medwireNews: A diabetes self-management support system delivered by text message may help patients to improve their glycemic control, shows a study in The BMJ.
Moreover, the program was very popular with the 177 study participants who were randomly assigned to use it, with 95% of the 169 who completed the follow-up survey saying it was useful, 71% that it helped them learn more about their diabetes, and 83% that it influenced their behaviors or how they managed their diabetes. Almost all (97%) the participants said they would recommend the program to others.
Rosie Dobson (University of Auckland, New Zealand) and study co-authors say the program (SMS4BG) represents “a low cost, scalable solution for increasing the reach of diabetes self management support.”
They add that the study “showed that a text messaging programme can increase a patient’s feelings of support without the need for personal contact from a healthcare professional.”
The concept of patient-centered care is a central pillar of diabetes care philosophy, as is tailoring of individualized therapy.
The program delivered “core motivational and support messages” to facilitate good diabetes self-management, and these were tailored to the individual participants’ needs, goals, and demographics. The patients could also opt for additional modules that included foot care, young adult support, insulin control, and blood glucose monitoring reminders. For the latter, participants could reply to the reminder texts with their blood glucose results, which they could later view as a graph on a password-protected website.
The study patients were aged an average of 47 years, and had poorly controlled diabetes (about two-thirds with type 2 diabetes), with glycated hemoglobin (HbA1c) levels of at least 65 mmol/mol (8%). Just three of the patients chose to stop receiving the text messages within the first 3 months of the intervention; half continued for 3 months, 18% opted for an additional 6 months, and 32% continued for the maximum 9 months.
During these 9 months, patients had an average reduction in HbA1c of 8.85 mmol/mol. There were an additional 177 patients in a control group who received usual care and achieved an average 3.96 mmol/mol reduction in HbA1c levels, which the researchers suggest was an effect of clinical trial participation, and say “it is not expected that these improvements would be sustainable past the initial few months without intervention.”
The between-group difference of 4.23 mmol/mol was statistically significant, but was smaller than the predefined clinically significant difference of 5.5 mmol/mol (0.5%).
“Therefore, this study is unable to conclude that the effects of the SMS4BG intervention are clinically significant,” write the researchers.
But they add that “[a]lthough further investigation is needed, we believe the results have the potential to still be clinically relevant in practice, particularly among individuals with high levels of HbA1c, such as the participants with poorly controlled diabetes in this study.”
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