Whatsapp- Based Monitoring to Support Diabetes Self Care after Hospital Discharge: A Case Series
DOI:
https://doi.org/10.37287/ijghr.v8i5.2034Keywords:
diabetes mellitus, glycemic control, mobile health, self-care, whatsAppAbstract
Effective self-care is essential for maintaining glycemic control in patients with type 2 diabetes mellitus. However, sustaining self-care behaviors after hospital discharge can be challenging, particularly for patients with complications and physical limitations. Digital communication platforms such as WhatsApp Messenger may provide a practical tool for remote monitoring and support of diabetes self-management. This case series aimed to describe the implementation of structured diabetes education followed by WhatsApp-based monitoring to support diabetes self-care after hospital discharge. Two patients with uncontrolled type 2 diabetes mellitus and multiple comorbidities participated in this case series. Before discharge, patients and caregivers received structured diabetes education and completed self-assessment using the Summary of Diabetes Self-Care Activities (SDSCA). After discharge, self-care behaviors—including diet adherence, physical activity, foot care, and self-monitoring of blood glucose (SMBG)—were monitored for four weeks through weekly reports submitted via WhatsApp. Healthcare professionals reviewed the reports and provided feedback and guidance. Both patients demonstrated improved self-care behaviors during the four-week monitoring period. In Case 1, mean random blood glucose decreased from 240 mg/dL to 102 mg/dL with improved diet adherence, increased physical activity, and regular SMBG. In Case 2, mean random blood glucose improved from 204 mg/dL to 125 mg/dL with consistent diet adherence, regular foot care, and caregiver-assisted physical activity. WhatsApp-based monitoring combined with structured education may improve diabetes self-care behaviors and glycemic control during home care after hospital discharge.
References
Ageru, T. A., Le, C. N., Wattanapisit, A., Woticha, E. W., Truong, N. T., Stanikzai, M. H., Abiso, T. L., & Suwanbamrung, C. (2024). Diabetes self-care intervention strategies and their effectiveness in Sub-Saharan Africa: A systematic review. PLOS ONE, 19(10), e0305860-. https://doi.org/10.1371/journal.pone.0305860
Alhazmy, R. S., Khalil, A. H., & Almutary, H. (2024a). Effects of an instructional WhatsApp group on self-care and HbA1c among female patients with Type 2 diabetes mellitus. PLOS ONE, 19(9), e0305845-. https://doi.org/10.1371/journal.pone.0305845
Alhazmy, R. S., Khalil, A. H., & Almutary, H. (2024b). Effects of an instructional WhatsApp group on self-care and HbA1c among female patients with Type 2 diabetes mellitus. PLoS ONE, 19(9 September). https://doi.org/10.1371/journal.pone.0305845
Anderson, E., Koss, M., Castro Luque, A. L., Garcia, D., Lopez, E., & Ernst, K. (2021). WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality. JMIR Form Res, 5(10), e20970. https://doi.org/10.2196/20970
Annersten Gershater, M., Zdravkovic, S., & Elgzyri, T. (2024). Changes in daily nursing needs and self-care capability of people with diabetes after in-hospital treatment for foot complications: A descriptive study. Nursing Open, 11(5), e2186. https://doi.org/https://doi.org/10.1002/nop2.2186
Asmat, K., Sivarajan Froelicher, E., Dhamani, K. A., Gul, R., & Khan, N. (2024). Effect of patient-centered self-management intervention on glycemic control, self-efficacy, and self-care behaviors in South Asian adults with type 2 diabetes mellitus: A multicenter randomized controlled trial. Journal of Diabetes, 16(9), e13611. https://doi.org/https://doi.org/10.1111/1753-0407.13611
