Pilot of interactive texting for diabetes self-management education and support

Controlling type 2 diabetes requires medication adherence, monitoring blood sugar, weight management, and dietary and physical activity behaviors. Estimates link a 1% reduction in hemoglobin A1c (HbA1c) to up to a 40% decrease in complications. Accessible supports for self-management behaviors can help increase adherence and lower HbA1c. However, uninsured and low-income populations may experience unique self-management challenges and have limited access to self-management supports.

To assess the feasibility, acceptability, and preliminary effectiveness of a pharmacist-driven 6-month pilot intervention to support diabetes self-management behaviors utilizing text messages among uninsured and underinsured patients with uncontrolled diabetes.

Eligible participants were English or Spanish-speaking patients at a Federally Qualified Health Center in Northern Illinois who had poorly controlled type 2 diabetes (HbA1c > 7) and access to a smartphone. Participants' HbA1c was measured at enrollment and upon completion. Interactive and informational messages were sent to participants using a secure text-messaging application. Messages included explanations, encouragement, and problem-solving suggestions. Message frequency was tapered to withdraw support gradually. Message engagement was tracked within the text-messaging software.

Electronic medical records identified 192 eligible patients with type 2 diabetes, of whom 76 consented to enroll in the intervention. Mean HbA1c at enrollment was 9.3%. Engagement with messages did not vary by demographic or clinical characteristics. Of 75 participants in the analytic sample, 60 completed the postintervention HbA1c measurement. Thirty-five (58.3%) had clinically significant reductions in their HbA1c, and 16 (26.7%) reduced their HbA1c to under 7%, which is considered controlled. Smaller groups saw either HbA1c decreases of less than 0.5% (n = 8, 13.3%), no change (n = 3, 5.0%), or increases (n = 14, 23.3%).

This feasible and low-cost pilot intervention utilizing pharmacist services helped a large portion of patients attain a clinically significant reduction in their HbA1c and contributed to some individuals achieving blood sugar control.