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Teens who text can ease transition to adult type 1 diabetes care
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SAN DIEGO — Even automated text message reminders to check blood glucose can prevent worsening glycemic control in adolescents who are engaged in their medical care, according to a speaker here.
“Teens with type 1 diabetes often struggle with self-management as they simultaneously face the normal developmental challenges of adolescence,” Lori Laffel, MD, MPH, chief of the pediatric, adolescent and young adult section and senior investigator/co-head of the section on clinical, behavioral and outcomes research at Joslin Diabetes Center, and professor of pediatrics at Harvard Medical School, said in a news briefing. “This often leads to suboptimal adherence and worsening HbA1c, which can hamper transfer to adult care and promote early complications in young adulthood.”
Laffel and colleagues conducted a yearlong randomized controlled trial to evaluate methods to improve self-care among teens with type 1 diabetes. The study included 301 adolescents aged 13 to 17 years at baseline who were randomly assigned to one of four intervention groups: text messaging (n = 74), problem solving (n = 74), text messaging plus problem solving (n = 77) or usual care (n = 76). The mean age was 15 years, all had type 1 diabetes for at least 6 months, mean HbA1c was 8.5%, 22% were minorities and 63% were using an insulin pump.
Participants had quarterly office visits. Those in the text-messaging group received an automated text each day, at a self-selected time, asking them to reply with their blood glucose level. Lack of response led to an increase in messaging up to four times per day. The problem-solving group completed five educational modules focusing on blood glucose monitoring, bolus dosing, self-advocacy and preparing for transfer to adult care. The combined group received both interventions.
The primary outcome was change in HbA1c at 12 months. Laffel and colleagues observed no significant differences in HbA1c over time among the groups; however, they noted differences according to engagement in those who received text messages. Teens who replied to more than a third of the messages had no significant increase in HbA1c at 12 months. Those who responded to less than 33% of the messages, and those who did not receive messages, had significant increases in HbA1c (P = .05 and P = .01, respectively). Problem-solving training appeared to have no effect on glucose control.
“Given the high penetration of mobile phones and the wide acceptance of text messaging among teens in general, it is encouraging that a two-way text messaging program can preserve HbA1c, thus preventing the expected deterioration often seen in teens with type 1 diabetes,” Laffel said. “Use of two-way text messaging may help teens with type 1 diabetes in their transition to self-care and transfer to adult providers.” – by Jill Rollet
Reference:
Laffel LM. 194-LB. Presented at: American Diabetes Association 77th Scientific Sessions; June 9-13, 2017; San Diego.
Disclosure : Laffel reports consulting for Animas, AstraZeneca, Boehringer Ingelheim, Dexcom, Eli Lilly and Company, Johnson & Johnson Diabetes Institute, LifeScan, Menarini Diagnostics, Novo Nordisk, Oshadi, Roche Diagnostics and Sanofi US.