NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes

J Diabetes Sci Technol. 2017 May;11(3):468-475. doi: 10.1177/1932296817695337. Epub 2017 Feb 1.


Background: There is growing evidence for the feasibility of text-based interventions for pediatric patients with type 1 diabetes (T1D). However, less is known regarding whether the use of personalized text messages with high-risk youth and their caregivers is associated with improvements in youth health. This study examines the use of diabetes-specific texts and associated health outcomes for participants of the Novel Interventions in Children's Healthcare (NICH) program.

Methods: Text messages sent to youth with T1D and their caregivers during NICH intervention were coded regarding diabetes relevance and adherence-related content. Health outcome data (eg, HbA1c values, hospital admissions) prior to and following NICH program enrollment were collected.

Results: Fewer than half (43%) of texts sent to patients and their caregivers were identified as being related to diabetes, and over 95% of diabetes-related texts were identified as adherence-related. Participants in the NICH program demonstrated a significant decrease in HbA1c values, t(23) = 2.78, p ≤ .05, and DKA-related hospital visits, t(24) = 2.78, p ≤ .01, during program involvement. Although no relationships were identified between patient-recipient text characteristics and health outcomes, the frequency and type of text messaging with caregivers was significantly associated with changes in health outcomes.

Conclusions: This study represents the most extensive evaluation of diabetes-related SMS use and health outcomes for NICH participants to date. Findings demonstrate improvements in patient health during NICH program involvement. Implications include that sending frequent, personalized, and adherence-reinforcing texts to patients' caregivers may result in improved patient health, decreased utilization, and, potentially, associated reductions in health care costs.

Keywords: NICH; SMS; adolescence; mHealth; text message; type 1 diabetes.

MeSH terms

  • Adolescent
  • Caregivers
  • Child
  • Diabetes Mellitus, Type 1*
  • Female
  • Glycated Hemoglobin A / analysis
  • Humans
  • Male
  • Patient Education as Topic / methods*
  • Reminder Systems*
  • Retrospective Studies
  • Text Messaging*


  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human