February 26, 2007 (Miami) -- A new interactive, cell phone-based technology appears to be feasible and efficacious in the prevention and management of type 2 diabetes, according to a controlled trial presented here at the 2007 annual meeting of the American College of Preventive Medicine.

"The 'Confidant System' is a cell phone-based biometric system for real-time health coaching," lead investigator David Katz, MD, MPH, told Medscape. "The purpose of our study was to demonstrate the feasibility of using the Confidant System to assist with diabetes self-care management in a clinic population, as evidenced by successful implementation, ease of use, and patient and clinician satisfaction with the system," he said. Dr. Katz is public health director of the Prevention Research Center at Yale University School of Medicine in New Haven, Connecticut.

In the Novel Interactive Cell Phone Technology for Health Enhancement (NICHE) study, 30 patients at 2 community health centers in Connecticut were assigned to either the intervention group (n = 15) or the control group (n = 15). Subjects at the intervention site received the Confidant System technology (Confidant-enabled pedometer, glucometer, and cell phone with remote-access daily feedback and reminders) and used it for 3 months, along with standard diabetes management. Subjects in the control group received only standard diabetes care. The researchers evaluated the system through feedback using surveys, focus groups, interviews, and clinical tests.

According to Dr. Katz, a qualitative assessment of clinician and patient experience after 3 months of use has shown that it is feasible to incorporate this technology into a primary care setting. "We found that both patients and providers could use the Confidant System in this setting," he said.

Although the trial was not powered for clinical outcomes, a quantitative analysis of the results showed improvements in markers of glycemic control, as well as diabetes knowledge and self-efficacy. There was a decrease in the level of glycosylated hemoglobin (-0.1%; P = .15) and an increase in self-efficacy ( P = .008) in the intervention group compared with the control group.

This new technology is "a step ahead of others," according to Gordon DeFriese, PhD, professor emeritus of social medicine and epidemiology at the University of North Carolina at Chapel Hill. Dr. DeFriese is not associated with the study.

"Previously, there were computer-based and computer-assisted technologies that provided for the uploading of clinical measures taken by the patient, but the integration of cell phone technology incorporating the capabilities of Bluetooth technology, along with health educational messaging is a major step forward," Dr. DeFriese told Medscape.

"It enables biomedical measures such as HbA1c, blood pressure, weight, etc, to be transmitted instantly via Bluetooth technology to the patient's cell phone, and then immediately to a computer server, which sends back rapid profiles of recent measures and offers simultaneous health educational coaching messages, while at the same time transmitting these clinical measures to one's physician," Dr. DeFriese said.

He also pointed out that the study conducted by Dr. Katz and colleagues was "a limited test of acceptance by patients and clinicians.... It was not a full-scale randomized trial of the use in a large population of diabetics," he said. "For what the study was, it was very useful.... This technology, which is being improved every week, is perhaps a major breakthrough in enabling the patient with chronic illness to gain a measure of informational control and immediacy of feedback and reinforcement that has been lacking in other computer-assisted means of promoting effective disease management in these populations."

ACPM 2007 Annual Meeting: Poster 38. Presented February 22, 2007.

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