Effects of Mobile Text Messaging on Glycemic Control in Patients With Coronary Heart Disease and Diabetes Mellitus

Abstract

Background: Mobile health interventions may support risk factor management and are readily scalable in healthcare systems. We aim to evaluate the efficacy of a text messaging–based intervention to improve glycemic control in patients with coronary heart disease and diabetes mellitus in China. Methods and Results: The CHAT-DM study (Cardiovascular Health and Texting-Diabetes Mellitus) was a parallel-group, single-blind, randomized clinical trial that included 502 patients with both coronary heart disease and diabetes mellitus from 34 hospitals in China. The intervention group (n=251) received 6 text messages per week for 6 months in addition to usual care. Messages were theory driven and culturally tailored to provide educational and motivational information on glucose monitoring, blood pressure control, medication adherence, physical activity, and lifestyle. The control group (n=251) received usual care and 2 thank you messages per month. The primary outcome was change in glycated hemoglobin (HbA 1C [hemoglobin A 1C ]) from baseline to 6 months. Secondary outcomes were change in proportion of patients achieving HbA 1C <7%, fasting blood glucose, systolic blood pressure, LDL (low-density lipoprotein) cholesterol, body mass index, and physical activity from baseline to 6 months. The end points were assessed using analyses of covariance. The follow-up rate was 99%. When compared with control group at 6 months, the intervention group had a greater reduction in HbA 1C (−0.2% versus 0.1%; P =0.003) and a greater proportion of participants who achieved HbA 1C <7% (69.3% versus 52.6%; P =0.004). Change in fasting blood glucose was larger in the intervention group (between-group difference: −0.6 mmol/L; 95% CI, −1.1 to −0.2; P =0.011), but no other outcome differences were observed. Nearly all participants reported that messages were easy to understand (97.1%) and useful (94.1%). Conclusions: A text message intervention resulted in better glycemic control in patients with diabetes mellitus and coronary heart disease. While the mechanism of this benefit remains to be determined, the results suggest that a simple, culturally sensitive mobile text messaging program may provide an effective and feasible way to improve disease self-management. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02883842.

Medication Adherence Interventions for Cardiovascular Disease in Low- and Middle-Income Countries: A Systematic Review

“…Four studies were conducted in Africa: two in Nigeria, 19,20 one in Ghana, 21 and one in South Africa 22 Eight of the studies were conducted in the Americas: Brazil, [23][24][25][26][27] Argentina, 28 Portugal, 29 and Chile. 30 Thirty-three of the studies were conducted in Asia: Jordan, 31,32 Iran, [33][34][35][36][37][38][39][40][41] Philippines, 42 Malaysia, 43 China, [44][45][46][47][48][49][50] Taiwan, 51 India, [52][53][54][55][56][57] Vietnam, 58 Pakistan, [59][60][61] and Thailand 62,63 (Table 1). Also, 35 of the studies were randomized clinical trials and nine articles were non-randomized studies; one study was a cohort study; others were quasiexperimental and pre-post studies.…”

“…Reminders were more effective when they were personalized or interactive rather than generic. Many (48%, n=22) of the interventions included in this review were conducted by phone calls 24,33,45,48,49,57,64,65 or by SMSs, including customized and interactive messages 30,45,46,60 and electronic pillboxes. 62 Only one study implemented incentives as a strategy to improve adherence in the form of free antihypertensive medication and transportation funds to attend clinic appointments.…”

Effectiveness of a customised mobile phone text messaging intervention supported by data from activity monitors for improving lifestyle factors related to the risk of type 2 diabetes among women after gestational diabetes: protocol for a multicentre randomised controlled trial (SMART MUMS with smart phones 2)

“…11 Recent publications of text messaging for people with diabetes, the Self-Management Support for Blood Glucose (SMS4BG) programme, the Cardiovascular Health and Text Messaging-Diabetes Mellitus (CHAT-DM) study and the Rapid Education/Encouragement and Communication for Health (REACH) programme have demonstrated small improvements in HbA1c of 0.3%-0.4% (3-4 mmol/mol). [41][42][43] There are studies showing the effectiveness of DHI interventions during pregnancy for weight management. For example, Guo et al's 44 RCT showed evidence of less weight gain among those using a mobile medical application compared with control (3.2±0.8 vs 4.8±0.7, p<0.001).…”

Effectivity of Health Education with Telenursing on the Self-care Ability of Coronary Artery Disease Patients: A Systematic Review

“…Table 3 shows that the included studies were conducted in Asia [18], [26], [27], Holmes-Rovner et al in America [20], and in Australia [23], [24], [25]. All articles included in the systematic review used English, while none of the articles in Indonesian were included because they did not meet the eligibility criteria in the selection process.…”

“…Five studies (n = 2358) used text message media, including WhatsApp text message, to provide health education about the components of self-care for CAD patients, including; general information regarding CAD, risk factors for PAC, a healthy lifestyle (smoking, diet, and physical activity), secondary prevention of chest pain, and medication adherence reminders [18], [23], [24], [27], one study discussed risk factor monitoring [27] and one study on secondary preventive management of chest pain, as well as two studies of medication adherence. Overall, studies reported health education by telenursing using text message media as a simple intervention and feasible to improve the management of CAD and reduce risk factors.…”