Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA.
Department of Psychology, San Diego State University, San Diego, CA
Diabetes Care. 2017 Oct;40(10):1349-1355. doi: 10.2337/dc17-0230. Epub 2017 Jun 9.
Type 2 diabetes is growing in epidemic proportions and disproportionately affects lower-income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the "digital divide" to improve care.
A randomized, nonblinded, parallel-groups clinical trial design allocated = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items.
The majority of patients were middle-aged (mean age 48.43 years, SD 9.80), female (75%), born in Mexico (91%), and uninsured (75%) and reported less than a ninth-grade education level (73%) and mean baseline HbA 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA over time compared with UC ( = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA ( < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high.
Use of a simple, low-cost text messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.
2 型糖尿病的发病率呈流行趋势，且不成比例地影响低收入和多元化社区。短信可能是克服“数字鸿沟”以改善护理的最快捷方法之一。
采用随机、非盲、平行组临床试验设计，将 126 名低收入、西班牙裔 2 型糖尿病控制不佳的患者分为 Dulce Digital 干预组或常规护理（UC）组。 Dulce Digital 组参与者在 6 个月内每天最多可收到三条激励性、教育性和/或行动号召短信。主要结局是 HbA；次要结局是血脂、血压和 BMI。通过焦点小组和自我报告的调查项目评估满意度和可接受性。
大多数患者年龄在中年（平均年龄 48.43 岁，标准差 9.80），女性（75%），出生于墨西哥（91%），未参保（75%），报告教育程度低于九年级（73%），平均基线 HbA 为 9.5%（80mmol/mol），标准差 1.3，空腹血浆葡萄糖为 187.17mg/dL，标准差 64.75。时间与组间的交互作用表明，与 UC 相比， Dulce Digital 组在时间上 HbA 显著降低（=0.03）。次要临床指标无统计学显著影响。参与者发送的血糖值数量是 6 个月 HbA 的统计学显著预测因素（<0.05）。对 Dulce Digital 干预的满意度和接受度评分很高。
在患有 2 型糖尿病的高危西班牙裔个体中，使用简单、低成本的短信程序被发现非常容易接受，与 UC 相比，血糖控制得到了更大的改善。
