Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Jan 19, 2021
Date Accepted: Jul 21, 2021
Date Submitted to PubMed: Sep 15, 2021
An Enhanced SMS-based Support and Reminder Program for Young Adults with Type 2 Diabetes (TEXT2U): Randomized Controlled Trial
ABSTRACT
Background:
Clinic attendance, metabolic control, engagement in self-management and psychological health are suboptimal in young-onset (<40 years) type 2 diabetes.
Objective:
We examined the effectiveness of an enhanced SMS-based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management and psychological health in young-onset type 2 diabetes.
Methods:
A twelve-month, parallel-arm, randomized controlled trial comparing an enhanced, semi-personalized SMS-based intervention (incorporating one to eight, supportive and/or informative text messages/month) against standard care was conducted in a specialist, young adult type 2 diabetes clinic. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included: (i) metabolic indices, (ii) pathology and self-monitored blood glucose (SMBG) data availability and, (iii) psychosocial well-being.
Results:
Forty participants were randomized and 32 completed their 12-month study visit. Average participant age was 32.7±5.1 years, 50% were male, and baseline HbA1c was 7.3±1.9% (56±20 mmol/mol). A higher proportion of the intervention group achieved 100% attendance (57% vs 26% control); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids or availability of pathology and SMBG data. Odds of recording an improvement in Diabetes Empowerment Scale-Short Form score were higher in the intervention group at six months [OR 4.3 (1.1-17)] with attenuation of effect at study end [OR 3.1 (0.9-11)]. Program acceptability was high; >90% of participants would recommend the program to new patients.
Conclusions:
An enhanced SMS-based support and reminder program doubled scheduled attendance rates for young-onset type 2 diabetes. The program was highly acceptable, provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Clinical Trial: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202).
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