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. 2017 Jul 25;2(2):e15.
doi: 10.2196/diabetes.7910.

Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation

Robert Mattson Peters #  1 , Matt Lui #  1 , Kunjan Patel  2 , Lewis Tian  2 , Kavon Javaherian  1 , Eric Sink  2 , Ran Xu  1 , Zhuchen Xu  1 , Wint Aung  2 , Li Zhou  3 , Justin Huynh  4 , Gregory Polites  1 , Melvin Blanchard  1 , Avik Som  1   5 , Will Ross  1 , Carlos Bernal-Mizrachi  6   7
Affiliations

Improving Glycemic Control With a Standardized Text-Message and Phone-Based Intervention: A Community Implementation

Robert Mattson Peters et al. JMIR Diabetes. .

Abstract

Background: Type II diabetes mellitus (T2DM) presents a major disease burden in the United States. Outpatient glycemic control among patients with T2DM remains difficult. Telemedicine shows great potential as an adjunct therapy to aid in glycemic control in real-world settings.

Objective: We aimed to explore the effectiveness of EpxDiabetes, a novel digital health intervention, in improving hemoglobin A1c (HbA1c) and fasting blood glucose (FBG) among patients with uncontrolled diabetes.

Methods: We recruited 396 patients from a community clinic in St. Louis, Missouri, from a database of patients diagnosed with T2DM and with a most recent HbA1c >7% as part of a quality improvement project. An automated call or text-messaging system was used to monitor patient-reported FBG. If determined to be elevated, care managers were notified by email, text, or electronic medical record alert. Participants self-reported their FBG data by replying to EpxDiabetes automated phone calls or text messages. Data were subsequently analyzed, triaged, and shared with providers to enable appropriate follow-up and care plan adjustments. Absolute HbA1c reduction, patient engagement, and absolute patient-reported FBG reduction were examined at approximately 6 months post implementation.

Results: EpxDiabetes had an average 95.6% patient response rate to messages at least once per month and an average 71.1% response rate to messages at least once per week. Subsequent HbA1c drop with EpxDiabetes use over 4 months was -1.15% (95% CI -1.58 to -0.71) for patients with HbA1c >8% at baseline compared to the change in HbA1c over 4 months prior to the implementation of EpxDiabetes of only -0.005 points (95% CI -0.28 to 0.27), P=.0018.

Conclusions: EpxDiabetes may help reduce HbA1c in patients with high HbA1c baselines (>8%). The intervention demonstrates high patient engagement sustainable for at least 6 months.

Keywords: SMS; diabetes management; diabetes mellitus; electronic health (eHealth); glycemic control; mobile health (mHealth); telehealth; telemedicine.

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Conflict of interest statement

Conflicts of Interest: AS has a financial conflict of interest with Epharmix, Inc. He is Chief Medical Officer and a founder of the company.

Figures

Figure 1
Figure 1
EpxDiabetes intervention flow diagram.
Figure 2
Figure 2
Change in HbA1c from pretrial baseline at 4 months from initiation (error bars represent SEM; *P<.05 for change from baseline).
Figure 3
Figure 3
Average fasting blood glucose change over time (error bars represent SEM).
See this image and copyright information in PMC

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