1. The TExT-MED program did not result in a statistically significant improvement in HbA1c levels.
2. The program was associated with trends toward improvement in HbA1c as well as secondary outcomes, especially improved medication adherence.
Evidence Rating Level: 1 (Excellent)
Study Rundown: mHealth – the use of mobile telephones as a vehicle to provide public health or medical interventions – is gaining attention as a potentially scalable and low-cost means of improving clinical outcomes and increasing healthy behaviors among patients. Preliminary research on bidirectional mHealth-based interventions that enabled clinician to monitor glycemic control and devise management strategies from afar have been promising. However, it is unclear whether programs that require less input from patients and practitioners could also be effective, particularly among low-resource patient populations. This randomized controlled trial aimed to determine whether a unidirectional text messaging-based intervention could improve the health of diabetic patients in a safety net ED. Though it found trends towards improvement in HbA1c levels and all secondary outcomes, none reached statistical significance. With these findings, the authors declare the program a success and the study yet another data point in the growing evidence-base for text-based interventions as a scalable and cost-effective adjunct tool for chronic disease management. Further research might explore why the effects seen were greater among Latino populations, as this may have important implications for other public health interventions and the need for language and culturally concordant messaging. Future studies with longer follow-up periods and larger sample sizes may further classify the health impact of such interventions.
In-Depth [randomized controlled trial]: This study aimed to determine whether a text message–based mobile health intervention (TExT-MED) improves clinical outcomes, increases healthy behaviors, and decreases ED utilization in a safety net population. 128 adult patients with poorly controlled diabetes (glycosylated hemoglobin [Hb A1C] level ≥8%) in an urban, public ED were enrolled in the study and randomly assigned to receive either two daily text messages for six months in English or Spanish or no text messages. The primary outcome of interest was the change in Hb A1C at 6 months between groups. Secondary outcomes, including changes in medication adherence, self-efficacy, performance of self-care tasks, quality of life, and diabetes-specific knowledge, were collected at enrollment and at 6-month follow-up.
The primary outcome of median Hb A1C decreased by 1.05% in the TExT-MED group compared with 0.60% in the control group (Δ 0.45; 95% CI –0.27 to 1.17). Similar trends toward greater improvement in the treatment group were observed in all secondary outcomes, though largest in medication adherence. All effects observed were larger among Spanish speakers.
By Elizabeth Kersten and Andrew Bishara
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