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Text to Move: a randomized controlled trial of a text-messaging program to improve physical activity behaviors in patients with type 2 diabetes mellitus
Agboola S, Jethwani K, Lopez L, Searl M, O'Keefe S, Kvedar J
Journal of Medical Internet Research 2016 Nov;18(11):e307
clinical trial
6/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Text messages are increasingly being used because of the low cost and the ubiquitous nature of mobile phones to engage patients in self-care behaviors. Self-care is particularly important in achieving treatment outcomes in type 2 diabetes mellitus (T2DM). OBJECTIVE: This study examined the effect of personalized text messages on physical activity, as measured by a pedometer, and clinical outcomes in a diverse population of patients with T2DM. METHODS: Text to Move (TTM) incorporates physical activity monitoring and coaching to provide automated and personalized text messages to help patients with T2DM achieve their physical activity goals. A total of 126 English- or Spanish-speaking patients with glycated hemoglobin A1c (HbA1c) > 7 were enrolled in-person to participate in the study for 6 months and were randomized into either the intervention arm that received the full complement of the intervention or a control arm that received only pedometers. The primary outcome was change in physical activity. We also assessed the effect of the intervention on HbA1c, weight, and participant engagement. RESULTS: All participants (intervention n = 64; control n = 62) were included in the analyses. The intervention group had significantly higher monthly step counts in the third (risk ratio (RR) 4.89, 95% CI 1.20 to 19.92, p = 0.03) and fourth (RR 6.88, 95% CI 1.21 to 39.00, p = 0.03) months of the study compared to the control group. However, over the 6-month follow-up period, monthly step counts did not differ statistically by group (intervention group 9,092 steps; control group 3,722 steps; RR 2.44, 95% CI 0.68 to 8.74, p = 0.17). HbA1c decreased by 0.07% (95% CI -0.47 to 0.34, p = 0.75) in the TTM group compared to the control group. Within groups, HbA1c decreased significantly from baseline in the TTM group by -0.43% (95% CI -0.75 to -0.12, p = 0.01), but nonsignificantly in the control group by -0.21% (95% CI -0.49 to 0.06, p = 0.13). Similar changes were observed for other secondary outcomes. CONCLUSION: Personalized text messaging can be used to improve outcomes in patients with T2DM by employing optimal patient engagement measures.

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