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  • 1
    Online Resource
    Online Resource
    582-P: Process Evaluation of Dulce Digital–Me: An Adaptive mHealth Intervention for Underserved Hispanics with Diabetes
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: Diabetes self-management education and support improves clinical outcomes in populations disproportionately impacted by type 2 diabetes, including ethnic/racial minorities and individuals of low socioeconomic status. Mobile health (mHealth) interventions have been shown to reduce barriers to accessing these services. The Dulce Digital-Me study sought to integrate adaptive mHealth technologies into diabetes management to enhance self-management support and reduce inequities. This process evaluation uses the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework. The study was effective in reaching a sample that was representative of the intended population, with no differences in baseline clinical characteristics (HbA1c, systolic blood pressure, or LDL cholesterol) between eligible participants who did not (N=261) versus did (N=310) enroll in the study (ps & gt;0.15) . A key informant interview revealed that the medical assistant health coach (MA) found the adoption of the study to be successful in positively impacting patients’ diabetes self-management. Participants across study arms had no significant differences in delivery of mHealth content (ps & gt;0.07) , demonstrating that the intervention was implemented with fidelity. Participants who received Dulce Digital-Me with additional support from an MA were most engaged in responses to ecological momentary assessment prompts (p & lt;0.02) , suggesting utility and acceptability of integrating medical assistants with mHealth interventions. Perceptions of implementation among study participants were positive—with 93% of all participants reporting that the intervention was helpful in managing their diabetes—and were consistent across study arms (p=0.7) . Further studies are warranted to evaluate the efficacy and maintenance of the study following the RE-AIM model to determine whether this intervention warrants expansion to additional settings and patient populations. Disclosure S.R.Spierling bagsic: None. E.Farcas: None. J.G.Godino: None. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. L.Gallo: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. K.L.Savin: None. E.Soriano: None. E.N.San diego: None. N.Orendain: None. T.Clark: None. H.Sandoval: None. M.Chichmarenko: None. P.Perez-ramirez: None. Funding National Institutes of Health, NIDDK: (R01DK112322) National Institutes of Health, NCATS: (UL1TR002550 & KL2TR002552)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-582-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 2
    Online Resource
    Online Resource
    36-LB: Dulce Digital-Me—A Randomized Comparative Effectiveness Trial of Static vs. Adaptive Digital Interventions for Hispanic Adults with Diabetes
    American Diabetes Association ; 2023
    In:  Diabetes Vol. 72, No. Supplement_1 ( 2023-06-20)
    Details
    In: Diabetes, American Diabetes Association, Vol. 72, No. Supplement_1 ( 2023-06-20)
    Abstract: We compared the effectiveness of Dulce Digital (DD), a diabetes education text messaging program, versus Dulce Digital-Me (DD-Me), which included DD text messaging plus algorithm-driven, personalized goal-setting and feedback, in improving diabetes outcomes in Hispanic adults with type 2 diabetes (T2D). In this open-label comparative effectiveness trial, Hispanic adults with T2D were randomized (1:1:1) to receive DD, or the more personalized DD-Me approach delivered via automated, algorithm-driven text messaging (DD-Me_Auto) or telephonic communication from a health coach (DD-Me_Tel) across 6-months as part of existing primary care. Changes in clinical (HbA1c—primary) and patient reported outcomes were examined over 12 months. We enrolled N=310 Hispanic participants (69.7% female; M=52.1±10.2 years; 93.2% Spanish preferred; HbA1c M= 9.3±1.6 %) to receive DD (n=107), DD-Me_Auto (n=106) or DD-Me_Tel (n=97). Mixed models revealed no difference between DD and DD-Me (combined Auto+Tel) in rate of HbA1c change across 6- or 12-months, ps & gt;0.05. All groups showed clinically and statistically significant improvements in HbA1c across 6-months [DD ∆ = -0.17% per month post baseline (95% CI -0.22,-0.10); DD-Me_Auto ∆= -0.20% (95% CI -0.26,-0.14); DD-Me_Tel ∆ = -0.15% (95% CI -0.20,-0.10), ps & lt;.001]. Effect sizes were slightly attenuated, but remained statistically significant at 12-months (∆ HbA1c= -0.08% to -0.05% per month; ps & lt; 0.001). Self-management behaviors and diabetes distress improved across 12-months in all groups. DD-Me (combined) showed greater improvement in medication adherence versus DD over time (Bint=-0.20, 95% CI -0.33,-0.01, p & lt; 0.01). Two low-cost digital interventions for Hispanic adults with low income and T2D had similar and clinically significant effects on HbA1c across 