Text messages improve diabetes self-management and blood sugar control

NIHR | September 2018 | Text messages improve diabetes self-management and blood sugar control

A study from New Zealand underlines how a text message service was well-received by patients with diabetes, the participants who received the text message achieved a small reduction in blood sugar levels. 



The trial randomized 366 patients with  with poorly controlled type 1 or type 2 diabetes (HbA1c 65mmol/mol or more) to receive either text messages in addition to usual care or usual care alone. The texts were individually tailored to motivate participants to engage in behaviours relating to diabetes management.

What are the implications?

Text message support appears to be a safe, well received, and modestly effective adjunct to standard care for patients with poorly controlled diabetes. However, the HbA1c 4.2mmol/mol difference between the groups was small and did not reach the pre-set 5.5mmol/mol clinically meaningful difference by the researchers. Nevertheless, any improvement is likely to help reduce the risk of complications.

There is increasing interest and investment in UK programmes applying mobile technology to the prevention and management of diabetes and other chronic diseases.

Uncertainties remain around the long-term benefits of such interventions, their cost-effectiveness, their use in overcoming health care inequalities, and the optimal content and frequency of their messages.

For further information see the NIHR Signal

Published Abstract

Objective: To determine the effectiveness of a theoretically based and individually tailored, text message based, diabetes self management support intervention (SMS4BG) in adults with poorly controlled diabetes.

Design: Nine month, two arm, parallel randomised controlled trial. SETTING: Primary and secondary healthcare services in New Zealand.

Participants: 366 participants aged 16 years and over with poorly controlled type 1 or type 2 diabetes randomised between June 2015 and November 2016 (n=183 intervention, n=183 control).

Interventions: The intervention group received a tailored package of text messages for up to nine months in addition to usual care. Text messages provided information, support, motivation, and reminders related to diabetes self management and lifestyle behaviours. The control group received usual care. Messages were delivered by a specifically designed automated content management system.

Main outcome measures: Primary outcome measure was change in glycaemic control (HbA1c) from baseline to nine months. Secondary outcomes included change in HbA1c at three and six months, and self efficacy, diabetes self care behaviours, diabetes distress, perceptions and beliefs about diabetes, health related quality of life, perceived support for diabetes management, and intervention engagement and satisfaction at nine months. Regression models adjusted for baseline outcome, health district category, diabetes type, and ethnicity.

Results: The reduction in HbA1c at nine months was significantly greater in the intervention group. Of 21 secondary outcomes, only four showed statistically significant improvements in favour of the intervention group at nine months. Significant improvements were seen for foot care behaviour (adjusted mean difference 0.85, overall diabetes support, health status on the EQ-5D visual analogue scale, and perceptions of illness identity. High levels of satisfaction with SMS4BG were found, with 161 (95%) of 169 participants reporting it to be useful, and 164 (97%) willing to recommend the programme to other people with diabetes.

Conclusion: A tailored, text message based, self management support programme resulted in modest improvements in glycaemic control in adults with poorly controlled diabetes. Although the clinical significance of these results is unclear, the findings support further investigation into the use of SMS4BG and other text message based support for this patient population.

Full reference:

Dobson, R. et al.| 2018| Effectiveness of text message based, diabetes self management support programme (SMS4BG): two arm, parallel randomised controlled trial| BMJ|Vol. 361 | 2018 | doi: 10.3310/signal-000640

Early age of type 1 diabetes diagnosis linked to greater heart risks and shorter life expectancy, compared to later diagnosis

University of Glasgow | August 2018 | Early age of type 1 diabetes diagnosis linked to greater heart risks and shorter life expectancy, compared to later diagnosis

Researchers at the University of Glasgow have found that early onset for type 1 diabetes is linked to a shorter life expectancy, by an average of 16 years shorter than a patient without diabetes. For those diagnosed with type 1 later in life,  their lifespan is 10 years shorter than people without a diagnosis of diabetes (via University of Glasgow). life-stage-icon-2889015_1280.png


The research, which is published in The Lancet, is a longitudinal observational study in Sweden that tracked over 27, 000 people with type 1 for an average of 10 years.

