Cell phone-assisted self-management of diabetes offers a new approach to improving chronic care; however, introducing this new technology presents many challenges to a health care team. The George Washington University-District of Columbia Cell Phone Diabetes Project enrolled 32 patients with Type 2 diabetes from a community clinic using patients' cell phones connected to the Well Doc Diabetes Manager System with monitoring by case managers and monthly reports to primary care providers. Despite monetary incentives (cell phone rebates), dropout rate was high (50%), because of lack of use or inability to afford low-cost cell phone service. Active patients had sustained system use with improved diabetes standard-of-care goals and reduced hospitalizations and emergency department visits. On the basis of this pilot program, the authors assessed the multiple links in the chain (patients, case managers, primary care providers, support staff, medical record systems, disease management software, cell phones) that affect the success of a mHealth chronic care strategy.