Text Messaging Interventions Help Improve Glycemic Control for Diabetes

Pharmacists are increasingly recognized as essential members of the diabetes care team, particularly as new digital health strategies emerge to tackle the chronic challenges of medication adherence and complex treatment plans.^1,2 A recent systematic review and meta-analysis highlights text messaging interventions as a scalable approach that offers modest yet statistically significant improvements in glycemic control, providing pharmacists with a powerful adjunct to traditional care models.³

“Mobile health technologies, particularly text messaging interventions, are emerging as promising tools to bridge care gaps and complement in-person evaluations due to their scalability and asynchronous nature,” the study authors said.³ “These interventions leverage existing cellular network infrastructure and take advantage of a behavior that is deeply ingrained in daily life across socioeconomic groups.”

Text messaging interventions are proving to be effective for enhancing diabetes management, demonstrating an association with reductions in hemoglobin A_1c (HbA_1c) over short periods. Specifically, studies show that texting interventions led to a 0.29-unit greater reduction in percent HbA_1c over control groups after 3 months and a 0.19-unit greater reduction after 6 months.³

This short-term impact is particularly pronounced in patients struggling most with their control. Among those with a mean baseline HbA_1c of 8.6% or greater, texting was associated with a 0.48-unit greater HbA_1c reduction at 3 months and a 0.36-unit greater reduction at 6 months. These interventions promote glycemic control by providing awareness of blood glucose trends and encouraging healthy behaviors, including medication adherence, physical activity, and healthy eating.³

The integration of such technology is highly relevant given that people with diabetes face a high risk for medication-related issues due to often having complex treatment plans, multiple medical conditions, and numerous health care providers and medicines. Despite advances, adherence remains a significant hurdle, with about 50% of chronic disease medications, including those for diabetes, not being taken as prescribed at the correct time or dose relative to eating. Furthermore, studies indicate that 20% to 30% of all medication prescriptions are never filled.¹

In addressing these adherence and control gaps, pharmacists are well-positioned as experts in pharmacotherapy, equipped to identify, prevent, and resolve medication-related problems. This partnership often takes place through collaborative drug therapy management (CDTM), which has been linked to improved blood sugar control in people with diabetes. Within CDTM, pharmacists conduct comprehensive reviews of medicines and medical records, coordinate with the patient's diabetes care team, and assess patient responses to therapy, which can lead to timely interventions.¹ Pharmacists’ clinical activities can even include changing the regimen or adjusting dosing after obtaining agreement from the prescriber.²

The intervention strategies most frequently utilized by pharmacists in diabetes management are comprehensive diabetes education and medication review.² Pharmacists educate patients on safely using their medicines and blood glucose meters, and they also advise patients about diabetes self-management and refer them to specialized services like diabetes self-management education and support.¹ These efforts, whether delivered through traditional face-to-face sessions or increasingly via scheduled telephone calls, often incorporate a combination of strategies to improve patients’ medication adherence and glucose control.²

While digital tools like text messaging offer a compelling avenue to improve short-term outcomes, particularly when delivered as part of multicomponent interventions, the benefits observed in studies tend to diminish by 12 months, according to the study authors. This underscores the critical necessity for pharmacists to employ comprehensive, sustained support strategies—like promoting the ABCs of diabetes (A_1C, blood pressure, cholesterol, and smoking cessation) and considering socioeconomic factors—in addition to leveraging digital aids to achieve durable, clinically meaningful HbA_1c reductions. The ability of pharmacists to integrate medication review, patient education, and technology into a holistic service model is key to enhancing patient outcomes and simplifying the complexities inherent in long-term diabetes management.^1-3

“Across 29 RCTs [randomized controlled trials], texting interventions were associated with modest, statistically significant reductions in HbA_1c at 3 and 6 months versus usual care, with no clear benefit and high heterogeneity by 12 months,” the study authors wrote.³ “Effects were larger in studies with higher baseline HbA_1c, highlighting baseline control as a key effect modifier.”

READ MORE: Insulin Management Resource Center

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REFERENCES

1. CDC. Promoting medication management. Updated May 15, 2024. Accessed November 19, 2025. https://www.cdc.gov/diabetes/hcp/clinical-guidance/promote-medication-management.html

2. Hassan F, Hatah E, Ali AM, Wen CW. The intervention strategies and service model for pharmacist-led diabetes management: a scoping review. BMC Health Serv Res. 2023;23(1):46. Published 2023 Jan 18. doi:10.1186/s12913-022-08977-1

3. Pirouzmand N, Ko GS, Godoy LC, et al. Text messaging interventions are associated with reductions in HbA1c among patients with diabetes: a systematic review and meta-analysis. BMJ Open Diabetes Res Care. 2025;13(6):e005218. Published 2025 Nov 16. doi:10.1136/bmjdrc-2025-005218