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Cited by 106Mobile Health and mHealth ApplicationsDiabetes Management and EducationDigital Mental Health Interventions

The development and feasibility of a web-based intervention with diaries and situational feedback via smartphone to support self-management in patients with diabetes type 2

Open access
Nes, Andréa A.G., van Dulmen, Sandra, Eide, Erlend, Finset, Arnstein, Kristjánsdóttir, Ólöf Birna, Steen, Ida Synnøve, Eide, Hilde·2012·Diabetes Research and Clinical Practice
DOI 10.1016/j.diabres.2012.04.019
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Abstract

Aims The aim of the study was to develop and test the feasibility of a three months web-based intervention, delivered by a smartphone to support self-management in patients with type 2 diabetes.Methods The intervention included use of a smartphone enabling access to daily web-based diaries and individualized written situational feedback. The participants registered their eating behavior, medication taking, physical activities and emotions three times daily using the mobile device. They also registered their fasting blood glucose level in the morning diary. A therapist had immediate access to submitted diaries and used the situational information to formulate a personalized feedback based on Acceptance Commitment Therapy. The purpose of the diaries and the situational feedback was to stimulate self-management.Results Eleven of the fifteen participants included in the study completed the intervention, which was evaluated as supportive and meaningful. Most of the participants reported positive life style changes. The response rate to the daily registration entries was good and few technical problems were encountered.Conclusions The described intervention is feasible and should be tested out in a large-scale study. The developed smartphone application seems a promising tool for supporting patients with type 2 diabetes to make important life style changes.

AI snapshot

Written from the paper’s full text.

TL;DR

This pilot study developed and tested a three-month web-based smartphone intervention using daily diaries and ACT-based written situational feedback to support self-management in type 2 diabetes. Eleven of fifteen participants completed it; the intervention was rated supportive and meaningful, with good diary response and few technical problems, and the authors recommend a large-scale study.

Key findings

  • Of 15 included participants, 11 completed the intervention; 4 dropped out before starting because they believed filling in diaries three times daily would take too much time. Participants were 5 women and 10 men aged 46–71 years (mean = 59.6); 13 were recruited from GPs and 2 from the researchers’ network.
  • Diary response rate ranged from 21% to 97%, with an average of 68%. Most participants reported the diaries as a positive experience and judged content/questions easy, inspiring, and useful; 7 evaluated three diaries per day as acceptable, 8 considered the number of questions suitable, and 8 were completely satisfied with weekly feedback.
  • Mean HbA1c was 7.39% (SD = 1.11%) before inclusion and 6.9% (SD = 0.8%) at the end of intervention. Improvements were observed on HbA1c, fasting blood glucose, BMI, ADDQoL-19, and PAID, but the authors state these results are of limited value because of the small sample size.
  • Participants reported the intervention helped them manage diabetes by reinforcing coping strategies, following diet plans, checking blood glucose, and taking medication correctly; technical problems included touch-display/phone-size issues, failed blood glucose transfer, and occasional diary submission problems.

Methods

  • Pilot feasibility study conducted in Oslo, Norway, between April 2010 and September 2010; intended to include 10–15 participants with type 2 diabetes. Thirty-six people were invited, 15 agreed, and 11 completed. Recruitment was intended through GPs but also used the researchers’ social network because GP recruitment was difficult.
  • The three-month intervention used borrowed Samsung Omnia i900 smartphones with: three daily web-based diaries (morning 16, midday 12, evening 19 questions) prompted by SMS; fasting blood glucose registration; individualized written situational feedback based on Acceptance Commitment Therapy, given daily during the first month and weekly during the next two months; audio mindfulness/relaxation files; and the Few Touch Application for glucose, food, and activity recording.
  • Evaluation included a post-intervention questionnaire with five main areas (8–20 items each) scored on five-point Likert scales, two semi-structured interviews halfway through and after the study, therapist/researcher clinical impressions, and before/after health measures: HbA1c, BMI, ADDQoL-19, PAID, and blood tests. Analyses used descriptive statistics in SPSS version 18 and a descriptive thematic summary of interviews.

