Text to Move: A Randomized Controlled Trial of a Text-Messaging Program to Improve Physical Activity Behaviors in Patients With Type 2 Diabetes Mellitus

Abstract

BackgroundText messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM).ObjectiveThis study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM.MethodsText to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) >7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement.ResultsAll participants (intervention: n=64; control: n=62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio [RR] 4.89, 95% CI 1.20 to 19.92, P=.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, P=.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group: 9092 steps; control group: 3722 steps; RR 2.44, 95% CI 0.68 to 8.74, P=.17). HbA1c decreased by 0.07% (95% CI –0.47 to 0.34, P=.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by –0.43% (95% CI –0.75 to –0.12, P=.01), but nonsignificantly in the control group by –0.21% (95% CI –0.49 to 0.06, P=.13). Similar changes were observed for other secondary outcomes.ConclusionPersonalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures.

Adherencia terapéutica en pacientes con diabetes mellitus tipo II y el uso de la tecnología móvil básica: una revisión sistemática = Therapeutic adherence in patients with diabetes mellitus type II and use of basic mobile technology: a systematic review

“…Seis estudios (Agboola et al, 2016;Bogner et al, 2012;Goode et al, 2015;Tamban et al, 2013;Vervloet, 2014;Vervloet et al, 2012) fueron incluidos en la revisión cuasisistemática. Todos ellos eran ensayos clínicos controlados y/o aleatorios.…”

“…Tres estudios estaban enfocados en pacientes diagnosticados de DMT2 que tuvieran prescrito antidiabéticos orales (Bogner et al, 2012;Vervloet, 2014;Vervloet et al, 2012). Tres estudios estaban enfocados al ejercicio físico en pacientes con DMT2 (Agboola et al, 2016;Goode et al, 2015;Tamban et al, 2013). Finalmente, dos incluyeron la dieta (Goode et al, 2015;Tamban et al, 2013).…”

“…Por otro lado, aumentó la realización de ejercicio físico y el cuidado por la alimentación en aquellos sujetos que recibieron mensajes de texto y/o llamadas (Tabla 5). No obstante, sólo dos estudios indagaron en la satisfacción de la intervención (Agboola et al, 2016;Vervloet et al, 2012). En el estudio llevado a cabo por Goode et al (2015) desglosó el grupo de intervención en tres: 1) con menos de 12 llamadas, 2) entre 12 y 20 llamadas y 3) más de 20 llamadas -con un máximo de 27 llamadas) en el trascurso de los 18 meses de duración.…”

Addressing people and place microenvironments in weight loss disparities (APP-Me): Design of a randomized controlled trial testing timely messages for weight loss behavior in low income Black and White Women

“…(17–21) The theoretical frameworks guiding these studies are social cognitive and self-regulation theories, and transtheoretical model. These studies sent messages from the study staff or machine.…”

Measuring Free-Living Physical Activity With Three Commercially Available Activity Monitors for Telemonitoring Purposes: Validation Study (Preprint)

“…For example, to monitor physical activity or to deliver a step count prescription strategy for patients with type 2 diabetes or hypertension [13,14]. However, these pedometers are difficult to use for remote monitoring, since they require the patient to manually record the daily number of steps and to send these data to the caregiver.…”