Mobile Healthcare System Provided by Primary Care Physicians Improves Quality of Diabetes Care

Background and Objectives: To evaluate the clinical feasibility of a mobile healthcare (mHealthcare) system comprising a smartphone application with electronic feedback from the primary care physicians. Methods: We enrolled 169 patients with type 2 diabetes from 10 primary care clinics; data for 138 patients were analyzed. Patients' data were recorded including self-monitoring of blood glucose (SMBG) and physical activity. Primary care physicians performed electronic monitoring, sent feedback messages, and referred patients to the tertiary hospital as needed. We evaluated glycated hemoglobin A1C (HbA1c) and quality of diabetes care at baseline and at 3-month follow-up. Results: The mean age of participants was 57.5±9.0 years, and 58.7% were men. HbA1c levels decreased significantly from 7.9±1.1% to 7.5±0.9% (p<0.001). The quality of self-management assessed by a summary of diabetes self-care activities and the degree of diabetes knowledge improved without increasing diabetes-specific distress or hypoglycemia. We also found that patients with higher baseline HbA1c and with a better knowledge of diabetes care were good responders to this system. Professional feedback, SMBG, and daily activates seemed to be important factors to success of mHealthcare. Conclusions: We showed that a proposed mHealthcare system has clinical feasibility to improve the quality of diabetes care in subjects with type 2 diabetes who can use a smartphone in real clinical practice.