A new study published in the Journal of Medical Internet Research has highlighted improvements in diabetes management by text messaging.
Insulin dependent patients must monitor their blood sugar levels regularly; however getting the correct dose of insulin can be a problem initially. Patients are usually started on a relatively low dose of insulin, with the dose then adjusted as necessary.
Currently patients receive home-visits from nurses, and titrate their insulin during the visit. However, this is time consuming for both the patient and their visiting healthcare provider.
The study in diabetes management by text messaging – conducted by New York’s Bellevue Hospital – aimed to reduce the burden on both the hospital and patients and improve the care provided to an urban, low-income population. The study tested whether it was possible to use SMS messages to help patients reach their optimal insulin glargine dose within 12 weeks.
The randomized control trial was conducted on 61 consenting patients. A control group of 27 patients received the typical level of care provided to patients. They received visits from a clinician, and during those face to face visits, insulin dosage was adjusted.
33 patients received daily SMS text messages requesting their blood glucose readings, which were then assessed by a nurse at the hospital. After consulting the MITI titration algorithm, the nurse called the patient and told them to adjust their insulin titration if necessary.
The results of the trial show a statistically significant proportion of patients – 88% – reached their optimal insulin glargine dose within 12 weeks, compared to 27% of individuals in the control group. The response rate to the text messages was over 84%, indicating the method was easy to follow, and the nurse was able to contact 91% of the patients within 2 attempts.
By using text messages, patients reported a higher level of satisfaction than those in the control group. They also managed to save an average of 39 minutes in travel time and 45 minutes at the clinic. 61% of patients had appointment co-pays. Patients saved time and money, care could be provided much more efficiently and the majority of patients were highly satisfied with the care they received.
In this case, patients consented to receive the text messages and take part in the study; however under HIPAA Rules, the transmission of Protected Health Information via text message is not permitted. Text messages are insecure and can be intercepted. The content of those messages could therefore potentially be read by unauthorized individuals.
In order for diabetes management by text messaging to be extended to other hospital patients, and for other healthcare providers to adopt similar programs, information must be sent to patients via a secure text message platform. Health and Hospitals Corp, which runs the Bellevue Hospital, is now looking for a partner to provide diabetes management by text messaging in compliance with HIPAA. The program can then be extended to other Bellevue patients, and patients receiving treatment at other NYC hospitals run by HHC.