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Dr. Arora and Dr. Menchine are Associate Professors of Emergency Medicine at the Keck School of Medicine of the University of Southern California. In the Los Angeles County public healthcare system, low-income patients with diabetes face significant barriers to accessing primary care and the health education they need. Increasingly, patients in safety-net systems rely on overcrowded, ill-equipped emergency departments (ED) for chronic diabetes care. Our previous work in the Los Angeles County Hospital ED has shown that our patients with diabetes have: 1) extremely poor glycemic control (mean HbA1C = 8.8%) 2) critical gaps in diabetes knowledge 3) high prevalence of obesity (51% BMI >30) and 4) high prevalence of depression (34% major depression). Alarmingly, 50% reported being hospitalized in the past year, and 1/3 had no primary care. Innovative approaches are needed to reach, engage and activate this at-risk population.

Mobile health (mHealth) refers to the use of mobile phones and other mobile devices as a platform on which to provide public health or medical interventions. The clinical and public health efficacy of mHealth is only beginning to be rigorously assessed but initial results of several trials assessing outcomes in patients with diabetes is encouraging. However, there have been no trials utilizing mHealth in disparity populations, and the impact on Spanish-speaking Latinos is wholly unknown. We present the 3-month follow-up data of our 6 month TExT-MED (Trial to Examine Text-Based mHealth for Emergency department patients with Diabetes) RCT in which patients received unidirectional twice-daily text messages designed to motivate, educate and empower patients with poorly-controlled diabetes.  This innovative, easily adaptable and low-cost solution has potential to improve glycemic control, knowledge and healthy lifestyle choices in a patient population that has been difficult to reach and almost impossible to treat by transforming an ED visit into the beginning of a lasting and successful long-term diabetes management plan.