Dulce Digital-Me: results of a randomized comparative trial of static versus adaptive digital interventions for Latine adults with diabetes

• Published in: Annals of behavioral medicine Vol. 59; no. 1
• Main Authors: Philis-Tsimikas, Athena, Fortmann, Addie L, Clark, Taylor, Spierling Bagsic, Samantha R, Farcas, Emilia, Roesch, Scott C, Schultz, James, Gilmer, Todd P, Godino, Job G, Savin, Kimberly L, Chichmarenko, Mariya, Jones, Jennifer A, Sandoval, Haley, Gallo, Linda C
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 04.01.2025
• Subjects: Adult; Aged; Cholesterol, LDL - blood; Comparative Effectiveness Research; Diabetes; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - therapy; Feedback; Female; Glycated Hemoglobin - analysis; Humans; Male; Middle Aged; Patient Education as Topic - methods; Text Messaging; clinical effectiveness; comparative effectiveness; type 2 diabetes; educational intervention DSMES; digital technology; Hispanic American
• ISSN: 0883-6612; 1532-4796; 1532-4796
• DOI: 10.1093/abm/kaae077

Abstract Objective To compare the effectiveness of a static, text-based diabetes education and support intervention (Dulce Digital, DD) versus a dynamic approach with personalized feedback and goal setting (Dulce Digital-Me, DD-Me) in improving diabetes outcomes. Design and methods Comparative effectiveness trial in 310 Latine adults with poorly managed type 2 diabetes in a Federally Qualified Health Center in Southern California, randomized to DD, DD-Me-Auto (algorithm-driven text-based personalized feedback), or DD-Me-Tel (coach delivered personalized feedback). Changes in HbA1c (primary outcome), low-density lipoprotein-cholesterol, systolic blood pressure, and patient-reported outcomes were examined across 6 and 12 months, with the primary comparison being DD versus DD-Me (combined automated and telephonic). Results Participants were 52.1 (±10.2) years old, 69.7% female, with HbA1c 9.3% (±1.6) at baseline. Across groups, there was a statistically significant improvement in HbA1c at 6 months (mean∆ per month = −0.17, 95% CI −0.20, −0.14; P < .001) and 12 months (mean∆ per month = −0.07, 95% CI −0.09, −0.05; P < .001). However, there were no time-by-group interaction effects indicating group differences in clinical outcomes across 6 or 12 months. The DD-Me groups showed greater improvements across time than the DD group for diabetes self-management behaviors. Conclusions Static and adaptive digital interventions for Latine adults with type 2 diabetes 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. ClinicalTrials.gov registration NCT03130699, Initial Release 04/24/2017, https://clinicaltrials.gov/ct2/show/NCT03130699?term=NCT03130699&draw=2&rank=1. Latine individuals with type 2 diabetes responded positively to static and adaptive digital text messaging approaches in their language of choice resulting in better glycemic outcomes. Lay Summary Diabetes prevalence is rising among US adults, affecting 37.3 million people, or 11.3% of the US population with higher rates in the Latine population. Diabetes poses a substantial burden on society, and individuals of low income from diverse backgrounds experience significant health disparities. Diabetes self-management education and support (DSME/S) provides a solid foundation to deliver better healthcare, improve adherence, quality of life, and cost outcomes, and reduce disparities. However, many at-risk individuals cannot access DSME/S due to practical barriers. This study compared the effectiveness of a static, text-based DSME/S intervention (Dulce Digital, DD) versus a dynamic approach with personalized feedback and goal setting (Dulce Digital-Me, DD-Me) in improving diabetes outcomes. The study compared blood sugar outcomes in 310 Latine adults with poorly managed type 2 diabetes in a Federally Qualified Health Center in Southern California, randomized to DD, DD-Me-Auto (algorithm-driven text-based personalized feedback), or DD-Me-Tel (coach delivered personalized feedback). Participants were 52.1 (±10.2) years old, 69.7% female, with HbA1c 9.3% (±1.6) at baseline. The program was feasible and acceptable in Latine individuals with type 2 diabetes, and they responded positively to static and adaptive digital text messaging approaches in their language of choice, resulting in better glycemic outcomes. Graphical Abstract Graphical Abstract