[Show abstract][Hide abstract] ABSTRACT: To conduct a 1-year randomized clinical trial to evaluate a remote comprehensive diabetes self-management education (DSME) intervention, Diabetes TeleCare, administered by a dietitian and nurse/certified diabetes educator (CDE) in the setting of a federally qualified health center (FQHC) in rural South Carolina.
Participants were recruited from three member health centers of an FQHC and were randomized to either Diabetes TeleCare, a 12-month, 13-session curriculum delivered using telehealth strategies, or usual care.
Mixed linear regression model results for repeated measures showed a significant reduction in glycated hemoglobin (GHb) in the Diabetes TeleCare group from baseline to 6 and 12 months (9.4 +/- 0.3, 8.3 +/- 0.3, and 8.2 +/- 0.4, respectively) compared with usual care (8.8 +/- 0.3, 8.6 +/- 0.3, and 8.6 +/- 0.3, respectively). LDL cholesterol was reduced at 12 months in the Diabetes TeleCare group compared with usual care. Although not part of the original study design, GHb was reduced from baseline to 12 and 24 months in the Diabetes TeleCare group (9.2 +/- 0.4, 7.4 +/- 0.5, and 7.6 +/- 0.5, respectively) compared with usual care (8.7 +/- 0.4, 8.1 +/- 0.4, and 8.1 +/- 0.5, respectively) in a post hoc analysis of a subset of the randomized sample who completed a 24-month follow-up visit.
Telehealth effectively created access to successfully conduct a 1-year remote DSME by a nurse CDE and dietitian that improved metabolic control and reduced cardiovascular risk in an ethnically diverse and rural population.
Diabetes care 08/2010; 33(8):1712-7. · 7.74 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: ContextRecruiting and retaining minorities from rural, community health centers is a challenge. Collaboration between the researchers and health center personnel and activities to enhance trust may improve results.PurposeTo describe recruitment and retention strategies and report results of a 12-month clinical trial of a telemedicine-based diabetes self-management intervention, conducted within a rural community health center.MethodsMulti-level, multi-staged recruitment process including collaborative planning, data extraction, medical record review, telephone screen, 2 in-person enrollment visits and randomization. Target sample was adults ≥ 35 years of age with type 2 diabetes, glycated hemoglobin (GHb) > 7% with no significant comorbidities to prevent safe participation. Follow-up visits occurred at 6 and 12 months post-randomization.FindingsOf those eligible from medical record review, 65% were African-American(AA)/other and female. Approximately 33% of those successfully contacted by telephone were randomized (n = 165), yielding a predominately AA/other (73.9%) and female (74.5%) sample. Among those eligible at the Telephone Screen, a greater percentage of Non-Hispanic Whites (NHW) refused participation than AA/other (54.2% vs 45.8%), while a greater percentage of women refused compared to men (64.4% vs 35.6%). Significant baseline differences were found by ethnicity for education, insurance, transportation and diastolic blood pressure; by gender for income, transportation, weight, and home monitoring of blood glucose. Overall 6 and 12 month retention rates were 90.9% and 82.4%, respectively, with a greater percentage of AA/Other and female participants retained.ConclusionsOur collaborative approach was successful in recruiting and retaining ethnically diverse study participants who reside in a rural underserved area of South Carolina. Differences in baseline characteristics and retention by ethnicity and gender were found. Successful translational research must allow for a collaborative approach addressing factors at the level of the community health center, key personnel, and patients in an effort to build trust for the purpose of advancing the science of translating research to practice.