Do people with type 2 diabetes enrol and engage with a mobile phone-based text message intervention to improve effective use of their medication?

Problem

Type 2 diabetes affects over 400 million people worldwide and when poorly managed diabetes can lead to major complications. The impact of non-adherence to diabetes medication in the UK is estimated at £100 million per year in avoidable treatment costs. People are often concerned about starting new medicines and face difficulties in taking them regularly. Use of brief messages to provide education and support self-management, delivered through mobile phone-based text messages, can be an effective tool for some long-term conditions. We have developed messages aiming to support patients’ self-management of type 2 diabetes in the use of medications and other aspects of self-management, underpinned by theory and evidence. The primary aim of this feasibility study was to assess recruitment rates.

Approach

A multicentre individually randomised, six-month, controlled trial in primary care recruiting 209 adults (≥35 years) with type 2 diabetes in England. Participants were randomised to receive short text messages three times a week with messages designed to produce change in medication adherence (n=103) or usual care (n=106).Outcomes: The primary outcomes were participant recruitment, retention and follow-up rates at 26 weeks Additional outcomes were proportion of medical history data, medication/prescribing data and clinical outcomes data (e.g. HbA1c, blood pressure and cholesterol) obtained from patients’ medical records. We collected data on health status, healthcare utilisation, medication adherence, and hypothesised mediating variables with a self-report questionnaire. We also collected information on message delivery and interactions with the system.

Findings

In total 209 participants were randomised from 16 general practices. Recruitment rate was 57.4% from 364 expressions of interest. Participants ranged in age from 36 to 96 with a mean age of 63.4 years (SD 10.2). 41.1% were female and 12.9% were from a non-white British ethnic group (27 participants).94.2% (197/209) remained in the trial for the full 6 months with follow-up rates for self-reported questionnaires of 80.4% – 84.7% (health status 81.3%, health care utilisation 80.4% and hypothesised mediating variables 84.7%).On average participants in the treatment group received 79.56 messages during the 6 months (approx. 8200 messages sent), and 89 participants interacted by replying to the system in total with 55 participants interacting with Like/Dislike commands.

Consequences

Recruitment and retention of patients with type 2 diabetes to an SMS text message intervention was feasible. Completion rates of follow-up questionnaires by participants at 6-months was good. A 1000-participant effectiveness and cost effectiveness study is in progress.