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Cited by 169Mobile Health and mHealth ApplicationsDiabetes Management and EducationDiabetes Management and Research

Dulce Digital: An mHealth SMS-Based Intervention Improves Glycemic Control in Hispanics With Type 2 Diabetes

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Fortmann, Addie L., Gallo, Linda C., Garcia, Maria Isabel, Taleb, Mariam, Euyoque, Johanna A., Clark, Taylor, Skidmore, Jessica, Ruiz, Monica +3 more·2017·Diabetes Care
DOI 10.2337/dc17-0230PMC PMC5606313
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Abstract

OBJECTIVE: Type 2 diabetes is growing in epidemic proportions and disproportionately affects lower-income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the “digital divide” to improve care. RESEARCH DESIGN AND METHODS: A randomized, nonblinded, parallel-groups clinical trial design allocated N = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA1c; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items. RESULTS: The majority of patients were middle-aged (mean age 48.43 years, SD 9.80), female (75%), born in Mexico (91%), and uninsured (75%) and reported less than a ninth-grade education level (73%) and mean baseline HbA1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA1c over time compared with UC (P = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA1c (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high. CONCLUSIONS: Use of a simple, low-cost text messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.

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Authors
Fortmann, A. L., Gallo, L. C., Garcia, M. I., Taleb, M., Euyoque, J. A., Clark, T., Skidmore, J., Ruiz, M., Dharkar-Surber, S., Schultz, J., & Philis-Tsimikas, A.
Affiliations
  • Scripps Health (US)
  • San Diego State University (US)
  • University of California San Diego (US)
  • Neighborhood Healthcare, San Diego, CA
  • Scripps Whittier Diabetes Institute, Scripps Health, San Diego, CA
Corresponding author
  • Gallo, Linda C.
  • Schultz, James
ORCID
Venue
Diabetes Care
Publisher
American Diabetes Association
Published
2017-06-09
Volume
40
Issue
10
Pages
1349-1355
ISSN
  • 0149-5992 (ISSN-L)
  • 1935-5548
DOI
10.2337/dc17-0230
PMC
PMC5606313
OpenAlex
W2622674087
Cited by
169
References
6
Citations by year
2026: 11 · 2025: 18 · 2024: 23 · 2023: 14 · 2022: 29 · 2021: 23 · 2020: 20 · 2019: 19 · 2018: 9 · 2017: 2
FWCI
22.16
Type
journal article
Language
en
Open access
Licence
www.diabetesjournals.org/content/license (vor, 103 d)
Locations
  • Diabetes Care (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • McKesson Foundation (115M803379)
  • National Center for Advancing Translational Sciences (NCATS 1UL1 TR001114-01)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
Keywords
type 2 diabetes, glycemic control, text messaging, mobile health, Hispanic patients, low-income populations, HbA1c, digital divide, patient satisfaction, acceptability, self-monitoring of blood glucose, educational intervention
MeSH terms
Adult, Blood Glucose, Blood Pressure, Diabetes Mellitus, Type 2, Feasibility Studies, Female, Glycated Hemoglobin, Hispanic or Latino, Humans, Male, Mexico, Middle Aged, Socioeconomic Factors, Body Mass Index, Telemedicine, Self Report, Text Messaging

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