Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial

Abstract

ObjectiveTo determine the effectiveness of a theoretically based and individually tailored, text message based, diabetes self management support intervention (SMS4BG) in adults with poorly controlled diabetes.DesignNine month, two arm, parallel randomised controlled trial.SettingPrimary and secondary healthcare services in New Zealand.Participants366 participants aged 16 years and over with poorly controlled type 1 or type 2 diabetes (HbA1c ≥65 mmol/mol or 8%) randomised between June 2015 and November 2016 (n=183 intervention, n=183 control).InterventionsThe intervention group received a tailored package of text messages for up to nine months in addition to usual care. Text messages provided information, support, motivation, and reminders related to diabetes self management and lifestyle behaviours. The control group received usual care. Messages were delivered by a specifically designed automated content management system.Main outcome measuresPrimary outcome measure was change in glycaemic control (HbA1c) from baseline to nine months. Secondary outcomes included change in HbA1c at three and six months, and self efficacy, diabetes self care behaviours, diabetes distress, perceptions and beliefs about diabetes, health related quality of life, perceived support for diabetes management, and intervention engagement and satisfaction at nine months. Regression models adjusted for baseline outcome, health district category, diabetes type, and ethnicity.ResultsThe reduction in HbA1c at nine months was significantly greater in the intervention group (mean −8.85 mmol/mol (standard deviation 14.84)) than in the control group (−3.96 mmol/mol (17.02); adjusted mean difference −4.23 (95% confidence interval −7.30 to −1.15), P=0.007). Of 21 secondary outcomes, only four showed statistically significant improvements in favour of the intervention group at nine months. Significant improvements were seen for foot care behaviour (adjusted mean difference 0.85 (95% confidence interval 0.40 to 1.29), P<0.001), overall diabetes support (0.26 (0.03 to 0.50), P=0.03), health status on the EQ-5D visual analogue scale (4.38 (0.44 to 8.33), P=0.03), and perceptions of illness identity (−0.54 (−1.04 to −0.03), P=0.04). High levels of satisfaction with SMS4BG were found, with 161 (95%) of 169 participants reporting it to be useful, and 164 (97%) willing to recommend the programme to other people with diabetes.ConclusionA tailored, text message based, self management support programme resulted in modest improvements in glycaemic control in adults with poorly controlled diabetes. Although the clinical significance of these results is unclear, the findings support further investigation into the use of SMS4BG and other text message based support for this patient population.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12614001232628.

Long‐term follow‐up of a randomized controlled trial of a text‐message diabetes self‐management support programme, SMS4BG

“…Extensive end‐user engagement and formative work was undertaken to inform the development of the programme, which has been previously described . SMS4BG was found to be acceptable and perceived to be useful in a small pilot study , and a pragmatic randomized controlled trial (RCT) found it to result in modest but significant improvements in glycaemic control at 9 months' follow‐up .…”

Text messages for diabetes self-management support

“…1 Of 21 secondary outcomes assessed, there were statistically significant improvements in four: foot care behaviour, perceived support for diabetes management, health status and how much patients experienced diabetes-related symptoms.…”

“…1 In this trial, the authors accepted that the reductions in HbA 1c were not considered to be clinically important, with an average reduction of 4.2mmol/mol (0.4%). However, they report that the programme showed a high level of acceptability, with most participants finding the intervention useful and willing to recommend it to others.…”

“…In this context, the effectiveness of a text message-based support intervention for diabetes self-management has been tested in a randomised controlled trial. 1 The trial, conducted in New Zealand, included 366 participants aged 16 years and over with poorly controlled type 1 or type 2 diabetes who were randomised to either a tailored package of text messages for up to 9 months in addition to usual care, or to usual care only. The study targeted patients who were struggling to control their diabetes (HbA 1c >64mmol/mol [8%]), those living in rural and remote areas and those from priority populations (e.g.…”

“…1 Participants could choose to receive blood glucose monitoring reminders to which they could reply with their result by text message. They could then view their results graphically over time on a password-protected website.…”