Automated Text Messaging provides Personalised Support

Aug 2018

The number of New Zealanders living with diabetes has doubled from 125,000 to 250,000 in the past 10 years, with 40 new diabetes diagnoses every day. With evidence showing that managing diabetes can be difficult for many, academics at the University of Auckland’s National Institute for Health Innovation (NIHI), part of the Faculty of Medical and Health Sciences, developed a text message based self-management programme.

The randomized controlled trial assessed the effectiveness of SMS4BG (self management support for blood glucose) compared to usual care alone in 366 adults with diabetes from around New Zealand. The participants ranged from 16 to 80 years old. The group was split into two, and one set received a tailored package of text messages SMS4BG for up to nine months in addition to usual care.

The study found that those who received the SMS4BG programme had a greater improvement in their HbA1c, or the measurement of sugar levels in their blood, compared to those in the other group that only received their usual care.

Of the people who received the SMS4BG programme, 95 per cent say they found it useful, and 97 per cent say they would recommend it to others.

The growing prevalence of diabetes is considered to be one of the biggest global health issues. People of ethnic minorities, including Pacific and Māori (New Zealand indigenous population) groups, are particularly vulnerable to the development of diabetes, experience poorer control, and increased rates of complications.

Diabetes complications can be prevented or delayed with good blood glucose control, which is not only advantageous for a person’s quality of life but also will substantially reduce healthcare costs associated with treating or managing the complications.

SMSB4G intervention, developed with Waitemata DHB, provided direct information and support for those managing either type 1 or type 2 diabetes.

“There’s something about those prompts direct to your phone that remind you about the behaviour you’re trying to change, or the outcome you’re trying to achieve,” Robyn Whittaker, public health physician and the study’s principal investigator says.

Lead author Dr Rosie Dobson, of the Faculty of Medical & Health Science’s National Institute for Health Innovation, says the results are important given the rise in diabetes in New Zealand, with an estimated 200,000 adults living with the disease.

“Text messaging has the potential to make personalised support accessible to people when it is most needed within their daily lives. By utilising simple and widespread technology we can make this type of diabetes support accessible to nearly all people with diabetes with minimal barriers.”


The flexibility of mobile phones and their adoption into everyday life mean that they are an ideal tool in supporting people with diabetes whose condition needs constant management. Additionally, they can provide effective methods of support to patients in rural and remote locations where access to healthcare providers can be limited.

This study shows the potential of SMS4BG to provide a low cost, scalable solution for increasing the reach of diabetes self-management support. While there is still further work to be done to see if behavioural changes can be made due to text alerts, it is evident that a text messaging programme can increase a patient’s feelings of support without the need for personal contact from a healthcare professional.

The study was funded by the Health Research Council in partnership with Waitemata and Auckland District Health Boards, and the Ministry of Health. 

Watch Auckland mum Adrienne Ackerman talk about her experiences with SMS4BG below.




• The number of New Zealanders living with diabetes has doubled from 125,000 to 250,000 in the past 10 years. It is believed approximately 90 per cent of those new diagnoses are type 2.

• There are, on average, 40 new diabetes diagnoses every day in New Zealand.

• One in four (25 per cent) New Zealanders are estimated to have pre-diabetes.

• Everyone is risk of developing diabetes; however for some it's greater than others.

• In 2013, the highest rate of diabetes in New Zealand was in the Indian ethic group (11 per cent), followed by Pacific peoples (9.6 per cent).

• Maori are three times as likely to have type 2 diabetes as non-Maori, and are more likely to develop complications. Type 2 diabetes is increasingly occurring in Maori and Pacific children under the age of 15.

• In 2008 the estimated direct cost for type 2 diabetes was $600 million per year. The forecast cost of diabetes was predicted to rise from $600 million in 2006/07 to $920 million in 2011/12, $1,310 million in 2016/17 and $1,770 million in 2021/22.

• A person's risk of progressing from pre-diabetes to type 2 diabetes can be roughly halved if they lose weight, change their diet, increase exercise and/or have drug treatment.


To read the full study please click here