Text intervention alone insufficient to sustain type 2 diabetes improvements
medwireNews: A tailored text messaging intervention might help lower glycated hemoglobin (HbA1c) levels in people with type 2 diabetes in the short-term, but additional support may be needed for sustained improvements, US study data show.
Lindsay Mayberry (Vanderbilt University Medical Center, Nashville, Tennessee, USA) and co-authors say the Rapid Education/Encouragement and Communications for Health (REACH) intervention “helped patients remember their medications and reduced initial adherence barriers, but some barriers may be difficult to address with text content alone.”
They suggest: “Addition of tailored components such as counseling with a clinical pharmacist, diabetes self-management education, or health coaching,” may help to address some of these barriers, such as beliefs and behavioral skills deficits, and thus maintain behavioral improvements.
The study included 506 individuals with type 2 diabetes who were randomly assigned to receive the REACH intervention (n=253) or to continue with usual care (n=253) for 12 months, with additional follow-up to 15 months.
The intervention included daily self-care promotion one-way texts that addressed self-care behaviors or were tailored to address self-identified barriers to medication taking and daily interactive texts that asked about medication taking. There were also weekly medication taking feedback texts that provided feedback and encouragement based on responses to the interactive texts. After 6 months, 56% of participants opted to reduce the frequency of the daily texts to three or four times per week.
The researchers report in Diabetes Care that, at baseline, there was no significant difference in mean HbA1c between the REACH and control arms, at 8.6% (70.0 mmol/mol) versus 8.5% (69.0 mmol/mol).
By 3 months, HbA1c was a significant 0.26% lower with versus without the intervention, and the difference increased to a significant 0.31% at 6 months.
The effect size was even greater among individuals with a mean baseline HbA1c of 8.5% or higher (n=219), at 0.74% after 6 months.
However, despite the initial improvements, there were no significant differences in HbA1c between the intervention and control groups at 12 months or at 15 months when the participants were no longer receiving the text messages.
Mayberry and team also found that REACH significantly improved self-efficacy up to 6 months, and significantly improved medication taking and dietary behavior up to 12 months, but there was no difference between the intervention and control groups in any of the outcomes at 15 months.
The researchers note that around half of the participants were of racial or ethnic minority groups and half had low socioeconomic status, but neither of these factors modified any of the outcomes.
Mayberry et al conclude that “text messaging is an ideal mechanism for engaging adults at-risk for poor outcomes in diabetes self-management, but additional components may be needed over time to sustain effects.”
They add: “An important next step is to meaningfully integrate [mobile] Health interventions that improve self-care into clinical care to determine if effects can be enhanced and sustained.”
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