MedicalResearch: What are the main findings of the study?
Dr. Philis-Tsimikas: Findings from the Dulce Digital study suggest that a text message-based self-management intervention improves glycemic control in high risk Latinos with type 2 diabetes.
Researchers recruited 126 Latinos with type 2 diabetes and HbA1c greater than 7.5% from federally-qualified health centers (FQHCs) that serve disadvantaged populations to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging. Cell phones were provided to patients who did not have them, along with text messaging instructions.
Patients were randomized after completing clinical and self-reported measurements at baseline and these assessments were then repeated at 3 and 6 months. Both Dulce Digital and control groups received usual care. The Dulce Digital group received three types of text messages — educational and motivational; medication reminders; and blood glucose monitoring prompts — two to three messages each day initially, with frequency tapering over 6 months. Project Dulce staff then monitored blood glucose responses, assessed reasons for hyperglycemia or hypoglycemia and encouraged follow up with providers as needed.
Still ongoing, the current analyses included 106 completed participants (mean age= 49.25±9.49 years, 74% female), 52 of which were Dulce Digital participants. Findings showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.4%, vs. 9.5% to 9.3%, P<.05) at 6 month follow-up. No significant group differences, however, have been observed for lipids, weight or blood pressure.
MedicalResearch: Were any of the findings unexpected?
Dr. Philis-Tsimikas: At the six-month mark, it was found that the Dulce Digital participants had a significantly larger decrease in HbA1c test levels than the control group. From these results, we can infer that the patient is getting the text messages, reading the text message, and checking their blood glucose. These are sent back and a RN is acting on the results. We can see that these patients are actually engaged.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Philis-Tsimikas: The use of mobile phones in health care is very promising, especially when it comes to low-income populations with chronic diseases.
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.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Philis-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.