OBJECTIVE Type 2 diabetes is growing in epidemic proportions and disproportionately affects lower income, diverse communities. Text messaging may provide one of the most rapid methods to overcome the “digital divide” to improve care.

RESEARCH DESIGN AND METHODS A randomized, nonblinded, parallel-groups clinical trial design allocated N = 126 low-income, Hispanic participants with poorly controlled type 2 diabetes to receive the Dulce Digital intervention or usual care (UC). Dulce Digital participants received up to three motivational, educational, and/or call-to-action text messages per day over 6 months. The primary outcome was HbA_1c; lipids, blood pressure, and BMI were secondary outcomes. Satisfaction and acceptability were evaluated via focus groups and self-report survey items.

RESULTS The majority of patients were middle aged (mean age 48.43 years, SD 9.80 years), female (75%), born in Mexico (91%), uninsured (75%), and reported less than a ninth-grade education level (73%); mean baseline HbA_1c 9.5% (80 mmol/mol), SD 1.3, and fasting plasma glucose 187.17 mg/dL, SD 64.75. A statistically significant time-by-group interaction effect indicated that the Dulce Digital group achieved a significantly greater reduction in HbA_1c over time compared with UC (P = 0.03). No statistically significant effects were observed for secondary clinical indicators. The number of blood glucose values texted in by participants was a statistically significant predictor of month 6 HbA_1c (P < 0.05). Satisfaction and acceptability ratings for the Dulce Digital intervention were high.

CONCLUSIONS Use of a simple, low-cost text-messaging program was found to be highly acceptable in this sample of high-risk, Hispanic individuals with type 2 diabetes and resulted in greater improvement in glycemic control compared with UC.

目的2型糖尿病正在以流行病的比例增长，并且不成比例地影响着低收入，多样化的社区。文本消息传送可能是克服“数字鸿沟”以改善护理的最快捷方法之一。

研究设计与方法一项随机，无盲，平行组的临床试验设计分配了N = 126名2型糖尿病控制不佳的低收入西班牙裔参与者，以接受Dulce Digital干预或常规护理（UC）。Dulce Digital参与者在6个月内每天收到多达三则激励，教育和/或号召性用语消息。主要结果是HbA _1c ; 血脂，血压和BMI是次要结果。通过焦点小组和自我报告调查项目评估满意度和可接受性。

结果大多数患者为中年（平均年龄48.43岁，标准差9.80岁），女性（75％），在墨西哥出生（91％），未投保（75％），并且报告的教育水平低于九年级（ 73％）; 平均基线HbA _1c 9.5％（80 mmol / mol），SD 1.3，空腹血糖187.17 mg / dL，SD 64.75。具有统计学意义的逐组交互作用效果表明，与UC相比，Dulce Digital组随着时间的推移实现了HbA _1c的明显降低（P = 0.03）。二级临床指标未观察到统计学上的显着影响。参与者发短信输入的血糖值数量是6个月HbA _1c（P<0.05）。Dulce Digital干预的满意度和可接受性等级很高。

结论在这种高风险的2型糖尿病西班牙裔个人样本中，使用简单，低成本的短信程序是高度可接受的，与UC相比，其血糖控制水平得到了更大的改善。