Being a teen with T1D can be challenging. Like their non-T1D peers, they are transitioning to becoming fully-independent adults. Unlike their peers, they must also learn to manage their diabetes on their own. As any T1D adult or parent of a child with T1D knows, managing diabetes takes a lot of work. Teens may think they are ready, but may be unprepared for the reality of 24/7 self-care. Studies have shown that adolescent patients have greater difficulty adhering to treatment and medication activities than adults. So how can we help T1D teens make a successful transition to self-care? At the 77th ADA Scientific Sessions, researchers from Joslin Diabetes Center, led by Lori Laffel, MD, MPH, released findings from a study that suggests text messaging may be the key.
How can text messaging help?
Parents, have you managed to keep from giving your teen a mobile phone? If so, you’re part of an increasingly exclusive club. Mobile phones have become a fact of life for teens. Over three quarters of teens (77%) have cell phones. In addition, about one in four teens have smartphones: some 23% of kids aged 12-17 say they have a smartphone.
What’s more, texting has become teens’ preferred way to communicate. Overall, 75% of all teens text. They’re also texting more frequently. According to a 2010 report from the Pew Internet and American Life Project, half of teens send 50 or more text messages a day. By 2012, that number had risen to 60 texts per day. Many parents have given up on trying to call or email their kids because texting seems to be the easiest way to get in touch with them! If text messaging is the primary mode of communication for teens, it stands to reason that teens with T1D might be more likely to pay attention and respond to text reminders about their diabetes care.
About the study
The study gathered 301 teenagers with an average age of 15 years. At the beginning of the study, the teens had been living with T1D for an average of 6.4 years, and had an overall A1C of 8.5 percent. Sixty-three percent were using insulin pumps.
Participants were randomly separated into four groups. Group one received text message reminders (at self-selected times) to check their blood glucose and reply with their blood glucose levels. Group two (the problem-solving group) received five self-care modules that addressed strategies to improve T1D self case. The third group received both text messages and problem solving modules. The fourth group received no interventions. Participants were monitored over a 12-month period, with study visits occurring every 3 months.
The study results strongly suggest that 2-way text messaging can help teens with T1D maintain and even improve their blood glucose levels.
Teens with a low response rate (less than 33 percent) and teens who did not receive text messages had significant A1C increases over the 12-month period. However, teens who received text messages and responded to 33 percent or more of the messages did not have a significant increase in A1C over the 12-month period. Furthermore, teens in the text messaging group who responded to the majority of the text message reminders (with a response rate of 68-100 percent) demonstrated the best glycemic control, with an average A1C level of 8.1 percent.
Researchers are planning further T1D text messaging studies over the next 6 to 12 months. Given the wide acceptance of mobile phones and text messaging among teens, we’d love to see more studies in this area. For example, the original study focused on automated text messaging, so it would be great to see studies on the effectiveness of different forms of text messaging. Would peer to peer text messaging be more or less effective? Are texts from parents more or less likely to be ignored by a teen? Also, what is the optimum frequency of text message reminders? Any strategy that can successfully help T1D teens with their transition to self-care is worth pursuing!
On a personal note, I was excited this study because of its very realistic approach to teens’ diabetes care. Its goal wasn’t to improve the teens’ A1C, but merely to maintain it. That in and of itself is a huge accomplishment during the teenage years. It recognized from the onset how challenging the teen years are and the intervention set realistic goals for this age group. As a mother of a teenage daughter myself, I greatly appreciated this approach.