Hispanics, a group that showed higher type 2 diabetes (T2D) prevalence and poor self-management and clinical outcomes, were disproportionately adversely impacted by COVID-19. The California Department of Public Health reported that Hispanics made up 39% of California’s population but an unprecedented 57% of the confirmed COVID-19 cases. This devastating finding was especially notable on the US/Mexico border. Diabetes had emerged as a leading risk factor for severe COVID-19 illness leading to hospitalization, was associated with greater disease severity and mortality, and was an independent predictor of intensive care placement and invasive ventilation. It became increasingly clear that maintaining good glucose control improved the prognosis of COVID-19 among people with pre-existing T2D. However, social distancing, quarantine, and stay-at-home/lockdown guidelines may have impacted one’s ability to maintain adequate glycemic control.

Research was needed to evaluate the effect and clinical outcomes of a flexible, easily adopted low-cost digital intervention that improved glucose excursions and provided urgently needed COVID-19 mitigation strategies, among rapidly rising groups of high-risk Hispanics with poorly controlled T2D in US/Mexico border communities. Strong evidence from the parent grant Dulce Digital-Me supported the use of technology (such as text messaging) alone or in combination with coaching interventions as a viable and desired method of delivering tailored diabetes self-management education and COVID awareness messaging to high-risk, underserved populations in a manner that was more convenient for both patients and staff while having the added benefit of being cost-effective for health systems, especially within low-resource settings. However, effective interventions encountered barriers which precluded guaranteed success upon implementation in the real world.

This project, which took place along the San Diego/Tijuana border, historically the busiest land port of entry in the Western Hemisphere, assessed the effect of providing an enhanced digital texting intervention—Dulce Digital-COVID Aware (DD-CA)—to N = 172 Hispanic patients with T2D upon discharge from a recent hospitalization.