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

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dc.contributor.authorFarmer, A
dc.contributor.authorBobrow, K
dc.contributor.authorLeon, N
dc.contributor.authorWilliams, N
dc.contributor.authorPhiri, E
dc.contributor.authorNamadingo, H
dc.contributor.authorCooper, S
dc.contributor.authorPrince, J
dc.contributor.authorCrampin, A
dc.contributor.authorBesada, D
dc.contributor.authorDaviaud, E
dc.contributor.authorYu, L-M
dc.contributor.authorN’goma, J
dc.contributor.authorSpringer, D
dc.contributor.authorPauly, B
dc.contributor.authorTarassenko, L
dc.contributor.authorNorris, S
dc.contributor.authorNyirenda, M
dc.contributor.authorLevitt, N
dc.date.accessioned2021-10-25T08:55:51Z
dc.date.available2021-10-25T08:55:51Z
dc.date.issued2021-10-21
dc.date.updated2021-10-24T03:11:33Z
dc.description.abstractBackground 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.en_US
dc.identifier.apacitationFarmer, A., Bobrow, K., Leon, N., Williams, N., Phiri, E., Namadingo, H., ... Levitt, N. (2021). Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial. <i>BMC Public Health</i>, 21(1), 1907. http://hdl.handle.net/11427/35282en_ZA
dc.identifier.chicagocitationFarmer, A, K Bobrow, N Leon, N Williams, E Phiri, H Namadingo, S Cooper, et al "Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial." <i>BMC Public Health</i> 21, 1. (2021): 1907. http://hdl.handle.net/11427/35282en_ZA
dc.identifier.citationFarmer, A., Bobrow, K., Leon, N., Williams, N., Phiri, E., Namadingo, H., Cooper, S. & Prince, J. et al. 2021. Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial. <i>BMC Public Health.</i> 21(1):1907. http://hdl.handle.net/11427/35282en_ZA
dc.identifier.ris TY - Journal Article AU - Farmer, A AU - Bobrow, K AU - Leon, N AU - Williams, N AU - Phiri, E AU - Namadingo, H AU - Cooper, S AU - Prince, J AU - Crampin, A AU - Besada, D AU - Daviaud, E AU - Yu, L-M AU - N’goma, J AU - Springer, D AU - Pauly, B AU - Tarassenko, L AU - Norris, S AU - Nyirenda, M AU - Levitt, N AB - 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. DA - 2021-10-21 DB - OpenUCT DP - University of Cape Town IS - 1 J1 - BMC Public Health KW - Digital health KW - Adherence KW - Type 2 diabetes KW - Randomised trial KW - Sub-Saharan Africa KW - SMS text-messages LK - https://open.uct.ac.za PY - 2021 T1 - Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial TI - Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial UR - http://hdl.handle.net/11427/35282 ER - en_ZA
dc.identifier.urihttps://doi.org/10.1186/s12889-021-11874-7
dc.identifier.urihttp://hdl.handle.net/11427/35282
dc.identifier.vancouvercitationFarmer A, Bobrow K, Leon N, Williams N, Phiri E, Namadingo H, et al. Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial. BMC Public Health. 2021;21(1):1907. http://hdl.handle.net/11427/35282.en_ZA
dc.language.isoenen_US
dc.language.rfc3066en
dc.publisher.departmentDepartment of Medicineen_US
dc.publisher.facultyFaculty of Health Sciencesen_US
dc.rights.holderThe Author(s)
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/en_US
dc.sourceBMC Public Healthen_US
dc.source.journalissue1en_US
dc.source.journalvolume21en_US
dc.source.pagination1907en_US
dc.source.urihttps://bmcpublichealth.biomedcentral.com/
dc.subjectDigital healthen_US
dc.subjectAdherenceen_US
dc.subjectType 2 diabetesen_US
dc.subjectRandomised trialen_US
dc.subjectSub-Saharan Africaen_US
dc.subjectSMS text-messagesen_US
dc.titleDigital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trialen_US
dc.typeJournal Articleen_US
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