Racial differences in the effectiveness of a multifactorial telehealth intervention to slow diabetic kidney disease
Open accessAbstract
Background: African Americans are significantly more likely than non-African Americans to have diabetes, chronic kidney disease, and uncontrolled hypertension, increasing their risk for kidney function decline. Objective: The objective of this study was to compare how African Americans and non-African Americans with diabetes responded to a multifactorial telehealth intervention designed to slow kidney function decline. Research Design: Secondary analysis of a randomized trial. Primary care patients (N=281, 56% African American) were allocated to either: (1) a multifactorial, pharmacist-delivered phone-based telehealth intervention focused on behavioral and medication management of diabetic kidney disease; or (2) an education control. Measures: The primary study outcome was change in estimated glomerular filtration rate (eGFR). Linear mixed models were used to explore the moderating effect of race on the relationship between study arm and eGFR decline over time; the mean annual rate of eGFR decline was estimated by race and study arm. Results: Findings demonstrated a differential intervention effect on kidney function over time by race (P interaction=0.005). Among African Americans, the intervention arm had significantly greater preservation of eGFR over time than the control arm (difference in the annual rate of eGFR decline=1.5 mL/min/1.73 m 2; 95% confidence interval: 0.04, 3.02). For non-African Americans, the intervention arm had a faster decline in eGFR over time than the control arm (difference in the annual rate of eGFR decline=−1.7 mL/min/1.73 m 2; 95% confidence interval: −3.3, −0.02). Conclusion: A multifactorial, pharmacist-delivered telehealth intervention for diabetic kidney disease may be more effective for slowing eGFR decline among African Americans than non-African Americans.
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Interventions that target social disparities have been shown to reduce the burden caused by social determinants of health.
“Various interventions with specific strategies targeting the underlying disparities resulting from social factors have been shown to be effective in reducing the burden posed by SDOH.1669,1670”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [1669]
The Discussion says the STOP-DKD intervention may attenuate some racial disparities in diabetic kidney disease by addressing barriers related to access, health behaviors, and medication management. But it says the intervention was not designed specifically to address racial disparities, and its findings are tentative; it does not establish that interventions targeting social disparities generally reduce the burden of social determinants of health. Page numbers were not supplied. (LLM, conf=0.86)
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- Authors
- Kobe, E. A., Diamantidis, C. J., Bosworth, H. B., Davenport, C. A., Oakes, M., Alexopoulos, A.-S., Pendergast, J., Patel, U. D., & Crowley, M. J.
- Affiliations
- Duke University (US)
- Department of Medicine, Division of General Internal Medicine
- Corresponding author
- Kobe, Elizabeth A.
- Davenport, Clemontina A.
- Pendergast, Jane
- ORCID
- Venue
- Medical Care
- Published
- 2020-08-21
- Volume
- 58
- Issue
- 11
- Pages
- 968-973
- ISSN
- 0025-7079 (ISSN-L)
- PMC
- PMC7572637
- OpenAlex
- W3081391529
- Cited by
- 15
- References
- 39
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 7 · 2023: 1 · 2022: 3 · 2021: 1
- FWCI
- 0.78
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Medical Care (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- U.S. Department of Veterans Affairs (CDA 13-261, IK6 HX003161)
- National Institutes of Health (UL1TR002553, UL1TR001117, TL1TR002555)
- National Institute of Diabetes and Digestive and Kidney Diseases (P30DK096493, R01DK093938, K23DK099385, R34DK102166, T32DK007012)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Telemedicine and Telehealth Implementation
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- diabetic nephropathy, telehealth intervention, racial disparities, African Americans, estimated glomerular filtration rate decline, medication management, behavioral interventions, primary care, diabetes mellitus
- MeSH terms
- Adolescent, Adult, Aged, Black or African American, Diabetes Mellitus, Type 2, Diabetic Nephropathies, Female, Glomerular Filtration Rate, Humans, Male, Middle Aged, Patient Education as Topic, Pharmacists, Socioeconomic Factors, Telephone, Health Behavior, Telemedicine, Disease Management, White People, Racial Groups, Medication Adherence, Young Adult
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