The aging of the global population has played a key role in the rise of chronic diseases. In an analysis of the statistics of death causes by Statistics Korea in 2012, it was found that the most widely occurring chronic diseases were cancer, cardiovascular disease, cerebrovascular disease, intentional self-harm (suicide), diabetes, and pneumonia, in that order [1]. Of those, diabetes is on the rise globally. According to the World Health Organization (WHO), about 20 million people have currently been diagnosed as diabetics. About 11 million people died of diabetes in 2005, and the WHO forecast that death from diabetes would increase to twice this number by 2030 [2].

Like most chronic disease patients, diabetics, with effective disease control achieved through systematic and continuous treatment and management, can live the same healthy lives as those of normal people. However, the conventional diabetes treatment and management process, which is centered on hospitals, has several limitations, as shown in the following, in its attempts to satisfy the above requirements. First, diabetes health management and education programs are mainly operated in a form of one-way communication. One-way communication means physician-centered and physician-led communication. Second, there is inadequate systematic assistance via social support to solve the problem of emotional support for diabetics, who need to receive lifelong treatment. Third, adopting advanced health information technology is required for effective healthcare. Beyond the conventional method, social networking service (SNS) communication-based treatment and mobile application based treatment [3,4,5,6,7] have emerged recently. This study proposes an SNS-based mobile application for diabetes self-management; the system offers tailored information that can induce changes in patient behavior through relevant and helpful messages, exchanges, and information.

HealthTWITTER is a social network-based intervention program created for the prevention of diabetes and the disease's continuous management. It has been designed using an algorithm that offers tailored health management service for individuals. Unlike original diabetes management apps [16,17,18], which only represent input information, HealthTWITTER may be supported through SNS and is designed based on the reliable TTM model for effective health behavior intervention. As a result of these developments, it is thought that HealthTWITTER will have high application rates for patients in their 20s and 30s, who receive less intensive health management since attentive supervision is focused on the age brackets of 65 and older. To test our application for the targeted group, we gathered preliminary outcomes from the participants of the '2030 Camp' operated by the Korean Diabetes Association in July 2012 [19]. More than 80% of the participants said they had the intention to use HealthTWITTER. Although this study can play a pivotal role in promoting the SNS-based health care industry's development, the following limitations exist:

First, there is limitation in the study target. This study limited the research target to diabetics in their 30s and 40s, who have low awareness rates and treatment rates, with the intention of increasing attention paid to them. The development of an algorithm that can be applied to all age brackets will be necessary in the future.

Second, there is difficulty in securing reference group data. To create a reference group, exercise-related data from the initial stage of contracting diabetes is necessary. Although clustering was conducted based on the iCDMS data, which targeted elderly people aged 65 or older, there was a limitation in that the data were different in direction from the data used in this study. Further studies will need to present a reference group through the acquisition of reliable cumulative data by linking with the Seoul City Metabolic Syndrome Management Service, which manages chronic disease patients with minimum ages of at least in the 30s [20].

In October 2013, the Ministry of Health and Welfare issued an announcement of legislation on the revision of the Medical Service Act to allow u-health care between patients and doctors; this idea was focused on neighborhood medical centers, with the hope of enhancing treatment effects by offering chronic disease management anytime. Through the HealthTWITTER app, a collaborative patient-physician health care model will be developed with two advantages; namely, the reduction of poor adherence to chronic disease treatment and the decline in increasing health and medical service costs.