Low–income Hispanics with type 2 diabetes who received health–related text messages every day for six months saw improvements in their blood sugar levels that equaled those resulting from some glucose–lowering medications, researchers with the Scripps Whittier Diabetes Institute reported.

The Dulce Digital clinical trial represents the first randomized controlled study to look at the use of text messages to help underserved Hispanics better self–manage their diabetes through glycemic control.

The results were published in the journal Diabetes Care.

The Dulce Digital study was conducted between October 2012 and August 2014 with 126 participants who were recruited from medical clinics operated by Neighborhood Healthcare, a nonprofit community health organization, in the Southern California counties of San Diego and Riverside.

Participants were either uninsured or received coverage through MediCal. A majority of them were middle–aged, female, born in Mexico and reported less than a ninth–grade education.

All participants watched a 15–minute diabetes educational video, received a blood glucose meter and instructions on using it, and were given access to usual care including voluntary visits with a primary care physician, a certified diabetes educator and group diabetes self–management education.

The 63 participants who were randomly assigned to the study group received two to three short text messages a day at the beginning of the trial, which tapered off slightly over the next six months. Participants used their own cell phones, or were provided one by the researchers, and they each received $12 a month to cover the costs of the study’s texts. On average, each participant received 354 messages over the course of the study. The texts covered a range of educational, motivational and actionable messages. For example:

• Use small plates! Portions will look larger and you may feel more satisfied after eating.
• It takes a team! Get the support you need – family, friends and support groups can help you to succeed.
• Tick, tock. Take your medication at the same time every day!
• Time to check your blood sugar. Please text back your results.

The study focused on hemoglobin A1C, a blood test that measures average blood glucose during the previous two to three months. For people with diabetes, a recommended A1C level is 7 percent or less.

At the start of the Dulce Digital study, the combined participant groups registered a baseline mean A1C of 9.5 percent. After three months, the mean A1C for the group receiving the texts had improved to 8.5 percent while the control group had a mean A1C of 9.3 percent. At six months, the study group’s mean A1C was still 8.5 percent while the control group registered a 9.4 percent mean.

Valley Center, Calif., mural artist Gloria Favela, 48, was one of the study group participants who saw big improvements.

After the trial ended, 96 percent of the study group participants said the text messages helped them to manage their diabetes “a lot.” The same amount said they would continue receiving Dulce Digital text messages if given the choice, and 97 percent said they would recommend the program to friends and family members.