• Research into Auto SMS in chronic disease published in Health Affairs
• HBA1C reduced
• Costs of care reduced
• Satisfaction with care increased
• Content included reminders, questions and allowed for responses

Auto TXTing May Boost Diabetes Self-Care

Published: Feb 3, 2014

By David Pittman, Washington Correspondent, MedPage Today

Patients with diabetes who received a text message reminder about checking their blood sugar or refilling their medicines saw improvements in clinical outcomes and lower healthcare costs, researchers said.

The 74 patients enrolled in CareSmarts, a mobile phone-based program that provides automated self-management support, had HbA1c glucose levels that went from an average of 7.9% before the 6-month study period to an average of 7.2% afterward (P=0.01), reported Shantanu Nundy, MD, managing director at Evolent Health, in Arlington, Va., and colleagues in Health Affairs.

Costs also fell 8.8% in the intervention group, with a decline in the number and costs of outpatient visits, they added. No changes in clinical outcomes (P=0.08) or costs were seen in the 274 patients who were not enrolled in CareSmarts and made up the control group.

“Our study offers early evidence that [mobile health] can enable healthcare organizations to effectively support patients beyond the traditional healthcare setting and achieve the triple aim of better health, better healthcare, and lower costs,” they wrote.

Patients with type 1 or type 2 diabetes with access to a personal cell phone were recruited for the study at the University of Chicago. Participants were responsible for any text messaging costs charged by their phone carriers, but they were given a $25 cash incentive at the completion of the study.

The average age of the study-arm patients was 53 and nearly 70% were African American, with an average diabetes duration of 8 years. One-third of patients had well-controlled diabetes (HbA1c of 7% or less). Of the 74 patients, 67 completed the 6-month program.

The text messages included reminders (“Time to check your blood sugar”) and questions, such as “Do you need refills of any of your medications?” The patients responded by text, and healthcare providers followed up depending on the responses. The patients also received educational materials.

The intervention group saw improvements in glycemic control (P=0.01) and reported better satisfaction with overall care (P=0.04), according to the authors.

However, broader use of such text messaging tools will require federal guidance and regulations, they cautioned.

“Although we found a business case for the use of [mobile health], the diffusion and sustainability … depends on a supportive policy environment,” they wrote.

While the FDA recently said it wouldn’t regulate mobile apps that don’t interface with an FDA-regulated device, such as glucometers and blood pressure monitors, uncertainty remains about apps used as an accessory to a medical device or those that support medical decision-making.

“In addition, more work is needed to clarify the overlapping roles of the FDA, the Office of the National Coordinator for Health Information Technology, and the Federal Communications Commission,” the authors wrote.

Nundy and colleagues called for government-driven privacy guidelines around provider-to-patient communication through mobile apps, saying organizations are “less likely to develop innovative programs in this area.”

Diabetes care has been one field with a large number of mobile apps for clinicians and patients to better monitor and control the disease. Some applications require a provider’s prescription.