Babazadeh, T., Lotfi, Y., & Ranjbaran, S. (2023). Predictors of self-care behaviors and glycemic control among patients with type 2 diabetes mellitus. Frontiers in Public Health, Volume 10-2022. https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2022.1031655
Baroni, I., Caruso, R., Dellafiore, F., Ausili, D., Barello, S., Vangone, I., Russo, S., Magon, A., Conte, G., Guardamagna, L., & Arrigoni, C. (2022). Self-care and type 2 diabetes mellitus (T2DM): a literature review in sex-related differences. Acta Biomedica Atenei Parmensis, 93(4), e2022277. https://doi.org/10.23750/abm.v93i4.13324
Bretschneider, M. P., Kolasińska, A. B., Šomvárska, L., Klásek, J., Mareš, J., & Schwarz, P. E. H. (2025). Evaluation of the Impact of Mobile Health App Vitadio in Patients With Type 2 Diabetes: Randomized Controlled Trial. J Med Internet Res, 27, e68648. https://doi.org/10.2196/68648
Cheung, N. W., Redfern, J., Thiagalingam, A., Hng, T.-M., Marschner, S., Haider, R., Faruquie, S., Von Huben, A., She, S., McIntyre, D., Cho, J.-G., & Chow, C. K. (2023). Effect of Mobile Phone Text Messaging Self-Management Support for Patients With Diabetes or Coronary Heart Disease in a Chronic Disease Management Program (SupportMe) on Blood Pressure: Pragmatic Randomized Controlled Trial. J Med Internet Res, 25, e38275. https://doi.org/10.2196/38275
Dagnew, B., Debalkie Demissie, G., & Abebaw Angaw, D. (2021). Systematic Review and Meta-Analysis of Good Self-Care Practice among People Living with Type 2 Diabetes Mellitus in Ethiopia: A National Call to Bolster Lifestyle Changes. In Evidence-based Complementary and Alternative Medicine (Vol. 2021). Hindawi Limited. https://doi.org/10.1155/2021/8896896
Dugani, S. B., Mielke, M. M., & Vella, A. (2021). Burden and management of type 2 diabetes in rural United States. Diabetes/Metabolism Research and Reviews, 37(5), e3410. https://doi.org/https://doi.org/10.1002/dmrr.3410
ElGerges, N. S. (2020). Effects of therapeutic education on self-efficacy, self-care activities and glycemic control of type 2 diabetic patients in a primary healthcare center in Lebanon. Journal of Diabetes & Metabolic Disorders, 19(2), 813–821. https://doi.org/10.1007/s40200-020-00567-4
Emara, R. A., Hamed, M., Awad, M., & Zeid, W. (2021). Effect of diabetes self-management education program on glycemic control in diabetic patients attending the family medicine outpatient clinic, Suez Canal University Hospital, Ismailia, Egypt. The Egyptian Journal of Internal Medicine, 33(1), 30. https://doi.org/10.1186/s43162-021-00058-9
Fernández, César, Vicente, María Asunción, Guilabert, Mercedes, Carrillo, Irene, & Mira, José Joaquín. (2023). Developing a mobile health app for chronic illness management: Insights from focus groups. DIGITAL HEALTH, 9, 20552076231210664. https://doi.org/10.1177/20552076231210662
Firdaus, M. K. Z. H., Jittanoon, P., Boonyasopun, U., & Che Hasan, M. K. (2023). he effect of mHealth program on behavior modification and health outcomes among patients with diabetes: A randomized controlled trial study. Belitung Nursing Journal, 9(5), 437–447.
Hailu FB, Moen A, & Hjortdahl P. (2019). Diabetes Self-Management Education (DSME) – Effect on Knowledge, Self-Care Behavior, and Self-Efficacy Among Type 2 Diabetes Patients in Ethiopia: A Controlled Clinical Trial. Diabetes Metab Syndr Obes, 12, 2489–2499.
International Diabetes Federation. (2022). IDF Diabetes Atlas (10th edition).
Kemenkes. (2018). Diabetes :Penderita di Indonesia bisa mencapai 30 juta orang pada tahun 2030. Https://P2ptm.Kemkes.Go.Id/.
