Background: Among digital health interventions, TM can be a useful tool in teens with T1D. However, attrition remains a major issue, with engagement decreasing over time. We aimed to describe patterns of engagement in an incentivized TM intervention and to assess impact of engagement on A1C in teens with T1D and suboptimal control randomized to the TM arm.

Methods: Of 165 teens (12-18 years old, T1D duration >1 year, A1C ≥8%) recruited into a 6-month RCT, 83 were assigned to TM intervention and received daily educational/motivational TMs using the MyDiaText™ platform. Socio-demographic and clinical data were obtained from medical record review. Participants were rewarded biweekly for the most consecutive TM responses. TM response rate (RR) was defined as number of responses/total messages received. High RR was defined as >50%. Paired t-tests, ANOVA, and Pearson correlation were used in statistical analysis.

Results: At entry, teens (57% males, 52% white) had a mean(±SD) age of 16±2 years, T1D duration 7±4 years; 55% were pump-treated, 65% used CGM, and A1C was 10±1.9%. Clinical concerns for depression were seen in 28%. The mean overall RR was 58.6%(±28.9%), and the high RR group included 66% of participants. High and low RR groups did not differ by sex, race, age, T1D duration, use of technology, baseline A1C, or clinical depression. Over the 6 months, A1C improved significantly to 9.2±1.8% (p=0.00), with 35% improving by ≥1%. High responders were twice as likely to improve A1C by ≥1% than low responders (p=0.18). There was a significant decline in RR over time (r2=0.9, p=0.00).

Conclusions: In teens with T1D and suboptimal control, socio-demographic factors did not predict engagement with a financially incentivized TM intervention. However, high responders tended to improve their A1C, likely due to increased engagement in self-care. There remains a need to create a digital health intervention that maintains engagement over extended periods for teens with T1D.


T. Kaushal: None. T. Lipman: None. L.E. Katz: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US.


National Institutes of Health (P30DK036836, K12DK094721, 2T32DK063688)

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