Patterns of Engagement With an Incentivized Text Messaging Intervention (MyDiaText) in Teens With Type 1 Diabetes in Suboptimal Control

Adolescents with type 1 diabetes are vulnerable to suboptimal glycemic control, generally due to insufficient self-care behaviors (1,2). Because they have some of the highest rates of mobile communication technology use (3), this modality may hold promise for providing reminders or encouragement to adolescents to engage in self-care. However, the effects of text messaging interventions on self-care and glycemic outcomes are mixed, with some reports favoring improvements in teen self-care behaviors such blood glucose monitoring frequency or medication adherence (4–7). In an alternative attempt to reach this high-risk age-group, researchers have explored the use of financial incentives to promote self-care behaviors, which yielded some glycemic benefit in the short term (8,9). However, there is limited research on the combination of a financial incentive and a mobile health intervention (10,11) and the potential benefits that could accrue from blending these approaches. Nonetheless, use of either a unimodal or a bimodal intervention requires that adolescent recipients remain engaged with the program. In this report, we describe adolescent engagement during a 6-month study of a psychoeducational text messaging intervention that incorporated financial incentives. The primary study included adolescents with type 1 diabetes in suboptimal control and showed a potential increase in self-reported self-care in those receiving the intervention as intended (10). This analysis of the primary study’s intervention group described patterns of adolescent engagement with the intervention and identified factors associated with responsiveness. We also evaluated the potential impact of engagement on glycemic outcomes and self-care. This study analyzed 6 months of data from teenagers with type 1 diabetes receiving an incentivized text messaging intervention aimed at increasing education and support for diabetes self-care. Youths were eligible for inclusion if they were 12–18 years of age, had a duration of type 1 diabetes of …