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Texting ‘as good as medication’ for improving type 2 diabetes management

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Text messages can be as effected as some drugs for improving the management of type 2 diabetes, according to US researchers.

They found patients who received health-related text messages every day for six months saw improvements in their blood sugar levels that equalled those resulting from some glucose-lowering medications.

“We believe text messaging has great potential to improve the management of diabetes”

Athena Philis-Tsimikas

Their research represents the first randomised controlled trial to look at the use of text messages to help low income people from the Hispanic community to better self-manage diabetes through glycemic control, said the study authors.

The Dulce Digital study, published in the journal Diabetes Care, was carried out by a team from the Scripps Whittier Diabetes Institute in San Diego.

According to the American Diabetes Institute, Hispanic people face a higher risk of developing the disease – 13.9% compared with 7.6% for non-Hispanic white people.

The new study was conducted between October 2012 and August 2014 with 126 participants who were recruited from medical clinics. The majority of them were middle-aged, female, and born in Mexico.

All participants watched a 15-minute diabetes educational video, received a blood glucose meter and instructions on using it, and were given access to usual care including voluntary visits with a primary care physician, a certified diabetes educator and group diabetes self-management education.

The 63 participants who were randomly assigned to the study group received two to three short text messages a day at the beginning of the trial, which tapered off slightly over the next six months.

Participants used their own mobile phones, or were provided one by the researchers, and they each received around £9.40 a month in funding to cover the costs of the study’s texts.

On average, each participant received 354 messages over the course of the study. The texts covered a range of educational, motivational and actionable messages. For example:

  • Use small plates! Portions will look larger and you may feel more satisfied after eating
  • It takes a team! Get the support you need – family, friends and support groups can help you to succeed
  • Tick, tock. Take your medication at the same time every day!
  • Time to check your blood sugar. Please text back your results
  • The study focused on HbA1C levels during the previous two to three months

At the start, the combined participant groups registered a baseline mean HbA1c of 9.5%. After three months, the mean HbA1C for the group receiving the texts had improved to 8.5%, while the control group had a mean of 9.3%.

At six months, the study group’s mean HbA1C was still 8.5% while the control group registered a 9.4% mean.

After the trial ended, 96% of the study group participants said the text messages helped them to manage their diabetes “a lot”.

The same amount said they would continue receiving text messages if given the choice, and 97% said they would recommend the programme to friends and family members.

Scripps Whittier Diabetes Institute

Texting ‘as good as medication’ at improving type 2 diabetes management

Athena Philis-Tsimikas

The researchers also found that participants who texted in their blood glucose levels more often had better HbA1C measures than other study group participants who texted back to the researchers less frequently.

They speculated that the increased text volume reflected an overall higher level of engagement and participation in the programme.

Study author Dr Athena Philis-Tsimikas said: “As a low-cost intervention, we believe text messaging has great potential to improve the management of diabetes, especially among patients who struggle, due to employment, transportation and other barriers, to access health care services.

“These findings suggest that, on a wider scale, a simple, low-cost text message-based approach like the one offered through Dulce Digital has the potential to significantly benefit many people who struggle every day to manage their diabetes and maintain their health,” she added.

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