¡Sí, Yo Puedo Vivir Sano con Diabetes! A Self-Management Randomized Controlled Pilot Trial for Low-Income Adults with Type 2 Diabetes in Mexico City

Abstract

Background Type 2 diabetes (T2D) is a worldwide epidemic and a leading cause of death in Mexico, with a prevalence of 15.9%, and >70% of diagnosed adults have poor glycemic control [glycated hemoglobin (HbA1c) >7.5%]. We developed a diabetes self-management education program contextualized to the study population, including dietary preferences, health literacy, and health system. Objectives We aimed to evaluate the efficacy of a self-management + text message program (¡Sí, Yo Puedo Vivir Sano con Diabetes!) on primary (HbA1c), and secondary behavioral (self-management), clinical, and psychosocial outcomes in adults with T2D in Mexico City. Methods Participants were recruited at public primary healthcare centers (Seguro Popular), and randomly allocated to treatment (n = 26) or wait-list control groups (n = 21) with data collected at 3 and 6 mo. The program included 7 weekly sessions and 6 mo of daily text/picture messages. Descriptive statistics and a generalized linear mixed model with intent-to-treat analysis were calculated. Results Participants were 55.5 ± 8.8 y of age (mean ± SD), 68% female, 88.6% overweight/obese, and 57% lived in food-insecure households. Mean ± SD T2D duration was 11.9 ± 7.8 y and HbA1c was 9.2% ± 1.5%. There was 89% attendance at sessions and 6.4% attrition across both groups at 6 mo. Group-by-time effects were seen in self-monitoring of blood glucose (P < 0.01) and diabetes self-efficacy (P < 0.04); and a trend for lower HbA1c was seen in the intervention group at 6 mo (P = 0.11). Significant improvements in dietary behavior (P < 0.01) were demonstrated in the intervention group over time, but this did not reach statistical significance compared with the control group. Conclusions The program was associated with clinically significant improvements in T2D self-management, self-efficacy, and HbA1c over time. Thus, T2D self-management skills, including diet, were improved in a vulnerable metropolitan population. This trial was registered at clinicaltrials.gov as NCT03159299.

Effect in self-care behavior and difficulties in coping with diabetes during the COVID-19 pandemic

“…This could reflect that when a patient has better self-care activities performance, it is more likely to have better diabetes management in health contingencies scenarios, and patients are less dependent on the health-care system to continue managing their disease. Therefore, effective strategies focused on improving selfcare and provide self-efficacy in regular care should be considered to decrease diabetes disease burden in these scenarios 7,18,19 .…”

An Umbrella Review of Text Message Programs for Adults With Type 2 Diabetes

“…31 Another recent pilot study evaluated the effect of an illustrated text message program in low-income adults with T2DM in Mexico City with a trend toward significant improvement in A1C compared to a control group. 32 Continued research to address health disparities in T2DM via text message programs is indicated. Complex technology-based programs to support diabetes self-management may not be accessible to certain populations, who may have low health and technology literacy, without considerable education and support.…”

Subphenotyping of COVID-19 patients at pre-admission towards anticipated severity stratification: an analysis of 778 692 Mexican patients through an age-gender unbiased meta-clustering technique

“…However, the Mexican population shows a particular high prevalence of comorbidities, such hypertension and diabetes, and obesity, which are directing the population to undesirable risks for severe coronavirus outcomes. For example in 2020, Type 2 diabetes (T2D) is a leading cause of death in Mexico, with a prevalence of 15.9% 6 . Given the potential heterogeneity in Mexican population and COVID-19 severity, mainly in comorbidities and morbimortality, it is crucial to have a pragmatic understanding of how severity patterns vary among these patients to anticipate individuals’ prognostic outcomes.…”

“…Several studies have suggested potential COVID-19 subphenotypes, mainly within specific comorbidities such as pulmonary diseases or diabetes 3,4 or related to distinct genetic variants 5 . However, the Mexican population shows a particularly high prevalence of comorbidities, like hypertension, diabetes –a leading cause of death in 2020 6 – and obesity, which is leading the population to particular and undesirable risks for severe coronavirus outcomes. It remains crucial an understanding of how severity patterns vary among Mexican patients to anticipate individuals’ prognostic outcomes.…”

“…Several studies have suggested potential COVID-19 subphenotypes, mainly within specific comorbidities such as pulmonary diseases or diabetes 6,7 or related to distinct genetic variants 8 . However, the Mexican population has its particularity due to a high prevalence of comorbidities, like hypertension, diabetes -a leading cause of death in 2020 9 and obesity, which is leading the population to a undesirable risks for severe coronavirus outcomes than many other high-income countries 10 . Since distinct target population often present heterogeneous clinical characterization and severity outcomes, it remains crucial a transparent understanding regarding the characterization of COVID-19 subphenotypes in Mexican patients to help anticipate individuals' prognostic outcomes if one gets infected and evaluate subphenotypic severity presentations.…”