TY - JOUR
T1 - The Partnership to Improve Diabetes Education Trial
T2 - a Cluster Randomized Trial Addressing Health Communication in Diabetes Care
AU - White, Richard O.
AU - Chakkalakal, Rosette James
AU - Wallston, Kenneth A.
AU - Wolff, Kathleen
AU - Gregory, Becky
AU - Davis, Dianne
AU - Schlundt, David
AU - Trochez, Karen M.
AU - Barto, Shari
AU - Harris, Laura A.
AU - Bian, Aihua
AU - Schildcrout, Jonathan S.
AU - Kripalani, Sunil
AU - Rothman, Russell L.
N1 - Publisher Copyright:
© 2020, Society of General Internal Medicine.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - Background: Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings. Objective: The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients. Design: Cluster randomized controlled trial. Patients: Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN. Interventions: A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics). Main Measures: Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care. Key Results: Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (− 0.76 [95% CI, − 1.08 to − 0.44]; P <.001 vs − 0.54 [95% CI, − 0.86 to − 0.21]; P =.001), odds of poor eating (0.53 [95% CI, 0.33–0.83]; P =.01 vs 0.42 [95% CI, 0.26–0.68]; P <.001), treatment satisfaction (3.93 [95% CI, 2.48–6.21]; P <.001 vs 3.04 [95% CI, 1.93–4.77]; P <.001), and self-efficacy (2.97 [95% CI, 1.89–4.67]; P <.001 vs 1.81 [95% CI, 1.1–2.84]; P =.01). No significant difference was observed between study arms in adjusted analyses. Conclusions: Both interventions improved the participant’s A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.
AB - Background: Effective type 2 diabetes care remains a challenge for patients including those receiving primary care in safety net settings. Objective: The Partnership to Improve Diabetes Education (PRIDE) trial team and leaders from a regional department of health evaluated approaches to improve care for vulnerable patients. Design: Cluster randomized controlled trial. Patients: Adults with uncontrolled type 2 diabetes seeking care across 10 unblinded, randomly assigned safety net clinics in Middle TN. Interventions: A literacy-sensitive, provider-focused, health communication intervention (PRIDE; 5 clinics) vs. standard diabetes education (5 clinics). Main Measures: Participant-level primary outcome was glycemic control [A1c] at 12 months. Secondary outcomes included select health behaviors and psychosocial aspects of care at 12 and 24 months. Adjusted mixed effects regression models were used to examine the comparative effectiveness of each approach to care. Key Results: Of 410 patients enrolled, 364 (89%) were included in analyses. Median age was 51 years; Black and Hispanic patients represented 18% and 25%; 96% were uninsured, and 82% had low annual income level (< $20,000); adequate health literacy was seen in 83%, but numeracy deficits were common. At 12 months, significant within-group treatment effects occurred from baseline for both PRIDE and control sites: adjusted A1c (− 0.76 [95% CI, − 1.08 to − 0.44]; P <.001 vs − 0.54 [95% CI, − 0.86 to − 0.21]; P =.001), odds of poor eating (0.53 [95% CI, 0.33–0.83]; P =.01 vs 0.42 [95% CI, 0.26–0.68]; P <.001), treatment satisfaction (3.93 [95% CI, 2.48–6.21]; P <.001 vs 3.04 [95% CI, 1.93–4.77]; P <.001), and self-efficacy (2.97 [95% CI, 1.89–4.67]; P <.001 vs 1.81 [95% CI, 1.1–2.84]; P =.01). No significant difference was observed between study arms in adjusted analyses. Conclusions: Both interventions improved the participant’s A1c and behavioral outcomes. PRIDE was not more effective than standard education. Further research may elucidate the added value of a focused health communication program in this setting.
KW - diabetes care
KW - disparities
KW - health communication
KW - public health
KW - vulnerable populations
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U2 - 10.1007/s11606-019-05617-z
DO - 10.1007/s11606-019-05617-z
M3 - Article
C2 - 31919724
AN - SCOPUS:85077694481
SN - 0884-8734
VL - 35
SP - 1052
EP - 1059
JO - Journal of general internal medicine
JF - Journal of general internal medicine
IS - 4
ER -