Adolescents don't always check their blood glucose levels as often as they should. Because frequent monitoring is a keystone of diabetes care, this can make their parents frantic.

In response, parents may try to dictate their children's behavior, a tactic that often backfires with rebellious teenagers. Upcoming mobile technologies may lessen the need for parental interference by giving adolescents an independent way to work through the complex information necessary to make good self-care decisions.

Dr. Aaron E. Carroll, Assistant Professor of Pediatrics at Indiana University's School of Medicine, believes that future monitoring systems incorporating mobile communication with testing may reduce this parent-teenager conflict.

"Just the fact that there is diabetes makes for a lot more conflict, nagging, and difficulties in the parent-adolescent relationship," he states. "I don't think there is any quick technological fix to solve these problems. However, we have studied how to use technology to improve the adolescent-parent-doctor dynamic and make things better."

What Exists So Far and How It Works

Most diabetic patients test their blood sugar level several times a day and log the results, but the readings aren't usually reported until the next doctor visit. To address this problem, North Carolina's Confidant, Inc., has developed a device that collects information from a glucose meter and transmits it wirelessly via mobile phone to a file server.

The file server then interprets this information, compares it to other measures taken over time, and sends encouraging or instructional messages back to the patient. Thomas Wall, VP of Business Development, says, "For kids, especially teenagers, using a cell phone is familiar ground. [This program] is like carrying a dedicated personal health coach built into a mobile phone.

Not only is it convenient and promotes healthy decision-making, but it also offers customized coaching to motivate and support lifestyle changes." The latest FDA clearance occurred in 2006, but refinements continue and the technology is not yet available.

Dr. Lori Laffel, Chief of the Pediatric, Adolescent and Young Adult Section at the Joslin Diabetes Clinic in Boston, headed a pilot study involving a wireless hand-held device. "We found that youth ages 8-18 with type 1 diabetes were more apt to monitor their blood glucose levels more often when engaged in a game called DiaBetNet," she says. DiaBetNet integrates blood glucose, insulin dosing, and carbohydrate intake data and challenges users to predict their next glucose levels.

"The data stored in the PDAs are wirelessly transmitted to a central secure server," Dr. Laffel explains. "The study demonstrated the ease of introducing new technology to pediatric patients with diabetes, with an additional benefit of increased blood glucose monitoring among the game group participants."

Dr. Carroll's team has done usability studies of an all-in-one FDA-approved diabetes cell phone with built-in glucose monitor, designed by Healthpia America in New Jersey and set to be available to the public later this year.

"Kids don't want to be stigmatized. They don't like being different, so hiding the technology in the cell phone is a big plus," Dr. Carroll reports. He hopes that such devices will tighten the relationship between the doctor, clinic, and child.

"We'd be building up the independence of the child and improving the adolescent's ability to manage their own diabetes," he says. However, he stresses, "This is still early. It needs further study to show that it actually does work and makes a difference before people are going to widely adopt such expensive technology."