Using Remote Monitoring to Address Health Disparities in Type 2 Diabetes
- Conditions
- Diabetes Mellitus, Type 2
- Interventions
- Other: Usual CareDevice: Blood glucose monitor with Digital Platform and Health CoachingDevice: Continuous glucose monitor
- Registration Number
- NCT06517576
- Lead Sponsor
- Lawndale Christian Health Center
- Brief Summary
Patient populations at community health centers, specifically Black or African American and Hispanic or Latino populations with Type 2 diabetes, experience significant health disparities. In particular, they have higher rates of diabetes-related complications and other related conditions such as myocardial infarction, cerebrovascular disease, kidney failure, blindness, neuropathy, and the risk of amputation. Diabetes affects 34 million adults in the US. Achieving a target HbA1c less than 8% can be challenging through diabetes management. Patients are able to monitor their blood glucose levels with devices such as blood glucose meters or continuous glucose monitors to facilitate diabetes management and glycemic control. Past studies have demonstrated that these devices are effective in engaging patients in the improvement of diabetes management. Current advancements in remote patient monitoring and self-monitoring have been observed to be effective in facilitating improvement in diabetes outcomes. However, the effectiveness and financial feasibility of these devices delivered in conjunction with automated patient engagement systems in remote patient monitoring programs is not well understood among underinsured, underserved, and vulnerable minority populations as they face a high-cost barrier particularly with continuous glucose monitors. To better address this gap in knowledge, this pilot study will compare and examine the effectiveness of these interventions on patient outcomes with Type 2 diabetes among populations in the West Side of Chicago. Study the comparative effectiveness among patients with uncontrolled Type 2 diabetes on insulin in an intervention group using remote patient monitoring and automated patient engagement system with blood glucose monitors to a group using a self-monitoring program with continuous glucose monitors and a usual care group receiving standard care. Conduct a feasibility analysis and financial impact of these programs among an underinsured and underserved population of Black/African Americans or Hispanic/Latinos with Type 2 diabetes.
- Detailed Description
This will be conducted at a Lawndale Christian Health Center, a community health center in the West Side of Chicago that serves a largely Black or African American and Hispanic or Latino population. To accomplish this objective, Aim 1 will study the impact on patients with uncontrolled Type 2 diabetes on insulin by comparing an intervention group that features remote patient monitoring with an automated patient engagement system and health coaching using blood glucose meters compared to a group that features a self-monitoring program using continuous glucose monitoring devices and a usual care group with standard care, and Aim 2 will examine the feasibility of implementing these interventions and financial impact of each treatment group at a community health center. To understand the effect of this study on health outcomes, patient level data will be examined including primary outcomes for health measurements such as HbA1c, blood glucose, BMI/weight, estimated glomerular filtration rate (eGFR), patient-reported outcomes including medication adherence, daily activities, diabetes self-management activities, and secondary outcomes for health measurements such as LDL cholesterol, systolic and diastolic blood pressures, as well as implementation outcomes such as acceptability, appropriateness, and feasibility. The costs of implementation and delivery will be examined using a budget impact analysis. This study will be essential for informing the impact on health disparities through remote monitoring with automated patient engagement compared to self-monitoring when providing care for underinsured and underserved populations.
Recruitment & Eligibility
- Status
- ENROLLING_BY_INVITATION
- Sex
- All
- Target Recruitment
- 150
- 18 years of age or older
- Have an assigned primary care provider
- Diagnosis of Type 2 diabetes
- Medication use is insulin
- HbA1c of 8.0% or higher
- Diagnosis of chronic kidney disease at Stage 4 or higher
- Diagnosis of pregnancy
- Diagnosis of behavioral health conditions including serious mental illness or severe depression in the past 6 months.
- All participants must have a smartphone that is able to access internet services.
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Usual care group receiving standard care Usual Care Participants in this group will receive standard care for diabetes. Remote patient monitoring and automated patient engagement system with blood glucose monitors Blood glucose monitor with Digital Platform and Health Coaching Participants in this group will receive blood glucose monitors and will check their blood glucose daily with monitoring through a digital platform and provided health coaching. Self-monitoring program with continuous glucose monitors Continuous glucose monitor Participants in this group will receive continuous glucose monitors and will self monitor their blood glucose measurements with support by their care team.
- Primary Outcome Measures
Name Time Method Blood Glucose 4 Months Blood glucose measurements based blood glucose monitor (BGM) and continuous glucose monitor (CGMs).
Engagement with digital platform with a daily submission of blood glucose 4 Months Daily blood glucose measurements from blood glucose monitor submitted to the digital platform
Implementation - Acceptability of Intervention Measure (AIM) Baseline and at 4 Months Self-reported perception among patients that this service is agreeable, palatable, or satisfactory with a likert scale of disagree to agree.
Implementation - Intervention Appropriateness Measure (IAM) Baseline and at 4 Months Self-reported perception among patients that this service is fit, relevant, and compatible with a likert scale of disagree to agree.
Implementation - Feasibility of Intervention Measure (FIM) Baseline and at 4 Months Self-reported perception among patients that this service is successfully used or carried out within a primary care setting with a likert scale of disagree to agree.
The Diabetes Self-Management Questionnaire (DSMQ) on eating, medication, glucose monitoring, physical activity, and healthcare use Baseline and at 4 Months Self-reported perception among patients of eating behavior, medication adherence, glucose monitoring, physical activity, and healthcare use with a likert scale of applies to me very much, applies to me a considerable degree, applies to some degree, and does not apply to me.
Glycated Hemoglobin Baseline and at 4 Months HbA1c based on blood sugar attached to hemoglobin based on lab analysis of blood.
- Secondary Outcome Measures
Name Time Method Weight Baseline and at 4 Months Weight in pounds
Height Baseline and at 4 Months Height in inches
Estimated glomerular filtration rate Baseline and at 4 Months The eGFR based on blood test.
Low-density lipoprotein Cholesterol Baseline and at 4 Months The LDL cholesterol based on blood test.
Blood Pressure Baseline and at 4 Months The systolic and diastolic blood pressure using blood pressure monitor.
Clinic Visit 4 Months The total count of clinic visits both virtually and on-site.
Hospitalizations 4 Months The total count of hospital admissions.
Costs of Implementation 4 Months Total estimated costs of implementing interventions using a budget impact analysis
Trial Locations
- Locations (1)
Lawndale Christian Health Center
🇺🇸Chicago, Illinois, United States