Text Messaging Intervention for Teens and Young Adults With Diabetes

Abstract

Text messaging is the primary mode of communication among adolescents and young adults. According to recent survey data, the majority of teenagers (78%) have a cell phone, with almost half of those (47%) owning a smartphone. 1 Adolescents "out-text" any other age group, with an average of 3364 texts per month, followed by young adults in the amount of texts sent per month. 2 There is an enormous opportunity in health education, prevention, and intervention research to capitalize on this activity and to assess the feasibility and benefits of mobile health (mHealth) programs among adolescents. 3,4 Adolescents and young adults with diabetes represent an important group for mHealth initiatives. Diabetes self-care behaviors are aimed at normalizing blood glucose levels in efforts to prevent the development of both acute and chronic complications. However, despite the need to optimize blood glucose levels to preserve health, and with many new treatment technologies that assist in this, many adolescents and young adults fail to achieve the recommended glycemic outcomes. 5-7 Furthermore, overweight and obesity are particular challenges for adolescents and young adults in general and for those with diabetes, both type 1 and type 2. 8,9 Diabetes management is particularly difficult during adolescence and emerging adulthood due to many reasons, including the effect of puberty during adolescence on glycemic control, 10 and many behavioral and psychological factors that contribute to deterioration of blood glucose levels. 11,12 Challenges facing adolescents include difficulties adhering to the numerous aspects of diabetes self-care including frequent glucose monitoring, insulin administration, diet, and exercise, 13-15 peer-related concerns (eg, worry about what friends think about diabetes, avoidance of diabetes self-care tasks in the presence of peers and coworkers), 16-18 and depression. 19-21

Developmental Changes in the Roles of Patients and Families in Type 1 Diabetes Management

“…Moreover, >80% of patients felt that Sweet Talk had improved their self-management adherence, and 90% wanted to continue receiving text messages. Along similar lines, Markowitz et al (69) studied an mHealth intervention using text messaging incorporating general healthy lifestyle messages, with the goal of enhancing goal-setting among adolescents and young adults with T1D. Over a one-month pilot intervention period, self-efficacy and glycemic control measures did not change, but the text messaging intervention was acceptable to patients and was rated highly, again suggesting the potential of text messaging interventions to increase motivation for change in these age groups.…”

Texting to Increase Adolescent Physical Activity: Feasibility Assessment

“…For example, in a review of information and communication technologies promoting PA to children and adolescents, only three of the nine studies included texting as part of the intervention, and only one of these promoted only PA. 40 Although studies have investigated text messages as a method for promoting PA alone, 41–44 most have promoted PA along with other behaviors, such as improved diet; 45–58 and/or reduced sedentary behavior. 48,49,51,53,56,57 Of these, most were designed to promote diabetes 41,46,47,50,54 or weight 48,51–53,55,58 management. Further, while some studies have investigated text messages as the primary intervention mode, 41,45,59 most have incorporated them into multi-component interventions that combined text messages with other intervention components such as in-person meetings, telephone calls, apps, and/or online programs.…”

Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults

“…Of particular note is the poor glycemic control evident in the study population, with an average A1C of 10.8%. This is significantly higher than recent epidemiological data showing an average A1C of 8.7% amongst 18–25 year olds with T1D (4), recent intervention studies amongst adolescents and young adults with T1D which ranged from 7.6% – 9.4% (11, 14, 15), and SEARCH study data reporting an average A1C of 8.5% among Hispanic-American youth with T2D, ages 15–19 years old (52). Our study’s inclusion criteria of having an A1C ≥8% accounts in part for this discrepancy.…”

“…Among these studies, only one specifically addressed the diabetes care challenges of low-socioeconomic status (SES) or minority populations (11), and only two included young adults with T2D (13, 15). Further, most interventions addressing young adults’ diabetes care focus primarily on facilitating the transition from pediatric to adult healthcare systems.…”