Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial
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 reducti...
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| creator | 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 |
| description | 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.
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.
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.
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.
Clinicaltrials.gov Identifier: NCT01221090. |
| doi_str_mv | 10.1186/1471-2458-14-71 |
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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.
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.
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.
Clinicaltrials.gov Identifier: NCT01221090.</description><identifier>ISSN: 1471-2458</identifier><identifier>EISSN: 1471-2458</identifier><identifier>DOI: 10.1186/1471-2458-14-71</identifier><identifier>PMID: 24450992</identifier><language>eng</language><publisher>England: BioMed Central Ltd</publisher><subject>Adolescent ; Adult ; African Americans ; Aged ; Behavior ; Clinical trials ; Comparative analysis ; Computers, Handheld ; Cultural differences ; Diabetes ; Diabetes Mellitus, Type 2 - ethnology ; Diabetes Mellitus, Type 2 - therapy ; Diabetes therapy ; Epidemiology ; Ethnicity ; Female ; Glycated Hemoglobin - analysis ; Glycosylated hemoglobin ; Health care policy ; Health maintenance organizations ; Hispanic Americans ; HMOs ; Humans ; Male ; Middle Aged ; Personal digital assistants ; Population ; Public health ; Racial Groups ; Science ; Self Care - methods ; Self-care, Health ; Software ; Studies ; Supervision ; Treatment Outcome ; Young Adult</subject><ispartof>BMC public health, 2014-01, Vol.14 (1), p.71-71, Article 71</ispartof><rights>COPYRIGHT 2014 BioMed Central Ltd.</rights><rights>2014 Forjuoh et al.; licensee BioMed Central Ltd. 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.</rights><rights>Copyright © 2014 Forjuoh et al.; licensee BioMed Central Ltd. 2014 Forjuoh et al.; licensee BioMed Central Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b613t-a6354d1c84c8c7982978f78209f281918c5555c93c31f7cb1543adcd1db1b1d63</citedby><cites>FETCH-LOGICAL-b613t-a6354d1c84c8c7982978f78209f281918c5555c93c31f7cb1543adcd1db1b1d63</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909304/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC3909304/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,724,777,781,861,882,27905,27906,53772,53774</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24450992$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Forjuoh, Samuel N</creatorcontrib><creatorcontrib>Bolin, Jane N</creatorcontrib><creatorcontrib>Huber, Jr, John C</creatorcontrib><creatorcontrib>Vuong, Ann M</creatorcontrib><creatorcontrib>Adepoju, Omolola E</creatorcontrib><creatorcontrib>Helduser, Janet W</creatorcontrib><creatorcontrib>Begaye, Dawn S</creatorcontrib><creatorcontrib>Robertson, Anne</creatorcontrib><creatorcontrib>Moudouni, Darcy M</creatorcontrib><creatorcontrib>Bonner, Timethia J</creatorcontrib><creatorcontrib>McLeroy, Kenneth R</creatorcontrib><creatorcontrib>Ory, Marcia G</creatorcontrib><title>Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial</title><title>BMC public health</title><addtitle>BMC Public Health</addtitle><description>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.
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.
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.
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.
