The economic burden of diabetes on patients and their families is considerable. According to the most recent estimate in 2007, the yearly cost of diabetes was approximately $174 billion. Landmark studies have demonstrated that improved metabolic control of patients with diabetes reduces microvascular complications, and cardiovascular risk. Despite proven advances, adherence to American Diabetes Association (ADA) clinical care guidelines is suboptimal. Diabetes self-management educational (DSME) curricula conducted by certified diabetes educators (CDE) in single and group sessions have been shown to foster adherence to medication regimens, self-management of blood glucose, and promote lifestyle changes to improve diet and activity. However, CDE workforce shortages may be related to suboptimal adoption of clinical care guidelines. Telehealth strategies such as interactive videoconferencing may improve access to a CDE by facilitating distant learning by adults with diabetes. The next challenge is the development of an approach to extend the potential reach of DSME using interactive videoconferencing to address more people with diabetes throughout the US. The capacity of telehealth technology for innovative strategies may be important in terms of new ways of using interactive videoconferencing to enhance self-care. The goals of Advanced TeleCare, LLC in this Phase 1 SBIR proposal are to 1) explore the feasibility of simultaneously conducting remote DSME to two groups of participants separated geographically and 2) evaluate potential benefits of this approach in terms of diabetes-related outcomes. To accomplish this, we propose the following two aims: 1) Modify a remote DSME curriculum based on social identity theory to stimulate knowledge sharing and collaborative learning to reinforce participant motivation, behavior change, and commitment by fostering cohesive group identities, and 2) Conduct a feasibility study of adults with Type 2 diabetes recruited from two primary care practices in Greenville County, SC and Seattle, WA who receive a shortened three-month remote DSME curriculum. Recruitment of sites in coastal states across the US will be a demonstration of possible reach of this approach. The primary outcome of the feasibility study will be GHb in a pre-test: post-test design and secondary outcomes will be participant attitudes about group affiliation and satisfaction. To address the research aims, our investigative team spans expertise and experience in diabetes management and research as well as telehealth strategies in the setting of a physician's practice. Previous work by these investigators involving all aspects of diabetes self-care both in-person and via telehealth technologies, ensure that the proposed Phase 1 work will be accomplished. This sets the stage for Advanced TeleCare's SBIR Phase 2 effectiveness study of Diabetes TeleCare2 and the development of a sound commercialization plan.
This project is relevant to public health because of the focus on evaluating new ways to teach and motivate people with diabetes to improve their health habits. First, a feasibility study will show how well a diabetes education session is delivered to two small groups of adults when each group is at a different primary care practice. To accomplish this, sessions will be conducted remotely by telehealth or interactive videoconferencing. Second, we will evaluate if ways to foster group identity, such as naming each group receiving education or doing group competitions, increase health behaviors that result in better control of diabetes.