Comment on: Text message service helps support adults with diabetes self-care
Battleground for health
Digital health is the new frontier in healthcare delivery. Diabetes is a perfect battleground in which to try digital strategies for health delivery [1]. Its endemic and chronic nature, and close relationship with lifestyle and behavioral factors, suggest a need for repeated contact with healthcare professionals. The traditional framework of healthcare delivery, however, does not suit many persons with diabetes.
Most people living with diabetes experience poor control, due to multiple reasons. One of these may be infrequent, or inadequate, contact with healthcare providers, leading to incomplete health education and awareness. While efforts have been made to increase the pool of diabetes educators, these fall short of the ever-expanding needs of the diabetic world. Dobson et al [2] render yeoman service to the cause of good diabetes care by reporting the effectiveness of a text message based self-management support intervention in adults with uncontrolled type 2 diabetes.
Mobile health: A battle half-won
Dobson et al conducted a 9-month long, dual-arm parallel randomized controlled trial conducted across primary and secondary healthcare services in New Zealand. Along with standard care, the intervention group was given text messages related to diabetes self-management and lifestyle behaviors.
Glycated hemoglobin fell significantly in this group, and was associated with improvements in foot care behavior, overall diabetes support, self-reported health status, and perceptions of illness identity. Near universal consensus was reported regarding perceived usefulness (95%) and willingness to recommend the program to other persons with diabetes (97%). At the same time, no improvement was observed in behaviors related to diet, exercise, glucose monitoring, smoking, or in levels of diabetes distress, illness comprehension quality of life, or appraisal, emotional and informational support [2].
New horizons
Digital diabetology, including mobile based diabetes care, will certainly play a greater role in the years to come. Mobile based interventions have already proven their worth in preventing [3] and managing diabetes [2]. Further research is needed, however, to enhance the value of such healthcare delivery strategies. The key in attaining perfection in such delivery is “patient-centeredness” or “person-centeredness” [4].
Person-centered diabetes care delivery and educational content
The concept of patient-centered care is a central pillar of diabetes care philosophy, as is tailoring of individualized therapy. A similar attitude should be used not only for the content of diabetes care (ie, choice of non-pharmacological pharmacological therapy),but also for the method of diabetes care delivery and for self-management education and support.
Bidirectional communication
Dobson et al convey their understanding of this concept by reporting usage of ethno-specific messages [2]. Future studies should explore this facet of diabetes care in greater depth. Another suggestion would be to create two-way communication channels between patient and provider. This will allow the person with diabetes to explain her or his values, needs and preferences. This in turn will help in identification and dissemination of individual-oriented healthcare messages, and live up to the standards of person-centered care.
Opportunities and directions
Technology has given us a novel opportunity to improve the standard of diabetes care across the world. We welcome Dobson et al’s efforts in this direction. Collaboration between clinical diabetes care providers, public health specialists, communication experts, and artificial intelligence scientists is needed to navigate, and master, this exciting path towards good diabetes care.