Although it is well established that  patients with type 1 diabetes are at increased risk of health problems and have shorter life expectancies, partly due to premature cardiovascular disease. Until this point the impact of age of diagnosis on this excess mortality and cardiovascular risk was unclear. In order to contribute to the limited evidence base, the researchers calculated the excess risk of all-cause mortality, cardiovascular mortality, acute heart attack, stroke, cardiovascular disease, coronary heart disease, heart failure, and atrial fibrillation in 27,195 individuals from the Swedish National Diabetes Register compared to 135,178 controls matched for age, sex, and county from the general population (average age 29 years).

After adjustment for a range of variables that could have influenced the results  among them but not limited to  age, sex, , diabetes duration, and previous history of cardiovascular complications. The researchers found cardiovascular risks and survival were strongly related to the participant’s age at disease onset, with people diagnosed under the age of 10 having five-fold increased risk of heart attack and coronary heart disease than those diagnosed at age 26-30 years. The younger group also had much higher risk of heart failure and stroke than peers without diabetes and those diagnosed at an older age.

These new estimates suggest that individuals diagnosed before the age of 10 have a 30-times greater risk of serious cardiovascular outcomes like heart attack (0.31 cases per 100,000 person years for participants with diabetes vs 0.02 cases in every 100,000 person-years for controls) and heart disease than those in the general population, whilst risk levels are around six times higher for people diagnosed between ages 26 and 30 (Source: University of Glasgow).

Read the full, unedited news release from the University of Glasgow


Diabetes epidemic predicted to increase rise in heart attacks and stroke

British Heart Foundation | August 2018 | Growing diabetes epidemic to trigger ‘sharp rise’ in heart attacks and strokes by 2035

Currently  in England, nearly 4 million people are living with diabetes. Extrapolation of data based on the increasing number of people with diabetes predicts that almost  39,000 people living with diabetes suffering a heart attack in 2035 – a rise of 9,000 compared to 2015 – and over 50,000 people suffering a stroke – a rise of 11,000.


BHF expect that to rise to over 5 million over the next 20 years, as a result of the population’s  worsening lifestyles and the UK’s growing obesity rates.  As well as the increased risk of heart attacks and stroke, this rise in diabetes cases will increase the number of people suffering from conditions including angina and heart failure. BHF forecasts this will put further pressure on the NHS with previous estimates suggesting the yearly cost of treating people with diabetes will be £16.9 billion by 2035, up from £9.8 billion in 2012.

BHF are underlining  urgent need for ‘bold action’ to tackle lifestyle factors, such as obesity and a poor diet, that are leading to spiraling rates of diabetes, as well as a greater focus within the health sector on earlier diagnosis.

Read the full news story at BHF 

In the news:

BBC News Rise in diabetes ‘to cause surge in heart disease and strokes’

Sky News Diabetes epidemic set to cause surge in heart attacks and strokes

Daily Mail  Britain’s diabetes time-bomb: Rise of Type 2 will cause heart attacks and strokes to soar over the coming years with 30% increase in serious illnesses linked to the condition

The Telegraph Obesity epidemic will fuel 30 per cent rise in heart attacks in 2035

Times Diabetes means big rise in heart attacks

The Guardian Diabetes epidemic ‘will lead to rise in heart attacks and strokes’

Knowledge is power in diabetes self-care

NHS England | August 2018 |Knowledge is power in diabetes self-care

NHS England have  worked with NHS Digital, Diabetes UK and people with Type 1 diabetes to develop an online space where people can find the information that they have told us is important to them. They hope that providing an online resource with all the useful links in one place will help people with Type 1 diabetes gain the knowledge and confidence to manage their condition.

The new Type 1 diabetes online resource is a simple and effective way for those newly diagnosed with Type 1 diabetes to learn about the disease and to understand how to manage it most effectively (Source: NHS England).

New resource for patients newly diagnosed with type 1 diabetes


New resource for patients newly diagnosed with type 1 diabetes

NHS Digital | August 2018 | Type 1 diabetes 

NHS Digital have developed a new interactive resource for patients with type 1 diabetes. The resource is intended to equip people with Type 1 with the knowledge and confidence to manage their diabetes. 

The section on ‘newly diagnosed- things to help’ which includes resources on how to inject insulin, checking blood glucose levels and appointments and check ups as well as useful advice around living with the condition. They are encouraging healthcare  professionals to refer newly diagnosed patients, their parents and carers to the site as a ‘one stop shop’ for Type 1 Diabetes support. 

