A recent study by UMass Chan Medical School researcher Ben S. Gerber, MD, MPH, and researchers at University of Illinois Chicago, found that hemoglobin A1C, an average blood sugar measure, improved with mobile health support among Black and Hispanic adults with type 2 diabetes, compared to a control group.
A1C in the intervention group improved by a mean of -0.79 percentage points compared with -0.24 percentage points in the waiting list control group over one year.
The study, which appeared in JAMA Network Open, presents an innovative model for community disease management, using mobile health tools with support from clinical pharmacists and community health workers, according to Dr. Gerber, professor of population & quantitative health sciences and medicine and co-principal investigator of the study. Lisa K. Sharp, PhD, from the College of Nursing, UIC, is also a co-principal investigator.
“We think that it’s the best of both worlds, having clinical pharmacists from a medical organization and health workers from the community come together,” said Gerber.
Diabetes affects 37.3 million people in the United States, or 11.3 percent of the population, according to the Centers for Disease Control and Prevention. Common diabetes health complications include heart disease, chronic kidney disease, nerve damage and other problems. It is the eighth leading cause of death and costs an estimated $327 billion each year in medical costs and lost work and wages.
Diabetes rates are highest among American Indian or Alaska natives (14.5 percent), Blacks (12.1 percent) and Hispanics (11.8 percent).
Participants in the study, which was conducted before the COVID-19 pandemic, were enrolled and randomized into two groups from an academic medical center and affiliated federally qualified health centers in Chicago.
Patients in the mobile health intervention group received home visits from a community health coach who would bring an iPad with a data plan and facilitate telehealth visits with a clinical pharmacist. The pharmacist provided medication management, addressed adverse effects and assisted in medication taking.
Patients in the control group received standard care for a year before starting the mobile health intervention. All patients were followed for two years. The control group also had improvement after receiving the mobile health intervention later on.
“There are a lot of studies that show there’s inequity in telehealth use. So, we’re facilitating it with a health coach. All study patients were able to get some of the same benefit of telehealth, without the same requirements of owning and being familiar with doing telehealth,” Gerber said.
Community health coaches also texted or telephoned participants to remind them of appointments or encourage self-management behaviors such as being physically active, eating healthy, checking blood sugar levels and taking medication.
A third mobile health component was a multimedia series of videos, which included other patients sharing their experiences with diabetes and animations to explain aspects of the disease.
“We had videos of patients talking about how important it is to get your eyes checked regularly if you have diabetes,” Gerber said. “In other videos, people have talked about strategies to exercise, like parking their car a little farther away; or sharing about their depression and diabetes.”
Gerber and his colleagues at UMass Chan are conducting a National Institutes of Health-funded study that builds on the mobile health intervention, evaluating continuous glucose monitors worn by people with diabetes to monitor their blood sugar levels at home.