Diabetes is characterized by high blood glucose resulting from defects in the production of insulin and related factors. Poor medication adherence is associated with diminished control of type 2 diabetes mellitus (T2DM) and can lead to increased disease complications and a higher cost burden. A primary causative factor for suboptimal adherence is patients' inability to recall and act upon proper dosage regimens. Health literacy and active patient involvement in treatment decisions are associated with adherence. Therefore, the objective of the study is to improve medication adherence in patients with T2DM via use of short message service (SMS) text message reminders as measured by change in percent hemoglobin A1C (HbA1c). Additional study aims include examining the predictive potential of health literacy and the impact of the participatory medicine model on medication adherence. A randomized, controlled, open-label study will be conducted at a clinic pharmacy that will enroll 162 patients with T2DM. Patients will be randomized to one of three arms: 1) standard care [control], 2) daily, unidirectional SMS medication reminder, and 3) bidirectional, patient selected SMS medication reminders. Medication adherence will be assessed via Morisky Medication Adherence Scale (MMAS) and confirmed by change in HbA1C, measured at baseline, 3-, and 6-months. Health literacy will be evaluated with the Rapid Estimate of Adult Health Literacy - Short Form (REALM-SF). Correlation analyses will be used to characterize the effect of SMS on adherence. A repeated measure Analysis of Variance (ANOVA) approach will be used to compare the group and time factors. If significant improvement is detected in the intervention group, it could be the basis for a large, multi-center study to be used as guidance for a low cost, high impact method to increase medication adherence, improve patient outcomes, and help address the $174 billion cost burden of the this public health issue.