Sociodemographic and clinical correlates of key outcomes from a Mobile Insulin Titration Intervention (MITI) for medically underserved patients

Background

Insulin titration is typically done face-to-face with a clinician; however, this can be a burden for patients due to logistical issues associated with in-person clinical care. The Mobile Insulin Titration Intervention (MITI) used basic cell phone technology including text messages and phone calls to help patients with diabetes find their optimal basal insulin dose (OID).

Objective

To evaluate sociodemographic and clinical correlates of reaching OID, text message response rate, and days needed to reach OID.

Methods

Primary care providers referred patients to MITI and nurses delivered the program. Three multivariable regression models quantified relationships between various correlates and primary outcomes.

Results

The sample included 113 patients from 2 ambulatory clinics, with a mean age of 50 years (SD?=?10), 45% female, 79% Hispanic, 43% unemployed, and 46% uninsured. In regression models, baseline fasting blood glucose (FBG) was negatively associated with odds of reaching OID and 100% text responses, and positively associated with days to reach OID, p?<?.05).

Conclusions

Patients with higher baseline FBG levels were less successful across outcomes and may need additional supports in future mHealth diabetes programs.

Practical Implications

Basic cell phone technology can be used to adjust patients’ insulin remotely, thereby reducing logistical barriers to care.