Evidence map›Paper›PMID 34674688›Full record

Trial reportBMC public health2021

Digital messaging to support control for type 2 diabetes (StAR2D): a multicentre randomised controlled trial.

A Farmer, K Bobrow, N Leon, N Williams, E Phiri, H Namadingo, S Cooper, J Prince, A Crampin, D Besada and 9 more

Erratum issuedAbstract readMulticenter StudyRandomized Controlled Trial
PubMed Full text at PMC Publisher
In one paragraph

Trial report in BMC public health, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 22 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 10 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Pooled it
  4. Pooled it
  5. Pooled it
  6. Pooled it
  7. Pooled it
  8. Pooled it
  9. Pooled it
  10. Pooled it
  11. Article
  12. Review
  13. Article
  14. Review
  15. Article
  16. Article
  17. Article
  18. Article
  19. Review
  20. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

19 authors.

A Farmer *Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK. andrew.farmer@phc.ox.ac.uk.ORCID http://orcid.org/0000-0002-6170-4402
K Bobrow *Chronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.
N LeonHealth Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa.
N WilliamsNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
E PhiriMalawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
H NamadingoMalawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
S CooperCochrane South Africa, South African Medical Research Council, Cape Town, South Africa.
J PrinceInstitute of Biomedical Engineering, Oxford, UK.
A CrampinMalawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
D BesadaHealth Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa.
E DaviaudHealth Systems Research Unit, South-African Medical Research Council, Cape Town, South Africa.
L-M YuNuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
J N'gomaKamuzu Central Hospital, Lilongwe, Malawi.
D SpringerBoston Consulting Group, London, UK.
B PaulyDepartment of Diabetes and Endocrinology, Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa.
L TarassenkoInstitute of Biomedical Engineering, Oxford, UK.
S NorrisHuman Nutrition Unit, South African Medical Research Council, Johannesberg, South Africa.
M NyirendaMalawi Epidemiology and Intervention Research Unit, Lilongwe, Malawi.
N LevittChronic Disease Initiative for Africa, University of Cape Town, Cape Town, South Africa.

Funding

Medical Research Council MR/M016498/1
6 · The paper itself

Abstract

backgroundFailure to take medicines for diabetes as prescribed contributes to poor outcomes from the condition. Mobile phones are ubiquitous and short message service (SMS) texts have shown promise as a low-cost intervention. We tested the effectiveness of SMS-text messaging in improving outcomes in adults with type 2 diabetes.

methodsStAR2D was a 12-month two-arm randomised trial of SMS-text messaging and usual care in Cape Town, South Africa and Lilongwe, Malawi. Messages used behaviour change theory and were developed with patients and staff. The intervention group received four messages each week. The primary outcome was change in HbA1c. Secondary outcomes were the proportion of patients who collected > 80% medication and changes in systolic blood pressure, lipids, cardiovascular risk, and the proportion of the participants reaching treatment goals.

resultsThe trial took place between 1 October, 2016 and 1 October 2018, 1186 participants were randomised to intervention (593) and control (593) groups. 91% of participants completed follow-up. There was a reduction in HbA1c (DCCT) in both groups but not in mean change (95% CI) between groups (- 0.08% (- 0.31 to 0.16) (IFCC - 0.82 mmol/mol (- 3.44 to 1.79). There was a small but not significant increase in the proportions of participants likely to have collected 80% or more of medication (Relative risk 1.11 (0.84 to 1.47; P = 0.47). There was a significant difference between groups in change in systolic blood pressure from baseline of 3.46 mmHg (1.48 to 5.44, P = 0.001) in favour of the intervention group. The between group difference in change in 10-year risk of coronary heart disease was - 0.71% (- 1.46 to 0.04, P = 0.064). The proportion of participants meeting treatment goals in the intervention group was 36.0% and in the control group 26.8% (Relative risk 1.36 (1.13 to 1.63, P = 0.001). Participants reported many challenges to adherence despite finding messages acceptable and useful.

conclusionsWhilst SMS text messages do not lead to improved glycaemia in these low-resource settings there appeared to be an impact on blood pressure and achievement of treatment goals but the mechanisms for this are unclear. Text messages alone, may be unsuccessful unless accompanied by health system strengthening and other forms of self-management support for type 2 diabetes.

trial registrationTrial registration: ISRCTN, ISRCTN70768808. Registered 1 July 2015, http://www.isrctn.com/I ISRCTN70768808.

Indexed as

Cell PhoneDiabetes Mellitus, Type 2Text MessagingAdultHumansMedication AdherenceSouth AfricaAdherenceDigital healthRandomised trialSMS text-messagesSub-Saharan AfricaType 2 diabetes

Identifiers

PMID34674688
PMCPMC8529732

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.