Effectiveness and costs of strategies to recruit Australian adults with type 2 diabetes into a text message intervention (DTEXT) study

Abstract Background Mobile phone text message interventions have the potential to improve the health of people with type 2 diabetes at a population level. This study aimed to determine the effectiveness and acceptability of a mobile phone text message intervention (DTEXT) on diabetes control and self-management behaviours for Australian adults with type 2 diabetes. Methods A two-armed parallel non-blinded randomised control trial was conducted with 395 community dwelling adults with type 2 diabetes and HbA1c ≥7.0% (53 mmol/mol). Block randomisation occurred after completion of baseline measures. The control group received usual care, the intervention group received usual care and the automated six month text message intervention (daily messages for months 1-3, four messages per week for months 4-6). Pathology measures and self-report telephone surveys were assessed using intention to treat analysis. Generalised estimating equations determined between group changes in HbA1c at 3 and 6 months. Secondary outcomes included change in nutrition, physical activity, blood lipid profile, body mass index, quality of life, self-efficacy, medication adherence and program acceptability. Results No significant difference was observed between the intervention (n=197) or control group (n=198) for HbA1c at 3 months (-0.11%; CI -0.28, 0.07; d= -0.05, p=0.23) or 6 months (-0.13%; CI -0.33, 0.08; d= -0.05, p=0.22). A significant improvement in nutrition was seen with consumption of vegetables at 3 months (0.74 serves/day; 95%CI 0.34, 1.12; d =0.31, p<0.01) and 6 months (0.42 serves/day; 95% CI 0.03, 0.82; d =0.18, p=0.04); fruit at 3 months (0.21 serves/day; 95% CI 0.00, 0.41; d =0.09, p<0.05) and discretionary sweet foods at 3 months (-1.10 times/week; 95% CI -2.03, -0.16; d =-0.47, p=0.02). No other significant effects were seen at 3 months and 6 months. The intervention demonstrated high rates of acceptability (94.0%) and minimal withdrawal (1.5%). Conclusions A mobile phone text message intervention can improve some nutritional behaviours in people with type 2 diabetes, but does not significantly improve HbA1c or other health outcomes. DTEXT provides a highly accepted and potentially scalable form of self-management support that can complement existing diabetes care. Trial Registration Australian New Zealand Clinical Trials Registry, Trial ID: ACTRN12617000416392. Registered: 23 March 2017.

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An Adaptive, Algorithm-based Text Message Intervention to Promote Health Behavior Adherence in Type 2 Diabetes: Treatment Development and Proof-of-Concept Trial

Journal of Diabetes Science and Technology ◽

10.1177/19322968211065067 ◽

2021 ◽

pp. 193229682110650

Author(s):

Christopher M. Celano ◽

Christina Massey ◽

Jessica Long ◽

Sonia Kim ◽

Olivia Velasquez ◽

...

Keyword(s):

Physical Activity ◽

Type 2 Diabetes ◽

Adaptive Algorithm ◽

Controlled Trial ◽

Text Message ◽

Self Care ◽

Well Being ◽

Psychological Outcomes ◽

Text Messages

Background: Most individuals with type 2 diabetes (T2D) struggle to adhere to one or more health behaviors. Text message interventions (TMIs) have the potential to improve adherence but have had mixed effects on diet and activity in T2D. We developed an eight-week, adaptive, algorithm-driven TMI to promote physical activity, diet, self-care, and well-being. Then, in a single-arm trial, we assessed its feasibility, acceptability, and preliminary efficacy in 15 individuals with T2D and suboptimal adherence. Methods: Participants received daily text messages and were asked to rate the utility of each message (0=not helpful, 10=very helpful). These ratings were used by an algorithm to select subsequent messages based on each participant’s prior ratings. We assessed intervention feasibility by rates of message transmission/response and acceptability through ratings of message utility and burden. Finally, we examined pre-post changes in diabetes self-care, diet, physical activity, and psychological outcomes and calculated effect sizes (Cohen’s d). Results: All text messages were delivered, and participants provided ratings for 79% of messages, above our a priori thresholds for feasibility. Participants rated the individual messages and overall TMI as subjectively useful (utility: 8.1 [SD=2.1] and 7.8 [SD=2.0], respectively) and not burdensome (burden: 0.8 [SD=1.8]). The intervention led to significant, medium- to large-sized improvements in self-care ( d=0.77), diet ( d=0.99), and activity ( d=0.61) but minimal change in psychological outcomes. Conclusions: The TMI was feasible and well-accepted, and it led to promising improvements in adherence-related outcomes. These findings should be confirmed in a larger randomized controlled trial.

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Feasibility of text message sleep assessment in African American and Latino patients with type 2 diabetes

Journal of Clinical Sleep Medicine ◽

10.5664/jcsm.8828 ◽

2021 ◽

Vol 17 (1) ◽

pp. 69-78

Author(s):

Alana Biggers ◽

Julia Henkins ◽

Isaye Barton ◽

Colin Hubbard ◽

Rose Perez ◽

...

