Mobile technology enhances the potential to assess, prompt, educate, and engage individuals with diabetes. The near-ubiquitous presence of mobile phones allows real-time contextually relevant support for diabetes self-care. We review the design of mobile interventions included in a recent meta-analysis. Although mobile programs can lead to improvements in glycemic control, many aspects, such as the role of the diabetes clinician, real-time features, and patient engagement have not been documented. Studies with the greatest impact on hemoglobin A(1c) integrated patient feedback and a role for clinicians. Research is needed regarding feasible and efficacious roles for clinical support in mobile interventions. Recommendations for design and research include the following: consideration of patient and clinician burden; identification of patterns and metrics for patient treatment adherence and engagement; integration of goal setting and problem solving; enhancing patient education; a greater focus on patient-centered motivational strategies; and utilization of study designs that relate intervention design elements to outcomes.