"Don't forget! Check blood sugar before and after physical activity."
"Use small plates! Portions will look larger and you may feel more satisfied after eating."
"Tick, tock. Take your medication at the same time every day!"
These are just a few of the text messages that participants received as part of the Dulce Digital study conducted by the Scripps Whittier Diabetes Institute, a subsidiary of Scripps Health and one of the nation's leading diabetes research, patient care and education organizations.
Initial results of the Dulce Digital study were presented at the 74th Scientific Sessions of the American Diabetes Association in San Francisco on June 13. The study findings suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
"The use of mobile phones in health care is very promising, especially when it comes to low-income populations with chronic diseases," said Athena Philis-Tsimikas, M.D., corporate vice president for the Scripps Whittier Diabetes Institute. "We found that by using text messages we were able to circumvent many of the barriers these patients face, such as lack of transportation or childcare, while still being able to expand the reach of diabetes care and education."
Scripps partnered with a San Diego-based community clinic that provides services to a large proportion of Latino patients with type 2 diabetes. The 126 study participants were randomized into one of two arms: standard diabetes management care (control) only or text messaging and standard care. Standard care consisted of regular visits with a primary care physician and a brief computerized presentation conducted in English or Spanish that included; diabetes nutrition standards; desired targets for blood sugar, cholesterol and blood pressure; and medications recommended to achieve control.
For the text messaging group, the same standard care was provided but in addition messages were sent to their mobile devices at random times throughout the week. The messages focused on healthy nutrition tips, the benefits of physical activity and medication adherence, and requests to check blood sugar and send back results. Two to three messages were sent each day at the beginning of study enrollment, and the frequency tapered off over a six-month period.
"At the six-month mark, we found that the Dulce Digital participants had a significantly larger decrease in hemoglobin A1c test levels than the control group," said Dr. Tsimikas.
Potential next steps include incorporating text messaging into conventional self-management education programs. Patients may be seen in one-on-one visits or groups visits and then have the text messages added as supplements once they get home. Messages would continue as ongoing reminders of care over the next six months.
The McKesson Foundation was a funding partner that supported the conduct of this study.
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