Keyword(s):

Type 2 Diabetes ◽

African American ◽

Text Message ◽

Sleep Assessment

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Use of a Text Message Program to Raise Type 2 Diabetes Risk Awareness and Promote Health Behavior Change (Part I): Assessment of Participant Reach and Adoption

Journal of Medical Internet Research ◽

10.2196/jmir.2928 ◽

2013 ◽

Vol 15 (12) ◽

pp. e281 ◽

Cited By ~ 25

Author(s):

Lorraine R Buis ◽

Lindsey Hirzel ◽

Scott A Turske ◽

Terrisca R Des Jardins ◽

Hossein Yarandi ◽

...

Keyword(s):

Type 2 Diabetes ◽

Health Behavior ◽

Behavior Change ◽

Text Message ◽

Health Behavior Change ◽

Diabetes Risk ◽

Risk Awareness

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Walking with Diabetes (WW-DIAB) programme a walking programme for Indonesian type 2 diabetes mellitus patients: A pilot randomised controlled trial

SAGE Open Medicine ◽

10.1177/2050312118814391 ◽

2018 ◽

Vol 6 ◽

pp. 205031211881439

Author(s):

Novita Intan Arovah ◽

Bernadeta Margareta Wara Kushartanti ◽

Tracy L Washington ◽

Kristiann C Heesch

Keyword(s):

Physical Activity ◽

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Controlled Trial ◽

Text Message ◽

Related Quality ◽

Randomised Controlled ◽

Walking Programme

Objectives: This pilot study aimed to examine the feasibility and effectiveness of a pedometer-based walking programme in Indonesian type 2 diabetes mellitus patients. Methods: Feasibility was assessed by monitoring participant recruitment, retention, and adherence to the step-monitoring and recording instructions. Effectiveness was assessed in a pilot randomised controlled trial. Participants were type 2 diabetes mellitus patients randomly assigned to a pedometer-only (PED-only) group (n = 22) and a pedometer with text message support (PED+) group (n = 21). Outcomes were step counts, self-reported physical activity, social cognitive constructs, glycaemic parameters, and health-related quality of life. These were assessed at baseline, 12-week intervention, and 12 weeks later. Longitudinal analyses using generalised estimating equations were carried out to assess treatment and time effects on study outcomes. Results: All but one participant (98%) attended 12- and 24-week data collection follow-ups. Throughout the study period, 82% of PED+ participants submitted their daily steps log. Daily steps increased in both groups (p < 0.001) but more in the PED+ group (2064 more steps at week 24, 95% confidence interval: 200–3925, p = 0.03). Self-reported physical activity levels and glycaemic parameters increased similarly in the two groups over time (p < 0.05). Improvements in social cognitive processes were seen only in the PED+ group (p < 0.05). There were no significant improvements in health-related quality of life. Conclusion: This study provides preliminary evidence that a pedometer-based walking programme, with or without additional support, is feasible and improves physical activity and glucose levels in Indonesian type 2 diabetes mellitus patients. Greater increases in step counts can result from the provision of text message support and education materials than from the provision of a pedometer only.

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An Umbrella Review of Text Message Programs for Adults With Type 2 Diabetes

The Diabetes Educator ◽

10.1177/0145721720965464 ◽

2020 ◽

Vol 46 (6) ◽

pp. 514-526

Author(s):

Robin Whittemore ◽

Lauren Siverly ◽

Dora Lendvai Wischik ◽

Christina R. Whitehouse

Keyword(s):

Type 2 Diabetes ◽

Systematic Reviews ◽

Text Messaging ◽

English Language ◽

Clinical Care ◽

Text Message ◽

Self Management ◽

International Studies ◽

Umbrella Review

Purpose The purpose of this umbrella review was to synthesize the evidence from published systematic reviews on the effectiveness of text message programs for adults with type 2 diabetes (T2DM) on glycemic management (A1C), self-management, and other clinical outcomes. The effect of directionality of the program was also explored. Methods A systematic search was conducted using multiple databases. Inclusion criteria were systematic review of text message programs for adults with T2DM, evaluated A1C, and English language. Quality assessment was completed using AMSTAR-2 guidelines. Data were extracted by multiple coders, and results were synthesized. Results The final sample included 9 systematic reviews published between 2011 and 2019, with 72 unique international studies. Text message programs focused on diabetes self-management and reducing health risks through educational and motivational content with some providing personalized feedback. A meta-analysis of program effect on A1C was conducted in 5 reviews with a pooled difference in A1C from −0.38% to −0.8%. Adults with T2DM of shorter duration and lower A1C had better treatment effects. Evidence on unidirectional versus bidirectional programs is conflicting; however, both improve outcomes. Evidence of text message programs targeting medication engagement was inconclusive. Some programs improved blood pressure, lipids, self-management, self-efficacy, and health behaviors. High satisfaction and an average of 9.6% to 18.7% attrition was reported. Conclusions Text messaging programs can improve T2DM outcomes, are a highly accessible mode of communication, are relatively inexpensive, and are an underutilized adjunct to clinical care.

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