Using Mobile Phones to Measure Adolescent Diabetes Adherence
Using Mobile Phones to Measure Adolescent Diabetes Adherence
复制标题
DOI：
10.1037/a0025543
复制
发表时间：
2012-01-01
影响因子：
4.2
通讯作者：
Johnson, Kevin B.
中科院分区：
文献类型：
--
作者：
Mulvaney, Shelagh A.;Rothman, Russell L.;Johnson, Kevin B.
目的：1）描述并确定使用基于手机的生态瞬时评估（EMA）来测量青少年1型糖尿病患者的血糖监测和胰岛素给药的可行性，2）将EMA与传统的自我报告和血糖控制联系起来，3）使用EMA识别一天中不同时间和不同时间的依从性模式。方法：青少年1型糖尿病患者（n = 96）完成了手机使用和依从性的基线测量。从医疗记录中获得糖化血红蛋白对照（通过HbA 1c水平测量）。一个青少年亚组（n = 50）完成了为期10天的EMA，以评估血糖监测频率、血糖监测时间、胰岛素给药和胰岛素剂量。三分之一的青少年在学校不允许使用手机治疗糖尿病。父母对在家使用手机的限制并不普遍。结果：EMA应答率（59%）在10天的呼叫期内保持稳定。早晨时间与更差的监测和胰岛素给药相关，占错过自我护理任务的59-74%。EMA报告的血糖检查缺失和胰岛素剂量缺失与传统的自我报告数据相关，但与HbA 1c水平无关。轨迹分析确定了两个亚组：一个具有持续充分的依从性，另一个具有更多变量和更差的依从性。后一种坚持方式显示血糖控制较差。结论：移动的电话提供了一种可行的方法来测量青少年的血糖监测和胰岛素给药，给定的评估持续时间有限。该方法提供了新的见解，关于模式的遵守，并应探讨在临床环境中的目标或定制的干预措施。
Objectives: 1) describe and determine the feasibility of using cell-phone-based ecological momentary assessment (EMA) to measure blood glucose monitoring and insulin administration in adolescent Type 1 diabetes, 2) relate EMA to traditional self-report and glycemic control, and 3) identify patterns of adherence by time of day and over time using EMA. Method: Adolescents with Type 1 diabetes (n = 96) completed baseline measures of cell phone use and adherence. Glycemic control (measured by levels of HbA1c) was obtained from medical records. A subgroup of adolescents (n = 50) completed 10 days of EMA to assess blood glucose monitoring frequency, timing of glucose monitoring, insulin administration, and insulin dosing. One third of adolescents were not allowed to use their cell phones for diabetes at school. Parental restrictions on cell phone use at home were not prevalent. Results: The EMA response rate (59%) remained stable over the 10-day calling period. Morning time was associated with worse monitoring and insulin administration, accounting for 59-74% of missed self-care tasks. EMA-reported missed glucose checks and missed insulin doses were correlated to traditional self-report data, but not to HbA1c levels. Trajectory analyses identified two subgroups: one with consistently adequate adherence, and one with more variable, and worse, adherence. The latter adherence style showed worse glycemic control. Conclusion: Mobile phones provide a feasible method to measure glucose monitoring and insulin administration in adolescents, given a limited assessment duration. The method provided novel insights regarding patterns of adherence and should be explored in clinical settings for targeting or tailoring interventions.