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Week of May 23, 2011


Cell phones help under-developed countries manage diseases

A new study by the Veterans Affairs Ann Arbor Healthcare System and U-M suggests that mobile phones could help low-income patients across the globe manage diabetes and other chronic diseases.

“Telehealth programs have been shown to be very helpful in a variety of contexts, but one of the main limitations for delivering these services in the developing world has been a lack of infrastructure,” says lead study author John Piette, a senior research scientist with the VA and professor of internal medicine at the Medical School.

For this study, researchers took advantage of the broad penetration of cell phones in Latin America and paired them with low-cost internet-based phone calls. The service used a cloud computing approach so that the program can be provided from a central location to countries around the globe that lack a strong technological infrastructure.

To test the service, the researchers enrolled patients with diabetes from a clinic in a semi-rural area of Honduras. Patients received weekly, automated, interactive phone calls and overwhelmingly reported that the program helped them to improve their diabetes management and general health.

Over the six-week study, researchers saw a clinically important improvement in patients’ hemoglobin A1C, a measure of blood sugar control. The results are forthcoming in the June issue of the American Journal of Preventive Medicine.

“We wanted to demonstrate that it was possible to deliver a high-tech program from U-M to very vulnerable patients with diabetes in Honduras who only have local cell phone service,” Piette says.

The developing world faces a cardiovascular disease crisis as fast food becomes ubiquitous and people shift to urban centers and less active modern lifestyles. Worldwide, the number of people with diabetes is expected grow from 285 million to 439 million by 2030.

The patients who used the program the most were the ones who had higher blood pressure at the outset, had more severe diabetes and lived farther away from the clinic, says Piette, who also is associate director for global health communications at the Center for Global Health. On average, the patients in the study had only five years of formal education and annual household incomes of $2,500.

Patients also had the option of enrolling in the program with an informal caregiver or CarePartner, who also received calls to their cell phones informing them of how the patient was doing and providing suggestions for how they could help support the patient’s self-care.

“We believe the work of Dr. Piette and his colleagues represents an important and sustainable milestone in innovative global health strategies for the prevention, diagnosis and management of noncommunicable diseases,” says Global Health Director Dr. Sofia Merajver. “This work truly stands the chance to improve the health of millions of people in a relatively short time.”

Piette says future research will examine the program’s success against a control group and extend the study period over a longer time period.

Additional U-M authors are Martha Ganser, Muhima Mohamed, Nicolle Marinec and Sheila Krishnan.



Mike Ross, financial aid officer senior, Office of Financial Aid, on how training and preparation for sports competition positively impacts his approach to work: “It takes a lot of motivation and attention to detail to do my job well.”


“Reconstruction of an Antenna (as seen on TV)” from UMMA Projects: Amalia Pica, May 28-Sept. 18, U-M Museum of Art.

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