Could a Text Messaging System Be the Answer to Adherence Issues?

Diabetes is a serious condition that is characterized by high blood sugar, excessive urination, increased appetite, and extreme thirst. Diabetes is often accompanied by a wide variety of comorbidities such as high blood pressure, abnormal cholesterol, and others.

As pharmacists, it is our job to not only ensure that our patients with diabetes are receiving the therapies they need but to also make sure that the patients are properly adhering to them. So how exactly do we do this? Typically we tell our patients to keep handwritten logs of their blood glucose levels and to set alarms in order to remember to take the medications at the same time each day. Although these methods work for some of the population there is still a large chunk of the population that struggles with adherence. According to the American Diabetes Association a 2-way text messaging system maybe the answer, as this method has shown to either maintain or lower glycemic control.

A study was conducted by researchers a the Joslin Diabetes Center, who randomly assigned a total of 301 teenagers to 1 of 4 groups. The first group included a text messaging system that reminded patients to check their blood glucose levels. This group received daily reminders and required them to text back their blood glucose levels at several times during the day, receiving a maximum of 4 texts a day. The second group’s tactic was problem solving, which basically educated the patient by providing each participant with 5 modules that focused on the importance of blood glucose monitoring and insulin bolus dosing methods. The third group was a combination of the first 2 groups, meaning each participant received both text messages and the modules while the fourth group didn’t receive any intervention as well.

The study concluded that text message reminders not only preserved the glycemic control but also improved it, lowering the A1C from 8.5% to 8.1%. During the year-long study, the participants with high response rates to the text message reminders demonstrated the best glycemic control compared to the groups that did not receive text messaging. With all of this in mind, could this be a solution to adherence issues and how could we as pharmacists implement this into future practice?

We all are aware of the big role technology plays within this generation as it has become an essential in daily life. People of all ages are now consumed within their smartphones and computers. So what if this system was to be implemented as a service that the pharmacy could now offer?

As pharmacists, we could collect the patient’s cell phone number and have them text back their blood glucose levels so that we could not only keep them on track with their regimens but also be able to share this information with the patient's other health care providers so that their condition is being controlled properly. Maybe health care providers have been approaching the problems with adherence all wrong.

What is your opinion on the idea of 2-way text messaging systems, as this may be something that pharmacies can start incorporating into the wide variety of services that are offered?

References

American Diabetes Association (ADA) Position Statement. Standards of Medical Care in Diabetes — 2016. Diabetes Care. 2016;39 (suppl 1):S1-S112.

Laffel L, et al. Text Message Intervention for Teens with Type 1 Diabetes (T1D) Preserves A1C: Results of an RCT. Presented at: The American Diabetes Association’s 77th Scientific Sessions, June 9-13, 2017. San Diego.