Limitations

  • Stated: the small sample size limits the value of outcome results; HbA1c alone is not enough to draw conclusions about behavioral change, and a further study should include an instrument assessing self-management.
  • Stated: recruitment from GPs was challenging; the researcher was involved in writing feedback, performing and evaluating interviews, which may have influenced evaluation results; lack of nonverbal communication was a challenge for the therapist; technical problems could cause frustration and affect dropout rates.
  • Evident from the text: this was a feasibility pilot without a control group, so it cannot establish effectiveness; the intervention was tested in a small, partly network-recruited sample, and several technical and usability issues remained to be improved before larger testing.

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Integrity signals

Registry

Crossref · 10.1016/j.diabres.2012.04.019

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 26 cited sources checked · 0 supported · 0 flagged

  • Findingown data
    § ABSTRACT · p. 2

    Most participants reported positive lifestyle changes.

    “Most of the participants reported positive life style changes.”
    Quote in the paperSubstantial claim
  • Findingown data
    § [TABLE 3] · p. 6

    Patients ranked satisfaction with the content of the feedback at a high level.

    “The patients also ranked satisfaction with the content of the feedback at a high level.”
    Quote in the paperNot a substantial claim
  • Findingown data
    § [TABLE 3] · p. 6

    Feedback helped participants manage their diabetes by reinforcing favorable coping strategies.

    “They reported that the feedback helped them to manage their diabetes by reinforcing favorable coping strategies.”
    Quote in the paperSubstantial claim
  • Findingnone given
    § ABSTRACT · p. 2

    Few technical problems were encountered.

    “few technical problems were encountered”
    Quote in the paperNot a substantial claim
  • Findingown data
    § ABSTRACT · p. 2

    Eleven of the fifteen participants included in the study completed the intervention.

    “Eleven of the fifteen participants included in the study completed the intervention”
    • Also stated in: § 3.1. Study sample · p. 6 · plain
      “Four participants dropped out and eleven completed the study.”
    Quote in the paperSubstantial claim
  • May combine two claims. 26
  • Classified as probably not a substantial claim. 29

  • May combine two claims.

    Findingown data
    § [TABLE 3] · p. 6

    The main problems with smartphone use were the touch display and the size of the telephone.

    “The main problems were the use of touch display (unusual, illogical with small letters) and the size of the telephone (too big).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § ABSTRACT · p. 2

    Participants evaluated the intervention as supportive, meaningful and motivating.

    “which was evaluated as supportive and meaningful”
    • Also stated in: § 3.2.1. Evaluation based on questionnaires · p. 6 · plain
      “most of them perceived this experience as supportive, meaningful and motivating”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [TABLE 3] · p. 6

    Feedback encouraged participants to follow their diet plan, check their blood glucose level and take their medication at the correct time and dosage.

    “The feedback also encouraged the participants to follow their diet plan, check their blood glucose level and take their medication at the correct time and dosage.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.1. Study sample · p. 6

    Mean HbA1c level was 7.39% (SD 1.11%) the week before inclusion and 6.9% (SD 0.8%) at the end of the intervention.

    “Mean average HBA1c level the week before inclusion was 7.39% (SD = 1.11%) and 6.9% (SD = 0.8%) at the end of intervention.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § [TABLE 3] · p. 6

    The diary response rate ranged from 21% to 97%, with an average of 68%.

    “The diary response rate ranged from 21% to 97% (see Table 2 ) with an average of 68%.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [TABLE 3] · p. 6

    Most participants reported the diaries as a positive experience and judged the content and questions in the diaries to be easy, inspiring and useful.

    “Most of the participants reported the diaries as a positive experience and judged the content and questions in the diaries to be easy, inspiring and useful”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.2.2. Interviews · p. 7

    Feedback helped patients define their own goals based on health values, identify barriers related to goal achievement and develop strategies to overcome the barriers.

