(CCSP102) DOES TEXTING IMPROVE GLYCEMIC CONTROL IN DIABETES? A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALS

Background: Despite the importance of glycemic control in reducing long-term adverse cardiovascular events, the majority of patients with diabetes are unable to achieve optimal control. Texting is a cost-effective and widely accessible option to augment preventative care for these patients. However, it remains unclear whether texting can lead to clinically significant outcomes. Our objective was to perform a meta-analysis summarizing available data on the impact of texting versus non-texting usual care on glycemic control in patients with diabetes.

METHODS AND RESULTS: This systematic review and meta-analysis followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. EMBASE, PubMed, and Cochrane were systematically searched for randomized controlled trials (RCTs) evaluating the impact of texting in adults 18 years or older with Type I or Type II diabetes in Western high-income countries. The primary outcome was mean change in HbA1c between baseline and follow-up assessments. Two reviewers performed a risk of bias assessment for each eligible trial using Version 2 of the Cochrane risk-of-bias tool for randomized trials (RoB 2). Results were pooled using a random effects model in RevMan 5.4. Heterogeneity was evaluated using χ2 and I2 statistics. Among 8 eligible trials (2232 patients) that reported HbA1c at 3 months, texting was associated with a significant reduction in HbA1c compared to control groups (-0.21%, 95% CI: -0.40 to –0.02, p=0.008, I2=64%). At 6 months (8 trials, 2553 patients), texting was also associated with a significant reduction in HbA1c compared to control groups, (–0.13%, 95% CI: -0.21 to –0.04, p=0.004, I2=0%). Texting had a non-significant reduction in HbA1c at 12 months when compared to control groups.

Conclusion: Text-messaging interventions lead to a significant reduction in HbA1c compared to usual care in diabetic patients at 3 and 6 months, with an insignificant reduction at 12 months. Given the simplicity and low cost of texting, implementing texting as an adjunct to standard care for diabetic patients should be considered.