A July 2015 study explored the use of text messaging to help people with diabetes adjust their insulin doses for optimal blood sugar control. The study’s striking results illustrate some of the potential benefits of increasing the use of mobile technology in health care.
Natalie Levy, head of the diabetes program at Bellevue Hospital in New York, often works with low-income diabetic patients who are insulin-dependent. Good blood sugar control for these patients requires careful monitoring of daily blood sugar levels and insulin doses. Traditional practice for adjusting insulin doses requires frequent clinic visits, which can be difficult for people with limited transportation options or jobs that don’t offer sick leave. Copays can also be cost-prohibitive for low-income patients. Levy found that while most of her patients did not have smartphones, almost all of them had cellphones capable of text messaging.
In the 12-week study, 33 patients received daily text messages asking them to send in blood sugar readings. Nurses provided daily monitoring of the readings and held weekly phone consultations with each patient, adjusting the insulin dose as needed based on the readings provided by the patient. A control group of 27 patients did not receive the text messages and continued to visit the clinic in person for insulin dosage adjustments.
Only 37 percent of the patients who adjusted their insulin doses during in-person clinic visits were able to maintain satisfactory blood sugar readings, compared with 88 percent in the group that received daily text messages. The text-message group also spent two hours less time having their doses adjusted and spent $15 less on clinic copays. Patients in the text-message group also expressed greater satisfaction with their treatment. These patients also had a high response rate to the text message requests, submitting their morning blood sugar readings in response to nearly 85 percent of the requests.
Patient-care researcher Dominick Frosch tells NPR that giving patients greater control over management of their conditions, with medical professionals in a consulting role, can make it easier for patients to implement effective treatment plans. Comments from patients in the Bellevue Hospital study suggest that giving patients a more active role in their treatment fosters an increased sense of empowerment and engagement. One patient in the study stated, “It got my head in the game,” while another said, “I was actually checking my finger sticks every day.”
A 2014 pilot program at University of Chicago Medicine also experimented with the use of text messaging to improve diabetes management. This program sent daily automated messages with general information about diabetes care and reminders to take blood sugar readings and refill medications. Nurses monitored text replies from the participants and initiated any necessary follow-up care.
This results of this six-month pilot program were also positive. Hemoglobin A1c readings, which reflect average blood sugar over a two to three month period, improved by 0.7 percent overall, with a reduction of 1.8 percent in the participants who had the worst readings at the beginning of the program. Although the program resulted in an increased drug cost of $520 per patient, other health care costs for each patient decreased by more than $1,300, resulting in a net savings of over $800. Patient satisfaction levels were also high for this program, with 73 percent reporting that they were satisfied.
Both University of Chicago Medicine and Bellevue Hospital hope to expand use of these text messaging programs to improve patient care.
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Both of these studies illustrate how modern technology can play a part in improving management of chronic conditions such as diabetes. Check out this video to learn about another new technology that uses silica glass for blood glucose testing with no needles and no pain.Whizzco