penelitian dan Pengembangan Kesehatan
Kementerian Kesehatan Republik Indonesia; 2018. Available from:
http://www.kesmas.kemkes.go.id/assets/upload/dir_519d41d8cd98f00/files/Hasil-riskesdas-2018_1274.pdf
2. Konsensus pengelolaan dan pencegahan diabetes melitus tipe 2 di Indonesia 2015.Jakarta: Perkumpulan Endokrinologi
Indonesia (Perkeni); 2015.