Behavioral and technological interventions targeting glycemic control in a racially/ethnically diverse population: a randomized controlled trial
Open accessAbstract
BACKGROUND: Diabetes self-care by patients has been shown to assist in the reduction of disease severity and associated medical costs. We compared the effectiveness of two different diabetes self-care interventions on glycemic control in a racially/ethnically diverse population. We also explored whether reductions in glycated hemoglobin (HbA1c) will be more marked in minority persons. METHODS: We conducted an open-label randomized controlled trial of 376 patients with type 2 diabetes aged ≥18 years and whose last measured HbA1c was ≥7.5% (≥58 mmol/mol). Participants were randomized to: 1) a Chronic Disease Self-Management Program (CDSMP; n = 101); 2) a diabetes self-care software on a personal digital assistant (PDA; n = 81); 3) a combination of interventions (CDSMP + PDA; n = 99); or 4) usual care (control; n = 95). Enrollment occurred January 2009-June 2011 at seven regional clinics of a university-affiliated multi-specialty group practice. The primary outcome was change in HbA1c from randomization to 12 months. Data were analyzed using a multilevel statistical model. RESULTS: Average baseline HbA1c in the CDSMP, PDA, CDSMP + PDA, and control arms were 9.4%, 9.3%, 9.2%, and 9.2%, respectively. HbA1c reductions at 12 months for the groups averaged 1.1%, 0.7%, 1.1%, and 0.7%, respectively and did not differ significantly from baseline based on the model (P = .771). Besides the participants in the PDA group reporting eating more high-fat foods compared to their counterparts (P < .004), no other significant differences were observed in participants' diabetes self-care activities. Exploratory sub-analysis did not reveal any marked reductions in HbA1c for minority persons but rather modest reductions for all racial/ethnic groups. CONCLUSIONS: Although behavioral and technological interventions can result in some modest improvements in glycemic control, these interventions did not fare significantly better than usual care in achieving glycemic control. More research is needed to understand how these interventions can be most effective in clinical practice. The reduction in HbA1c levels found in our control group that received usual care also suggests that good routine care in an integrated healthcare system can lead to better glycemic control. TRIAL REGISTRATION: Clinicaltrials.gov Identifier: NCT01221090.
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In T2DM, eleven studies reported a decrease of HbA1c within the app intervention groups, yielding a mean difference of -0.42%.
“Eleven of the studies reported a decrease of HbA1c within the app intervention groups, yielding a mean difference of –0.42% [50-52,54-61], but only 1 study reported a significant change of –1.1% (P<.001) [56].”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [60]
Three T2DM studies did not find a significant difference between groups.
“while 3 studies did not find a significant difference between groups [52,59,60] and 1 study did not report on differences between groups [61].”
From Effectiveness of Disease-Specific mHealth Apps in Patients With Diabetes Mellitus: Scoping Review (2021) · cites this paper as [60]
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- Authors
- Forjuoh, S. N., Bolin, J. N., Huber Jr, J. C., Vuong, A. M., Adepoju, O. E., Helduser, J. W., Begaye, D. S., Robertson, A., Moudouni, D. M., Bonner, T. J., McLeroy, K. R., & Ory, M. G.
- Affiliations
- Texas A&M Health Science Center (US)
- Texas A&M University (US)
- Corresponding author
- Forjuoh, Samuel N
- ORCID
- Venue
- BMC Public Health
- Published
- 2014-01-23
- Volume
- 14
- Issue
- 1
- Pages
- 71-71
- ISSN
- 1471-2458 (ISSN-L)
- PMC
- PMC3909304
- OpenAlex
- W1997725190
- Cited by
- 36
- References
- 48
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 1 · 2022: 2 · 2021: 4 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 6 · 2016: 3 · 2015: 3 · 2014: 3
- FWCI
- 4.02
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Public Health (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- OakTrust (Texas A&M University Libraries) (submittedVersion)
- Funders
- National Institutes of Health (5p20md002295-02)
- National Institute on Minority Health and Health Disparities (1P20MD002295)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, glycemic control, HbA1c, Chronic Disease Self-Management Program, personal digital assistants, behavioral interventions, technology-based interventions, racial and ethnic minorities, usual care, integrated health system, diabetes self-management education, dietary habits
- MeSH terms
- Adolescent, Adult, Aged, Diabetes Mellitus, Type 2, Ethnicity, Female, Glycated Hemoglobin, Humans, Male, Middle Aged, Self Care, Software, Treatment Outcome, Computers, Handheld, Racial Groups, Young Adult
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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