    “The patients reported that the feedback helped them to define their own goals based on health values, identify barriers related to goals achievement and develop strategies to overcome the barriers.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data
    § 3.2.2. Interviews · p. 7

    Participants found it uncomfortable and sometimes inconvenient to take the borrowed smartphone along with their mobile.

    “As the smartphone with the intervention application was borrowed, the participants found it uncomfortable and sometimes inconvenient to take the smartphone along with their mobile.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [TABLE 4] · p. 6

    Two participants evaluated weekly feedback as too little and eight were completely satisfied.

    “Two participants evaluated weekly feedback as too little and eight were completely satisfied.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § [TABLE 3] · p. 6

    Just one participant reported no changes in the advising areas.

    “Just one participant reported no changes in the advising areas”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 3.2.2. Interviews · p. 7

    The long period also contributed positively to increasing honesty in answering the diary questions.

    “this period also contributed positively to increasing their honesty in answering the diary questions.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 3.2.2. Interviews · p. 7

    Most patients became committed to their values and goals and were willing to change their lifestyle to achieve a good health status.

    “They reported that they became committed to their values and goals and most of them were willing to change their life style to achieve a good health status.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § 3.2.2. Interviews · p. 7

    Patients missed variation in the questions and wanted weekends free from the diaries.

    “they missed a variation in the questions and wanted weekends free from the diaries.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Findingown data
    § 3.2.2. Interviews · p. 7

    Filling in the diaries gave patients a better insight into their diabetes and increased their coping and self-management strategies.

    “filling in the diaries gave them a better insight into their diabetes, increased their coping and self-management strategies.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    Patients wanted more information about diet.

    “The patients would have liked to receive more information about diet, as they reported that this theme was difficult to deal with.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § [TABLE 3] · p. 6

    Three participants did not feel motivated to do relaxation exercises.

    “three did not feel motivated to do relaxation exercises”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    A frequently occurring technical failure transferring the blood glucose level from the glucose meter to the smartphone was reported.

    “they also reported a frequently occurring technical failure transferring the blood glucose level from the glucose meter to the smartphone.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    The majority of participants would have liked to have an overview of all feedback messages.

    “The majority of participants would have liked to have had an overview of all feedback messages, where they could have found and read them again when they wanted.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    One participant would have preferred one intervention with group interaction where participants could motivate each other.

    “One participant would have preferred one intervention with group interaction where the participants could motivate each other.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    A long period of filling in diaries led to decreasing awareness.

    “a long period of filling in diaries led to decreasing awareness.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § [TABLE 4] · p. 6

    Seven participants evaluated three diaries per day as acceptable and considered the number of questions in the diary and length of the intervention as suitable.

    “Seven participants evaluated three diaries per day as acceptable and considered the number of questions in the diary and length of the intervention as suitable.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data
    § 3.2.2. Interviews · p. 7

    Stimuli to perform physical activities helped patients be more active.

    “The stimuli to perform physical activities helped the patients to be more active.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 3.2.3. The therapist's and researcher's clinical impressions · p. 8

    It was challenging to achieve the goal of always being empathic when communication with nonverbal signals and dialog were missing.

    “However, it was challenging to achieve the goal of always being empathic when the communication with nonverbal signals and dialog were missing.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 3.2.3. The therapist's and researcher's clinical impressions · p. 8

    The therapist and researcher felt that an interactive relationship was established with most patients.

    “The therapist (ISS) and researcher (AAGN) felt that an interactive relationship was established with most of the patients.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given
    § 3.2.3. The therapist's and researcher's clinical impressions · p. 8

    The authors expected participants to have sufficient knowledge about diabetes and diabetes treatment, but this was not the case.

    “We had expected that the participants had a sufficient knowledge about diabetes and diabetes treatment. This was not the case.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data
    § 4. DISCUSSION · p. 9

    Most participants were satisfied with the intervention and improvements on measures such as HbA1c, fasting blood glucose, BMI, ADDQoL19 and PAID were observed.