NHS Digital Type 1 
NHS Digital Get Support 

Assessing the value of diabetes intervention programmes

NIHR | August 2018 | Assessing the value of diabetes intervention programmes

A new blog post on the NIHR blog assesses the NHS DPP (Diabetes Prevention Programme). Designed by NHS England and Public Health England, working alongside Diabetes UK, the Diabetes Prevention Programme  (NHS DPP) is an ambitious and world-leading attempt to bring about behaviour change, through a standardised intervention delivered by four different providers, implemented across England to people at risk of developing diabetes. People at risk are identified and referred to a group programme which helps them understand the repercussions of diabetes and make changes to their lives to reduce their risk of getting it in the future.

The authors of the post  indicate that aspects of the NHS DPP are very successful. Although there had been concerns that groups in need of support would not attend, initial findings suggest that some of these groups (ethnic minorities, and those living in deprived areas) were showing good engagement.

The authors also emphasize that the early findings  do not tell us what would have happened if the programme had not been introduced, or whether it is a good investment compared to other alternatives. Programmes such as this tend to produce positive results at the outset but these may not be sustained.   As a result the authors have been commissioned by NIHR to conduct an independent evaluation of NHS DPP called DIPLOMA.

Further details of the DIPLOMA project  including a video and webinar slides are here

The full post can be read at NIHR 

The research study’s findings are also available from NIHR 

Periconception glycaemic control in women with type 1 diabetes and risk of major birth defects: population based cohort study in Sweden

Objective To examine the association between maternal type 1 diabetes and the risk of major birth defects according to levels of glycated haemoglobin (HbA1C) within three months before or after estimated conception.

Design Population based historical cohort study using nationwide health registers.

Setting Sweden, 2003-15.

Participants 2458 singleton liveborn infants of mothers with type 1 diabetes and a glycated haemoglobin measurement within three months before or after estimated conception and 1 159 865 infants of mothers without diabetes.

Main outcome measures Major cardiac and non-cardiac birth defects according to glycated haemoglobin levels.

Results 122 cases of major cardiac defects were observed among 2458 infants of mothers with type 1 diabetes. Compared with 15 cases of major cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 33 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 2.17, 95% confidence interval 1.37 to 3.42), 49 per 1000 for 6.5% to <7.8% (3.17, 2.45 to 4.11), 44 per 1000 for 7.8% to <9.1% (2.79, 1.90 to 4.12), and 101 per 1000 for ≥9.1% (6.23, 4.32 to 9.00). The corresponding adjusted risk differences were 17 (5 to 36), 32 (21 to 46), 26 (13 to 46), and 77 (49 to 118) cases of major cardiac defects per 1000 infants, respectively. 50 cases of major non-cardiac defects were observed among infants of mothers with type 1 diabetes. Compared with 18 cases of major non-cardiac defects per 1000 infants of mothers without diabetes, the rates among infants of mothers with type 1 diabetes were 22 per 1000 for a glycated haemoglobin level of <6.5% (adjusted risk ratio 1.18, 0.68 to 2.07), 19 per 1000 for 6.5% to <7.8% (1.01, 0.66 to 1.54), 17 per 1000 for 7.8% to <9.1% (0.89, 0.46 to 1.69), and 32 per 1000 for ≥9.1% (1.68, 0.85 to 3.33).

Conclusion Among liveborn infants of mothers with type 1 diabetes, increasingly worse glycaemic control in the three months before or after estimated conception was associated with a progressively increased risk of major cardiac defects. Even with glycated haemoglobin within target levels recommended by guidelines (<6.5%), the risk of major cardiac defects was increased more than twofold. The risk of major non-cardiac defects was not statistically significantly increased at any of the four glycated haemoglobin levels examined; the study had limited statistical power for this outcome and was based on live births only.

Reference:  BMJ 2018;362:k2638

Diabetic eye screening: cohort management

Public Health England| August 2018 | Diabetic eye screening: cohort management

Updated guidance from Department of Health and Social Care (DHSC) has been released to cover diabetic eye screening, it covers the management of people on the programme register of their local diabetic eye screening, known as the ‘screening cohort’.


The full guidance is available from Public Health England