Kerr, D., Ahn, D., Waki, K., Wang, J., Breznen, B., & Klonoff, D. C. (2024). Digital Interventions for Self-Management of Type 2 Diabetes Mellitus: Systematic Literature Review and Meta-Analysis. J Med Internet Res, 26, e55757. https://doi.org/10.2196/55757
Lee, E. Y., Cha, S.-A., Yun, J.-S., Lim, S.-Y., Lee, J.-H., Ahn, Y.-B., Yoon, K.-H., Hyun, M. K., & Ko, S.-H. (2022). Efficacy of Personalized Diabetes Self-care Using an Electronic Medical Record–Integrated Mobile App in Patients With Type 2 Diabetes: 6-Month Randomized Controlled Trial. J Med Internet Res, 24(7), e37430. https://doi.org/10.2196/37430
Li, Z., Lu, F., Wu, J., Bao, R., Rao, Y., Yang, Y., & Wang, H. (2024). Usability and Effectiveness of eHealth and mHealth Interventions That Support Self-Management and Health Care Transition in Adolescents and Young Adults With Chronic Disease: Systematic Review. J Med Internet Res, 26, e56556. https://doi.org/10.2196/56556
Maleki, M., Mousavi, P., Abedi, P., Rokhafrooz, D., & Maraghi, E. (2023). Effect of mobile-assisted education on health promoting lifestyle and blood sugar of women with gestational diabetes: a randomised controlled trial. BMJ Nutrition, Prevention & Health, 6(2). https://doi.org/10.1136/bmjnph-2023-000802
Manji, K., Hanefeld, J., Vearey, J., Walls, H., & de Gruchy, T. (2021). Using WhatsApp messenger for health systems research: a scoping review of available literature. Health Policy and Planning, 36(5), 774–789. https://doi.org/10.1093/heapol/czab024
Martinez, M., Santamarina, J., Pavesi, A., Musso, C., & Umpierrez, G. E. (2021). Glycemic variability and cardiovascular disease in patients with type 2 diabetes. BMJ Open Diabetes Research & Care, 9(1), e002032. https://doi.org/10.1136/bmjdrc-2020-002032
Martínez, N., Connelly, C. D., Pérez, A., & Calero, P. (2021). Self-care: A concept analysis. International Journal of Nursing Sciences, 8(4), 418–425. https://doi.org/https://doi.org/10.1016/j.ijnss.2021.08.007
Mash, R., Schouw, D., & Fischer, A. E. (2022). Evaluating the Implementation of the GREAT4Diabetes WhatsApp Chatbot to Educate People With Type 2 Diabetes During the COVID-19 Pandemic: Convergent Mixed Methods Study. JMIR Diabetes, 7(2), e37882. https://doi.org/10.2196/37882
Nasiri, M., Jafari, Z., Rakhshan, M., Yarahmadi, F., Zonoori, S., Akbari, F., Sadeghi Moghimi, E., Amirmohseni, L., Abbasi, M., Keyvanloo Sharstanaki, S., & Rezaei, M. (2023). Application of Orem’s theory-based caring programs among chronically ill adults: A systematic review and dose–response meta-analysis. International Nursing Review, 70(1), 59–77. https://doi.org/https://doi.org/10.1111/inr.12808
Nejamis, A., Gutierrez, L., López, M. V., Ciganda Cha, A. D., Mendoza Quispe, O., Irazola, V., & Beratarrechea, A. (2025). WhatsApp-Based Intervention for Diabetes Prevention and Care in Argentina: Implementation and Process Evaluation. JMIR Form Res, 9, e81098. https://doi.org/10.2196/81098
Pan, S., Zhang, Z., & Pang, W. (2024). The causal relationship between bacterial pneumonia and diabetes: a two-sample mendelian randomization study. Islets, 16(1), 2291885. https://doi.org/10.1080/19382014.2023.2291885
Paudel, G., Vandelanotte, C., Dahal, P. K., Biswas, T., Yadav, U. N., Sugishita, T., & Rawal, L. (2022). Self-care behaviours among people with type 2 diabetes mellitus in South Asia: A systematic review and meta-analysis. Journal of Global Health, 12. https://doi.org/10.7189/jogh.12.04056
Petrie, J., & Boyle, J. (2023). Davidson’s principles and Practice of Medicine (24th ed). elsevier.
