 SMS is comprised of two complementary and interactive components: 1 patient engagement e.g., the process of eliciting and responding to patients emotions and motivations related to health behaviors, and 2 behavioral change tools e.g., selecting specific goals, creating action plans. While several sophisticated SMS programs have been developed for T2DM, the vast majority are designed with a narrow focus on behavioral change tools, largely ignoring unique aspects of the patient context that drive and maintain health behavior. Considerable clinical research suggests that the addition of a structured, evidenced-based program of patient engagement can maximize the effectiveness of SMS programs for patients with T2DM in primary care. 