With approximately 38 million American adults living with diabetes, it remains one of the nation’s most pressing health challenges — and the eighth leading cause of death. While there’s no cure, proper self-management greatly improves quality of life and prevents serious complications like hypertension, kidney failure and vision loss. Yet for many individuals, consistent support for managing diabetes day-to-day remains out of reach.
Putting Patients at the Center of Comparing Self-Care Approaches
The “Management of Diabetes in Everyday Life” (MODEL) study — a PCORI-funded patient-centered comparative clinical effectiveness research study — set out to compare three care approaches to help adults with diabetes and at least one other chronic condition better manage their health: Personalized text messages, printed educational materials or one-on-one health coaching. These three are among the most promising low-cost, patient-centered approaches, yet they have never been directly compared.
What made the MODEL study unique was its deeply patient-centered design. Ruthie Tate and her fellow Patient Advisory Council (PAC) members brought more than lived experience with diabetes; they brought fresh ideas and a strong voice for the community. The PAC played a key role in shaping the study, helping the research team better understand what patients truly wanted and needed. As Ruthie put it, making space for patients to “ask questions of their own” helped them feel more open to the study’s text messages, coaching and educational interventions.
The MODEL study enrolled participants from 18 clinics across the Mid-South. Most were women (67%) and averaged 54 years of age. Additionally, 90% lived in areas with limited access to traditional care — making them an especially important group to engage in efforts to improve chronic care delivery.
Study Results: What Worked
After one year, participants in all three groups reported improvements in healthy eating and physical activity, though medication adherence remained the same. Importantly, those who received personalized text messages reported more days following a healthful diet compared to those who only received printed materials. Health coaching didn’t show greater benefits than educational materials for improving diet.
The success of the text messaging approach wasn’t just about technology — it was about tailoring care to people in the real world. Participants chose their top health goal and how often they wanted to receive messages. Engagement remained high throughout the year, with 90% of participants staying involved. That level of consistent engagement speaks to the power of patient-informed design.
PCORI's Patient-Centered Approach Makes a Difference
The patient-centered engagement PCORI requires for the research it funds improves study feasibility, acceptability and quality as well as the relevance of findings. “One of the most important lessons we’ve learned from the experience is how important patient expertise is,” said principal investigator James Bailey, M.D., MPH, reflecting that even the study’s interventions were selected by the PAC. “There's extensive literature showing that tailored messages have excellent uptake.”
By requiring patient engagement and real-world relevance, results from PCORI-funded studies aim to make a difference in the lives of patients nationwide. The MODEL study demonstrates that when patients like Ruthie are part of the process, the outcomes can be more impactful. Sometimes, it only takes a simple suggestion — like a text message — to spark lasting change in one’s health.
Posted: April 18, 2025