Want to Improve Diabetes Management? Send Texts

Text messaging is a practical, cost-effective way to engage and motivate low-income patients with type 2 diabetes to improve their long-term management of the disease, a recent study found. Researchers at the University of Southern California’s Keck School of Medicine in Los Angeles sent 2 text messages a day for 6 months to 128 low-income patients with type 2 diabetes. The texts contained educational and motivational messages, medication reminders, healthy living challenges and diabetes-related trivia. For example, a motivational message would have read: “Controlling your blood glucose, blood pressure, and cholesterol can mean a longer and healthier life.” And a healthy living challenge would have read: “Don’t drink any soda or juice today. Only drink water or milk.” According to the study, glucose levels decreased by 1.05% in patients who received text messages compared to 0.60% in patients who did not receive texts. Medication adherence jumped from 4.5 to 5.4 (based on the 8-point Morisky Medication Adherence Scale) in patients who received text messages compared to a net decrease of –0.1 in patients who were not contacted via text. Additionally, the proportion of patients who visited the emergency room during the 6-month study trended lower in the text message group compared with the usual visitation rate: 35.9% versus 51.6%, respectively. Although the decrease in glucose levels wasn’t statistically significant, the researchers were encouraged by the slight improvement in blood sugar management, and also pointed to the positive trends in quality of life and medication adherence among the study’s patients. They also pointed out that a majority of the patients enjoyed receiving the texts, thought they were a good way to learn about diabetes management and understood the content of the messages. All 128 of the patients said they’d recommend the messaging program to friends or family members with diabetes. A healthy lifestyle — proper diet, regular exercise and medication adherence — can improve glycemic control and outcomes in diabetics, said the researchers, but uninsured patients in resource-scarce communities often lack the appointment availability and personal finances to establish consistent outpatient care needed to properly manage the disease. They instead rely on emergency room visits for follow-up care, noted the study, which puts the onus on caregivers unfamiliar with properly treating chronic conditions. “Medication adherence is a critical variable in maximizing the benefits of drug therapy and reducing overall healthcare costs,” said Sanjay Arora, MD, the study’s lead author and an associate professor of clinical emergency medicine at the Keck School of Medicine. Dr. Arora noted that the reasons for non-adherence include a complex interplay between patient factors, available resources and social support systems, with the most commonly cited reason being simple forgetfulness. “Strategies to combat these factors with pharmacy case management and social workers are costly and labor intensive,” he added. “Text messaging is an automated, low-cost, technologically simple and highly scalable solution that is familiar to both patients and providers.” According to Dr. Arora, research has shown that even in poor communities, where costly smart phones are inaccessible, most patients have and use text messaging as a means of communication, making it the ideal platform on which to deliver an effective and automated diabetes management solution. The study appears in the Annals of Emergency Medicine. —Dan Cook Source: “Trial to Examine Text Message–Based mHealth in Emergency Department Patients With Diabetes (TExT-MED): A Randomized Controlled Trial” Article in press in Annals of Emergency Medicine http://bit.ly/HScCVh