Text messages may improve glycemic control in patients with diabetes and coronary disease

Automated texts providing educational and encouraging messages about self-management may have resulted in better glycemic control in patients with diabetes and coronary heart disease, a Chinese study found.

Researchers used data from Cardiovascular Health and Texting-Diabetes Mellitus (CHAT-DM), a parallel-group, single-blind, randomized clinical trial of 502 patients with both coronary heart disease and diabetes from 34 hospitals in China. An intervention group of 251 people received six text messages per week for six months in addition to usual care. Texts provided educational and motivational information on glucose monitoring, blood pressure control, medication adherence, physical activity, and lifestyle, among other topics. A control group of 251 people received usual care and two thank-you texts each month.

The primary outcome was change in HbA1c level from baseline to six months. Secondary outcomes included changes in the proportion of patients achieving HbA1c level below 7%, fasting blood glucose levels, systolic blood pressure, LDL cholesterol levels, body mass index, and physical activity from baseline to six months. Results were published Aug. 31 by Circulation: Cardiovascular Quality and Outcomes.

The intervention group achieved a significantly greater reduction in HbA1c level, with a mean absolute difference of 0.3% (−0.2% vs. 0.1% [95% CI, −0.5% to −0.1%]; P=0.003). The only prespecified subgroup of patients who showed a significant difference in effect from the intervention was those with higher baseline HbA1c level (P<0.001). The mean difference in change from baseline to six months between intervention and control groups was −0.79% (95% CI, −1.11% to −0.47%) for participants with a baseline HbA1c level greater than 7.5%. Effects did not differ significantly by age older versus younger than 60 years (P=0.754), men versus women (P=0.832), urban versus rural (P=0.451), education of more or less than 12 years (P=0.797), and non- versus current smoking (P=0.079). Fasting blood glucose level at the six-month follow-up was also lower in the intervention group than in the control group. No significant differences were seen for other secondary outcomes.

Among the intervention participants who attended the last follow-up visit, almost all believed the text messages were easy to understand (97.1%) and useful (94.1%). Over 80% of participants reported reading more than 75% of the messages during the study period, and about three-fourths reported saving messages for further learning. Nearly 94% of participants reported that they would be willing to continue receiving the text messages in the future.

“Capitalizing on the exponential growth in mobile phone usage over the past decade, a text messaging program offers a potential solution to increase the reach of [diabetes mellitus] self-management support and may provide a means to better address the burgeoning healthcare demand-capacity imbalance in the context of the growing burden of chronic conditions,” the authors wrote.