We compared the effectiveness of Dulce Digital (DD), a diabetes education text messaging program, versus Dulce Digital-Me (DD-Me), which included DD text messaging plus algorithm-driven, personalized goal-setting and feedback, in improving diabetes outcomes in Hispanic adults with type 2 diabetes (T2D). In this open-label comparative effectiveness trial, Hispanic adults with T2D were randomized (1:1:1) to receive DD, or the more personalized DD-Me approach delivered via automated, algorithm-driven text messaging (DD-Me_Auto) or telephonic communication from a health coach (DD-Me_Tel) across 6-months as part of existing primary care. Changes in clinical (HbA1c—primary) and patient reported outcomes were examined over 12 months. We enrolled N=310 Hispanic participants (69.7% female; M=52.1±10.2 years; 93.2% Spanish preferred; HbA1c M= 9.3±1.6 %) to receive DD (n=107), DD-Me_Auto (n=106) or DD-Me_Tel (n=97). Mixed models revealed no difference between DD and DD-Me (combined Auto+Tel) in rate of HbA1c change across 6- or 12-months, ps>0.05. All groups showed clinically and statistically significant improvements in HbA1c across 6-months [DD ∆ = -0.17% per month post baseline (95% CI -0.22,-0.10); DD-Me_Auto ∆= -0.20% (95% CI -0.26,-0.14); DD-Me_Tel ∆ = -0.15% (95% CI -0.20,-0.10), ps<.001]. Effect sizes were slightly attenuated, but remained statistically significant at 12-months (∆ HbA1c= -0.08% to -0.05% per month; ps < 0.001). Self-management behaviors and diabetes distress improved across 12-months in all groups. DD-Me (combined) showed greater improvement in medication adherence versus DD over time (Bint=-0.20, 95% CI -0.33,-0.01, p< 0.01). Two low-cost digital interventions for Hispanic adults with low income and T2D had similar and clinically significant effects on HbA1c across 12 months. Simple digital approaches can be integrated within primary care-based chronic care models to reduce diabetes disparities.


A. Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. K. L. Savin: None. J. A. Jones: None. M. Chichmarenko: None. H. Sandoval: None. L. Gallo: None. A. L. Fortmann: Employee; Dexcom, Inc. T. Clark: None. S. R. Spierling bagsic: None. E. Farcas: None. S. Roesch: None. J. H. Schultz: None. T. P. Gilmer: None. J. G. Godino: None.


National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK1123221UL1, TR002550)

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