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Text Messages That Will Help Patients Get Glycemic Control

Jun 16, 2018
 

With more than 8 trillion text messages sent worldwide every year, self-management support for blood glucose (SMS4BG) has potential to help improve glycemic management of patients who have diabetes.

We all know that to achieve and maintain good glycemic management is important. We also know that technology and healthcare are closely connected and there is an opportunity to use that relationship to empower the patients to take care of their own health using technology.

The authors of “Effectiveness of text message based, diabetes self-management support program” were trying to determine the efficacy of adding the SMS4BG technology to the normal glucose regimen in adults with type 1 or type 2 diabetes who have poor glycemic management.

A total of 366 participants age 16 years and older with an HbA1c of 8% in the preceding nine months were randomized to either intervention or control group in a 1:1 ratio.  Access to a mobile phone and open availability for nine months was also required. All participants continued with their regular diabetes management plan such as medication therapy, physician visits, tests, and any other diabetes support programs throughout the study. Additionally, the intervention group received SMS4BG. Messages such as “Healthy eating is an important part of your diabetes treatment and it will help you in controlling your blood glucose level” and “Just a reminder it is time to check your blood glucose, reply with the results” are examples of the text that the participants received.

As a primary outcome, the authors were looking for changes in HbA1c from baseline to the 9-month period. A vast list of secondary outcomes was also measured and includes changes in HbA1c at 3 and 6 months, diabetes self-care behaviors, diabetes distress, perceptions and beliefs about diabetes, health-related quality of life, perceived support for diabetes management, and intervention satisfaction at 9 months.

For the primary outcome, results demonstrate a significant reduction in HbA1c from baseline to 9 months when compared with the control group (p=0.007). In addition, when compared to the results obtained in the secondary outcomes, reduction in HbA1c was also statistically significant when compared with the control group (p=0.005).  Similarly, a significant improvement was observed on foot care behavior (p=0.001), perceptions and beliefs about diabetes (p=0.004), and perceived support for diabetes management (p=0.03). The other outcomes measured demonstrated were not statistically significant. On the other hand, participant satisfaction and acceptability were also measured. The authors stated that 92% of the participants reported high levels of satisfaction with SMS4BG, and 98% thought that text messaging was a good way to helps them to achieve a glycemic control. Also, 10 participants reported technical issues while receiving the intervention such as issues replying and bad reception.

Although statistically significance was observed in the primary and some of the secondary outcomes, the authors were unable to conclude clinical significance because the study has low statistical power. They believed that the results have the potential to still be clinically relevant in practice, specifically on those patients with high HbA1c but additional investigation should be done. In conclusion, the study has shown the potential of the text-messaging program to provide an effective and affordable solution in order to promote self-management support to those patients with poor glycemic management. Furthermore, the study showed that a text-messaging program could increase a patient’s feelings of support, which is essential to help them to achieve their goals.

Practice Pearls:

  • Text messaging has the potential to be effective for the delivery of self-management support to people with poorly managed diabetes. Further investigation should be done in order to support what this study concluded.
  • SMS4BG seems to be an appropriate and personalized support for all the diabetes population, regardless their location.
  • Technology is changing the healthcare system at a high speed and every day innovatory advances are released. We have to change with the times in order to fulfill the necessities of our patients.

References:

Dobson R, Whittaker R, Jiang Y, et al. Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial. Bmj. 2018. doi:10.1136/bmj.k1959.

Burke, Kenneth. “73 Texting Statistics That Answer All Your Questions.”Www.textrequest.com, 29 May 2018, www.textrequest.com.

Kennen Munoz Munoz, Pharm. D. Candidate 2019, LECOM School of Pharmacy