Text reminders – a low-cost strategy for type 2 diabetes?

By Dr Nacho Ricci Cabello. 

Type 2 diabetes is one of the most common conditions in the UK, and it is becoming more and more common. For many people it can be managed with healthy eating, exercise and the right medicines,  but for some adequate management is a challenge and this means they are at high risk of developing serious complications. These include stroke, blindness, kidney disease and amputations - which lead to disability and premature mortality.

There is a common misconception that diabetes is an important problem just in “rich” countries, where soft drinks and fast food restaurants are widespread. But that is not the case. Did you know that 80% of people with diabetes actually live in low- and middle- income countries? These countries have limited economic resources to fight against diabetes - a costly condition currently affecting more than 400 million people around the world. Finding low-cost strategies to tackle diabetes is now an urgent priority for global health.

Sending texts messages to patients to help them to manage their condition is a promising strategy. Text messages can be used to inform patients about the importance of a healthy lifestyle, remind them to do some tasks (such as taking their medication), or encourage and motivate them. They can be sent at minimal cost, at any time, place, or setting. They can be used to provide information through one-way systems (i.e. patients just receiving messages), but also to facilitate two-way communication between a patient and their health provider (i.e., interactive, with patients sending and receiving messages). Recent research has shown that messages can produce positive effects in other areas such as smoking cessation or medication adherence for antiretroviral therapy.

Text messages lead to a significant improvement in blood sugar levels. Positive effects were more consistently reported in studies conducted in low- and middle- income countries, compared to high-income countries.
- Dr Ignacio Ricci-Cabello, University of Oxford.

In collaboration with the University of Manchester and the University of Colombo (Sri Lanka), we recently carried out a study looking at the potential benefits of using text messages to promote healthier lifestyle behaviour in people with type 2 diabetes. The results of this study have recently been published in the Journal of Medical Internet Research. We systematically reviewed available literature, and identified 15 controlled trials evaluating the use of text messages to support lifestyle change behaviour in people with diabetes. We extracted relevant data from the trials, and pooled them together to estimate the overall effect of text messages.

Our main finding was that text messages lead to a significant improvement in blood sugar levels (difference in glycated haemoglobin of -0.53% between intervention groups compared to usual care). We also observed that

1. one-way and two-ways messages produced similar clinical effects, and;
2. positive effects were more consistently reported in studies conducted in low- and middle- income countries, compared to high-income countries.

Our study supports the growing interest about the use of text messages to drive health behaviour change. Text messages can be useful to promote healthier lifestyle, but also to support adequate use of medications: results from two recent studies by members of our team (a systematic review and a large trial in South Africa (StAR trial)) suggest that messages are also effective in supporting treatment adherence in patients with diabetes and with high blood pressure.

However this area of research is still in its infancy. More robust and larger trials are needed to confirm our findings, and researchers need to  better understandboth how and under which circumstances messaging interventions actually drive behaviour change and how these interventions can be optimised.

Although there is a long way ahead, text messages are emerging as a promising strategy to tackle diabetes at wide scale both in high and low- and middle-income countries - helping to reduce the burden of disease for hundreds of millions of people in the world.

Arambepola, C., Ricci-Cabello, I., Manikavasagam, P., Roberts, N., French, D., & Farmer, A. (2016). The Impact of Automated Brief Messages Promoting Lifestyle Changes Delivered Via Mobile Devices to People with Type 2 Diabetes: A Systematic Literature Review and Meta-Analysis of Controlled Trials Journal of Medical Internet Research, 18 (4) DOI: 10.2196/jmir.5425