Motivational text messaging may be the key to improving blood sugar control in patients with diabetes and coronary heart disease, according to a new Chinese study.
It’s the finding a randomized trial reported last week at ESC Congress 2019 together with the World Congress of Cardiology that took place in Paris, France.
How Was The Study Conducted?
The study, led by researchers at Fuwai Hospital, Beijing, China, enrolled 502 patients from 34 clinics in China.
In addition to usual care, patients were randomly assigned to the text messaging intervention or a control group for six months.
The intervention group received six messages per week, at random times of day, from an automated system set up by the researchers.
Topics included diabetes and coronary heart disease, glucose monitoring and control, blood pressure control, medication adherence, physical activity, and lifestyle recommendations on diet, foot care, and emotional management.
The control group also received two thank you text messages per month.
What Were The Findings?
At six months, blood glycated hemoglobin (3) (HbA1c) was significantly lower in the intervention group compared to control group (6.7% versus 7.2%).
On average, HbA1c fell by 0.2% in the intervention group and rose by 0.1% in the control group – a difference of 0.3% between groups.
To reduce the complications of diabetes, the target HbA1c is less than 7%.
Significantly more participants in the intervention group achieved the target (69.3%) compared to the control group (52.6%). The change in fasting blood glucose was larger in the intervention, compared to control, group (-0.5 versus 0.1 mmol/L, respectively).
Systolic blood pressure, low-density lipoprotein (LDL) cholesterol, body mass index, and self-reported physical activity did not differ between groups. The intervention was acceptable to participants, most of whom (97%) found the text messages useful, readable, and an appropriate method of contact.
“The effect in this study was not only statistically significant but also has the potential to be clinically relevant by reducing the risk of diabetic complications and death,” says Dr. Xiqian Huo of the Fuwai Hospital, Beijing, China.
“Capitalizing on the exponential growth in mobile phone usage over the past decade, a simple text-messaging program could increase the reach of diabetes self-management support,” she added.
She says it may provide a means to better address the burgeoning healthcare demand-capacity imbalance.
The study did not measure specifically which text messages were most effective.
However, Huo says Lifestyle advice such as strict dietary control may have contributed to glycaemic improvements, together with reminders to monitor blood glucose regularly.
“The messages were designed to provide information and motivation, and help patients set goals and manage stress,” she says.
Another characteristic of the text messages was that they were culturally sensitive – for example using traditional Chinese sayings and catchy rhyming.
“Chinese people tend to prefer direct and structured counseling instructions rather than indirect and insight-oriented approaches, so motivational messages were practical, with real-life examples instead of abstract theories,” Huo explains. “Social and family-oriented goals were used more often than individual achievement to help improve health behaviors, consistent with cultural norms in China.”
Huo notes that sending text messages to patients in the intervention group with low baseline HbA1c was safe and did not result in a further reduction in blood sugar levels or hypoglycemia.
She concludes her study has important public health implications since patients with coronary heart disease and diabetes are at high risk for diabetes-related complications and death and achieving glycaemic control is a central pillar of high-quality care.
Huo acknowledges that further investigation is needed.
However, she says this type of “non-pharmacological intervention,” could be a powerful tool to transform worldwide delivery of health services and improve health across diverse populations.