Text messaging plus educational materials improves healthy eating in uncontrolled diabetes

BACKGROUND: Although studies have demonstrated that many patient-centered behavioral interventions are effective in improving diabetes self-care, little is known regarding their comparative effectiveness. OBJECTIVE: The Management of Diabetes in Everyday Life (MODEL) Study sought to compare the effectiveness of promising alternative patient-centered behavioral interventions, including educational materials (EM) alone, health coaching (HC)+EM, and text messaging (TM)+EM, for improving diabetes self-care. DESIGN: Three-arm pragmatic randomized controlled trial (ClinicalTrials.gov NCT02957513). PARTICIPANTS: A total of 666 African-American adults with uncontrolled diabetes (hemoglobin A1c [HbA1c] ≥ 8%) and multiple chronic conditions from 19 Mid-South US primary care practices randomly assigned to EM, HC+EM, or TM+EM in a 1:2:2 ratio. INTERVENTIONS: EM-alone participants received culturally tailored and patient-vetted diabetes EM. HC+EM participants received motivational interviewing-based coaching from certified lay health coaches. TM+EM participants received personalized and tailored messages. MAIN MEASURES: Primary outcomes included patient-reported healthy eating, exercise, and medication adherence self-care behaviors. Secondary outcomes included HbA1c, body weight, quality of life, and primary care engagement. KEY RESULTS: All three arms significantly improved healthy eating, exercise, and HbA1c from baseline to 12 months. EM participants increased healthy eating days by 0.67 ± 0.19 day/week (95% CI, 0.30-1.04), HC+EM by 0.99 ± 0.15 day/week (95% CI, 0.70-1.28), and TM+EM by 1.36 ± 0.15 day/week (95% CI, 1.07-1.64). Improvements in exercise behaviors were similar in all arms. TM+EM participants experienced significantly greater improvement in healthy eating than EM-alone participants (0.69 ± 0.24 day/week). Average reduction in HbA1c was 0.76% ± 0.12% (p ≤ 0.0001) and 90 of 349 participants (25.8%) with complete data for HbA1c achieved reductions below 8%. CONCLUSION: The MODEL Study demonstrates that EM-alone, HC+EM, and TM+EM are effective for improving self-care behaviors and HbA1c. TM+EM is more effective than EM-alone in improving healthy eating. Low-cost EM, HC+EM, and TM+EM should be made more readily available in primary care settings nationwide.