819-P: Personalized Texts Improve Adherence and A1c over 6 Months among High-Risk Adults with Type 2 Diabetes

Medication nonadherence and suboptimal glycemia are common among adults with T2D, particularly minorities and people with low SES. Text messaging is used ubiquitously without disparities. REACH (Rapid Education/Encouragement And Communications for Health) is a theory-based text messaging intervention that iteratively personalizes content to participants’ diabetes medicines and barriers to adherence.

All participants have completed 6-month follow-up of a 15-month pragmatic RCT evaluating REACH. Adults (N=512) with T2D were recruited from community health centers and medical center primary care clinics. All participants received educational newsletters, completed A1c tests (venipuncture or mail-in kit) and surveys every 3 months; those assigned to REACH received daily texts. Surveys included a barriers assessment and the Summary of Diabetes Self-Care Activities medications subscale. Regression models examined change in barriers, adherence, and A1c (adjusted for test type) relative to controls.

Participants were predominantly non-white (53%) and low SES (56% annual incomes <$35K; 49% underinsured; 42% <high school degree; 11% homeless/unstably housed), with an average age 56.0±9.5 years; 54% female; 49% on insulin; and baseline A1c 8.6±1.8%. At 6 months, retention was 90% and average response rate to daily interactive texts was mean 84% [IQR 79-90]. The 6-month overall REACH effect on A1c was -0.3% (p<.05), but reductions were greater among participants with higher baseline A1c (interaction term p<.05) - demonstrating A1c reductions ≥1.0% among participants with baseline A1c≥12.5% and ≥0.5% among participants with baseline A1c≥8.0% (both p<.05). Relative to controls, REACH also reduced adherence barriers (p<.05) and improved adherence (.53 days per week, p<.001).

REACH engaged a diverse and high-risk group with daily texts, reduced barriers to adherence, improved adherence, and substantively improved A1c among patients with elevated glycemia at baseline.