Diabetes Disparities: Texting to Extend Treatment (DD-TXT)
Diabetes Disparities: Texting to Extend Treatment (DD-TXT)
One way to help Veterans improve their diabetes control is through the use of technology to
 help provide information, motivation, and reminders necessary to support diabetes
 self-management. The study will seek input from diverse groups of Veterans living with
 diabetes to help develop DD-TXT, a new customizable, interactive texting intervention that
 allows Veterans to choose what kinds of diabetes self-management support they need, and when.
 This diabetes support will be provided to Veterans through "Annie", a new VA texting system
 for self-management support. Patients will be randomized to receive DD-TXT or an
 education-only texting intervention called DSE that is based on a diabetes skills workbook in
 order to test the comparative effectiveness of DD-TXT.
Type 2 Diabetes is a common, complex health condition which can result in many serious and
 costly health complications if not treated and controlled properly. One in four Veterans are
 diagnosed with Type 2 Diabetes. Vulnerable Veterans, such as minority, low-income, or rural
 Veterans, and Veterans with comorbid mental health diagnoses, are disproportionately affected
 and are less likely to have their diabetes under control. The goal of this study, using a
 randomized comparative effectiveness design, is to test the comparative effectiveness of an
 interactive, tailored self-management texting protocol (DD-TXT), versus a traditional
 education-only intervention (DSE) in a sample of Veterans with uncontrolled diabetes.

 The investigators will recruit from Veterans age 18 years and above who are actively
 receiving care at the study sites (as determined by upcoming scheduled appointment) who have
 uncontrolled glucose (HbA1c >= 8.0% for at least 50% of the most recent 6 months).
 Participants who meet these conditions and enroll in the study will be randomized to one of
 two groups. Those randomized to the intervention group will receive text messages from the
 DD-TXT protocol for 6 months, and those in the comparison group will receive text messages
 from DSE, a diabetes skills education-only texting protocol, for 6 months. The primary
 outcome will be HbA1c percent time in control. Secondary outcomes include self-reported
 adherence to diabetes self-care recommendations (SCI-R), diabetes self-efficacy, diabetes
 distress, LDL, and blood pressure control. The investigators hypothesize that DD-TXT will
 result in better proximal health outcomes and diabetes self-management behaviors vs an
 education-only protocol (DSE).
Inclusion Criteria:

 -  Veterans

 -  active VHA patients with type 2 diabetes

 -  have had at least 4 VA outpatient encounters in the previous year

 -  have a future appointment scheduled, and not be hospitalized or institutionalized or
 have participated in Aim 1 DD-TXT development

 -  must have access to their own or a cohabiting family member's cell phone or smartphone
 for participation. --must be willing and able to text, not have any visual impairment
 that would prevent them from reading or replying to text messages, and must be
 cognitively capable of consent to participate.

 -  must also have HbA1c lab data (2+ values) for the 12 months prior to RCT recruitment.

 -  must have inadequate glycemic control for at least 50% of the 6 months before
 enrollment.

 Exclusion Criteria:

 -Non-Veterans