Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes
Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes
复制标题
DOI：
10.2337/dc17-0230
复制
发表时间：
2017-10-01
期刊：
影响因子：
16.2
通讯作者：
Philis-Tsimikas, Athena
中科院分区：
文献类型：
--
作者：
Fortmann, Addie L.;Gallo, Linda C.;Philis-Tsimikas, Athena
目标 2 型糖尿病的流行率正在上升，并且对低收入、多元化社区产生了不成比例的影响。短信可能是克服“数字鸿沟”以改善护理的最快速方法之一。 研究设计和方法 随机、非盲、平行组临床试验设计分配了 N = 126 名患有 2 型糖尿病控制不佳的低收入西班牙裔参与者，接受 Dulce 数字干预或常规护理 (UC)。 Dulce Digital 参与者在 6 个月内每天收到最多 3 条激励性、教育性和/或号召性用语短信。主要结局是 HbA(1c)；血脂、血压和体重指数是次要结果。通过焦点小组和自我报告调查项目评估满意度和可接受性。 结果大多数患者为中年（平均年龄 48.43 岁，SD 9.80）、女性（75%）、出生于墨西哥（91%）、无保险（75%），报告教育水平低于九年级（73%），平均基线 HbA1c 9.5%（80 mmol/mol），SD 1.3，空腹血糖187.17mg/dL，SD 64.75。统计上显着的逐组交互效应表明，与 UC 相比，Dulce Digital 组随着时间的推移实现了 HbA1c 显着更大的降低（P = 0.03）。次要临床指标没有观察到统计学上显着的影响。参与者发送的血糖值数量是第 6 个月 HbA(1c) 的统计显着预测因子 (P < 0.05)。 Dulce Digital 干预的满意度和可接受性评级很高。 结论 在这个患有 2 型糖尿病的高风险西班牙裔个体样本中，使用简单、低成本的短信程序是高度可接受的，与 UC 相比，血糖控制得到了更大的改善。
OBJECTIVEType 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.RESEARCH DESIGN AND METHODSA randomized, nonblinded, parallel-groups clinical trial design allocated N = 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(1c); lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items.RESULTSThe 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 HbA1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasmaglucose 187.17mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA1c over time compared with UC (P = 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(1c) (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high.CONCLUSIONSUse 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.