Text Message Intervention Helps Control HbA1c in Patients With Diabetes and Heart Disease

A mobile text message intervention resulted in better glycemic control in patients with type 2 diabetes and coronary heart disease, according to a study published in Circulation: Cardiovascular Quality and Outcomes.

The parallel-group, single-blind, multicenter, randomized CHAT-DM (Cardiovascular Health and Texting-Diabetes Mellitus) study included 502 patients with coronary heart disease and diabetes from 34 hospitals in China between August 2016 and April 2017.

The intervention group (n=251) received six text messages per week for six months in addition to usual care, while a control group (n=251) received usual care and two thank you messages per month. The intervention group received messages that were theory driven and culturally tailored to provide educational and motivational information on glucose monitoring, blood pressure control, medication adherence, physical activity, and lifestyle.

At baseline, mean glycated hemoglobin (HbA1c) was 7.0%, and mean fasting blood glucose level was 8.3 mmol/L.

Almost all patients (99%) were available for follow-up. At six months, the intervention group had a greater reduction in HbA1c (primary endpoint) compared with the control group (−0.2% vs. 0.1%; P=0.003), and HbA1c levels were significantly lower in the intervention group (6.7% vs. 7.2%). The intervention cohort also had a greater proportion of participants who achieved HbA1c <7% (69.3% vs. 52.6%; P=0.004).

Change in fasting blood glucose was larger in the intervention group (between-group difference, −0.6 mmol/L; 95% confidence interval, −1.1 to −0.2; P=0.011). No other between-group differences were observed.

Most participants said the messages were easy to understand (97.1%) and useful (94.1%). Almost all of the text message recipients indicated they would be willing to continue to receive text messages to help manage their disease.

However, the researchers noted that patients in the intervention cohort who already had low HbA1c levels at baseline did not experience further reductions—HbA1c remained stable throughout the study in these participants.

“A simple, culturally sensitive mobile text messaging program may provide an effective and feasible way to improve disease self-management,” the researchers concluded.

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