Text messages reduce emergency room visits for low income patients with diabetes

By Jonah Comstock
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HbA1c graphA study of a text messaging intervention for low-income patients with Type 2 diabetes showed a statistically significant affect on medication adherence and emergency room visits, but not HbA1c hemoglobin levels. It also showed that the texting intervention was more effective for Spanish speakers than English speakers.

The study of 128 patients, published in the Annals of Emergency Medicine, was designed to assess the impact of a mobile health intervention for a chronic condition on a population whose primary source of medical care is the emergency room, patients that represent a significant drain on costs to the healthcare system.

This study was conducted in the emergency department at Los Angeles County Hospital of the University of Southern California, which study authors describe as "the largest safety-net hospital of the public care system in Los Angeles County, serving more than 170,000 resource-poor patients annually". The patient population is 70 percent Latino and 14 percent black.

Patients with Type 2 diabetes were recruited from the emergency department for the study. A control group received normal care for Type 2 diabetes patients, while the experiment group received noninteractive text messages from a program called TExT-MED, or "Trial to Examine Text Message Based mHealth in ED Patients With Diabetes." They received two messages a day for six months, and the messages were a combination of educational or motivational messages, medication reminders, healthy living challenges, and diabetes trivia. They could choose to receive messages in English or Spanish.

UPDATE: Agile Health now owns the commercial rights to TExt-MED, which it used as the basis for its myAgileLife diabetes text message program.

Researchers found a 1 percent reduction in HbA1c levels in the text message group and a 0.6 percent reduction for the control group -- a difference well within the margin of error for the study. Self-reported medication adherence did improve significantly in the intervention group, however, and actually got worse in the control group. Only 36 percent of TExT-MED users returned to the emergency room during the six month follow up, as opposed to 52 percent of the control group. An equal number from both groups used primary care during that time.

Differences in both medication adherence and HbA1c were more pronounced when the Spanish speaking group was analyzed separately, though the HbA1c change was still not significant. Enthusiasm for the program was high, with 94 percent reporting they enjoyed the messages and 100 percent saying they would recommend them to a friend.

A number of studies have looked at the effect of text message interventions on diabetes. The Cochrane Library even conducted a meta-analysis, concluding that most mobile interventions produced a modest effect on HbA1c levels, although mobile interventions were slightly more effective than non-mobile computerized ones. Studies in the Cochrane review did not look specifically at the effect of text messaging on low-income populations, however.

Although researchers in this study didn't get the desired results in HbA1c, secondary outcome measures were promising enough that researchers are working on a follow-up. Study author Sanjay Arora told MobiHealthNews in an email that Agile Health has partnered with his team for future studies, which will continue to use Agile's interactive text messaging platform.