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Promoting Problem-Solving Among Low-Income Adults With Type 2 Diabetes: Cluster-Randomized Controlled Trial of a
Lena Mamykina1, Arlene M Smaldone1, Suzanne R Bakken1
1Columbia University, New York, NY, United States.
Journal of Medical Internet Research
|July 13, 2026
Summary
Mobile Diabetes Detective (MoDD) showed sustained glycemic control improvements in underserved type 2 diabetes patients over 12 months. This mHealth intervention offers tailored problem-solving support, highlighting its potential for long-term self-management benefits.
Area of Science:
- Digital Health
- Diabetes Management
- Public Health
Background:
- Problem-solving is crucial for type 2 diabetes self-management, yet it poses challenges for underserved populations.
- Mobile health (mHealth) interventions can enhance diabetes self-management, but few specifically target problem-solving skills.
Purpose of the Study:
- To evaluate the efficacy of the Mobile Diabetes Detective (MoDD) intervention in improving glycemic control among medically underserved adults with type 2 diabetes.
- MoDD is a web-based, automated intervention utilizing SMS text messaging for problem-solving support tailored to self-monitoring data.
Main Methods:
- An open-label, cluster-randomized controlled trial involving 248 adults with type 2 diabetes (HbA1c >7.5%) across 8 Federally Qualified Health Centers.
- Participants were randomized 1:1; the intervention group used MoDD for 12 months, while the control group received standard diabetes education.
- The primary outcome was the change in HbA1c from baseline to 12 months, analyzed using intention-to-treat methods.
Main Results:
- No significant difference in HbA1c was found between the MoDD intervention group and the control group at 12 months.
- Both groups showed initial HbA1c reductions by 3 months; the intervention group maintained this improvement over 12 months.
- Engagement with MoDD varied, with 39.6% using it weekly in the first 30 days and 19.8% weekly in the first 90 days. No adverse events were reported.
Conclusions:
- The MoDD intervention demonstrated potential for sustained within-group glycemic control improvement over 12 months in underserved type 2 diabetes patients.
- While not achieving significant between-group differences, the autonomous and tailored nature of MoDD suggests long-term benefits for self-management.
- An increase in diabetes distress was noted, possibly due to heightened awareness of glucose levels; MoDD could complement existing diabetes education.
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