Please select the eligibility criteria that correspond to the clinical trial below.
Title: The Mobile Insulin Titration Intervention (MITI) Study: Innovative Chronic Disease Management of Diabetes
Brief Summary: The purpose of this pilot study is to determine whether text message (and phone) communication can be effectively utilized to adjust long-acting insulin, compared to standard practice.


Options:
A: Providers:

Physicians will be eligible if they have a significant proportion of patients age 40 or older with metabolic disorders.

Inclusion criteria for nurses will be:

* a current RN, LPN certificate or BSN degree
* practicing at least 10 hours weekly
* providing primary care to adults over age 40 years with chronic illness

This should ensure that we recruit physicians and nurses who teach patients about medication as part of their routine responsibilities.

Patient Participants:

Community-dwelling adults who are patients of participating providers and who meet the following inclusion criteria will participate:

* age 40 and older
* native speaker of English or English speaker before age of 6
* no physical or cognitive impairments that could limit participation (e.g., stroke in the last 3 years, current cancer treatment involving radiation or chemotherapy)
* score of 24 or higher on the Mini Mental State Exam (Folstein, Folstein, \& McHugh, 1975)
* no severe visual impairment (\<20/50 corrected vision) or auditory impairment that would limit participation
* diagnosis of type 2 diabetes or other metabolic disorders (they are also likely to have other chronic illnesses such as hypertension)
* taking at least 5 prescribed medications
* HbA1c level of 7.0 or higher
B: Inclusion Criteria:

* \>= 18 years of age
* Have a designated Palo Alto Medical Foundation Primary Care Provider (PCP)
* Seen in primary or specialty care at the Palo Alto Division at least once in the preceding 24 months
* Diagnosis of diabetes
* Baseline A1C \>= 7.5%

Exclusion Criteria:

* Initial diagnosis of diabetes within the last 12 months
* Diagnosis of Type 1 diabetes
* Inability to speak and read in English
* Lack of regular access to a computer with Internet and email capabilities
* Unwilling to perform any self-monitoring at home, including blood glucose and blood pressure%
* Pregnant, planning to become pregnant, or lactating
* Currently enrolled in a care management program at Palo Alto Medical Foundation or elsewhere
* PCP determination that the study is inappropriate or unsafe for the patient
* Investigator discretion for clinical safety or protocol adherence reasons
C: Inclusion Criteria:

* Initiating long-acting insulin treatment or initiating the titration of long-acting insulin treatment
* Speaks English or Spanish
* Hemoglobin A1c \> or = 8%
* Able and willing to inject insulin
* Able and willing to provide informed consent

Exclusion Criteria:

* Short-acting insulin treatment
* Systemic glucocorticoids
* Sustained elevated serum creatinine \> or = 1.5 mg/dL for men and \> or = 1.4 mg/dL for women
* Hypoglycemia unawareness
* Type 1 diabetes
D: Inclusion Criteria:

* Written Informed Consent obtained before any trial-related activities Type 2 DM subjects;
* Age \> 18 years old,male or female;
* Continuous treated with two or more oral antidiabetic drugs (OADs) for the last 3 months,and the current HbA1c\>7.5%;
* Cooperative with structured management;

Exclusion Criteria:

* Subjects with type 1 diabetes;
* Gestational diabetes mellitus and other specific types DM;
* Those who are unwilling to sign in ICF;
* Subjects with repeated hypoglycemia;
* Subjects with BMI\>30kg/m2;
* Impaired liver function,defined as alanine aminotransferase (ALAT)\>= 2.5 or alkaline phosphatase (ALP)\>= 2 times upper referenced limit times upper normal limit;
* Females of childbearing age who are pregnant, breast-feeding or have the intention of becoming pregnant or not using adequate contraceptive methods throughout the trial (adequate contraceptive measures as required by local law or practice);
* Mental incapacity, unwillingness, or language barrier precluding adequate understanding or cooperation;
* Any other clinically significant condition or major systemic diseases, including serious coronary heart disease, cardiovascular disease, myocardial infarction within the past 12 months; severe neurology or psychology or psychiatric diseases; serious infection; actively disseminated intravascular coagulation;
* Malignant neoplastic diseases (except carcinoma in situ);
* Current addiction to alcohol or other addictive substances;

Answer: C