The use of mobile phones in dietary assessment in young people with Type 1 diabetes
Authors: Donald H. , Franklin V. , Greene S. 
Published: May 2009

Background:  Food is often a contentious issue for people with diabetes (Nutrition Sub‐Committee of Diabetes Care Advisory Committee of the UK, 2003) and being an adolescent with Type 1 diabetes (T1DM) can be extremely challenging (Cartwright et al., 2003). Tailoring interventions to engage with adolescents is essential for maintaining an effective and productive relationship with the healthcare team (Hampson et al., 2000). The use of modern technology, such as mobile phone cameras, may be a way of engaging with this client group. Food diaries are routinely used for dietary assessment in this group, although there may be difficulties with patient recall, establishing portion sizes and compliance with completion (Tefft & Boniface, 2000). This study aimed to assess the effect of mobile phones in dietary assessment in adolescents with T1DM.

Methods:  Fifteen adolescent patients with T1DM attending the Tayside Paediatric Diabetic Clinics were recruited. Participants were asked to complete food diaries for 4 days and to photograph (using the mobile phones provided) all food and drink consumed during that period. Photographs were downloaded to a computer using Bluetooth technology®. A dietitian estimated portion sizes from the diaries and photographs. The number of items ovn each day for each method was recorded. Dietary intake information was analysed for total energy intake and percent energy from carbohydrate, fat and protein using the dietary analysis package Dietplan 6 (Forestfield Software Ltd, Horsham, West Sussex, UK). Dietary recommendations for this client group (Hanas et al., 2006) are shown in Table 1. The dietary analyses with and without the use of mobile phones were compared using paired Student's t‐tests. Results are expressed as mean (SD) and range, as appropriate.

Results:  Eight participants [14.3 (1.8) years; duration of diabetes 8.4 months–11.2 years; HbA1C 9.5% (2.0%)] returned completed diaries and full sets of photographs. No statistically significant differences were seen in the number of items recorded by using food diaries 27.8 (7.8) and mobile phones 24.2 (9.6). Dietary analysis of the food diaries is shown in Table 1; there were no significant differences between the two groups.

 The effect of photographs taken by mobile phone on the dietary analysis of food diaries [mean (SD)]

Food diary
Food diary with photos
Recommended intakes

Protein (% total energy)
17.3
16.7
15

Fat (% total energy)
35.2
34.9
35

Carbohydrate (% total energy)
46.9
48.3
40

Discussion:  Although there were no significant differences in macronutrient intake as recorded in food diaries with and without the use of mobile phones, photographs provided additional information that facilitated the estimation of portion sizes in this client group. The almost ubiquitous use of mobile phones may provide a perfect medium for engaging young people in diabetes self‐management issues (Franklin et al., 2006), although their use in dietary assessment requires further exploration.

Conclusions:  Photographs taken using mobile phones may be a useful tool in the dietetic management of T1DM in adolescents.

References Cartwright, M., Wardle, J., Steggles, N., Simon, A.E., Croker, H., & Jarvis, M.J. (2003) Stress and dietary practices in adolescents. Health Psychol. 22, 362–369.

Franklin, V., Waller, A., Pagliari, C. & Greene, S. (2006) A randomized controlled trial of ‘Sweet Talk’, a text‐messaging system to support young people with diabetes. Diabet. Med.23, 1332–1338.

Hampson, S.E., Skinner, T.C., Hart, J., Storey, L., Gage, H. & Foxcroft, D. (2000) Behavioural interventions for adolescents with type 1 diabetes: how effective are they? Diabetes Care23, 1416–1422.

Hanas, R., Donaghue, K., Klingensmith, G. & Swift, P.G. (2006) International Society for paediatric and Adolescent Diabetes. ISPAD Clinical Practice Consensus Guidelines. Paediatr. Diabetes 7, 341–342.

Nutritional SubCommittee of Daibetes Care Advisory Committee of the UK (2003) The dietitians challenge: the implementation of nutritional advice for people with diabetes. J. Hum. Nutr. Diet. 16, 421–452.

Skinner, H., Biscope. S., Poland, B. & Goldberg, E. (2003) How adolescents use technology for health information: implications for health professionals from focus group studies. J. Med. Internet Res.5, E32.

Tefft, M.E. & Boniface, D.R. (2000) Estimating food and nutrient intake from food frequency questionnaire data by reference to a standard weighed diet survey. J. Hum. Nutr. Diet.13, 219–224.