Improving diabetes care through the use of social media platform

Diabetes is a healthcare epidemic with a significant financial, socioeconomic, and population health impact. It is estimated that it affects about 11.6% of the US population, roughly 38.4 million people of all ages in 2021.¹ The projected cost of diabetes care in the United States in 2022 is $412.9 billion.² Analysis of cost categories reveals that roughly one in four health care dollars in the US is spent in the care for people diagnosed with diabetes.² With such enormous economic and health implications, it is important to ensure the highest possible standards of care in the management of diabetes. The American Diabetes Association published Standards of Care in Diabetes, which serves as a comprehensive resource for all the key stakeholders; it addresses key elements of diabetes care, proposes treatment goals, provides tools to assess care quality, and aims to improve diabetes care outcomes across diverse populations.³ It emphasizes a multidimensional approach to diabetes care through prevention or delay of associated comorbidities and complications, comprehensive medical evaluation and assessment of comorbidities, facilitation of positive health behaviors and well-being, and the use of diabetes technology in the care of diabetic patients.³ These interventions can bring about improved outcomes in the lives and health of people with diabetes.⁴ A successful implementation of the above measures requires routine medical care with individualized patient goals, self-management education, and ongoing support.⁵ This cannot be achieved without interventions that facilitate patient scheduling, improve attendance to provider appointments, and provide patient information to providers and care teams.⁵

No-show rates for diabetic patients range from 4% to 40% in studies.⁵ Diabetic patients with higher no-show rates have poorer outcomes, e.g., higher glycosylated hemoglobin (HbA1c) levels and poorer glycemic control compared to those with lower no-show rates.⁵ A systematic review of 77 studies between 1987 and 2013 looked at interventions that facilitated scheduling patients with their provider and getting the patient to their appointment.⁵  Interventions that facilitated scheduling patients included phone reminders, letter reminders, scheduling when necessary while monitoring patients, and open access scheduling.⁵ Interventions that helped improve attendance included letter reminders, phone reminders, short message service (SMS) reminders, and financial incentives.⁵ This literature review concluded that multifaceted interventions aimed at appointment management and preparation during various phases of the medical outpatient care process improve diabetes disease management.⁵ Similarly, a systematic review of 28 studies published between 2005 and 2015 which compared the attendance rates of patients receiving SMS reminders compared to patients not receiving a reminder indicated that SMS reminders were an effective means of improving appointment attendance.⁶

It is estimated that 72% of US adults use social media, with around 49% using it daily.⁷ An average individual in the United States manages about 7.1 social media accounts and spends around 2 hours and 8 minutes per day on these platforms.⁷

The retrospective study by Hossain et al in this issue of Baylor University Medical Center Proceedings evaluates the impact of social media reminders on outpatient appointment attendance among diabetic patients using continuous glucose monitors.⁸ The study compares the use of social media appointment reminders to paper-based reminders among 171 diabetes patients receiving a continuous glucose monitor at a public hospital in suburban New York City. They concluded that the social media reminder group (88.2%, n = 60/68) had a significantly (P < 0.001) greater percentage for attendance at the follow-up appointment than the traditional reminder group (60.2%, n = 62/103), with an odds ratio of 4.35.⁸

Although the sample size is relatively small, the trend demonstrated in the study is pretty strong. This study could inspire similar initiatives on a larger scale involving multiple social media platforms beyond WhatsApp, the predominant social media platform used in the study. With newer approaches, new issues arise. It would also be interesting to see the technological (electronic medical record interface, etc.), as well as the legal challenges (e.g., Health Insurance Portability and Accountability Act) that we may have to address.

—Shovendra Gautam, MD, MBA
Baylor Scott & White All Saints Medical Center,
Fort Worth, Texas, USA
shovendra@gmail.com