Purvis, Rachel S, Moore, Ramey A, Ayers, Britni L, Felix, Holly C, Riklon, Sheldon, Andersen, Jennifer A, Hudson, Jonell S, O’Connor, Gail, Kelen, Meetu, Heely-Rolston, Lee-Ann Noelani, Shields, Xochitl, & McElfish, Pearl A. (2022). Diabetes Self-Care Behaviors and Barriers to Clinical Care During COVID-19 Pandemic for Marshallese Adults. The Science of Diabetes Self-Management and Care, 48(1), 35–43. https://doi.org/10.1177/26350106211065390
Russo, M. P., Grande-Ratti, M. F., Burgos, M. A., Molaro, A. A., & Bonella, M. B. (2023). Prevalence of diabetes, epidemiological characteristics and vascular complications. Prevalencia de diabetes, características epidemiológicas y complicaciones vasculares. Archivos de Cardiologia de Mexico, 93(1), 30–36.
Saini, R., Jeyaraman, M., Jeyaraman, N., Jain, V. K., Ramasubramanian, S., & Iyengar, K. P. (2024). Advancing orthopaedic trauma care through WhatsApp: An analysis of clinical and non-clinical applications, challenges, and future directions. World Journal of Orthopedics, 15(6), 529–538. https://doi.org/10.5312/wjo.v15.i6.529
Solh Dost, L., Gastaldi, G., Dos Santos Mamed, M., & Schneider, M. P. (2024). Navigating outpatient care of patients with type 2 diabetes after hospital discharge - a qualitative longitudinal study. BMC Health Services Research, 24(1), 476. https://doi.org/10.1186/s12913-024-10959-4
Sun, S., Simonsson, O., McGarvey, S., Torous, J., & Goldberg, S. B. (2024). Mobile phone interventions to improve health outcomes among patients with chronic diseases: an umbrella review and evidence synthesis from 34 meta-analyses. The Lancet Digital Health, 6(11), e857–e870. https://doi.org/10.1016/S2589-7500(24)00119-5
Tusubira, A. K., Nalwadda, C. K., Akiteng, A. R., & Hsieh, E. (2021). Social Support for Self-Care: Patient Strategies for Managing Diabetes and Hypertension in Rural Uganda. Annals of Global Health, 86.
Veluvali, A., Dehghani Zahedani, A., Hosseinian, A., Aghaeepour, N., McLaughlin, T., Woodward, M., DiTullio, A., Hashemi, N., & Snyder, M. P. (2025). Impact of digital health interventions on glycemic control and weight management. Npj Digital Medicine, 8(1), 20. https://doi.org/10.1038/s41746-025-01430-7
Wang, Q., An, Y., Wang, H., Zhang, N., & Deng, S. (2021). The clinical significance of changes in cTnT, CRP and NT-proBNP levels in patients with heart failure. American Journal of Translational Research, 2947-2954.
Yu, J., Fu, Y., Du, H., Wu, Q., Zhang, S., Zhao, B., Xue, E., Guo, Y., Yang, R., & Zhu, M. (2025). The effectiveness of nudge-based interventions on self-monitoring behaviours among patients with cardiometabolic diseases: a systematic review and meta-analysis. Health Psychology Review, 19(4), 878–905.
Zhang, K., Huang, Q., Wang, Q., Li, C., Zheng, Q., Li, Z., Xu, D., Xie, C., Zhang, M., & Lin, R. (2024). Telemedicine in Improving Glycemic Control Among Children and Adolescents With Type 1 Diabetes Mellitus: Systematic Review and Meta-Analysis. J Med Internet Res, 26, e51538. https://doi.org/10.2196/51538
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Indonesian Journal of Global Health Research
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
