Text‐message responsiveness to blood glucose monitoring reminders is associated with HbA1c benefit in teenagers with Type 1 diabetes. Issue 5 (25th February 2019)

• Record Type: Journal Article
• Authors: McGill, D. E.; Volkening, L. K.; Butler, D. A.; Wasserman, R. M.; Anderson, B. J.; Laffel, L. M.
• Is Part Of: Diabetic medicine. Volume 36:Issue 5(2019)
• Page Start: 600
• Page End: 605
• Publication Date: 2019-02-25
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13929
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To evaluate an 18‐month text‐messaging intervention in teenagers with Type 1 diabetes and to assess factors associated with text responsiveness and glycaemic benefit. Methods: Teenagers with diabetes ( N = 147), aged 13–17 years, received two‐way text reminders at self‐selected times to check blood glucose levels and reply with blood glucose results. Results: At baseline, the participants (48% boys, 78% white, 63% pump‐treated) had a mean ± sd age of 14.9 ± 1.3 years, diabetes duration of 7.1 ± 3.9 years and HbA1c concentration of 69 ± 12 mmol/mol (8.5 ± 1.1%). The mean proportion of days with ≥1 blood glucose response declined over time (0–6 months, 60 ± 26% of days, 7–12 months, 53 ± 31% of days, 13–18 months, 43 ± 33% of days). Over 18 months, 49% responded with ≥1 blood glucose result on ≥50% of days (high responders). Regression analysis controlling for baseline HbA1c revealed no significant change in HbA1c from baseline to 18 months in high responders ( P = 0.54) compared with a significant HbA1c increase in low responders (+0.3%, P = 0.01). In participants with baseline HbA1c ≥64 mmol/mol (≥8%), high responders were 2.5 times more likely than low responders to have a clinically significant [≥5.5 mmol/mol (≥0.5%)] HbA1c decrease over 18 months ( P < 0.05). In participants with baseline HbA1c <64 mmol/mol(<8%), high responders were 5.7 times more likely than low responders to have an 18‐month HbA1c <58 mmol/mol (<7.5%; P < 0.05). Conclusions: Teenagers with Type 1 diabetes who responded to text reminders on ≥50% of days over 18 months experienced clinically significant glycaemic benefit. There remains a need to tailor interventions to maintain teenager engagement and optimize improvements. What's new?: As teenagers with Type 1 diabetes become increasingly independent in self‐care behaviours, they are at risk of decreased adherence and deteriorating glycaemic control. This study of a text‐messaging intervention in teenagers with Type 1 diabetes demonstrated clinically significant glycaemic benefit in participants who responded to reminders on ≥50% of days over 18 months. The benefit was present in participants with baseline HbA1c ≥64 mmol/mol (≥8%), and in those with baseline HbA1c <64 mmol/mol (<8%). Teenagers who engaged with a mobile health intervention, such as text messaging, experienced improvement in glycaemic control. Such interventions should be tailored to maintain teenager engagement and optimize benefit.