Assessing Home Food Environment and Diabetes Self-management Among Adult Type 2 Diabetes Patients

Type 2 diabetes and its complications have become an important public health problem,
affecting nearly 350 million adults worldwide. However, successfully managing type 2 diabetes
through proper nutrition and healthy lifestyles remains challenging for many diabetes
patients. In this proposed project the investigators will (1) examine the impact of diabetes
self-management education using text messaging on increasing awareness of CVD risk
perception, dietary intake, physical activity, diabetes self-management, and quality of life
among adults with type 2 diabetes; and (2) determine whether diabetes self-management
education using text messages improve HA1C among adults with Type 2 diabetes. The study
sample will include 100 adult type 2 diabetes patients (30 years or older). Inclusion
criteria for the study sample of adult type II diabetes patients are: adults ages 30 or
older, English speaking, and Hemoglobin A1C levels > 6.5%.

Adult type 2 diabetes patients will be recruited from the Center for Diabetes & Nutritional
Health, an outpatient diabetes clinic of Methodist Hospital in Omaha with the assistance of
Certified Diabetes Educators and Registered Dietitians. Diagnosis of type 2 diabetes will be
based on patient self-report and verified by the Co-Primary Investigator (who is Certified
Diabetes educator and registered dietitian at the Methodist Hospital. The recruited adult
type 2 diabetes patients will be randomly assigned into the intervention group (50
participants) and control group (50 participants). The intervention group will receive 3
messages weekly consisting of nutrition education and diabetes self-management information
and skills for 3 months (12 weeks). The messages will consist of information on how to
increase fruits and vegetables and reduce high-fat and sugary foods intake, increase the
availability of fruits and vegetables and reduce high-fat and sugary foods in the home,
strategies to increase diabetes self-management skills, and awareness of cardiovascular
disease risk perception and knowledge. The text messages will be derived from the American
Association of Diabetes Educator (AADE) handouts ("Reducing Risks", "Monitoring", "Healthy
Coping", "Problem Solving", "Taking Medication", "Healthy Eating", and "Exercise") Text
messages will be positive and motivating and will include a link to a specific AADE7 handout
that allows participants to open and retrieve the specific AADE7 handout. Text messages will
be sent by the project investigators to the participants in the intervention group via a free
computer-based text messaging service. The computer is password protected and can only be
accessed by the investigators. Participant's phone numbers used for text message intervention
will be kept private. Only investigators and research assistant know the participant's cell
phone numbers used for text message intervention and each participant's cell number will not
be shared with anyone else including other study participants. Text messages will be sent by
the project investigators or research assistant to the patients and are one-way text
messages, meaning that patient do not need to reply to the text message. If a patient has a
medical concern about his/her diabetes, he/she is advised not to send a text message to the
investigator, but to contact his/her physician or call 911 instead. The control group will
not receive text messages. The participants (both intervention and control group) will
complete surveys at baseline (before study begins) and at the conclusion of the study (at
three month of the intervention) about their dietary and lifestyle habits, diabetes self-care
management, awareness of cardiovascular diseases, home food environment and quality of life.
The investigators will also collect patient's self-report Hemoglobin A1C values at baseline
and at the conclusion of the study (at three month of the intervention). If test effective,
the proposed text messaging intervention will help type 2 diabetes patients to manage
diabetes and have a healthier lifestyle.

Inclusion Criteria:

- Self-report adult type 2 diabetes patients

- Adults ages 30 or older

- English speaking

- Self-report Hemoglobin A1C > 6.5%

- Have a cell phone able to receive text messages

Exclusion Criteria:

- Individuals without Type 2 diabetes

- Less than 30 years of age

- Self-report Hemoglobin A1C less than 6.5%

- Does not have a cell phone to receive text messages

- Individuals who don't speak and understand English