Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes

Abstract

OBJECTIVEType 2 diabetes is growing in epidemic proportions and disproportionately affects lower-income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the “digital divide” to improve care.RESEARCH DESIGN AND METHODSA randomized, nonblinded, parallel-groups clinical trial design allocated N = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA1c; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items.RESULTSThe majority of patients were middle-aged (mean age 48.43 years, SD 9.80), female (75%), born in Mexico (91%), and uninsured (75%) and reported less than a ninth-grade education level (73%) and mean baseline HbA1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA1c over time compared with UC (P = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA1c (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high.CONCLUSIONSUse of a simple, low-cost text messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.

Short Message Service (SMS) e promoção do autocuidado em DM2: revisão integrativa

“…Part of the studies stip-ulated as the maximum number of characters for the content of the messages the maximum amount supported within an SMS. (4,9,23,29) About 21 topics were dealt with in the content of sent text messages. The most frequently mentioned topics were: medications (n=15); self-monitoring of glucose levels (n=9); motivation (n=9); education (n=7); diet (n=7); physical exercise (n=6); and foot care (n=3).…”

“…Research that registered unsatisfactory results adopted in its intervention a period with a mean of three months. (4)(5)(6)9,10,12,(17)(18)(19)24,26,29,31,32) This is probably due to the short interval between measurements and the delay in compliance with selfcare practices. (33) Thus, in order to obtain expressive results, it is possible to estimate as the ideal time interval for the performance of the SMS interventions of eight to 12 months.…”

“…Fortmann AL., et al (2017) (4) "Use small plates! Portions will look larger and you may feel more satisfied after eating"; "It takes a team!…”

“…Thus, there is a growing interest in the use of SMS as an educational methodological strategy to improve self-care through ease of communication and to reach individuals from different ethnic groups and socioeconomic levels. (4)(5)(6)(7) Sending text messages has shown to be a motivation for the proper management of diabetes by encouraging the recipients and making the assimilation of information easier. This is due to constant warnings about the importance of daily practices for health, which provides an increase in the link between the patient and his health center and promotes an improvement in the condition's clinical evolution.…”

An internet-based approach for lifestyle changes in patients with NAFLD: Two-year effects on weight loss and surrogate markers

“…In general, internet-based programs were shown to be less effective than face-to-face programs; their effectiveness may be increased by telephone recall systems 33 or text messages 34 but the reduced effectiveness is largely repaid by reduced costs and a larger audience. 35 This was also demonstrated in our setting, where nearly 60% of cases engaged in WBI lived outside the metropolitan area (and a few were scattered all over Italy), compared with the 27% of cases who entered the group-based behavioral approach.…”