Text Message Intervention for Teens with Type 1 Diabetes Preserves HbA1c: Results of a Randomized Controlled Trial

Abstract

Aims: Teens with type 1 diabetes (T1D) often struggle with diabetes self-management, which may lead to suboptimal self-care and worsening hemoglobin A1c (HbA1c). Innovative strategies are needed to improve self-care and protect against glycemic decline, especially during adolescence. We aimed to assess the impact on HbA1c of two interventions, problem-solving and text messaging, in teens with T1D. Methods: In a two-site randomized controlled trial, teens (N = 301) 13-17 years of age with T1D were randomized to one of the four groups using a 2 × 2 factorial design: Teenwork (TW), Text Messaging (Text), TW+Text, or Usual Care. TW intervention included problem-solving aimed at improving T1D self-care for blood glucose (BG) monitoring and insulin bolus dosing. Text intervention involved text reminders to check BG. The primary outcome was change in HbA1c from baseline to 12 months. Results: At baseline, teens (51% female, 78% white, 59% pump-treated) were (mean ± SD) 15.0 ± 1.3 years, had diabetes duration of 6.5 ± 3.7 years, and HbA1c 8.5% ± 1.1%. There was no significant difference in HbA1c over time by study group. Responsiveness to text reminders by teens in the TEXT and TW+TEXT predicted glycemic benefit; TW did not. Conclusions: Despite no HbA1c difference by study group, greater response to text message reminders to check BG led to better glycemic control and no deterioration in HbA1c; the problem-solving intervention did not. Given the high penetration of mobile phones and the wide acceptance of text messaging among teens in general, it is encouraging that a text messaging intervention can preserve HbA1c, thus preventing the expected deterioration in glycemic control often seen in teens with T1D.

Keywords: Adolescents; HbA1c; Pediatrics; Text messaging; Type 1 diabetes.

Conflict of interest statement

No competing financial interests exist.

Figures

FIG. 1.

CONSORT trial flow diagram. The CONSORT flow diagram shows participant flow through each stage of the randomized controlled trial (enrollment, intervention allocation, follow-up, and completion).

FIG. 2.

HbA1c over time. Mean HbA1c level is shown at each study time point for each study group. There were no differences in HbA1c among the study groups at any of the study time points (baseline, 3, 6, 9, or 12 months). HbA1c, hemoglobin A1c.

FIG. 3.

BG monitoring frequency over time. Mean BG monitoring frequency is shown at each study time point for each study group. At the 3-month time point, BG monitoring frequency was significantly higher in the TW+Text group compared with the Usual Care group (P = 0.01) and the TW group (P = 0.003) but did not differ from the Text-only group (P = 0.10). There were no differences in BG monitoring frequency among the groups at any other time points (0, 6, 9, or 12 months). *P < 0.05 for difference from TW+Text group, **P < 0.01 for difference from TW+Text group. BG, blood glucose.