2020-09-11_Online-Only_Supplemental_Materials.pdf (185.31 kB)

Effects of a tailored text messaging intervention among diverse adults with type 2 diabetes: Evidence from the 15-month REACH RCT

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posted on 05.11.2020, 23:21 by Lyndsay A. Nelson, Robert A. Greevy, Andrew Spieker, Kenneth A. Wallston, Tom A. Elasy, Sunil Kripalani, Chad Gentry, Erin M. Bergner, Lauren M. LeStourgeon, Sarah E. Williamson, Lindsay S. Mayberry
Objective: Text messaging interventions have high potential for scalability and to reduce health disparities; however, more rigorous, long-term trials are needed. We examined the long-term efficacy and mechanisms of a tailored text messaging intervention.

Research Design and Methods: Adults with type 2 diabetes participated in a parallel-groups, 15-month randomized trial, assigned to receive REACH (Rapid Education/Encouragement and Communications for Health) for 12 months or control. REACH included interactive texts and tailored texts addressing medication adherence, and non-tailored texts supporting other self-care behaviors. Outcomes included HbA1c, diabetes medication adherence, self-care, and self-efficacy.

Results: Participants (N=506) were approximately half racial/ethnic minority and half were underinsured, had annual household incomes <$35,000 USD and ≤ high school education; 11% were homeless. Average baseline HbA1c was 8.6%±1.8%; 70.0±19.7 mmol/mol) with n=219 having HbA1c≥8.5% (69 mmol/mol) and half were prescribed insulin. Retention was over 90%. Median response rate to interactive texts was 91% (interquartile range 75%, 97%). The treatment effect on HbA1c at 6 months (-0.31%; 95% CI [-0.61%, -0.02%]) was greater among those with baseline HbA1c≥8.5% (-0.74%; 95% CI [-1.26%, -0.23%]), and there was not evidence of effect modification by race/ethnicity or socioeconomic disadvantage. REACH improved medication adherence and diet through 12 months, and self-efficacy through 6 months. Treatment effects were not significant for any outcome at 15 months. REACH reduced barriers to adherence, but barrier reduction did not mediate outcome improvements.

Conclusions: REACH engaged at-risk patients in diabetes self-management and improved short-term HbA1c. More than texts alone may be needed to sustain effects.


This research is funded by the National Institutes of Health (NIH), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through R01-DK100694 and the Vanderbilt Center for Diabetes Translation Research (P30-DK092986). LSM was also supported by a career development award from NIH/NIDDK (K01-DK106306) and LAN was supported by a career development award from NIH/ National Heart, Lung, and Blood Institute (K12-HL137943). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.