title: Dulce Wireless Tijuana: A Randomized Control Trial Evaluating the Impact of Project Dulce and Short-Term Mobile Technology on Glycemic Control in a Family Medicine Clinic in Northern Mexico.
abstract: BACKGROUND
  The global epidemic of diabetes calls for innovative interventions. This study evaluated the effectiveness of the Project Dulce model, with and without wireless technology, on glycemic control and other clinical and self-reported outcomes in patients with poorly controlled type 2 diabetes in Mexico.
  
  
  METHODS
  Adults with type 2 diabetes and a glycated hemoglobin A1c (HbA1c) level of ≥8% were recruited from Family Medical Unit #27 of the Instituto Mexicano del Seguro Social (IMSS) in Tijuana, México, and randomly assigned to one of three groups: Project Dulce-only (PD); Project Dulce technology-enhanced with mobile tools (PD-TE); or IMSS standard of care/control group (CG). Clinical and self-reported outcomes were assessed at baseline, Month 4, and Month 10. Time-by-group interactions and within-group changes were analyzed.
  
  
  RESULTS
  HbA1c reductions from baseline to Month 10 were significantly greater in PD-TE (-3.0% [-33 mmol/mol]) and PD (-2.6% [-28.7 mmol/mol]) compared with CG (-1.3% [-14.2 mmol/mol]) (P = 0.009 and 0.001, respectively). PD-TE and PD also exhibited significant improvement in diabetes knowledge when compared with CG (P < 0.05 for both). No statistically significant differences were detected between PD and PD-TE on these indicators (P = 0.54 and 0.86, respectively). Several within-group improvements were observed on other clinical and self-report indicators but did not vary significantly across groups.
  
  
  CONCLUSIONS
  Project Dulce with and without wireless technology substantially improved glycemic control and diabetes knowledge in high-risk patients with type 2 diabetes in a Mexican family medical unit, suggesting that integrating peer-led education, nurse coordination, and 3G wireless technology is an effective approach for improving diabetes outcomes in high-risk populations.
authors.affiliation: 1 Family Medical Unit #27, Mexican Institute of Social Security , Tijuana, Baja California, Mexico .
authors.forename: María Cecilia
authors.initials: MC
authors.lastname: Anzaldo-Campos
authors.affiliation: 2 Autonomous University of Baja California , Tijuana, Baja California, Mexico .|3 International Community Foundation , San Diego, California.
authors.forename: Sonia
authors.initials: S
authors.lastname: Contreras
authors.affiliation: 2 Autonomous University of Baja California , Tijuana, Baja California, Mexico .
authors.forename: Adriana
authors.initials: A
authors.lastname: Vargas-Ojeda
authors.affiliation: 2 Autonomous University of Baja California , Tijuana, Baja California, Mexico .
authors.forename: Rufino
authors.initials: R
authors.lastname: Menchaca-Díaz
authors.affiliation: 4 Scripps Whittier Diabetes Institute , San Diego, California.
authors.forename: Addie
authors.initials: A
authors.lastname: Fortmann
authors.affiliation: 4 Scripps Whittier Diabetes Institute , San Diego, California.
authors.forename: Athena
authors.initials: A
authors.lastname: Philis-Tsimikas
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003131:Combined Modality Therapy / Q000451:nursing; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000451:nursing / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology / Q000517:prevention & control*; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D063731:Mobile Applications; D010348:Patient Care Team; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods*; D000067074:Peer Influence; D012306:Risk; D057566:Self Report; D059015:Wireless Technology
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human