The study did produce a statistically significant reduction in HbA1C in the Spanish-speaking cohort (-1.2 percent in the intervention group compared with -0.4 percent in the control group, D of 0.8 percent, [p=.025]). The Spanish cohort also maintained the significant differences in medication adherence and improvements to other secondary outcomes observed in the overall population. Additionally, the participants in the intervention group were 30.3 percent less likely to return to the ED than those in the control group (35.9 percent versus 51.6 percent, D of 15.7 percent [95 percent CI 9.4 percent to 22 percent], [p=0.073]).

Overall, 93.6 percent of the participants interviewed in follow-up enjoyed the TExT-MED program, and 100 percent would recommend it to family and friends. Notable quotes from patients include:

• “I am living well with this program. It has helped me enormously, enormously I come because it’s worked for me. It has worked for me. A lot.” (translated from Spanish)
• “They remind us not to forget to take the medicine and talk to the doctor. Be on time with your medicines. Do not wait to the last minute until we run out. We see all of this in those in the messages.”
• “It has been a very good program for all the people with diabetes, and with this program we are better controlling our lives, our way of living.” (translated from Spanish)

The next generation of the program is now available from Agile Health, which acquired commercial rights for TExT-MED from USC. The enhanced program, called MyAgileLife, has been expanded to include three messages per day. With a larger library of motivational and behavioral mastery messages, quizzes, and challenges, the messaging helps encourage and empower individuals to establish and maintain a productive primary-care relationship and to rationally utilize the broader health-care system to avoid the debilitating and costly complications that accompany poor glycemic control. New in this version is interactive, keyword-driven functionality, allowing participants to request and receive additional support 24-7 to help with mood or motivation, deal with slipups, or provide healthy tips when dining out or shopping for groceries. Program participants can specify the times of day they want to receive the messages and add personal daily reminders to take specific medications, check blood glucose, eat, and/or exercise at certain times of the day—or just walk the dog.

TExT-MED adds to the growing body of literature supporting mHealth as an innovative public-health solution for EDs that is effective, pragmatic, highly scalable, low cost, and widely accessible as well as may reduce ED visits while improving community health.