Engagement with mobile health intervention linked to improved glycemic control
medwireNews: Responsiveness to text message reminders about blood glucose monitoring is associated with glycemic benefit among adolescents with type 1 diabetes, study findings indicate.
Of 147 adolescents aged 13–17 years with mean baseline glycated hemoglobin (HbA1c) levels of 69 mmol/mol (8.5%), 49% responded to text message reminders with at least one blood glucose result on at least 50% of days over the 18-month intervention period.
These 72 patients, categorized as high responders, experienced no significant change in HbA1c levels from baseline to the 18-month follow-up after controlling for baseline values. By comparison, the 75 low responders – participants who replied to text message reminders on less than 50% of days – experienced a significant 3.3 mmol/mol (0.3%) increase in HbA1c levels over the study period.
Lori Laffel, from Harvard Medical School in Boston, Massachusetts, USA, and co-researchers explain that the intervention consisted of a two-way text messaging system in which participants received prompts to check blood glucose levels and reply with their measurements, with reminders sent if patients did not reply within 10 minutes. Congratulatory texts were sent after each text response, and the frequency of text messages increased gradually over the study period from one per weekend day at patient-selected times to a maximum of four messages daily.
The study authors report in Diabetic Medicine that there was a “clinically significant glycaemic benefit” associated with text message responsiveness in patients with both high and low HbA1c levels.
Indeed, among the 100 patients with baseline HbA1c levels of at least 64 mmol/mol (8.0%), those categorized as high responders were a significant 2.5 times more likely to experience a decrease in HbA1c of at least 5.5 mmol/mol (0.5%) from baseline to month 18 than those in the low responder group after adjusting for baseline levels.
And for the 47 participants with HbA1c concentrations below this threshold at baseline, high responders had a significant 5.7-fold higher likelihood of achieving levels of less than 58 mmol/mol (7.5%) – the ADA’s HbA1c target for adolescents – compared with low responders.
The researchers note that “[d]isappointingly, we observed a significant drop in text-message responsiveness over time,” with overall response rates decreasing from 60% at 0–6 months to 43% at 13–18 months.
However, they say that “this is quite consistent with other studies of text messaging and mobile health, highlighting the need to consider innovative ways to maintain engagement in interventions involving mobile platforms.”
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