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.
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.
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