# Dulce Digital-Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes

> **NIH NIH R01** · SCRIPPS HEALTH · 2020 · $563,051

## Abstract

Project Summary.
Individuals of low socioeconomic (SES) and ethnic minority status, including Hispanics, the largest U.S. ethnic
minority group, are disproportionately affected by diabetes. Poor healthcare access and cultural barriers
prevent optimal care, adherence, and clinical benefit, thus placing Hispanics at high risk for costly diabetes
complications. Our established academic-healthcare-community partnership has unique experience in
developing and testing innovative, cost-effective, and sustainable chronic care interventions to reduce
disparities and improve health in underserved communities. We recently developed Dulce Digital (i.e., “one-
size-fits-all” educational text messages, with nurse monitoring of patient-transmitted blood glucose values),
which improved glycemic control across 6 months, relative to usual care in a recent randomized controlled trial
(RCT) of N=126 Hispanic patients with poorly controlled type 2 diabetes (T2DM). Our process evaluation
indicated that Dulce Digital was both feasible and acceptable from patient and provider perspectives; however,
patients expressed a preference for a more individualized intervention, and providers requested an even
greater focus on health behavior change. Thus, the proposed RCT will examine the comparative effectiveness
of Dulce Digital versus “Dulce Digital-Me” (DD-Me) in N=414 Hispanic adults of low SES with poorly controlled
T2DM from Neighborhood Healthcare, a San Diego Federally-Qualified Health Center. Guided by patient and
provider feedback, DD-Me includes Dulce Digital components plus personalized goal-setting and feedback that
is responsive to the individual’s needs and preferences. The DD-Me adaptive feedback component will be
informed by the Resources and Support for Self-Management Model and Operant Conditioning Theory, and
based on the individual’s progress on intermediate behavioral targets (i.e., medication adherence assessed by
wireless sensor; brief mobile phone-based assessments of diet, physical activity, stress). Feedback will be
delivered via algorithm-driven automated messaging in 50% of DD-Me participants and by the care team
medical assistant in the remaining half to determine the feasibility and acceptability (given the purported
cultural relevance of interpersonal relationships in the Hispanic culture), and the comparative effectiveness and
cost of each delivery method. Changes in indicators of diabetes clinical control [i.e., glycosylated hemoglobin
(HbA1c) low density lipoprotein cholesterol (LDL-C), systolic blood pressure (SBP)], patient-provider
communication, and patient adherence (i.e., to medication and other diabetes self-management behaviors) will
be evaluated across twelve months. Thorough process and cost-effectiveness analyses will evaluate the
scalability and sustainability potential of DD-Me. Our comparative evaluation of two mHealth approaches will
elucidate how technology can be integrated most effectively and efficiently within existing nurs...

## Key facts

- **NIH application ID:** 10006888
- **Project number:** 5R01DK112322-05
- **Recipient organization:** SCRIPPS HEALTH
- **Principal Investigator:** Linda C Gallo
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2020
- **Award amount:** $563,051
- **Award type:** 5
- **Project period:** 2016-09-20 → 2022-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10006888

## Citation

> US National Institutes of Health, RePORTER application 10006888, Dulce Digital-Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes (5R01DK112322-05). Retrieved via AI Analytics 2026-05-27 from https://api.ai-analytics.org/grant/nih/10006888. Licensed CC0.

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