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Two-way text messaging may help glycaemic control in teens with T1D

Elaine Soliven
30 Jun 2017

More frequent text messaging responses to reminders to check blood glucose (BG) was associated with better glycaemic control in teens with type 1 diabetes (T1D), and may help the transition from paediatric to adult care which entails greater self-care routine, suggests a study presented at the American Diabetes Association’s 77th Scientific Sessions held in San Diego, California, US.

“Teens with T1D often struggle with self-management as they simultaneously face the normal developmental challenges of adolescence. This often leads to suboptimal adherence and worsening [Hb]A1c, which can hamper transfer to adult care and can promote early complications of diabetes in young adulthood,” said lead author Dr Lori Laffel from the Joslin Diabetes Center in Boston, Massachusetts, US.

The study consisted of 301 teens aged 13–17 years (50 percent male) who had T1D for a period of ≥6.5 months (mean HbA1c level 8.5 percent). Participants were randomized to four treatment groups: problem-solving (PS; self-care focusing on BG monitoring and insulin bolus dosing at mealtimes), 2-way text messaging (TM; whereby patients received TM reminders at self-selected times to report on their current BG levels), both PS and TM, or usual care. Patients were followed up every 3 months for a year. [ADA 2017, abstract 194-LB]

Within the TM group, participants were further categorized by different TM response rates (defined as the frequency of BG responses to text reminders): low (0–33 percent; n=64), moderate (34–67 percent; n=54), and high (68–100 percent; n=33).

Although changes in HbA1c levels were not significantly different between the treatment groups, the changes were significantly different between the various TM response subgroups at 1 year. Among teens in the TM group, those with a high response rate had the best glycaemic control (HbA1c 8.1 percent), while those with a low response rate had the worst control at 1 year (HbA1c 8.8 percent).

Teens with a low response rate to TM (p=0.05) and those who did not receive TM (p=0.01) had significantly increased HbA1c level at 1 year from baseline, indicating worsening glycaemic control.

On the other hand, teens with moderate or high response rates (>33 percent response rate) showed no significant increase in HbA1c levels from baseline over 12 months.

“Given the high penetration of mobile phones and the wide acceptance of text messaging among teens in general, it is indeed encouraging that a two-way text messaging program can preserve [Hb]A1c, thus preventing the expected deterioration of glycaemic control often seen in teens with T1D,” said Laffel.

“Continued texting through transition may offer a means to support self-care post-transfer,” she added.
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