Weight Management of Diabetic Patients: Can Text Messaging Help?

The prevalence of obesity and diabetes have steadily increased over the past three decades with projections calling for 83% of men and 72% of women becoming overweight or obese by 2020; similarly, the incidence of women with diabetes is projected to increase from 37 % to 44% (Shute, N., 2011). These drastic increases have brought about a dramatic growth of innovative disease management tools that have proven to increase patient control over their disease as well as enhance patient-practitioner correspondence. The literature provided information involving the use of text messaging to prompt the patients to increase their adherence to the treatment regime to help control their BMI levels and overall obesity rates through out the study. The purpose of the study is to examine the extent to which a text messaging intervention can effectively reduce overweight/obesity in adult diabetic patients. More specifically, our research questions are: (1). Is a text messaging intervention efficacious at reducing overweight/obesity in adult diabetic patients? (2). Does a text messaging intervention have a differential effect on reducing overweight/obesity in adult diabetic patients based on their socio-demographic characteristics, and glucose level? The secondary analysis of 133 diabetic patients in Denver, Colorado concluded that despite the vast amounts of literature supporting the use of text messaging, the weight and BMI of these patients did not alter during the study, shifting from a mean BMI of 33.7 to 33.6. This study provided insight into the need for further examination between the factors linking diabetes and obesity as well as the use of technology to help enhance disease adherence. Recommendations for this study include using a larger population with a wider variety of age and socioeconomic status as well as using multiple tools to measure obesity such as abdominal circumference and skin folds tests. WEIGHT MANAGEMENT AND TEXT MESSAGING 3 INTRODUCTION The alarming increase in the prevalence of diabetes and obesity constitutes a serious public health and financial burden in the United States. (Karmally, W. et al., 2012). According to most recent estimates of the Behavior Risk Factor Surveillance System (BRFSS, 2013), one out of ten people in the US suffers from diabetes, and more than six out of ten Americans are either overweight (36%) or obese (29%). Several health initiatives have been developed to address this national crisis, for example, two of Healthy People 2020’s goals refer to overweight and obesity rates in the US. Goals NWS-8 and 9 specifically refer to increasing the proportion of adults who are at a healthy weight from 30.8% to 33.9%, and decreasing the proportion of the adult population who are obese, from 33.9% to 30.5% respectively. The latter was added to the Leading Health Indicators (LHI) subset of Healthy People, this category is reserved for objectives that are acknowledged as high-priority health issues (Healthy People 2020, 2014). Along with objectives for weight management, Healthy People also developed numerous goals to reduce the incidence of diabetes in the population from 8.0 new cases of diabetes per 1,000 population to 7.2 new cases in the population aged 18-84 years. They also have created a LHI objective that pertains to a reduction in the proportion of individuals with diabetes with an A1c value greater than 9% from 17.9% to 16.1% (Healthy People 2020, 2014). Both diabetes and obesity are serious epidemics in their own accord, but research has concluded that obesity alone is the best predictor of undiagnosed diabetes. A study by Klein Woolthius, E.P., et al., 2009, targeted a variety of low to high-risk patients who were seen during their primary care visits. After testing for numerous variables, the researchers concluded that during these visits targeting middle age to older adults with obesity could act as an opportunistic screening for type 2 diabetes (Klein Woolthius, E.P., et al., 2009). WEIGHT MANAGEMENT AND TEXT MESSAGING 4 There have been countless efforts made to decrease the prevalence of diabetes and obesity in the past couple years, and at the forefront is the state of Colorado, which has instigated health promotion initiatives to curb the diabetes and obesity epidemics. In May 2013, Colorado’s governor, John Hickenlooper, announced the new health policy agenda. This report, The State of Health: Colorado’s Commitment to Become the Healthiest State, discusses the states strengths, weaknesses and outlines 18 initiatives to help the state achieve its goals. The initiatives are based off of four focus areas including (1) promoting prevention and wellness, (2) expanding coverage, access, and capacity, (3) improving health system integration and quality, (4) enhancing value and strengthening sustainability. Each initiative is accompanied by specific metrics that enables their progress to be tracked (Office of the Govenor, 2013). Despite efforts like The State of Health, these health conditions continue to pose a societal conundrum as 260,336 adults in Colorado (6% of the population) have diabetes. Of these, 36% and 46% are considered overweight and obese, respectively (BRFSS, 2013). The conjunction of these two conditions is particularly problematic, as it increases risk of mortality. Moreover, obesity constitutes an additional impediment in the management of diabetes, particularly in certain racial/ethnic groups such as African Americans and Hispanics who are already facing socioeconomic hurdles, or live on the brink of poverty. The State of Health report states that tackling obesity is it’s first initiative towards creating a healthier state and has created an Obesity Integration Project, which identifies, selects, and prioritizes evidence-based public health strategies that will be the most effective at reducing obesity and best use the state’s resources (Office of the Govenor, 2013). Initiatives like this have brought Colorado to the forefront of the battle against obesity and have helped propel them to one of the healthiest states in the US. WEIGHT MANAGEMENT AND TEXT MESSAGING 5 A series of additional health care initiatives have been undertaken in Denver, Colorado. The Denver Health Organization created the Healthy Eating, Active Living (HEAL) program to help combat the obesity issue. The HEAL program includes many activities such as: facilitating the Metro Denver Partnership for Healthy Beverages, evaluation of the Mayor’s Children’s Cabinet goal to reduce obesity by 1% annually, implementation of Colorado’s Healthy Hospital Compact to improve the food and beverage environment to make healthy options easy and routine, and the development of an Adult and Childhood BMI registry, along with many others (Denver Health, 2013). Colorado has also implemented a program: Diabetes Self-Management Education (DSME) to facilitate knowledge, skills and abilities that are necessary for diabetes self-care. This program has shown to be associated with higher patient adherence to preventive care practice leading to lowering average costs of patient care (Needs Assessment Examining Diabetes Self-Management in Colorado, 2009). The outcomes of this study shows that the prevalence of diabetes has doubled in the past 15 years, and is markedly escalated beginning at 55 years of age for all ethnicities. The evidence shows that individuals who have taken a selfmanagement class are more likely to participate in preventative practices such as: daily selfmonitoring blood glucose, annual A1C tests, annual foot and eye exams and an annual cholesterol check. These tests provided baseline data for the BRFSS to collect annual data to evaluate the use and effectiveness of programs like DSME (Needs Assessment Examining Diabetes Self-Management in Colorado, 2009). Although many forms of diabetes education has been tried and most have positive results, the rising prevalence of diabetes urges for new methods to be developed. Text messaging is a concept using cellphone technology to reach larges segments of the population, like those at risk for diabetes and providing them with WEIGHT MANAGEMENT AND TEXT MESSAGING 6 important health information (Center for Disease Control, 2014). For example, the use of text messaging as an efficacious weight management tool in diabetic adults has not been investigated.