Impact of mHealth-Augmented Social Support on Health Care Use Among Patients With Diabetes: Secondary Analysis of the TExT-MED+FANS Trial.

Background: The rising cost of unscheduled acute health care, particularly for emergency department (ED) visits, poses significant financial burdens. In 2021, aggregate costs for treat-and-release ED visits in the United States accounted for an estimated US $80 billion, while the total annual cost of diabetes was US $412.9 billion in 2022-representing about 1 in every 4 health care dollars, 61% of which are directly linked to diabetes. Objective: This study explores the impact of a mobile health (mHealth) intervention with augmented social support delivered via guided SMS text messaging on health care use among patients with diabetes through a secondary analysis of the TExT-MED+FANS (Trial to Examine Text-Messaging in Emergency Patients With Diabetes + Family and Friends Network Support) randomized controlled trial. Methods: The trial involved 173 participants randomized into either a FANS mHealth-augmented social support or an active control group that received the same support curriculum via mailed pamphlet; "augmented" social support refers to recruiting both individuals with diabetes and a designated family member or friend ("supporter") to participate. Supporters in the FANS arm received structured SMS guidance on how to assist the participant with diabetes in managing their condition. Health care use outcomes, including ED visits, hospitalizations, and clinic visits, were compared between groups during and after the intervention period using linear regression models on change in health care visits in the last year, with subgroup analysis by participant sex and supporter relationship. Results: Results showed significant reductions in acute unscheduled care visits for both groups during and after the intervention, with the FANS group experiencing a reduction of 1.04 visits during the intervention and 1.10 visits after the intervention, while the mailed pamphlet group had reductions of 1.47 and 1.53 visits, respectively (both P<.001). Clinic visits increased by 1.78 during the intervention phase (P=.01) but were not sustained postintervention. Hospitalizations modestly decreased in both groups, but the decrease was statistically significant only for the mailed pamphlet group (P=.002). Sex and supporter relationship differences were observed, with females supported by spouses in the active control group showing the largest decrease in unscheduled care visits. Conclusions: The findings suggest that mHealth interventions combined with structured social support can improve diabetes management and reduce health care costs. Although these conclusions are specific to this study, they align with prior research demonstrating the benefits of social support and mHealth interventions. These findings may inform future programs, including the design of low-cost, scalable interventions in resource-limited settings.