    “Most participants were satisfied with the intervention and improvements on measures such as HBA1c, fast blood glucose, BMI, ADDQoL19 and PAID were observed.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data
    § 3.3. Technical issues · p. 8

    One system breakdown occurred during the pilot period and the system was restored to working order the day after the problem was reported.

    “We had one system breakdown during the pilot period. The system was restored to working order the day after the problem was reported.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingnone given
    § 3.2.3. The therapist's and researcher's clinical impressions · p. 8

    For some patients, increased understanding of their disease was enough to change their lifestyle.

    “For some patients the increased understanding of their disease was enough to change their life style.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingnone given
    § 4. DISCUSSION · p. 9

    Recruitment from GPs was challenging and the need to find new ways of recruitment increased over time.

    “Recruitment from GPs was challenging and the need to find new ways of recruitment increased over time.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Study design and conductown data
    § 4. DISCUSSION · p. 9

    Because of the small sample size, these results are of limited value.

    “However, because of the small sample size, these results are of limited value.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 2.7.2. Assessment instruments · p. 5

    PAID is a brief self-report measure of diabetes-related distress that has been found useful in patients with diabetes (both type 1 and type 2).

    “PAID [25] is a brief self-report measure of diabetes-related distress that has been found to be useful in patients with diabetes (both type 1 and type 2).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] [25] Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetesrelated emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale. Diabetes Care 2000;23(9):1305-9. - source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation
    § 2.7.1. Feasibility of the intervention · p. 5

    The development of the questionnaire was based on a similar questionnaire from a previous study.

    “The development of this questionnaire was based on a similar questionnaire from a previous study [19] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [19] [19] Kristjansdottir O, Fors E, Eide E, Finset A, van Dulmen S, Wigers S, Eide H. Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given
    § 4. DISCUSSION · p. 9

    The researcher was involved in writing the feedbacks, performing and evaluating the interviews, and this may have influenced the evaluation results.

    “It is important to emphasize that the researcher (AAGN) was involved in writing the feedbacks, performing and evaluating of the interviews and this may have influenced the evaluation results.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given
    § 2.1. Study sample · p. 3

    The pilot study was approved by the Regional Ethical Committee.

    “was approved by the Regional Ethical Committee.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation
    § 4. DISCUSSION · p. 9

    Other studies have reported similar recruitment experiences.

    “Other studies have reported similar experiences [19] and [26] .”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [19] [19] Kristjansdottir O, Fors E, Eide E, Finset A, van Dulmen S, Wigers S, Eide H. Written online situational feedback via mobile phone to support self-management of chronic widespread pain: a usability study of a Web-based source

      Not checked in the free run.

    • cites [26] [26] van der Wouden J, Blankenstein A, Huibers M, van der Windt D, Stalman W, Verhagen A. Survey among 78 studies showed that Lasagna's law holds in Dutch primary care research. J Clin Epidemiol 2007;60(8):819-24. - source

      Not checked in the free run.

  • Classified as probably not a substantial claim.

    Interpretationnone given
    § 4. DISCUSSION · p. 9

    HbA1c measurement alone is not enough to draw conclusions concerning behavioral change.

    “we realize that this measurement itself is not enough to draw any conclusions concerning behavioral change.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 2.7.2. Assessment instruments · p. 5

    PAID scores have positive associations with HbA1c and are major predictors of poor adherence to treatment not involving general emotional distress.

    “PAID scores have been found to show positive associations with HbA1c, and are major predictors of poor adherence to treatment not involving general emotional distress.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [25] [25] Snoek FJ, Pouwer F, Welch GW, Polonsky WH. Diabetesrelated emotional distress in Dutch and U.S. diabetic patients: cross-cultural validity of the problem areas in diabetes scale. Diabetes Care 2000;23(9):1305-9. - source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Premisenone given
    § 4. DISCUSSION · p. 9

    Face-to-face communication usually provides valuable information that might change the therapist's interpretation of the patient's situation and thereby alter the therapist's strategy for treatment.

