Computerized Automated Reminder Diabetes System (CARDS): e-mail and SMS cell phone text messaging reminders to support diabetes management

Abstract

Background: Cell phone text messaging, via the Short Messaging Service (SMS), offers the promise of a highly portable, well-accepted, and inexpensive modality for engaging youth and young adults in the management of their diabetes. This pilot and feasibility study compared two-way SMS cell phone messaging with e-mail reminders that were directed at encouraging blood glucose (BG) monitoring.

Methods: Forty insulin-treated adolescents and young adults with diabetes were randomized to receive electronic reminders to check their BG levels via cell phone text messaging or e-mail reminders for a 3-month pilot study. Electronic messages were automatically generated, and participant replies with BG results were processed by the locally developed Computerized Automated Reminder Diabetes System (CARDS). Participants set their schedule for reminders on the secure CARDS website where they could also enter and review BG data.

Results: Of the 40 participants, 22 were randomized to receive cell phone text message reminders and 18 to receive e-mail reminders; 18 in the cell phone group and 11 in the e-mail group used the system. Compared to the e-mail group, users in the cell phone group received more reminders (180.4 vs. 106.6 per user) and responded with BG results significantly more often (30.0 vs. 6.9 per user, P = 0.04). During the first month cell phone users submitted twice as many BGs as e-mail users (27.2 vs. 13.8 per user); by month 3, usage waned.

Conclusions: Cell phone text messaging to promote BG monitoring is a viable and acceptable option in adolescents and young adults with diabetes. However, maintaining interest levels for prolonged intervals remains a challenge.

FIG. 1.

(A) A screenshot of the CARDS website showing a customized reminder schedule. This example shows four daily reminder times (9:00 a.m., 1:45 p.m., 3:30 p.m., and 9:00 p.m.) out of the maximum of 10 possible reminder times. The reminders at 9:00 a.m. and 9:00 p.m. occur daily, whereas those for 1:45 p.m. and 3:30 p.m. occur on alternating days Monday–Friday. A user may alter at anytime the reminder times and schedule. (B) A screenshot of the CARDS diary displaying BG data received by either e-mail or cell phone response as well as by retrospective data entry on the website by the user. H, Humalog insulin.

FIG. 2.

The average number of BG results per user by study month submitted to CARDS declined with time. In month 1, there were twice as many BG measurements submitted in the cell phone group compared with the e-mail group. By month 3, the number of BG measurements submitted declined markedly, and values were similar between groups.