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Text messages help low income Latinos better manage glucose levels
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SAN FRANCISCO — The use of text messages as part of diabetes self-management is proving effective in improving glycemic control for low-income Latinos with type 2 diabetes, according to research presented at the American Diabetes Association’s 74th Scientific Sessions.
Project Dulce, a nurse-led multidisciplinary team providing clinical care and peer educators to deliver diabetes education in federally-qualified health centers (FQHCs) that serve disadvantaged populations in San Diego, Calif., has improved patient outcomes but continues its work to overcome certain barriers.
“Ninety-one percent of the U.S. population already has a cell phone, so let’s use it as a way to circumvent these barriers of access to care,” Maria Isabel Garcia, NP, of Project Dulce, said during her presentation.
Garcia and colleagues recruited 116 Latinos with type 2 diabetes and HbA1c greater than 7.5% from FQHCs to investigate the impact of a diabetes self-management intervention delivered via mobile text messaging, known as Dulce Digital vs. usual care only. Cell phones were provided to patients who did not have them, along with text messaging instructions. Still ongoing, the study includes 71 participants (mean age=48.71±9.25 years, 80% female), 35 of the Dulce Digital participants.
Patients were randomized, and they completed a baseline assessment and received usual diabetes care; clinical and self-report measures were scheduled for 3 and 6 months. 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.
An interim analysis (months 0 to 3) showed significantly greater decreases in HbA1c with text messages compared with usual care only (9.4% to 8.7%, vs. 9.5% to 9.4%, P<.05). No significant group differences, however, have been observed for lipids, weight or blood pressure.
“We can infer that the patient is getting the text messages, reading the text message, checking their blood glucose and sending them back, and then we have the RN acting on the results,” Garcia said. “We can see that these patients are actually engaged.”
Project Dulce is currently doing focus groups to garner feedback on what patients thought of the intervention. The program is also looking to obtain a larger grant with a longer follow up to see if HbA1c improvements will be maintained over time.
According to Garcia, the staff also envisions such mobile technology being utilized for other health conditions and in various populations.
“It could be great to do more interventions similar to this for additional cardiometabolic indicators,” Garcia said, “and for other racial or ethnic populations and other high-risk populations.”
For More Information: Garcia MI. Abstract 10-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Disclosures: Garcia reports no relevant disclosures.
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Sue McLaughlin, MOL, BS, RD, CDE
Text messaging is a technology more and more people are using, and this is an example of how we can really take advantage of the newest methods of communication to connect with patients. As the population changes, we need to jump on the best ways to reach patients to really support them in managing their diabetes successfully.
We’re using the same principles of contacting patients and following up as we previously have. This is just another approach for relating with people, for giving them reminders, for checking in on how they are doing and for offering positive reinforcement. These are the kinds of things that can really make a difference.
In working with a student-led clinic for people with diabetes who have no resources, as well as with the Winnebago Indian Tribe, it was apparent that one of the biggest deterrents for patients not getting to classes or appointments was that they couldn’t. They want to be there, but they might not have transportation or there is a circumstance with a family member. This kind of technology helps to circumvent barriers and maintain connection with patients.
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