Type 2 Diabetes Exemplar: A Remote Care Service for North West London (T2DEx)

Type 2 Diabetes Exemplar (T2DEx): A Remote Care Service for North West London

The aim of T2DEx is to assess the feasibility, usability, acceptability, cost-effectiveness and safety of a digital support service for people in North West London at high risk of developing complications from Type 2 Diabetes Mellitus (T2DM).

Study Overview

• Status: Completed
• Conditions: Type 2 Diabetes Mellitus
• Intervention / Treatment: Behavioral: KNOW Diabetes; Other: Standard of care; Device: Huma; Behavioral: Video group consultations

Detailed Description

The Type 2 Diabetes Exemplar Programme has been designed as a collaborative effort through partners from the Discover-NOW Health Data Research Hub in North West London (NWL). The remote care service is being used in primary care to demonstrate how data and technology can improve health outcomes for people living with T2DM. The service has been designed via a cross-industry collaboration between North West London Clinical Commissioning Groups (NWL CCGs), AstraZeneca, Imperial College Health Partners and Huma. The service will be offered for patients at high risk of developing complications from T2DM (such as heart attack and stroke) and will combine video group consultations, remote monitoring via a smartphone app, and educational content such as lifestyle and diet advice.

This service seeks to strengthen population health management by providing better-tailored services and proactive interventions, particularly among population groups more at risk of the adverse impacts of COVID-19. Mortality risk from COVID-19 is approximately 25% higher in patients with T2DM and shielding has resulted in reduced primary care appointments for patients with T2DM. This has created an immediate need for primary care to adapt to provide care remotely to people with T2DM. Digital-first remote pathways could make care more accessible while finding time and cost efficiencies. By combining video group consultations and remote monitoring, we can inform the patient-clinician conversation making remote care in group settings safer, efficient and more personalised.

• Study Type: Interventional
• Enrollment (Actual): 235
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United Kingdom
  • London, United Kingdom
    • Hammersmith & Fulham Central Primary Care Network
  • London, United Kingdom
    • Hammersmith & Fulham Partnership Primary Care Network
  • London, United Kingdom
    • Harrow Collaborative Primary Care Network
  • London, United Kingdom
    • Healthsense Primary Care Network
  • London, United Kingdom
    • Metrocare & Celandine Health Primary Crae Network
  • London, United Kingdom
    • North Connect Primary Care Network
  • London, United Kingdom
    • Sphere Primary Care Network

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Patients over the age of 18 with the capacity to give consent

• Patients with 'high risk' OR 'very high risk' T2DM as defined by:

  • Very high risk - T2DM with existing ASCVD OR T2DM without ASCVD but with any 3 of the following:

    • HbA1c >58
    • SBP >140
    • Non-HDL >3.35 or LDL-C >2.5
    • Nephropathy (eGFR <45, or Urine ACR >3)
    • Retinopathy
    • Neuropathy (including moderate/high risk feet, previous foot ulceration and erectile dysfunction)
    • Currently smoking

  • High risk - T2DM without ASCVD but with any 2 of the following:

    • HbA1c > 58
    • SBP >140
    • Non-HDL >3.35 or LDL-C >2.5
    • Nephropathy: eGFR <45 or Urine ACR >3
    • Retinopathy
    • Neuropathy (including moderate/high risk feet, previous foot ulceration and erectile dysfunction)
    • Currently smoking
    • Black, Asian and minority ethic (BAME) status

Exclusion Criteria:

• Participants too ill to participate in the study (i.e., presence of a life-threatening condition, expected survival less than 3 months, clinically unstable)
• Participants who have previously participated in efforts that have informed the design of this research.
• Participant without access to a smartphone.
• Non-English language (the remote monitoring technology currently does not support additional languages).
• Visual disability (the remote monitoring technology currently does not natively support visual assistance).
• Active severe mental illness (SMI).
• Alcohol / drug abuse.
• Severe frailty (identified via the Electronic Frailty Index - eFI).
• Housebound / living in nursing home.
• Currently on the REWIND Programme (a NWL total diet replacement programme for patients with type-2 diabetes).

