March 12, 2019
2 min read

Text-based reminders help teens meet HbA1c goals

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Daily text reminders may be an effective tool in attaining glycemic targets for teenagers with type 1 diabetes, according to findings published in Diabetic Medicine.

“To protect against glycemic decline, teenagers may benefit from increased support and innovative ways to improve self-care,” Lori M. Laffel, MD, MPH, chief of the pediatric, adolescent and young adult section at the Joslin Diabetes Center of Harvard Medical School, and colleagues wrote. “Given the busy schedules and significant amount of time teenagers spend apart from families, they may need a remote means of support. Text messaging is a natural option given the prevalence of mobile phone and short message system use amongst teenagers.”

Laffel and colleagues designed a text-messaging intervention and tested it with 147 teenagers with type 1 diabetes (mean age, 14.9 years; 52% girls) over 18 months. The intervention involved sending a reminder to check blood glucose at a predetermined time once per day on the weekend before ramping up in frequency during the study period. Participants were considered responsive if they replied with their blood glucose reading after receiving the reminder text. To combat potential unresponsiveness to multiple texts as frequency increased, if a participant did not respond for 2 weeks, the reminders returned to once per day. Participants also underwent study visits every 3 months and had HbA1c measured every 6 months.

The researchers set targets for meaningful HbA1c improvements based on baseline measurements. Participants with HbA1c of 8%, or 64 mmol/mol, aimed to cut that measurement by at least 0.5% (5.5 mmol/mol), and those with baseline HbA1c of less than 8%, or 64 mmol/mol, were tasked with reaching a total measurement of less than 7.5% (58 mmol/mol) at 18 months. In addition, after the study, the researchers stratified the group based on responsiveness. High responders were participants who had at least one blood glucose response on at least 50% of the days. Low responders had a response on fewer than 50% of the days.

Forty-nine percent of all participants met the criteria for high response. At baseline, these participants more frequently checked their blood glucose (P = .016) and had lower levels of HbA1c (P = .004) than those considered low responders. Lower responders experienced an average increase of 0.3% (3.3 mmol/mol) in HbA1c at 18 months (P = .01) while change for high responders was not significant in either direction. However, high responders had lower HbA1c at 6 months (P < .05), 12 months (P < .01) and 18 months (P < .01).


In addition, high responders with baseline HbA1c of at least 8%, or 64 mmol/mol, were more likely to achieve meaningful improvement in HbA1c compared with low responders (OR = 2.5; 95% CI, 1.02-5.98). Similarly, high responders with baseline HbA1c of less than 8%, or 64 mmol/mol, experienced meaningful declines in HbA1c compared with low responders (OR = 5.7; 95% CI, 1.1-29.6).

Despite these findings, according to the researchers, overall responsiveness fell “disappointingly” during the study, with a rate of 60% from baseline to 6 months, 53% from 7 to 12 months and 43% from 13 to 18 months.

“This is quite consistent with other studies of text messaging and mobile health, highlighting the need to consider innovative ways to maintain engagement in interventions involving mobile platforms,” the researchers wrote. – by Phil Neuffer

Disclosures: The authors report no relevant financial disclosures.