    “Face-to-face communication usually provides valuable information that might change the therapist's interpretation of the patient's situation and thereby alter the therapist's strategy for treatment.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation
    § 4. DISCUSSION · p. 9

    With an intervention based on ACT, participants can learn to accept negative thoughts and feelings in order to achieve psychological flexibility and consequently improvement in diabetes self-management.

    “With an intervention based on ACT, participants can learn, among other things, to accept their negative thoughts and feelings in order to achieve psychological flexibility and consequently improvement in diabetes selfmanagement [18] .”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [18] [18] Gregg JA, Callaghan GM, Hayes SC, Glenn-Lawson JL. Improving diabetes selfmanagement through acceptance, mindfulness, and values: a randomized controlled trial. J Consult Clin Psychol 2007;75(2):336-43. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation
    § 4. DISCUSSION · p. 9

    Guilt is a common feeling for type 2 diabetes patients and negatively influences self-management.

    “According to Gregg, 2007 this is also a common feeling for type 2 diabetes patients and negatively influences self-management [22] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [22] [22] Gregg JA. The diabetes lifestyle book: facing your fears and making changes for a° long and healthy life. Oakland: New Harbinger Publications; 2007. -

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

    Interpretationnone given
    § 4. DISCUSSION · p. 9

    The daily diaries filled by the participants may have supported self-monitoring.

    “The daily diaries filled by the participants may have supported self-monitoring.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 4. DISCUSSION · p. 9

    Childress (2000) concluded that theoretical models to deliver a text-based format intervention need to be developed and patients must be informed that risks related to this relatively new method of treatment are unknown.

    “Already in 2000, Childress wrote an article analyzing the ethical aspect of online interventions and concluded, among other things, that theoretical models to deliver a text based format intervention need to be developed and patients must be informed that risks related to this relatively new method of treatment is unknown [28] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [28] [28] Childress AC. Ethical issues in providing online psychotherapeutic interventions. J Med Internet Res 2000;2(1):e5. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 1. INTRODUCTION · p. 2

    Treatments based on ACT for several chronic diseases are increasing worldwide and a large number of randomized controlled trials confirm positive effects on health outcomes.

    “Treatments based on ACT for several chronic diseases are increasing worldwide and a large number of randomized control trials confirm positive effects on health outcomes [17] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [17] [17] Powers MB, Zum Vo¨ rde Sive Vo¨ rding MB, Emmelkamp PMG. Acceptance and commitment therapy: a meta-analytic review. Psychother Psychosom 2009;78(2):73-80. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 1. INTRODUCTION · p. 2

    Web-based CBT and mobile phone interventions are increasingly used to support people with diabetes and other health problems.

    “Web-based CBT and mobile phone interventions are increasingly used to support people with diabetes [6] , [7] , [8] , [9] and [10] and other health problems [11]”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [6] [6] Kouris I, Mougiakakou S, Scarnato L, Iliopoulou D, Diem P, Vazeou A, Koutsouris D. Mobile phone technologies and advanced data analysis towards the enhancement of diabetes self-management. Int J Electron Healthc 2010;5(4):386-402. source

      Not checked in the free run.

    • cites [7] [7] Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, Gu D. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med J Br Diabet Assoc 2011;28(4):455-63. source

      Not checked in the free run.

    • cites [8] [8] Chomutare T, Fernandez-Luque L, Arsand E, Hartvigsen G. Features of mobile diabetes applications: review of the literature and analysis of current applications compared against evidence-based guidelines. J Med Internet Res 2011;13(3):e65. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation
    § 4. DISCUSSION · p. 9

    A recent meta-analysis of mobile phone interventions showed statistically significant improvements in glycemic control and self-management for patients with type 2 diabetes.

