Effect of Diabetes Education During Retinal Ophthalmology Visits on Diabetes Control
- Conditions
- Diabetic RetinopathyDiabetes
- Interventions
- Behavioral: Diabetes Education
- Registration Number
- NCT01323348
- Lead Sponsor
- Jaeb Center for Health Research
- Brief Summary
The purpose of this study is to assess whether glycemic control (assessed with HbA1c measurement) in individuals with type 1 or type 2 diabetes can be improved with a point-of-care measurement of HbA1c in the ophthalmologist's office combined with a personalized risk assessment for diabetic retinopathy and other complications of diabetes.
- Detailed Description
Although each patient with diabetes should be receiving diabetic education as part of their on-going routine medical care, it is likely that such education is delivered with different details and intensity. Motivating a patient with diabetes to become involved in his or her care is of primary importance in achieving better systemic control.
Ocular complications from diabetes remain the most common cause of blindness among American adults 20-74 years of age. A recent survey reported that loss of vision is the most feared of all diabetic complications. Thus, it is possible that an educational intervention at an ophthalmology office may have additional impact beyond the current standard of diabetes education at a primary care or diabetologist/endocrinologist office alone. This study will determine whether diabetes education in the ophthalmology office (which includes same-visit feedback of HbA1c levels, combined with standardized education regarding same-visit blood pressure, retinopathy status and overall diabetes education) can improve subsequent HbA1c as compared with current standard care in an ophthalmology office.
Materials used in this research setting must be applicable for use in ophthalmology practices. Therefore, the materials and procedures for this study have been developed with the goal of easy translation to this audience.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 1875
-
Age >18 years
-
Diagnosis of type 1 or type 2 diabetes mellitus
Any one of the following will be considered to be sufficient evidence that diabetes is present:
- Current regular use of insulin for the treatment of diabetes
- Current regular use of oral anti-hyperglycemia agents for the treatment of diabetes
- Documented diabetes by American Diabetes Associate and/or World Health Organization criteria
-
Routine care follow-up is yearly or more frequent
-
English or Spanish speaking
-
Able and willing to provide informed consent
-
Willing to complete 24 months of study follow up
- Known HbA1c (patient report or available records at time of enrollment) <7.5% within prior 6 months
- Active participation in any type of intervention study
- Initiation of insulin treatment within 3 months from date of enrollment
- Prior complete panretinal photocoagulation or prior diabetes-related vitrectomy in both eyes
- Advanced visual acuity loss in both eyes which prohibits ability to read study materials (tested as needed with reading test using materials in appropriate size script)
- Significant renal disease including use of erythropoietin (Procrit, Epogen, Eprex) or a history of chronic renal failure requiring dialysis or kidney transplant
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Diabetes Educational Intervention Diabetes Education Study participants in the intervention group will receive a diabetes management educational intervention at baseline and at follow-up visits. For those on an annual follow-up schedule, educational intervention will take place at baseline and 12 months. For those whose standard care involves more frequent, than annual, visits the educational intervention will take place no more than once every 12 weeks.
- Primary Outcome Measures
Name Time Method Change in HbA1c 12 Months Mean change in HbA1c from baseline to 12 months in intervention versus control for study participants being seen for standard care more frequently than every 12 months
- Secondary Outcome Measures
Name Time Method Diabetes Care Knowledge 12 Months/24 Months At baseline and at annual visits, study participants in all treatment groups will complete self-assessment questionnaires in order to assess perception of emotional problems frequently reported in type 1 and type 2 diabetes and to measure perceived adherence to diabetes self-care recommendations. At the annual visits, summary statistics will be presented on the responses as appropriate to the distribution and the treatment groups will be compared controlling for baseline responses.
Blood Pressure 12 Months/24 Months For analyses, systolic and diastolic blood pressure will be converted to an overall mean blood pressure according to the following calculation: diastolic blood pressure + 1/3 (systolic blood pressure - diastolic blood pressure). Blood pressure will be analyzed as the change in the weighted mean blood pressure from baseline to 12 months adjusted for the baseline weighted mean blood pressure. Treatment group comparisons will be made using ANCOVA to adjust for the baseline blood pressure, with GEE to adjust for the correlation within subjects of the same cluster.
Body Mass Index 12 Months/24 Months Treatment group comparisons will be made using analysis of covariance (ANCOVA) to adjust for the baseline HbA1c, with generalized estimating equations (GEE) to adjust for the correlation within subjects of the same randomization cluster.
Trial Locations
- Locations (34)
Elman Retina Group, P.A.
🇺🇸Baltimore, Maryland, United States
Retina and Vitreous Associates of Kentucky
🇺🇸Lexington, Kentucky, United States
University of North Carolina, Dept of Ophthalmology
🇺🇸Chapel Hill, North Carolina, United States
Valley Retina Institute
🇺🇸McAllen, Texas, United States
California Retina Consultants
🇺🇸Santa Barbara, California, United States
Retina Vitreous Consultants
🇺🇸Ft. Lauderdale, Florida, United States
University of Florida College of Med., Department of Ophthalmology
🇺🇸Jacksonville, Florida, United States
John-Kenyon American Eye Institute
🇺🇸New Albany, Indiana, United States
Wilmer Ophthalmological Institute at Johns Hopkins
🇺🇸Baltimore, Maryland, United States
The New York Eye and Ear Infirmary/Faculty Eye Practice
🇺🇸New York, New York, United States
Paducah Retinal Center
🇺🇸Paducah, Kentucky, United States
Charlotte Eye, Ear, Nose and Throat Assoc., PA
🇺🇸Charlotte, North Carolina, United States
Barnes Retina Institute
🇺🇸St. Louis, Missouri, United States
Penn State College of Medicine
🇺🇸Hershey, Pennsylvania, United States
Retina Associates of Cleveland, Inc.
🇺🇸Beachwood, Ohio, United States
Retina Research Center
🇺🇸Austin, Texas, United States
Carolina Retina Center
🇺🇸Columbia, South Carolina, United States
University of Wisconsin-Madison, Dept of Ophthalmology/Retina Service
🇺🇸Madison, Wisconsin, United States
Palmetto Retina Center
🇺🇸Columbia, South Carolina, United States
University of Illinois at Chicago Medical Center
🇺🇸Chicago, Illinois, United States
Loma Linda University Health Care, Dept. of Ophthalmology
🇺🇸Loma Linda, California, United States
Raj K. Maturi, M.D., P.C.
🇺🇸Indianapolis, Indiana, United States
Joslin Diabetes Center
🇺🇸Boston, Massachusetts, United States
Casey Eye Institute
🇺🇸Portland, Oregon, United States
Henry Ford Health System, Dept of Ophthalmology and Eye Care Services
🇺🇸Detroit, Michigan, United States
Retinal Consultants of San Antonio
🇺🇸San Antonio, Texas, United States
Medical College of Wisconsin
🇺🇸Milwaukee, Wisconsin, United States
Retina Center, PA
🇺🇸Minneapolis, Minnesota, United States
Case Western Reserve University
🇺🇸Cleveland, Ohio, United States
Retina and Vitreous of Texas
🇺🇸Houston, Texas, United States
University of Washington Medical Center
🇺🇸Seattle, Washington, United States
Wake Forest University Eye Center
🇺🇸Winston-Salem, North Carolina, United States
University of Pennsylvania Scheie Eye Institute
🇺🇸Philadelphia, Pennsylvania, United States
Central Florida Retina Institute
🇺🇸Lakeland, Florida, United States