Diabetes: Post-ER Follow-Up That Works

A study published online today in Annals of Emergency Medicine says that diabetic patients treated in the emergency department who were enrolled in a program in which they received automated daily text messages improved their level of control over their diabetes and their medication adherence. "Our results were especially pronounced for Latinos, who are twice as likely as non-Latinos to develop diabetes," said lead study author Sanjay Arora, MD, of the Keck School of Medicine at the University of Southern California in Los Angeles. "These patients, when followed up by text messages for 6 months, improved enough to reduce their dependence on the emergency department for care of their diabetes. Text messaging is effective, low-cost and widely available for our patients who often have no other source of medical care."

Adult patients with poorly controlled diabetes who visited an urban, public emergency department for care received two daily text messages for 6 months. For patients who received the text messages, blood glucose levels decreased by 1.05 percent and self-reported medication adherence improved from 4.5 to 5.4 (on an eight-point scale). Effects were even larger among Spanish speakers for both medication adherence and blood glucose levels. The proportion of patients who visited the emergency department was lower in the text messaging group (35.9 percent) than in the control group (51.6 percent). Almost all (93.6 percent) patients enrolled in the program reported enjoying it and 100 percent reported that they would recommend it to family and friends.

The text messaging program, called TExT-MED, included daily motivational messages such as "Having diabetes can lead to a heart attack or stroke – but it doesn't have to" and "Eat more fruits, vegetables, beans and whole grains and less salt and fat." In addition, it provided three medication reminders per week, two healthy living challenges per week and two trivia questions per week, designed to build diabetes awareness (sample: "Trivia" Eating too much sugar and other sweet foods is a cause of diabetes. A. True. B. False.).

"Diabetes is emerging as a public health epidemic, particularly in low-income, underserved inner city and minority populations who depend on safety-net systems for medical care," said Dr Arora. "Our goal is to transition our patients from crisis management to long-term diabetes management. In the absence of other health care options, reaching our patients by text message makes us partners in handling their disease and improves their quality of life."



Source-Eurekalert