- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT02990299
mHealth for Diabetes Adherence Support (mDAS)
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Many African-Americans and Latinos with diabetes do not achieve recommended diabetes goals placing them at high risk for complications. Team-based models of care can help in reaching goals of therapy. Additionally, mobile health (mHealth) technologies can further improve outcomes among those more difficult to reach. This study will evaluate the impact of a team-based, mHealth intervention designed to improve medication adherence, healthy eating, and physical activity behaviors. The investigators will compare this mHealth approach with usual care.
Clinical pharmacists and health coaches (HC) will deliver our proposed team-based intervention. mHealth delivery includes mobile phone text messaging, secure videoconferencing, and HC home visits. Pharmacists will focus on medication reconciliation and adherence. Health coaches will help identify psychosocial and environmental challenges to adherence in a culturally-sensitive manner. Together, they can assist in goal-setting, problem-solving, negotiation of competing priorities, and provide social support leveraging mHealth technologies.
Preliminary data from previous research by the research team supports the role of health coaches partnering with clinic- based pharmacists in improving diabetes outcomes in minorities. In the proposed mHealth intervention, patient- pharmacist videoconferencing will eliminate the need for in-person visits with a pharmacist, which is impractical for many low-income patients. In addition, pilot work suggests that text messaging is a preferable means of communication and may facilitate more frequent contact with patients.
This is a randomized, controlled trial to evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches. The research team will randomize 220 patients through UI Health to either: (1) mHealth diabetes adherence support through clinical pharmacists and health coaches; or (2) usual care. After one year, patients completing the mHealth intervention will be monitored for an additional year while the usual care group receives the mHealth approach. Outcomes include medication adherence, hemoglobin A1c, blood pressure, and LDL-cholesterol levels. The specific aims include: (1) evaluate the effectiveness of an mHealth diabetes adherence support intervention delivered by clinical pharmacists and health coaches to African-American and Latino adults with uncontrolled type 2 diabetes; (2) evaluate the maintenance of improved diabetes behaviors as well as clinical outcomes one year after completing the intervention; (3) evaluate the cost and cost-effectiveness of mHealth diabetes adherence support compared to usual care; and (4) evaluate the reach, adoption, and implementation of mHealth diabetes adherence support based on the RE-AIM framework.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
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Illinois
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Chicago, Illinois, United States, 60612
- University of Illinois Hospital and Health Sciences System
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Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Description
Inclusion Criteria:
- Self-identified as Latino/Hispanic or African-American
- Verbal fluency in English or Spanish
- Latest A1c ≥ 8.0% (within 3 mo)
- History of Type 2 Diabetes (> 1 year)
- Between the ages of 21 and 75 years
- Unlimited mobile phone/text messaging plan with ability to reply to text messages
- Home environment capable of video conferencing with wireless signal
- Receives primary care at UI Health clinical site for at least one year, with one visit during past year
- Able and willing to provide informed consent (agree to data collection requirements, accept randomization, agree to home visitation with HC and pharmacist involvement, and participate for two years)
Exclusion Criteria:
- Unable to verbalize comprehension of study or impaired decision making
- Family/household member already participating in same study
- Currently receiving regular pharmacist support through Medication Therapy Management or equivalent
- History of, or planned, gastric bypass or transplant surgery
- History of bipolar or psychotic disorder
- Other severe comorbidities that require complex, aggressive, or palliative treatment, e.g., stage 4 or greater renal disease, liver failure, cancer (other than nonmelanoma skin cancer), terminal illness
- Investigator discretion for safety concerns
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Health Services Research
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: mHealth for Diabetes Adherence Support
Participants will receive in-person support from a health coach and a clinical pharmacist with whom they will meet with regularly via videoconference.
After one year, participants who have completed the mDAS intervention will be monitored for an additional year with usual care to evaluate maintenance.
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Participants will be paired with a health coach who will provide ongoing support and resources in medication and lifestyle adherence and diabetes self-management.
The health coach will perform regular home visits, telephone support and tailored text-messages based on the participant's preferences and needs.
They will help assess barriers to adherence and use motivational interviewing to help patients set goals and create action plans.
They will also facilitate videoconferences with an assigned clinical pharmacist who will provide consultation on medication use, reconciliation and adherence, identify therapeutic goals and formulate an approved plan of care.
Other Names:
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No Intervention: Usual Care
Participants will receive their usual care for the first year of their enrollment in the study.
They will receive a referral to a diabetes educator and a clinical pharmacist, a one-page sheet of contact information for their healthcare providers, and paper-based, low-literacy diabetes information.
After one year, they will change to the mDAS intervention arm for one year.
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What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Time Frame |
---|---|
Hemoglobin A1c
Time Frame: 24 months
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24 months
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Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Self-reported medication adherence
Time Frame: 24 months
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A 3-item questionnaire will be administered to measure adherence to diabetes medications.
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24 months
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Blood Pressure
Time Frame: 24 months
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24 months
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LDL Cholesterol
Time Frame: 24 months
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LDL Cholesterol will be measured as part of a Full Lipid profile blood test.
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24 months
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Diabetes Self-Management
Time Frame: 24 months
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Self-management will be measured by the revised 11-item Summary of Diabetes Self Care Activities questionnaire.
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24 months
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Health related quality of life
Time Frame: 24 months
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General health-related quality of life will be measured by the EuroQOL 5D (EQ-5D).
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24 months
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Diabetes related quality of life
Time Frame: 24 months
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Diabetes-related quality of life will be measured by the Diabetes Distress Screening Instrument (DDS4).
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24 months
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Depression
Time Frame: 24 months
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Measured with the nine-item Patient Health Questionnaire (PHQ-9)
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24 months
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Alcohol Misuse
Time Frame: 24 months
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Measured using the 3-item AUDIT-C questionnaire
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24 months
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BMI
Time Frame: 24 months
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Height and weight will be taken at each time point to determine BMI
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24 months
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Social Support
Time Frame: 24 months
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4-item questionnaire measuring satisfaction with support from friends, family and health care team
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24 months
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Diabetes Self-efficacy
Time Frame: 24 months
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8 -item questionnaire measuring confidence in diabetes self-management skills
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24 months
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Other Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Healthcare utilization
Time Frame: 24 months
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This will include costs associated with hospital admissions, emergency room and outpatient visits and prescription medications.
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24 months
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Program cost
Time Frame: 24 months
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This will include costs associated with the intervention including pharmacists and health coaches (training, salaries, implementation), educational materials, tablet computers and associated data service, text messaging and videoconferencing.
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24 months
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Health Coach Satisfaction
Time Frame: 1 year after health coach assignment
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A survey administered to the patient for feedback on their assigned health coach.
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1 year after health coach assignment
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Collaborators and Investigators
Investigators
- Principal Investigator: Ben S Gerber, MD, MPH, University of Illinois at Chicago
- Principal Investigator: Lisa K Sharp, PhD, University of Illinois at Chicago
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimated)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Keywords
Additional Relevant MeSH Terms
Other Study ID Numbers
- 2016-0380
- 1R01DK108141 (U.S. NIH Grant/Contract)
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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