Effect of Diabetes Education During Retinal Ophthalmology Visits on Diabetes Control

Phase 3

Completed

• Conditions: Diabetic Retinopathy; Diabetes

• 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.

Study Timeline

• Study First Submitted: 2011-03-24
• Study First Submitted QC: 2011-03-24
• Study First Posted: 2011-03-25
• Study Start: 2011-10
• Primary Completion: 2014-07
• Study Completion: 2015-01
• Status Verified: 2016-08
• Last Update Submitted: 2016-08-25
• Last Update Posted: 2016-08-26

Recruitment & Eligibility

• Status: COMPLETED
• Sex: All
• Target Recruitment: 1875

Inclusion Criteria

1. Age >18 years

2. 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

3. Routine care follow-up is yearly or more frequent

4. English or Spanish speaking

5. Able and willing to provide informed consent

6. Willing to complete 24 months of study follow up

Exclusion Criteria

1. Known HbA1c (patient report or available records at time of enrollment) <7.5% within prior 6 months
2. Active participation in any type of intervention study
3. Initiation of insulin treatment within 3 months from date of enrollment
4. Prior complete panretinal photocoagulation or prior diabetes-related vitrectomy in both eyes
5. 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)
6. 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

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)

Loma Linda University Health Care, Dept. of Ophthalmology; 🇺🇸 Loma Linda, California, 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

Central Florida Retina Institute; 🇺🇸 Lakeland, Florida, United States

University of Illinois at Chicago Medical Center; 🇺🇸 Chicago, Illinois, United States

Raj K. Maturi, M.D., P.C.; 🇺🇸 Indianapolis, Indiana, United States

John-Kenyon American Eye Institute; 🇺🇸 New Albany, Indiana, United States

Retina and Vitreous Associates of Kentucky; 🇺🇸 Lexington, Kentucky, United States

Paducah Retinal Center; 🇺🇸 Paducah, Kentucky, United States

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