Virtual Diabetes Care for Adults With Type 2 Diabetes on Medicaid and Insulin Therapy

This 12-month pilot tests a nurse-led, app-based intervention to improve diabetes self-management for Medicaid patients. It includes MyChart messaging to give education, phone help on problem-solving with clinicians, and using a diabetes app to track data. The study aims to enhance self-management behaviors through health technology.

Inclusion Criteria: * A1C \>7 for age 18-64, A1C\>8 for age 65 or older within 12 months prior baseline * A1C\>7 for age 18-64, A1c\>8 for age 65 or older at baseline * Medicaid recipient or dual Medicaid and Medicare recipient * Age 18 or older * Type 2 diabetes * On insulin therapy * Owning and using Android or iOS smartphone for at least 6 months * English proficiency * Adequate vision to read text messages on their current smartphone * Smartphone use proficiency. Smartphone proficiency will be self-reported and determined by telephone as the ability to use a smartphone in ways other than emailing, texting, and making phone calls. Exclusion Criteria: * Pregnancy * Patients with cognitive impairment who will be screened with the Six-Item Screener to Identify Cognitive Impairment Among Potential Research Subjects.