Spotlight on self-management

One study found that personalized text messaging improved patients' self-management while another looked at the potential value of providing social comparisons to other patients' diabetes control.


Two recent studies looked at methods to improve patients' self-management of their diabetes.

The first study, published by The BMJ on May 17, included 366 patients in New Zealand with type 1 or 2 diabetes and an HbA1c level of 65 mmol/mol (8%) or higher. Half were randomized to usual care while the other half received a tailored package of text messages that provided information, support, motivation, and reminders related to diabetes self-management and lifestyle behaviors for up to nine months.

The patients receiving the texts had a greater reductions in HbA1c levels at nine months than control patients (mean change, −8.85 mmol/mol [0.81%] vs. 3.96 mmol/mol [0.36%]; adjusted mean difference −4.23; 95% CI, −7.30 to −1.15; P=0.007). They also showed significant improvements on four of 21 secondary outcomes: foot care, overall diabetes support, health status on the EQ-5D visual analogue scale, and perceptions of illness identity. Almost all patients (95%) said the intervention was useful, and 97% would recommend it to others.

The overall reduction in HbA1c level did not reach the prespecified cutoff for clinical significance, the study authors noted. However, the results at three and nine months did show significant differences, suggesting that the “the intervention shows promising effects on treating people with poorly controlled diabetes and warrants further investigation.”

An important aspect of the study was that the texting was tailored and personalized to the individual patients, the authors noted. A strength of the study was its high proportion of patients from ethnic minority groups. An accompanying blog post noted that the intervention was co-designed with patients and clinicians, including a Maori advisory group.

Another study, published by BMJ Open Diabetes Research & Care on May 21, assessed the potential of social comparisons of diabetes health status to improve patients' self-management. It was based on semistructured interviews with 25 patients with type 2 diabetes. Seventeen of the survey patients expressed a desire for social comparison information (i.e., self-evaluation in comparison with others) regarding their diabetes health status. Slightly fewer (n=14) said that goal-based comparisons were important to their understanding of their diabetes management.

The patients “commonly anticipated increased motivation and improved health behaviors in response to both social and goal-based comparisons,” although they also noted the importance of being compared to similar patients, the authors said. Social comparisons could be incorporated into patient web portals and could engage patients' competitiveness, appear more personalized than standard glycemic goals, and inspire patients to learn from similar individuals with better self-management, the study authors said.