Diabetes is a growing health problem. Estimates suggest that by 2040, more than half a billion people will have the condition. Among the developed nations, the United States has the highest prevalence rates at 11%. The rate is higher among the poor because they cannot access proper nutrition or healthy foods. Poverty also limits access to intervention. One of the groups profoundly affected by the condition is the Hispanic Americans who also show poor glycemic control after diagnosis with the condition. Glycemic control is an essential component of self-management, as diabetes is a long-term condition. However, the main drawback with self-management is the inability of some population to access diabetes self-management education (DSME) due to health barriers and impracticability given their living conditions.
Despite the challenges of accessing DSME, researchers have suggested the use of digital technology to deliver education. The adoption of mobile health (m-health) can help address barriers to traditional face-to-face visits. One of the ways of delivering education is via text messaging, which is widely adopted by mobile users not just in the United States but the world. Text messaging is a basic technology, but has the potential to deliver much-needed education to diabetes patients to train them on DSME, especially among the most vulnerable populations.
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In this study, the researchers used 12 participants in the Dulce Digital study. The sample included Spanish and English speaking men and women aged between 18 years to 75, who were either uninsured or underinsured. The group has diabetes and poor glycemic control. The group consisted of individuals who were relatively healthy and active and not very sick. The location of the recruitment was clinics within Neighborhood Healthcare, health centers funded by the federal government meant for low-income people in San Diego, and Riverside counties.
The study tested the intervention using parallel groups, non-blinded, and randomized design. During the baseline visit, the participants were educated via videos on how to manage their glucose levels and given the tools to achieve that objective. After randomization, 63 participants were included in the digital Dulce projects where the researchers keep sending them information message or DSME during the duration of the study. Some of the contents of text messages included reminders asking participants to take drugs or test their sugar levels. On average, the participants received three messages daily for six months. The researchers conducted assessments during the study period.
At the end of the study, almost all of the participants reported that the messages helped them manage their diabetes. Also, a majority indicated that they would continue to receive those messages. They would also recommend messages to friends and relatives with diabetes. The feelings of those in the group are consistent with the findings of the study, which showed that those receiving messages managed to control their glycemic control. At the beginning of the study, the participants had poor control, but those under DSME showed more exceptional ability to manage their condition. The messages they got via the program reminded them to take medication and gave them useful skills to manage their condition. They could test their glucose levels and therefore seek intervention quickly before things deteriorated to the point of possible admission to the hospital. The skills also played a crucial role in the group, considering that many did not have insurance or were underinsured. The skills allowed them to remain healthy and continue with their daily activities without being brought down by the condition. The ability to maintain their health played an essential role in helping them remain productive, with fewer sick days and lower rates of hospital admission.
The findings of the study have a massive implication for the management of diabetes. Diabetes is a chronic condition, and estimates suggest that in the future, it will continue to affect more people. At the same time, there is no guarantee that insurance will be more affordable to most people, especially in poorer countries. The implication is that low-cost management models will prove beneficial in addressing the health concern. This study finds that the low-cost solution, such as text messages is a simple and yet powerful way of disseminating DSME. Thus, for countries struggling to address the condition, including the United States, digital technology can help address the condition.
The technology is suitable, considering that almost everyone owns a phone and accessing a text message free. As long as the government funds the cost of sending those messages, health workers can continue to engage with diabetes patients using text messages. The messages are empowering without being too distractive. In the study, researchers were only sending three messages daily, which is manageable for most people. Only six people opted out of the message program, indicating that the users did not find the messages intrusive or violated their personal space. The study demonstrates a simple and yet useful tool for empowering patients to manage their condition without the inconvenient face to face visits. Sometimes, the most expensive solution is not the best or the most effective, given certain structural constraints such as poverty and inadequate resources.
References
Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., . . . Philis-Tsimikas, A. (2017). Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes. Diabetes Care, 40 (10), 1349-1355. doi:10.2337/dc17-0230
