Text to move: A randomized controlled trial of a text-messaging program to improve physical activity behaviors in patients with type 2 diabetes mellitus

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=.03) and fourth (rr 6.88,95% ci 1.21 to 39.00,p=.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: 9092 steps; control group: 3722 steps; rr 2.44,95% ci 0.68 to 8.74,p=.17). hba1c decreased by 0.07% (95% ci -0.47 to 0.34,p=.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=.01),but nonsignificantly in the control group by -0.21% (95% ci -0.49 to 0.06,p=.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. © stephen agboola,kamal jethwani,lenny lopez,meghan searl,sandra o'keefe,joseph kvedar.