African Americans (AA) with Type 2 diabetes (T2DM) have higher prevalence of diabetes, poorer metabolic control and greater risk for complications and death compared to White Americans. Self-management interventions that include diabetes education and skills training are effective at improving metabolic control in diabetes. Recent findings indicate that patients with diabetes, especially ethnic minority patients, prefer telephone-delivered diabetes education to group visits or internet-based education. Preliminary data from our group suggest that a culturally-tailored telephone-delivered diabetes education and skills training intervention is an effective strategy to improve metabolic control in AA patients with T2DM. Use of telephone contact, video- conferencing, PDAs and web-based systems offer new opportunities to bridge the gap in support for diabetic patients between face to face visits with their health care providers. The FORA system is an inexpensive, off- the-shelf,state-of-the-art technology whereby a person/caregiver and a provider can communicate accurately on data needed for self-management of diabetes. The system is comprised of an easy to operate 2-in-1 Blood Glucose and Blood Pressure monitor that uploads results to a secure website via a modem. The provider (in this case a diabetes educator) can review the glucose and blood pressure readings weekly and use the data to tailor diabetes education and self-care skills training using motivational enhancement techniques to achieve optimal metabolic control. However, no large RCT has tested whether providing feedback to patients using novel technology like the FORA 2-in-1 Blood Glucose and Blood Pressure monitor leads to improvements in glycemic and blood pressure control or whether using the feedback to tailor and augment diabetes education and skills training are effective at improving metabolic control. We propose a randomized controlled study to test the efficacy of a technology-intensified diabetes education/skills training (TIDES) intervention using the FORA system in AAs with poorly controlled T2DM. The long-term goal of the project is to identify effective strategies to improve metabolic control and hence reduce diabetes complication and mortality rates in AAs with T2DM.

Public Health Relevance

There are no large randomized clinical trials in AAs with poorly controlled T2DM that examine the use of technology-based feedback to tailor and/or augment diabetes education and skills training (i.e. technology- intensified diabetes education and skills training). This study provides a unique opportunity to address this gap in the literatur. The findings of this study; if successful; will lead to the implementation of this feasible; evidence-based intervention for high risk minority patients with T2DM.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
7R01DK098529-05
Application #
9414144
Study Section
Special Emphasis Panel (ZRG1-HSOD-J (09)F)
Program Officer
Thornton, Pamela L
Project Start
2013-05-05
Project End
2017-04-30
Budget Start
2017-04-07
Budget End
2017-04-30
Support Year
5
Fiscal Year
2016
Total Cost
$206,067
Indirect Cost
$72,257
Name
Medical College of Wisconsin
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
937639060
City
Milwaukee
State
WI
Country
United States
Zip Code
53226
Asuzu, Christopher C; Walker, Rebekah J; Williams, Joni Strom et al. (2017) Pathways for the relationship between diabetes distress, depression, fatalism and glycemic control in adults with type 2 diabetes. J Diabetes Complications 31:169-174
Walker, Rebekah J; Strom Williams, Joni; Egede, Leonard E (2016) Influence of Race, Ethnicity and Social Determinants of Health on Diabetes Outcomes. Am J Med Sci 351:366-73
Egede, Leonard E; Bishu, Kinfe G; Walker, Rebekah J et al. (2016) Impact of diagnosed depression on healthcare costs in adults with and without diabetes: United States, 2004-2011. J Affect Disord 195:119-26
Winchester, Rhonda J; Williams, Joni S; Wolfman, Tamara E et al. (2016) Depressive symptoms, serious psychological distress, diabetes distress and cardiovascular risk factor control in patients with type 2 diabetes. J Diabetes Complications 30:312-7
Doshi, Tejas; Smalls, Brittany L; Williams, Joni S et al. (2016) Socioeconomic Status and Cardiovascular Risk Control in Adults With Diabetes. Am J Med Sci 352:36-44
Mayberry, Lindsay Satterwhite; Egede, Leonard E; Wagner, Julie A et al. (2015) Stress, depression and medication nonadherence in diabetes: test of the exacerbating and buffering effects of family support. J Behav Med 38:363-71
Walker, Rebekah J; Gebregziabher, Mulugeta; Martin-Harris, Bonnie et al. (2015) Understanding the influence of psychological and socioeconomic factors on diabetes self-care using structured equation modeling. Patient Educ Couns 98:34-40
Walker, Rebekah J; Smalls, Brittany L; Egede, Leonard E (2015) Social determinants of health in adults with type 2 diabetes--Contribution of mutable and immutable factors. Diabetes Res Clin Pract 110:193-201
Dawson, Aprill Z; Walker, Rebekah J; Campbell, Jennifer A et al. (2015) Effect of perceived racial discrimination on self-care behaviors, glycemic control, and quality of life in adults with type 2 diabetes. Endocrine 49:422-8
Williams, Joni L Strom; Egede, Leonard E (2014) Nontraditional risk factors as mediators of racial differences in diabetes risk. J Gen Intern Med 29:271-2

Showing the most recent 10 out of 14 publications