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Non-Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: T2DEx remote care service	Behavioral: KNOW Diabetes; Each patient is signed up to a series of educational email campaigns to complement the VGC sessions and provide broader education around diabetes management. Patients receive two emails per week during the 12-week service on a variety of topics.; Device: Huma; Digital remote patient monitoring using blood pressure and blood sugar devices in combination with a smartphone app ('the Huma app'). Participants are provided with home monitoring devices and download the Huma app. Data recorded via the Huma app is self-reported and includes activity data, diet information, blood glucose measurements, blood pressure measurements, weight, and the Diabetes Distress Scale.; Other Names: Huma app; Behavioral: Video group consultations; Each patient is invited to attend a total of three VGCs during the 12-weeks lasting approximately one hour and 15 minutes each. Each session is facilitated by a Practice Nurse (PN) and consists of 6-10 people with T2DM. The self-reported Huma app (see below) and patient EPR data are used to populate a "Discussion Dashboard" which is used in each VGC to facilitate discussion. During the first VGC session, patient goals are discussed and adjusted in a group setting with topics relevant to their condition covered by the PN. Between each VGC session, patients spend time working on their goals and continuing to enter self-reported metrics into the Huma app. During the second and third VGC sessions, each patient is discussed, along with their performance against agreed goals.; Other Names: VGC
Other: Matched control group; This study will create a matched control group using propensity score matching (PSM), a quasi-experimental method used to mimic the characteristics of a randomised control trial that has been shown to reduce biases. PSM uses statistical techniques to construct an artificial control group by matching each study participant with a non-treated participant of similar characteristics. PSM computes the probability that a person would enrol in a program based on pre-defined characteristics, giving a 'propensity score'.	Other: Standard of care; Normal primary care service provided to matched control group.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
% Participants Downloading Huma App		12 weeks
Video Group Consultation Sessions Attended	the number of participants attending at least one VGC	12 weeks
Blood Glucose Measurements Recorded	Number of participants entering at least one measurement	12 weeks
Blood Pressure Measurements Recorded	Number of participants entering at least one blood pressure measurement	12 weeks
Number of Weight Measurements Recorded	Number of participants entering at least one weight measurement	12 weeks
Number of Diabetes Distress Scale Scores Recorded	Number of participants entering at least one DDS measurement	12 weeks
Number of Deaths		12 weeks
Number of Participants With Emergency Department Admissions		12 weeks
Number of Participants With Hospital Admissions		12 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in HbA1c	Change in HbA1c from beginning to end of programme	6 months
Change in Total Cholesterol	Change in total cholesterol from beginning to end of programme	6 months
Change in Weight	Change in weight from beginning to end of programme	6 months
Change in Systolic Blood Pressure	Change in systolic BP from beginning to end of programme	6 months

Collaborators and Investigators

• Sponsor: Imperial College London
• Collaborators: AstraZeneca; Huma; North West London Collaboration of CCGs (NWL CCGs); Imperial College Health Partners (ICHP)

Study record dates

Study Major Dates

• Study Start (Actual): June 1, 2021
• Primary Completion (Actual): June 30, 2022
• Study Completion (Actual): October 31, 2022

Study Registration Dates

• First Submitted: January 25, 2021
• First Submitted That Met QC Criteria: January 28, 2021
• First Posted (Actual): January 29, 2021

Study Record Updates

• Last Update Posted (Actual): February 20, 2024
• Last Update Submitted That Met QC Criteria: February 19, 2024
• Last Verified: February 1, 2024

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Glucose Metabolism Disorders; Metabolic Diseases; Endocrine System Diseases; Diabetes Mellitus; Diabetes Mellitus, Type 2
• Other Study ID Numbers: 20IC6484

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No