I used BEATDiabetes in my endocrinology practice. BEATDiabetes is a mHealth program for people with Type 2 diabetes and prediabetes that combines frequent text message-based engagement and financial incentives to catalyze behavior change and improve blood sugars. Text messaging leverages technology that most patients are already using to deliver advice about diet, exercise, and diabetes self-care at the times and places where people are actually making the decisions that affect their health. Participants receive semi-customized diabetes management or prevention tips several times a week and have the option to schedule optional, customized reminders to check blood sugars, take medications, and exercise. The program also incorporates financial incentives to provide short-term motivation for people to make healthy choices that often have a long time horizon for benefit. For the majority of participants, this consists of the ability to qualify for the $1000 BEATDiabetes Drawing held 3 times a year, although sites have the capacity to customize or opt out of the incentives. Participants with Type 2 diabetes earn entry in the drawing by improving their A1C by 1 point compared to their previous best while in the program or by achieving an A1C under 7, and participants with prediabetes earn entry in the drawing by returning their A1C or fasting glucose to normal, non-prediabetic levels.

Participants typically sign-up online, although they can also enroll on paper or over the phone. Since it is a text message-based program, all that is required is a mobile phone that can accept text messages. Although there is the capacity for two-way messaging, the program is based on one-way push messaging, and participants are generally not expected to respond to the messages. After the initial referral, the program runs independently of the clinic with the exception of providing A1C results at baseline and 3 times a year in advance of the drawings.

In a pilot project in participants with uncontrolled Type 2 diabetes, participants achieved an average A1C improvement of 0.8-1 during the course of the 12 month program. Participants rated the program 4.6 out of 5 stars. Most participants appreciated the additional support between clinic visits and especially found the text reminders helpful in improving compliance with glucose testing and medications. In my practice, most patients reported very positive feedback, improvement in A1c's, felt like texting helped stay on track, improved glucose testing and medication compliance.