According to the National Diabetes Information Clearinghouse [1], in 2005–2008, 79 million Americans of US population aged 20 years or older (35% of population aged 20 years or older) had pre-diabetes. Diabetes affected 25.8 million (8.3% of population) in the US alone with direct and indirect medical cost amounting to 116 and 58 billion dollars in 2007, respectively [1]. Medical expenses for people with diabetes are twice as high as the medical expenses for people without diabetes [1]. Those numbers are growing at an ever-increasing rate. Consequences for the mismanagement of diabetes include kidney failure, non-traumatic lower limb amputations, and cases of blindness. Diabetes was found to be the seventh leading cause of mortality in United States [1].
Researchers and practitioners are challenged to find efficient and effective solutions to improve diabetes management. Self-management focuses on patients’ behavior with respect to their care for their chronic condition. Related terms include Patient Empowerment and Patient Self-Care. McGowan [2] provides a background of various definitions of self-management as well as related terms and misconceptions. Self-management often includes preparing people to manage their health behaviors on day-to-day basis, participating in treatment or education designed to attain specific results, practicing tasks and developing attitudes that reduce the emotional or physical impact of illness, with or without assistance from clinicians [2]. For the purpose of this systematic review, the authors will follow the definition provided by Adams, Greiner [3]. According to this definition, “Self-management relates to the tasks that an individual must undertake to live well with one or more chronic conditions. These tasks include gaining confidence to deal with medical management, role management, and emotional management.” A key characteristic of this definition is the depiction of self-management as a set of behaviors by the patient, i.e., the patient is the primary actor (as opposed to the provider). With respect to diabetes, self-management includes self-monitoring of blood glucose, physical activity or exercise, nutrition, and medication [4], [5]. In addition to these basic tasks, recent advances reflected in clinical guidelines recommend other self-management related activities including self-management education and personalized feedback, weight management, communication and patient monitoring by clinicians, other therapeutics (foot, eye care), immunization, and complication management [6], [7], [8], [9].
Attempts to leverage IT in diabetes self-management dates back to the late seventies and have shown promising outcomes [10]. An area that has received considerable attention is the use of IT interventions such as, Internet, computer, electronic equipment, smart phones and health analytics in self-monitoring of the daily physiological behaviors. As a result, a large number of studies have reported different attempts to leverage various kinds of IT in diabetes self-management. Recent reviews have evaluated the potential benefit of technologies in diabetes management [11], and how different technologies have been used to enhance the care of patients with diabetes [11], [12], [13], [14], [15], [16], [17], [18], [19], [20]. Conclusions drawn from these studies are important and provide several implications. Yet, they tend to focus on a specific technology, they do not necessarily adhere to a clear definition of self-management where the patient is the primary actor, and they tend to focus on blood glucose monitoring as opposed to a holistic view of diabetes self-management. The objective of the paper is to determine, in a systematic review, how information technology (IT) has been used to enhance self-management for adults with Type 1 and 2 diabetes. The paper identifies key information technologies that are used (or proposed) for the self-management of diabetes, highlights reported clinical outcomes, and identifies challenges and research directions for leveraging IT for diabetes self-management.