Motivational text messages could be the key to better glycemic control in patients with both diabetes mellitus and coronary heart disease (CHD), according to research out of China.
Co-first author Xiqian Huo, MD, and colleagues outlined the specifics of the CHAT-DM (Cardiovascular Health and Texting-Diabetes Mellitus) study in Circulation: Cardiovascular Quality and Outcomes Aug. 31. The project involved 502 patients with both diabetes and CHD across 34 hospitals in China, the epicenter of the world’s largest diabetes epidemic.
It’s estimated that 10.9% of the Chinese population have diabetes, Huo and co-authors explained—a higher percentage than the U.S. or any other developed country—and just one-third of those people achieve adequate glycemic control. CHD can complicate things further, presenting as a common comorbidity in 12% to 31% of middle-aged diabetics.
“Diabetes self-management education and support, focused on risk factor control and lifestyle modification, is a cornerstone of secondary prevention in patients with diabetes and CHD,” the authors wrote in their paper. “Traditional education strategies have included face-to-face visits, telephone consultations and health seminars. However, it is often difficult to generalize and implement such interventions nationally because of the high costs of organization, demanding labor investment and limited access to health services.”
That’s where texting comes in, they said. Text messages are swapped constantly worldwide, and with some 200,000 texts sent every second in China, they could present an opportunity for a low-cost, scalable health intervention.
Huo et al. split their study group in half, randomizing patients to either an intervention of six tailored text messages per week for six months in addition to usual care (251 patients) or usual care and two thank-you messages per month (251 patients). Text messages were theory-driven and culturally tailored to provide educational and motivational information about glucose monitoring, blood pressure control, medication adherence, exercise and lifestyle.
At six months, the researchers found their intervention group had a greater reduction in glycated hemoglobin (HbA1c) than their counterparts in the control group—a decrease of 0.2% versus a slight increase of 0.1%. A greater proportion of patients in the intervention group also achieved HbA1c of less than 7% (69.3% versus 52.6%).
Change in fasting blood glucose was larger in the intervention group than in the control group, resulting in a between-group difference of -0.6 mmol/L, but Huo’s team didn’t report any other outcome differences. Ninety-seven percent and 94.1% of participants said the text messages were easy to understand and useful, respectively.
The authors said their findings could have important public health implications, since patients with a dual diagnosis of diabetes and CHD are already at a high risk for mortality and major vascular events. The text messaging program was a cheap way to reduce HbA1c and promote glycemic control in a population that can struggle to keep their risk factors in check.
“Our study showed that a simple, culturally sensitive text messaging intervention resulted in improved glycemic control among patients with CHD and diabetes mellitus,” Huo et al. wrote. “The findings support further exploration of innovative, patient-centered mobile health approaches as supplements to current clinical practice, and they offer potential to generate public health benefits for millions across diverse populations.”