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Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial
BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whe...
Autores principales: | , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909304/ https://www.ncbi.nlm.nih.gov/pubmed/24450992 http://dx.doi.org/10.1186/1471-2458-14-71 |
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author | Forjuoh, Samuel N Bolin, Jane N Huber Jr, John C Vuong, Ann M Adepoju, Omolola E Helduser, Janet W Begaye, Dawn S Robertson, Anne Moudouni, Darcy M Bonner, Timethia J McLeroy, Kenneth R Ory, Marcia G |
author_facet | Forjuoh, Samuel N Bolin, Jane N Huber Jr, John C Vuong, Ann M Adepoju, Omolola E Helduser, Janet W Begaye, Dawn S Robertson, Anne Moudouni, Darcy M Bonner, Timethia J McLeroy, Kenneth R Ory, Marcia G |
author_sort | Forjuoh, Samuel N |
collection | PubMed |
description | BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants’ diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01221090. |
format | Online Article Text |
id | pubmed-3909304 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-39093042014-02-02 Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial Forjuoh, Samuel N Bolin, Jane N Huber Jr, John C Vuong, Ann M Adepoju, Omolola E Helduser, Janet W Begaye, Dawn S Robertson, Anne Moudouni, Darcy M Bonner, Timethia J McLeroy, Kenneth R Ory, Marcia G BMC Public Health Research Article BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants’ diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01221090. BioMed Central 2014-01-23 /pmc/articles/PMC3909304/ /pubmed/24450992 http://dx.doi.org/10.1186/1471-2458-14-71 Text en Copyright © 2014 Forjuoh et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Article Forjuoh, Samuel N Bolin, Jane N Huber Jr, John C Vuong, Ann M Adepoju, Omolola E Helduser, Janet W Begaye, Dawn S Robertson, Anne Moudouni, Darcy M Bonner, Timethia J McLeroy, Kenneth R Ory, Marcia G Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title_full | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title_fullStr | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title_full_unstemmed | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title_short | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
title_sort | behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909304/ https://www.ncbi.nlm.nih.gov/pubmed/24450992 http://dx.doi.org/10.1186/1471-2458-14-71 |
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