Text messaging may increase medical adherence in adolescents with diabetes

Using personalized cell phone text messages sent from physicians to adolescents with type 1 diabetes may help increase their adherence to medications and subsequently improve glycemic control, researchers said.

Jennifer Shine Dyer, MD, MPH, an endocrinologist at Nationwide Children’s Hospital in Columbus, Ohio, has developed and completed a pilot study that uses weekly customized text messages to remind adolescents about their personal treatment activities.

Results of the pilot study revealed an increase in overall treatment adherence and improved blood glucose levels in young people who received the text messages.

“We believe that texting and other forms of social media are tools to extend the doctor-patient relationship,” Dyer, also assistant professor in the department of pediatrics at Ohio State University College of Medicine, told Endocrine Today.

During 3 months, Dyer sent weekly text messages that were structured around inquiries about whether adolescents had remembered to test their glucose levels and meal boluses and asked about the frequency of high or low levels.

“I entered into a conversation by saying something personal that I knew was going on in their lives, such as, ‘How is band going?’ or ‘How is lacrosse?’” Dyer said.

Standard protocol questions were then asked to everyone, including:

How well are you doing with remembering your meal boluses?
How are your glucose checks going?
Are you having any high levels?
Are you having any low levels?

“Texts were concluded with a supportive message, such as ‘Keep up the good work,’” she said.

With the text message reminders, meal bolus adherence improved in all adolescents included in the small study, and HbA1c levels decreased from about 1.2% to 2.5%.

Benefits of instant communication

Although an e-mail reminder system may appear simpler and equally effective, Dyer said adolescents generally “do not use e-mail much,” adding that “text messages have far higher return rates because it is an immediate form of communication.”

“Mobile phones have great potential to innovate health care delivery because they are so readily available, and many physicians also have smart phones,” she said. “The technology is here, and it is creating an atmosphere of innovation.”

A further benefit of the text message reminder system was its effect on office time.

“Since we already have a lot of the basic information from texting, much more can be accomplished during office visits,” Dyer said. “One can cut the small talk and get straight to business.”

Barriers remain

As with the implementation of any new technology, several barriers may hinder widespread adoption — specifically, concerns about insurance compensation and privacy.

Another issue is how text message reminders may affect the physicians’ workload.

“When you open yourself to text messaging, you alter your availability to 24 hours,” Dyer said. “Although, I do not think that we live in a ‘9 to 5 world’ any longer.”

She said she will address these obstacles and other new methods to improve the adherence of adolescents at the World Research Group’s Third Annual Health 3.0 Conference: The Next Online Generation, slated for Jan. 25 to Jan. 27.

Drawing on the success of the text messaging program, Dyer has started work to implement an iPhone application for adolescents with diabetes. Similar to the texting message reminder system, the app would be the focus of a future study in which personalized, automated messages could be sent to multiple patients. Contact between the physician and patient, as well as psychological and self-care changes, would be measured.

Looking further, “it is important to consider and research other forms of social media as well because I do not think texting is the only answer,” Dyer said. “It will take more than text messaging to get a patient engaged — but it is a good place to start.” – by Matthew Brannon

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