Home / Resources / Articles / Can Automated Text Messages Improve HbA1c?

Can Automated Text Messages Improve HbA1c?

Jan 12, 2019
Editor: Joy Pape, MSN, FNP-C, CDE, WOCN, CFCN, FAADE

Author: Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy

Personalized messages based on motivational interviewing principles compared to usual care to determine if any significant difference in self-management of type 2 diabetes.

Due to increasing opportunity for sedentary lifestyles and high-calorie food intake, type 2 diabetes is becoming increasingly prevalent in higher income countries, the progression of which leads to a variety of micro; and macrovascular complications, which effects quality of life and longevity. Type 2 diabetes is a fairly well understood disease state and can be managed. It does take knowledge and diabetes self-management, including, for many patients, medication. Despite this, a large proportion of patients with type 2 diabetes regularly miss appointments with their provider, which may delay necessary assessment and intervention. A recent study has shown that those who miss 30% or more of their medical appointments tended to have a significantly higher HbA1c than those who kept their appointments. Other studies have shown that patients who are counseled using motivational interviewing techniques are consistently more likely to achieve treatment goals compared to those who are counseled using more conventional methods. This led researchers to hypothesize that if motivational interviewing techniques were used in regularly sent automated text messages, it may increase the likelihood of better glycemic management of people who have  in type 2 diabetes.


Since the researchers wished to determine causation, a randomized controlled trial was selected as the study design. The primary outcome was change in HbA1c and weight from baseline. The participants were recruited from patients receiving treatment for type 2 diabetes at the Dasman Diabetes Institute or affiliated primary care centers in Kuwait. Prospective participants were considered for inclusion if they were between the ages of 18 and 75 with elevated HbA1c, on a stable antidiabetic medical regimen (for the 3 months prior to inclusion), residing in Kuwait, with a mobile phone, and have a reading age of greater than or equal to 7 years. Exclusion criteria included short duration of type 2 diabetes, pregnancy, current mental illness, diabetic complications, cancer, or living with another participant. Once deemed eligible, patients were randomized into either control (usual care) or intervention group (usual care plus motivational text message). Motivational text messages consisted of encouragement to make dietary and lifestyle changes as well as some messages. which are personalized to the patient. Those personalized messages are based on data collected via wearable technology (pedometer / activity monitors). Participants in the intervention group can also prompt an encouraging message by texting HELP, CRAVE, or LAPSE to a given number, which will then send them a message of encouragement to help prevent an unhealthy behavior from occurring or occurring again. Participants were assessed physically (anthropometric, psychologic, physical activity, and diabetes status including HbA1c) at baseline and at the study’s end, 12 months later.

From the pool of prospective participants, 572 were deemed eligible and randomized into their respective groups. This number achieves a stated 90% power for detecting a 0.5% difference between groups for the primary outcome. While the results of this study have yet to be published, the concept does have to face validity in that text messages written with motivational interviewing techniques provide a method of more frequent communication, as well as a lifestyle modification reminder. If the final evidence supports the initial hypothesis, then these motivational text messages could potentially fill the gap in care left by patients regularly missing their diabetes management appointments.

Practice Pearls:

  • There are a large proportion of people with type 2 diabetes who regularly miss their diabetes self-management appointments. These individuals are at increased risk for higher HbA1c levels compared to those who do not miss appointments.
  • Motivational interviewing has been shown to improve likelihood of achieving clinical goals compared to traditional counseling techniques.
  • While the results of this study are still needed in order to determine the true impact of this intervention, text messages composed with motivational interviewing techniques could potentially fill a gap in diabetes care.


Al-Ozairi, Ebaa, et al. “Diabetes and TelecommunicationS (DATES) Study to Support Self-Management for People with Type 2 Diabetes: a Randomized Controlled Trial.” BMC Public Health, vol. 18, no. 1, Dec. 2018, doi:10.1186/s12889-018-6136-8.

Michael Zaccaro, Pharm. D. Candidate 2019, LECOM School of Pharmacy