Interactive Behavior Change Technology to Support Diabetes Self-Management

Abstract

The 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-of-pocket 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 …