Dulce Digital-COVID Aware (DD-CA) discharge texting platform for US/Mexico border Hispanics with diabetes + COVID-19

Project Summary: Hispanics, a group that shows higher type 2 diabetes (T2D) prevalence, and poor self-management andclinical outcomes, have been disproportionally adversely impacted by COVID-19. The California Department ofPublic Health reports that Hispanics make up 39% of California's population but an unprecedented 57% of theconfirmed COVID-19 cases. This devastating finding is especially notable on the US/Mexico border. Diabeteshas emerged as a leading risk factor for severe COVID-19 illness leading to hospitalization, is associated withgreater disease severity and mortality and is an independent predictor of intensive care placement andinvasive ventilation. It is becoming increasingly clear that maintaining good glucose control improves prognosisof COVID-19 among people with pre-existing T2D. However, social distancing, quarantine, and stay-at-home/lockdown guidelines may impact one's ability to maintain adequate glycemic control. Research isneeded to evaluate the effect and clinical outcomes of a flexible, easily adopted low cost digital interventionthat improves glucose excursions and provides urgently needed COVID-19 mitigation strategies, amongrapidly rising groups of high-risk Hispanics with poorly controlled T2D in US/Mexico border communities.Strong evidence from our parent grant Dulce Digital-Me, supports the use of technology (such as textmessaging) alone or in combination with coaching interventions as a viable and desired method of deliveringtailored diabetes self-management education and COVID awareness messaging to high-risk, underservedpopulations in a manner that is more convenient for both patients and staff while having the added benefit ofbeing cost-effective for health systems, especially within low resource settings. However, effectiveinterventions may encounter barriers which preclude guaranteed success upon implementation in the realworld. This project, taking place along the San Diego/Tijuana border, historically the busiest land port of entryin the Western Hemisphere, will assess the effect of providing an enhanced digital texting intervention-DulceDigital-COVID Aware (DD-CA) to N = 172 Hispanic patients with T2D upon discharge from a recenthospitalization. Key outcomes will assess the impact of DD-CA on hospital readmissions at 30 and 90 dayspost-discharge, glucose control and patient reported outcomes at 90 days post-discharge while also assessingCOVID status and the implementation process. Given that DD-CA offers the potential to address many of thepractical barriers to access and extend the reach of diabetes services, while additionally providing COVIDawareness support, it offers an ideal low-cost and flexible solution to reduce hospital admissions and re-admissions in US/Mexico border communities significantly and simultaneously affected by COVID-19 and T2D.Implemented in a typical hospital and post-discharge setting, it augments existing care team processes, thusproviding a valuable test of real-world effectiveness. More importantly, by helping to reduce existing inequitiesin access to diabetes and COVID-19 care, this program aims to improve health outcomes on a larger scale.