    “Studies based on mobile phone intervention that have been investigated in a recent metaanalysis, showed that improvements in glycemic control and self-management for patients with type 2 diabetes were statistically significant [7] .”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [7] [7] Liang X, Wang Q, Yang X, Cao J, Chen J, Mo X, Huang J, Wang L, Gu D. Effect of mobile phone intervention for diabetes on glycaemic control: a meta-analysis. Diabet Med J Br Diabet Assoc 2011;28(4):455-63. source

      Not checked in the free run.

45 of 45

  • The paper relies on this without support.

    No study has yet investigated the feasibility of delivering an intervention based on ACT through a smartphone using written situational feedback to stimulate self-management in people with type 2 diabetes.

    “to our knowledge, no study has yet investigated the feasibility of delivering an intervention based on ACT through a smartphone using written ' situational feedback ' to stimulate self-management in people with type 2 diabetes.”

  • The paper relies on this without support.

    Three daily diaries are necessary to identify emotions, thoughts and coping that usually fluctuate during the day.

    “The number of daily diaries was necessary to identify emotions, thoughts and coping, that usually fluctuate during the day.”

  • The paper relies on this without support.

    The first meeting and the telephone conversation prior to the intervention are important to insure the feasibility of the intervention.

    “Both believed that the first meeting and the telephone conversation prior to the intervention were important to insure the feasibility of the intervention.”

  • The paper relies on this without support.

    The pilot study participants are representative of people with type 2 diabetes for assessing feasibility of the intervention.

    “The results of this pilot study indicate that written online situational feedback via a smartphone is a feasible intervention for people with type 2 diabetes.”
4 of 4

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Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Stated diary question range excludes the midday diary

    Minor

    The methods say the diaries contained 16-19 questions, whereas Table 1 lists 12 questions for the midday diary.

  • Stated minimum participant age conflicts with Table 2

    Minor

    The text gives 46 as the youngest participant age, but Table 2 lists a participant aged 45.

  • Narrative count of participants finding the diary schedule suitable differs from Table 5

    Minor

    The text says seven participants found three diaries per day acceptable, while Table 5 records eight rating the number of daily diary entries suitable.

3 of 3

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Authors
Nes, A. A. G., van Dulmen, S., Eide, E., Finset, A., Kristjánsdóttir, Ó. B., Steen, I. S., & Eide, H.
Affiliations
  • OsloMet – Oslo Metropolitan University (NO)
  • University of Oslo (NO)
  • Buskerud University College (NO)
ORCID
Venue
Diabetes Research and Clinical Practice
Publisher
Elsevier BV
Published
2012-09
Volume
97
Issue
3
Pages
385-393
ISSN
0168-8227 (ISSN-L)
DOI
10.1016/j.diabres.2012.04.019
OpenAlex
W2001781529
Semantic Scholar
3f7a8d7442532fb73182691cbcfc80bad2b462f4
Cited by
106
References
27
Citations by year
2025: 2 · 2024: 1 · 2023: 6 · 2022: 6 · 2021: 8 · 2020: 5 · 2019: 8 · 2018: 8 · 2017: 11 · 2016: 19 · 2015: 11 · 2014: 12 · 2013: 8 · 2012: 1
FWCI
18.16
Type
journal article
Language
en
Open access
Licence
Locations
  • Diabetes Research and Clinical Practice (publishedVersion)
  • PubMed (publishedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
Keywords
type 2 diabetes, self-management, online intervention, mobile application, diaries, acceptance and commitment therapy, feasibility, dietary habits, medication adherence, physical activity, emotions, fasting blood glucose, lifestyle modification
MeSH terms
Aged, Diabetes Mellitus, Type 2, Feasibility Studies, Feedback, Female, Humans, Male, Medical Records, Middle Aged, Monitoring, Physiologic, Norway, Pilot Projects, Research Design, Self Care, Patient Satisfaction, Telemedicine, Internet, Cell Phone

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-09.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-09.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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