A Two-Way Text Messaging System Benefits Glycemic Control for Teens with Type 1 Diabetes

System improves transition from pediatric to adult care

News provided by

Jun 10, 2017, 13:00 ET

SAN DIEGO, June 10, 2017 /PRNewswire-USNewswire/ -- Teens with type 1 diabetes (T1D) who adhere to frequent communication through a two-way text messaging system were found to maintain or improve A1C levels while preparing to transition from pediatric to adult care settings, according to the study, "Text Message Intervention for Teens with Type 1 Diabetes (T1D) Preserves A1C: Results of an RCT," presented today at the American Diabetes Association's 77th Scientific Sessions® at the San Diego Convention Center.

The transition from pediatric health care to adult health care is challenging for young people with T1D, partially due to the high level of self-care involved. Once patients make the change from pediatric to adult care, their success at effectively managing diabetes during adolescence often predicts their success and maintenance of A1C levels as a young adult. This study evaluated the benefit of a text messaging system on the teens' A1C levels (glycemic control). The text messaging system was designed to remind the teens to check blood glucose, and the teens receiving the text messaging intervention were compared with teens receiving a problem-solving intervention versus teens receiving standard care.

The study was a 12-month, randomized, controlled trial that enrolled 301 teenagers with T1D from two clinical sites in the U.S. The patients had an average age of 15 years and had lived with T1D for an average of 6.5 years. At the beginning of the study, the participants had an overall average A1C of 8.5 percent. Insulin pumps were used by 63 percent of the sample, and all patients were seen by their health providers quarterly.

All study participants were randomized to one of four groups. The first group, the text messaging (TM) group, received texts with daily reminders to check and to send reply texts with their blood glucose levels at self- selected times. The patients in the TM group started with one text on weekend days and gradually increased to a maximum of four texts daily. The second group, the problem-solving (PS) group, received five self-care modules that emphasized increased blood glucose monitoring and insulin bolus dosing (insulin dosing at mealtimes), as well as self-advocacy and transfer preparation. The third group, the TM+PS group, received both the text message and problem-solving interventions. The fourth group did not receive any intervention. There were 74 teens in the TM group; 74 teens in the PS group; 77 teens in the TM+PS group; and 76 teens in the standard care group

The research indicated that text message reminders appeared to preserve and potentially improve glycemic control. Additionally, in a multivariate mixed linear model, the frequency of response to text messages significantly predicted A1C levels (p<.003), while the problem solving intervention did not. During the 12-month period, the teens who responded to the majority of the text message reminders—those with a response rate of 68 to 100 percent—demonstrated the best glycemic control, with A1C levels an average of 8.1 percent. Further, the A1C benefit resulting from teens responding to the majority of text reminders was similar for teens in both the TM and TM+PS groups.

Researchers plan to further evaluate durability of the text messaging intervention on glycemic control over the next 6 to 12 months.

"It is important to recognize the challenges faced by teens with type 1 diabetes as they navigate increasing independence in self-care," said lead study author Lori Laffel, MD, MPH, chief of the Pediatric, Adolescent and Young Adult Section and senior investigator/co-head of the Section on Clinical, Behavioral and Outcomes Research at Joslin Diabetes Center; and professor of pediatrics at Harvard Medical School. "Given the current landscape of cell phone use among teens, it is fitting to evaluate the potential impact of text message reminders aimed at assisting teens and young adults with their diabetes self-management as they transition from pediatric to adult diabetes care."

To speak with Dr. Laffel, please contact the Association's media relations team on-site at the San Diego Convention Center on June 9 - 13, by phone at 619-525-6250 or by email at [email protected].

The American Diabetes Association's 77th Scientific Sessions, to be held June 9-13, 2017, at the San Diego Convention Center, is the world's largest scientific meeting focused on diabetes research, prevention and care. During the five-day meeting, health care professionals have exclusive access to more than 2,500 original research presentations, participate in provocative and engaging exchanges with leading diabetes experts, and can earn Continuing Medical Education (CME) or Continuing Education (CE) credits for educational sessions. The program is grouped into eight interest areas: Acute and Chronic Complications; Behavioral Medicine, Clinical Nutrition, Education and Exercise; Clinical Diabetes/Therapeutics; Epidemiology/Genetics; Immunology/Transplantation; Insulin Action/Molecular Metabolism; Integrated Physiology/Obesity; and Islet Biology/Insulin Secretion. Brenda Montgomery, RN, MSHS, CDE,¹ President of Health Care and Education, will deliver her address on Saturday, June 10, and Alvin C. Powers, MD, President of Medicine and Science, will present his address on Sunday, June 11. Eight abstracts were selected by the Scientific Sessions Meeting Planning Committee to be presented on Tuesday, June 13, in the President's Oral Session. These abstracts represent important research being conducted in the field of diabetes today. In total, the 2017 Scientific Sessions includes 378 abstracts in 49 oral sessions; 2,152 poster presentations including 50 moderated poster discussions; and 360 published-only abstracts. Join the Scientific Sessions conversation on Twitter, #2017ADA.

