CoChat
Sign Up
Cited by 90Diabetes Management and EducationMobile Health and mHealth ApplicationsDiabetes Management and Research

Interactive Behavior Change Technology to Support Diabetes Self-Management

Open access
Piette, John D.·2007·Diabetes Care
DOI 10.2337/dc07-1046
Open this paper in CoChat — free accountOpen PDF

Abstract

The growing imbalance between need and resources for diabetes careThe 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-ofpocket 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 blueprint for how a transformed system of care should look (12), and diabetes educators and care managers have been a core resource in the vision for reshaping services so that they prevent, rather than just treat, patients' diabetes-related complications (6 -13).Unfortunately, care management programs and diabetes education services often struggle with staffing shortages, limited funding, and competing time demands (14 -16).Even under the best of circumstances, clinicians cannot provide the day-to-day support that many people with diabetes need to proactively address self-management problems.As a consequence of both resource constraints and acute care-oriented health systems, providers often spend their time only with patients who are either newly diagnosed, in crisis, or the most assertive in advocating on their own behalf.To meet the growing need for diabetes care given these realities, health systems must take a broader approach that views patients' care in the context of their social network, culture, and community (17). Interactive behavior change technology as a partial solution to the looming crisis in diabetes careInteractive behavior change technology (IBCT) is one potential resource for improving the effectiveness of diabetes management programs given the very real limits on funding and staffing time ( 18).IBCTs include the use of hardware and software to promote and sustain behavior changes (18).Examples include the use of PDAs, patient-centered Web sites, automated telephone calls, DVDs, and touchscreen kiosks.In general, these tools 1) assist patients and their clinicians in monitoring changes in health and self-care needs, 2) support patients' efforts to make behavior changes by promoting health and effective self-care, and 3) enhance communication between patients and potential supports for their disease management.Other types of technologies such as physician-targeted clinical decision aids, electronic medical records, and disease registries can also support quality diabetes care, but these tools are usually considered separately from IBCT because they provide information solely to the clinician and represent a more passive repository of data rather than a proactive effort to change behaviors.Some IBCTs are designed to assist patients in being more independent; thus, patients can improve their selfmanagement without assistance from their health care team.For example, resources such as electronic medication reminders, meters that provide longitudinal records of patients' glycemic control, and PDA-based calculators to monitor intake of various nutrients may assist patients with self-regulation and serve as important cues to action.While these tools can be valuable, there are limits to many patients' ability to manage their diabetes on their own, even with technologic supports.Just as the concept of doctor-centered care has given way to a greater emphasis on "self" care, improve-

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.2337/dc07-1046

Cites

99 of 99 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

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

  • For effective medical care of chronic illness, such as T2DM, adequate and sustainable self-management initiated by patients is important.

    “For effective medical care of chronic illness, such as Type 2 diabetes mellitus (T2DM), adequate and sustainable self-management initiated by patients is important [1-3].”

    From Long-Term Engagement With a Mobile Self-Management System for People With Type 2 Diabetes (2013) · cites this paper as [3]

Self-check

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

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Cited by

Sorted by citations

Related

Authors
Piette, J. D.
Affiliations
University of Michigan (US)
Corresponding author
Piette, John D.
ORCID
Piette, John D.
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2007-10-01
Volume
30
Issue
10
Pages
2425-2432
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc07-1046
OpenAlex
W2102727205
Cited by
90
References
99
Citations by year
2026: 1 · 2025: 1 · 2024: 2 · 2023: 1 · 2022: 1 · 2021: 2 · 2020: 1 · 2018: 3 · 2017: 8 · 2016: 6 · 2015: 5 · 2014: 11 · 2013: 10 · 2012: 8
FWCI
4.63
Type
journal article
Language
en
Open access
Locations
  • Diabetes Care (publishedVersion)
  • PubMed (publishedVersion)
Funders
U.S. Department of Veterans Affairs
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
diabetes self-management, Chronic Care Model, care management, diabetes educators, diabetes care costs, healthcare resource constraints, social networks
MeSH terms
Behavior, Communication, Diabetes Mellitus, Humans, Interpersonal Relations, Patient Education as Topic, Self Care, Social Change, Social Support

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.

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 ›

Are you an author, or do you see a problem with this page? Request a review