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Interactive Behavior Change Technology to Support Diabetes Self-Management

Where do we stand?

From the Department of Veterans Affairs Center of Excellence, the Michigan Diabetes Research and Training Center, and the University of Michigan Department of Internal Medicine, Ann Arbor, Michigan

Address correspondence and reprint requests to Dr. John D. Piette, HSR&D Center of Excellence, VA Ann Arbor Healthcare System, P.O. Box 130170, Ann Arbor, MI 48113-0170. E-mail: jpiette@umich.edu

Abbreviations: IBCT, interactive behavior change technology

The first 300 words of the full text of this article appear below.

The growing imbalance between need and resources for diabetes care

The number of people living with diabetes continues to rise at an astounding rate (1). Moreover, the epidemic of childhood obesity, coupled with widespread intake of high-fat, low-fiber diets, suggests that this problem will not abate in the foreseeable future (2). Even if the number of diabetic patients miraculously held constant, the need for diabetes medical management and self-care support would continue to trend upward. Diabetes treatment and outcomes have improved over recent years (3–5), and, like the population overall, patients are living longer. Meanwhile, expectations for diabetes care are increasing, with clearer standards for what self-care support should include (which is a good thing [6]), as well as increasingly aggressive goals for physiologic targets such as A1C and blood pressure (which has been more controversial [7,8]). Payers for health services are having an increasingly difficult time funding diabetes care. Experts agree that the current Medicare program will be insolvent in less than 20 years (9), and mounting costs on private insurers have led them to increase cost sharing, limit eligibility and benefits, and even close their doors completely. Insurers pass these financial pressures onto both service providers (through lower payments) and beneficiaries (through higher co-pays and fewer benefits), making out-of-pocket cost one of the major barriers to effective diabetes management (10,11). In short, we now face the untenable situation of a growing demand for diabetes services, coupled with fewer and fewer resources to pay for it.

Meeting this challenge requires addressing some of the most complex problems in health care, including how to coordinate diabetes services across providers and how to provide effective support for self-management between outpatient visits. The Chronic Care Model is now accepted worldwide as a . . . [Full Text of this Article]

Interactive behavior change technology as a partial solution to the looming crisis in diabetes care

So what's the problem?

Some examples of new approaches

Using electronic refill data to promote medication adherence and intensification

Promoting walking with enhanced pedometers

Enhancing patient-to-patient (peer) support

Supporting informal caregivers

Toward a thoughtful approach to IBCT development and implementation

Look before you leap (but do not forget to leap).
One size does not fit all.
Beware of "cool apps" (applications).
Information technologies are most effective when they support human contact

Diabetes self-management is rarely patients' primary life concern

Not all patients need IBCT

Translating innovations into new services requires collaborations between researchers, managers, clinicians, and people living with diabetes

Conclusions

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				L. Fisher and R. E. Glasgow A Call for More Effectively Integrating Behavioral and Social Science Principles Into Comprehensive Diabetes Care Diabetes Care, October 1, 2007; 30(10): 2746 - 2749. [Full Text] [PDF]