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PARIS – A simple, inexpensive automated text messaging program slightly improves glycemic control of usual care in patients with type 2 diabetes and coronary artery disease, according to a multicenter randomized trial conducted in China.
"Mobile phones are ubiquitous and widely used to schedule alerts and reminders, highlighting the potential of mobile health technology to bypass the practical barriers of traditional health care visits," said Xiqian Huo, MD, Fuwai Hospital, Beijing, China, and colleagues.
"The results of this study could be clinically relevant in everyday practice, particularly in patients with poorly controlled diabetes mellitus, for whom the benefit was maximal," they point out.
The study was presented by Huo at the ESC 2019 Congress and simultaneously published online in Circulation: quality and cardiovascular outcomes.
"This study has important implications for public health because patients with congenital heart disease and diabetes are at high risk for diabetes-related complications and death," she said.
CHAT-DM study conducted in China
The Cardiovascular Health and SMS – Diabetes Mellitus (CHAT-DM) study was conducted among 502 participants with both diabetes and coronary artery disease, recruited from 34 hospitals in China between August 2016 and April 2017.
The text messages were developed by a multidisciplinary team and included information on diabetes and congenital heart disease, blood glucose monitoring and control, blood pressure control, medication compliance, physical activity and recommendations. relating to lifestyle.
"Intervention group participants received six messages a week during the six-month study period in addition to standard treatment," observe investigators, "[while] the control group received two SMS of thanks … per month, as well as a standard treatment. "
The main criterion was the modification of glycated hemoglobin (HbA1 C) from the baseline at the end of the study. The investigators also assessed the proportion of patients who achieved an HbA target1 C <7% as well as other secondary parameters.
Average HbA1 C was 7.0% and mean fasting blood glucose was 8.3 mmol / L.
As Huo pointed out Medscape Medical News, the study team sent educational messages to members of the text messaging group to alert them to glucose monitoring as well as blood glucose control goals.
"Patients would be aware of the limits of surveillance safely," she noted in an email.
Greater HbA1 C Discounts in the text group for people initially above the target
At 6 months, significantly greater reductions in HbA1 C in the text messaging group, at -0.2%, compared with controls, at + 0.1% (P = 0.003), report the authors of the study.
HbA1 C levels were also significantly lower in the text messaging group, at 6.7%, compared to controls, at 7.2%, they add.
And more patients in the text messaging group achieved HbA1 C <7% at 6 months compared to controls (69.3% vs. 52.6%; P = 0.004).
Similarly, greater reductions in fasting blood glucose than baseline were observed in the text messaging group, at -0.5 mmol / L, compared to +0.1 mmol / L in the usual care (P = 0.011).
But text messages to participants who already had low HbA1 C initial levels did not further reduce the HbA level1 C stable levels, which remained stable throughout the study and in fact differed from the hbA1 C levels in control patients.
On the other hand, "in patients with HbA1 C levels above 7.5% initially, there was a significant and significant reduction in HbA1 C"Huo added.
Secondary outcomes, including systolic blood pressure, body mass index, low density lipoprotein cholesterol and self-reported physical activity levels did not differ between the two groups after the period of time. six months study.
Easy to understand, unique SMS
Importantly, almost all participants in the text messaging group indicated that the messages were easy to understand and useful.
Intervention group participants received about 155 text messages during the management study of their disease, all of which were unique (no repeated messages), noted the authors.
And almost all text message recipients have indicated that they would be willing to continue to receive text messages to help them manage their illness.
As Huo points out in a CES statement, the Chinese tend to prefer direct and structured advice rather than indirect approaches.
"[This meant that] Motivational messages were practical with concrete examples rather than abstract theories, "she added.
For example, participants in the intervention group could be told that they were afraid to measure their blood glucose because it hurt them, they had to try to take a blood sample on the side of the tip of their fingers or rotate the use of their fingers to minimize pain.
If patients forgot to take their medications, they were told to try to set the alarm on their cell phone to remind them that it was time to take their medications and / or to get them. inject insulin.
In the case of physical activity, it was asked recipients of text messages to try to walk quickly – it was good for their heart and would control their blood sugar.
"Lifestyle advice, such as strict dietary control, may have contributed to an improvement in blood sugar levels, as well as a reminder of regular blood sugar control," Huo said.
Huo has not reported any relevant financial relationship.
Results Card Ciriovasc Qual. Posted online 31 August 2019. Full text
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