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J Diabetes Complications. 2014 Mar-Apr;28(2):171-6. doi: 10.1016/j.jdiacomp.2013.11.008. Epub 2013 Nov 27.

Diabetes self-management support using mHealth and enhanced informal caregiving.

Author information

Department of Family Medicine, University of Michigan, Ann Arbor, MI, USA. Electronic address:
Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA; Dept of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA, USA.
Ann Arbor Department of Veterans Affairs Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA.



To characterize diabetes patient engagement and clinician notifications for an mHealth interactive voice response (IVR) service.


Observational study.


For three to six months, VA patients with diabetes received weekly IVR calls assessing health status and self-care along with tailored education. Patients could enroll with an informal caregiver who received suggestions on self-management support. Notifications were issued to clinicians when patients reported significant problems.


Patients (n = 303) participated for a total of 5684 patient-weeks, during which 84% of calls were completed. The odds of call completion decreased over time (AOR = 0.96, p < 0.001), and were lower among unmarried patients (AOR = 0.67, p = 0.038) and those who had difficulties with health literacy (AOR = 0.67, p = 0.039), diabetes-related distress (AOR = 0.30, p = 0.018), or medication nonadherence (AOR = 0.57, p = 0.002). Twenty-one clinician notifications were triggered per 100 patient-weeks. The odds of notification were higher during the early weeks of the program (AOR = 0.95, p < 0.001) and among patients who were older (AOR = 1.03, p = 0.004) or more physically impaired (AOR = 0.97, p < 0.001).


By providing information that is reliable, valid, and actionable, IVR-based mHealth services may increase access to between-visit monitoring and diabetes self-management support. The system detects abnormal glycemia and blood pressure levels that might otherwise go unreported, although thresholds for clinician notifications might require adjustment to avoid overloading clinicians. Patient engagement might be enhanced by addressing health literacy and psychological distress.


Care management; Diabetes; Primary care; mHealth

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