Internet-Based Mentoring Program for Patients with Type 1 Diabetes

Corresponding author: Seung-Hyun Ko Division of Endocrinology and Metabolism, Department of Internal Medicine, St. Vincent’s Hospital, 222 Banpo-daero, Seocho-gu, Seoul 137-701, Korea E-mail: [email protected] Regardless of the type of diabetes, lifestyle modifications is an essential component of diabetes management in patients with diabetes. Maintenance of self-care behavior, including dietary habits, physical activity frequency, and self-monitoring of blood glucose (SMBG), should be started with structured diabetes education. Diabetes Self Management Education (DSME) improves metabolic control, prevents and manages complications, and maximises quality of life in a cost-effective manner [1,2]. For this reason, clinical practice guidelines on diabetes recommend that DSME must be delivered by a certified educator who has received professional training or a multidisciplinary care team [3,4]. In addition, diabetes is typically a progressive chronic metabolic disease, and chronic illnesses are usually emotionally stressful, leading to both physical and psychological fatigue [5]. Also, changing the patients’ daily routines or modifying their lifestyles are not so easy, especially due to the adherence to their current habits that have lasted for a longtime. Even those that generally have self-caring behaviors are under the constant threat of severe and devastating diabetic complications or bothersome symptoms throughout their lives [5,6]. Therefore, to maintain the patients’ self-care behavior, the diabetes educators need to take into account various social, emotional, and psychological factors in addition to the patients’ clinical situation. Consequently, close monitoring of their adherence to previous habits, emotional support, and regular reinforcement is essential to help patients change their lifestyle and maintain it during their lifetime. To do this, a web-based telemedicine system is a good alternative strategy to guide patients with diabetes. Undoubtedly, telemedicine delivered by health care professionals is cost-effective, time-saving, convenient, and easily accessible. Especially in Korea, more than 40 million people use internet access, corresponding to about 82.5% of the Korean population [7]. Also, telemedicine has a substantial benefit for patients in the sense that it provides more individualized recommendations in real-time. Suh et al. [8] have recently reported a 12-week internet-based mentoring program for patients with type 1 diabetes whose glycemic control status were inadequate. Using the web-based mentoring protocol, 5 volunteer mentors guided 26 patients regarding appropriate insulin dosing, physical activity, and food intake within 48 hours of mentees’ request. Mentors were either patients themselves or a parent of one who already had experiences in diabetes management, not professional health care providers or doctors. Unfortunately, in contrast to our expectation, their glycemic control status (HbA1c) with glucose fluctuation (Average daily risk range), number of hypoglycemic episodes, and quality of life measured by Audit of Diabetes Dependent Quality of Life and Diabetes Treatment Satisfaction Questionnaire score were not improved after the mentoring program. However, they found that the mentoring program increased the frequency of SMBG. Considering their study conditions, such as long diabetes duration (about 6 years), young-aged adult (about 32 yearold) subjects, small study number, and short observation periEditorial Clinical Care/Education