About the American Diabetes Association
More than 29 million Americans have diabetes, and every 23 seconds another person is diagnosed with diabetes. The American Diabetes Association (Association) is the global authority on diabetes and since 1940 has been committed to its mission to prevent and cure diabetes and to improve the lives of all people affected by diabetes. To tackle this global public health crisis, the Association drives discovery in research to treat, manage and prevent all types of diabetes, as well as to search for cures; raises voice to the urgency of the diabetes epidemic; and provides support and advocacy for people living with diabetes, those at risk of developing diabetes and the health care professionals who serve them. For more information, please call the American Diabetes Association at 1-800-DIABETES (1-800-342-2383) or visit diabetes.org. Information from both of these sources is available in English and Spanish. Find us on Facebook (American Diabetes Association), Twitter (@AmDiabetesAssn) and Instagram (@AmDiabetesAssn).

194-LB Text-Message Intervention for Teens with Type 1 Diabetes (T1D) Preserves A1C: Results of an RCT

77th Scientific Sessions
News Briefing: Youth with Diabetes, Saturday, June 10, 4:00 p.m. PT

Presentation: Late-Breaking Poster Session
Location: Hall B
Session Time: Sunday, June 11, 12:00 - 1:00 pm

Authors: LORI M. LAFFEL, LISA K. VOLKENING, WENDY L. LEVY, DEBORAH A. BUTLER, BARBARA J. ANDERSON, Boston, MA, Houston, TX

Healthcare transition for young persons with T1D remains challenging; success in adult care (visit frequency and A1c) post-transfer is best predicted by self-management during adolescence. We aimed to support self-care during transition and assessed the impact on A1c of 2 interventions, text messaging (TM) and problem-solving (PS), in a 2x2 factorial design.

In a 12-month, 2-site RCT, 301 teens (50% male, 22% minority) were randomized to TM, PS, TM+PS, or neither. At baseline, teens were 15.0±1.3 y/o with T1D for 6.5±1.3 yr; mean A1c 8.5±1.1%, 63% pump-treated; groups did not differ by baseline characteristics. All participants were seen quarterly. TM group received 2-way texts with daily reminders to check and reply with BG levels at self-selected times, starting with 1 text/day and gradually increasing to a max of 4 texts/day. The PS group received 5 modules focused on self-care emphasizing increased BG monitoring and insulin bolus dosing as well as self-advocacy and transfer preparation. Over 1 year, A1c increased overall to 8.7±1.2% (p<.008). In a multivariate mixed model, frequency of response to TM significantly predicted A1c (p<.003, Figure), while PS did not. A1c benefit in the TM+PS was similar to that in the TM group.

With heightened mobile use by teens, 2-way TM appears to preserve and may improve glycemic control in teens in T1D. Continued texting through transition may offer a means to support self-care post-transfer.

Author Disclosures: L.M. Laffel: Consultant; Author; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Dexcom, Inc., Eli Lilly and Company, Johnson & Johnson Diabetes Institute, LLC, LifeScan, Inc., Menarini Diagnostics, Novo Nordisk Inc., Roche Diagnostics, Sanofi US, Oshadi, Animas Corporation. L.K. Volkening: None. W.L. Levy: None. D.A. Butler: None. B.J. Anderson: Advisory Panel; Author; Sanofi. Consultant; Author; Sanofi, The Leona M. and Harry B. Helmsley Charitable Trust. Research Support; Author; National Institutes of Health, Juvenile Diabetes Research Foundation, The Leona M. and Harry B. Helmsley Charitable Trust.

¹ Disclosures for Brenda Montgomery. Employer: AstraZeneca Pharmaceuticals. Montgomery's role as President, Health Care & Education of the American Diabetes Association (Association) is a voluntary position to which she was elected by the members of the Association in 2015. She continues to recuse herself from any and all discussions, decisions or votes that have or could be perceived as having a conflict of interest with her employer.

SOURCE American Diabetes Association