Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial

Abstract Background Failure to take medicines for diabetes as prescribed contributes to poor outcomes from the condition. Mobile phones are ubiquitous and short message service (SMS) texts have shown promise as a low-cost intervention. We tested the effectiveness of SMS-text messaging in improving o...

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Main Authors: A. Farmer (Author), K. Bobrow (Author), N. Leon (Author), N. Williams (Author), E. Phiri (Author), H. Namadingo (Author), S. Cooper (Author), J. Prince (Author), A. Crampin (Author), D. Besada (Author), E. Daviaud (Author), L-M Yu (Author), J. N'goma (Author), D. Springer (Author), B. Pauly (Author), L. Tarassenko (Author), S. Norris (Author), M. Nyirenda (Author), N. Levitt (Author)
Format: Book
Published: BMC, 2021-10-01T00:00:00Z.
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042 |a dc 
100 1 0 |a A. Farmer  |e author 
700 1 0 |a K. Bobrow  |e author 
700 1 0 |a N. Leon  |e author 
700 1 0 |a N. Williams  |e author 
700 1 0 |a E. Phiri  |e author 
700 1 0 |a H. Namadingo  |e author 
700 1 0 |a S. Cooper  |e author 
700 1 0 |a J. Prince  |e author 
700 1 0 |a A. Crampin  |e author 
700 1 0 |a D. Besada  |e author 
700 1 0 |a E. Daviaud  |e author 
700 1 0 |a L-M Yu  |e author 
700 1 0 |a J. N'goma  |e author 
700 1 0 |a D. Springer  |e author 
700 1 0 |a B. Pauly  |e author 
700 1 0 |a L. Tarassenko  |e author 
700 1 0 |a S. Norris  |e author 
700 1 0 |a M. Nyirenda  |e author 
700 1 0 |a N. Levitt  |e author 
245 0 0 |a Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial 
260 |b BMC,   |c 2021-10-01T00:00:00Z. 
500 |a 10.1186/s12889-021-11874-7 
500 |a 1471-2458 
520 |a Abstract Background Failure to take medicines for diabetes as prescribed contributes to poor outcomes from the condition. Mobile phones are ubiquitous and short message service (SMS) texts have shown promise as a low-cost intervention. We tested the effectiveness of SMS-text messaging in improving outcomes in adults with type 2 diabetes. Methods StAR2D was a 12-month two-arm randomised trial of SMS-text messaging and usual care in Cape Town, South Africa and Lilongwe, Malawi. Messages used behaviour change theory and were developed with patients and staff. The intervention group received four messages each week. The primary outcome was change in HbA1c. Secondary outcomes were the proportion of patients who collected > 80% medication and changes in systolic blood pressure, lipids, cardiovascular risk, and the proportion of the participants reaching treatment goals. Results The trial took place between 1 October, 2016 and 1 October 2018, 1186 participants were randomised to intervention (593) and control (593) groups. 91% of participants completed follow-up. There was a reduction in HbA1c (DCCT) in both groups but not in mean change (95% CI) between groups (− 0.08% (− 0.31 to 0.16) (IFCC − 0.82 mmol/mol (− 3.44 to 1.79). There was a small but not significant increase in the proportions of participants likely to have collected 80% or more of medication (Relative risk 1.11 (0.84 to 1.47; P = 0.47). There was a significant difference between groups in change in systolic blood pressure from baseline of 3.46 mmHg (1.48 to 5.44, P = 0.001) in favour of the intervention group. The between group difference in change in 10-year risk of coronary heart disease was − 0.71% (− 1.46 to 0.04, P = 0.064). The proportion of participants meeting treatment goals in the intervention group was 36.0% and in the control group 26.8% (Relative risk 1.36 (1.13 to 1.63, P = 0.001). Participants reported many challenges to adherence despite finding messages acceptable and useful. Conclusions Whilst SMS text messages do not lead to improved glycaemia in these low-resource settings there appeared to be an impact on blood pressure and achievement of treatment goals but the mechanisms for this are unclear. Text messages alone, may be unsuccessful unless accompanied by health system strengthening and other forms of self-management support for type 2 diabetes. Trial registration Trial registration: ISRCTN, ISRCTN70768808. Registered 1 July 2015, http://www.isrctn.com/I ISRCTN70768808. 
546 |a EN 
690 |a Digital health 
690 |a Adherence 
690 |a Type 2 diabetes 
690 |a Randomised trial 
690 |a Sub-Saharan Africa 
690 |a SMS text-messages 
690 |a Public aspects of medicine 
690 |a RA1-1270 
655 7 |a article  |2 local 
786 0 |n BMC Public Health, Vol 21, Iss 1, Pp 1-14 (2021) 
787 0 |n https://doi.org/10.1186/s12889-021-11874-7 
787 0 |n https://doaj.org/toc/1471-2458 
856 4 1 |u https://doaj.org/article/a1eafd98d2f94b3a84e7813f70c24b72  |z Connect to this object online.