@Article{info:doi/10.2196/27263,
author="Middleton, Timothy
and Constantino, Maria
and McGill, Margaret
and D'Souza, Mario
and Twigg, Stephen M
and Wu, Ted
and Thiagalingam, Aravinda
and Chow, Clara
and Wong, Jencia",
title="An Enhanced SMS Text Message--Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial",
journal="J Med Internet Res",
year="2021",
month="Oct",
day="21",
volume="23",
number="10",
pages="e27263",
keywords="young-onset type 2 diabetes; SMS; clinic attendance; engagement; diabetes; digital health; mobile health; adolescents",
abstract="Background: Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective: We examined the effectiveness of an enhanced SMS text message--based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods: A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message--based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100{\%} attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results: A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50{\%} (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3{\%} (SD 1.9{\%}) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100{\%} attendance (12/21, 57{\%}, vs 5/19, 26{\%}, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale--Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95{\%} CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95{\%} CI 0.9-11). Program acceptability was high; >90{\%} of participants would recommend the program to new patients. Conclusions: An enhanced SMS text message--based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579 ",
issn="1438-8871",
doi="10.2196/27263",
url="https://www.jmir.org/2021/10/e27263",
url="https://doi.org/10.2196/27263",
url="http://www.ncbi.nlm.nih.gov/pubmed/34524102"
}