Clinicaltrials.gov Identifier: NCT01221090.</description><subject>Adolescent</subject><subject>Adult</subject><subject>African Americans</subject><subject>Aged</subject><subject>Behavior</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Computers, Handheld</subject><subject>Cultural differences</subject><subject>Diabetes</subject><subject>Diabetes Mellitus, Type 2 - ethnology</subject><subject>Diabetes Mellitus, Type 2 - therapy</subject><subject>Diabetes therapy</subject><subject>Epidemiology</subject><subject>Ethnicity</subject><subject>Female</subject><subject>Glycated Hemoglobin - analysis</subject><subject>Glycosylated hemoglobin</subject><subject>Health care policy</subject><subject>Health maintenance organizations</subject><subject>Hispanic Americans</subject><subject>HMOs</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Personal digital assistants</subject><subject>Population</subject><subject>Public health</subject><subject>Racial Groups</subject><subject>Science</subject><subject>Self Care - 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ethnology</topic><topic>Diabetes Mellitus, Type 2 - therapy</topic><topic>Diabetes therapy</topic><topic>Epidemiology</topic><topic>Ethnicity</topic><topic>Female</topic><topic>Glycated Hemoglobin - analysis</topic><topic>Glycosylated hemoglobin</topic><topic>Health care policy</topic><topic>Health maintenance organizations</topic><topic>Hispanic Americans</topic><topic>HMOs</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Personal digital assistants</topic><topic>Population</topic><topic>Public health</topic><topic>Racial Groups</topic><topic>Science</topic><topic>Self Care - methods</topic><topic>Self-care, Health</topic><topic>Software</topic><topic>Studies</topic><topic>Supervision</topic><topic>Treatment Outcome</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Forjuoh, Samuel N</creatorcontrib><creatorcontrib>Bolin, Jane N</creatorcontrib><creatorcontrib>Huber, Jr, John C</creatorcontrib><creatorcontrib>Vuong, Ann M</creatorcontrib><creatorcontrib>Adepoju, Omolola E</creatorcontrib><creatorcontrib>Helduser, Janet W</creatorcontrib><creatorcontrib>Begaye, Dawn S</creatorcontrib><creatorcontrib>Robertson, Anne</creatorcontrib><creatorcontrib>Moudouni, Darcy M</creatorcontrib><creatorcontrib>Bonner, Timethia J</creatorcontrib><creatorcontrib>McLeroy, Kenneth R</creatorcontrib><creatorcontrib>Ory, Marcia G</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Public Health Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Materials Science & Engineering Collection</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>British Nursing Database</collection><collection>Agricultural & Environmental Science Collection</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>ProQuest Engineering Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Engineering Database</collection><collection>Environmental Science Database</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>Engineering Collection</collection><collection>Environmental Science Collection</collection><collection>MEDLINE - Academic</collection><collection>Safety Science and Risk</collection><collection>British Nursing Index</collection><collection>British Nursing Index (BNI) (1985 to Present)</collection><collection>British Nursing Index</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMC public health</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Forjuoh, Samuel N</au><au>Bolin, Jane N</au><au>Huber, Jr, John C</au><au>Vuong, Ann M</au><au>Adepoju, Omolola E</au><au>Helduser, Janet W</au><au>Begaye, Dawn S</au><au>Robertson, Anne</au><au>Moudouni, Darcy M</au><au>Bonner, Timethia J</au><au>McLeroy, Kenneth R</au><au>Ory, Marcia G</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial</atitle><jtitle>BMC public health</jtitle><addtitle>BMC Public Health</addtitle><date>2014-01-23</date><risdate>2014</risdate><volume>14</volume><issue>1</issue><spage>71</spage><epage>71</epage><pages>71-71</pages><artnum>71</artnum><issn>1471-2458</issn><eissn>1471-2458</eissn><abstract>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.
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.
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.
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.
Clinicaltrials.gov Identifier: NCT01221090.</abstract><cop>England</cop><pub>BioMed Central Ltd</pub><pmid>24450992</pmid><doi>10.1186/1471-2458-14-71</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1471-2458 |
| ispartof | BMC public health, 2014-01, Vol.14 (1), p.71-71, Article 71 |
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| subjects | Adolescent Adult African Americans Aged Behavior Clinical trials Comparative analysis Computers, Handheld Cultural differences Diabetes Diabetes Mellitus, Type 2 - ethnology Diabetes Mellitus, Type 2 - therapy Diabetes therapy Epidemiology Ethnicity Female Glycated Hemoglobin - analysis Glycosylated hemoglobin Health care policy Health maintenance organizations Hispanic Americans HMOs Humans Male Middle Aged Personal digital assistants Population Public health Racial Groups Science Self Care - methods Self-care, Health Software Studies Supervision Treatment Outcome Young Adult |
| title | Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-18T20%3A23%3A10IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Behavioral%20and%20technological%20interventions%20targeting%20glycemic%20control%20in%20a%20racially/ethnically%20diverse%20population:%20a%20randomized%20controlled%20trial&rft.jtitle=BMC%20public%20health&rft.au=Forjuoh,%20Samuel%20N&rft.date=2014-01-23&rft.volume=14&rft.issue=1&rft.spage=71&rft.epage=71&rft.pages=71-71&rft.artnum=71&rft.issn=1471-2458&rft.eissn=1471-2458&rft_id=info:doi/10.1186/1471-2458-14-71&rft_dat=%3Cgale_pubme%3EA539591029%3C/gale_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1493912370&rft_id=info:pmid/24450992&rft_galeid=A539591029&rfr_iscdi=true |