12 months. Simple digital approaches can be integrated within primary care-based chronic care models to reduce diabetes disparities. Disclosure A. Philis-tsimikas: Advisory Panel; Dexcom, Inc., Novo Nordisk A/S, Sanofi, Other Relationship; Medtronic, Research Support; Novo Nordisk A/S, Lilly, Viking Therapeutics, NIH - National Institutes of Health. K. L. Savin: None. J. A. Jones: None. M. Chichmarenko: None. H. Sandoval: None. L. Gallo: None. A. L. Fortmann: Employee; Dexcom, Inc. T. Clark: None. S. R. Spierling bagsic: None. E. Farcas: None. S. Roesch: None. J. H. Schultz: None. T. P. Gilmer: None. J. G. Godino: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK1123221UL1, TR002550)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db23-36-LB
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2023
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  • 3
    Online Resource
    Online Resource
    568-P: Predictors of Engagement and Adherence in a Text Messaging Diabetes Intervention for Hispanics
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: Mobile health delivery of diabetes self-management education and support (DSME/S) can reduce barriers among racial/ethnic minority populations (e.g., Hispanics) , but little is known about how participant characteristics shape adherence and engagement with mHealth interventions. The current study examined this using data from Dulce Digital-Me, a randomized trial that tested an adaptive mHealth DSME/S intervention among 3Hispanic adults with poorly managed type 2 diabetes from a Federally Qualified Health Center in San Diego, CA. In addition to core educational content, participants in three intervention arms received text messages with ecological momentary assessment (EMA) of health behaviors and prompts to check their blood glucose (BG) over 24 weeks. Linear regression models examined associations of age, sex, diabetes duration, health literacy (Single Item Literacy Scale) , and diabetes distress (Diabetes Distress Scale-17) at baseline with the percentage of EMA and BG checks completed, controlling for study arm. Average participant age was 52.6 years ± 11.5; 70% were female. Younger age (B=-.88) , longer diabetes duration (B=.51) , lower health literacy (B=-4.7) , and lower diabetes distress (B=-6.7) predicted significantly higher EMA completion, while only lower distress (B=-4.5) predicted higher BG check completion (all ps & lt;.05) . Follow-up analyses revealed that those with moderate distress tended to have higher completion rates than those with low or high diabetes distress. Overall, these results were in line with prior research in predominantly non-Hispanic samples, with the exception of health literacy, where we typically see a positive association with mHealth engagement. This finding may reflect that our intervention content was written for populations of lower literacy levels. Future qualitative research should expand on these findings to explore who adheres to and engages most with mHealth DSME/S. Disclosure T.Clark: None. A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. K.L.Savin: None. H.Sandoval: None. S.R.Spierling bagsic: None. L.Gallo: None. Funding National Institutes of Health (NCT03130699)
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-568-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
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  • 4
    Online Resource
    Online Resource
    493-P: Medical Assistant Health Coaching for Type 2 Diabetes in Primary Care: A Pragmatic, Cluster-Randomized Controlled Trial
    American Diabetes Association ; 2022
    In:  Diabetes Vol. 71, No. Supplement_1 ( 2022-06-01)
    Details
    In: Diabetes, American Diabetes Association, Vol. 71, No. Supplement_1 ( 2022-06-01)
    Abstract: While good cardiometabolic control can reduce complications in type 2 diabetes (T2D) , many individuals do not achieve clinical targets. This real-world trial compared medical assistant health coaching (MAC) to usual care (UC) in improving outcomes among adults with T2D and ≥ 1 of the following in the past 90 days: HbA1c ≥ 8%, LDL ≥ 100 mg/dL, SBP ≥ 140 mm/Hg. This N=600 study was conducted from 2016-2021 at four cluster-randomized clinics within two diverse health systems in Southern CA: a large, private insurance-based system [n = 298, majority non-Hispanic White, English-speaking, mid/upper socioeconomic status (SES) ]; M age = 70.2 ± 12.6] and a Federally-Qualified Health Center (n = 302, majority Hispanic, Spanish-speaking, lower SES; M age = 56.9 ± 12.0) . MAC and UC received diabetes care as usual in primary care, with referral to diabetes education and/or specialists as indicated. MAC also received in-clinic and telephone-based health coaching for up to one year (1-14 sessions; M = 5.2 ± 2.8) . Baseline mean HbA1c = 8.8 ± 2.2%, LDL = 101.8 ± 44.8 mg/dL, and SBP = 137.9 ± 19.4 mm/Hg. From baseline to 12-months, the percentage of individuals meeting quality metrics increased in both groups: HbA1c & lt; 8% (MAC: 74.8 to 79.9%; UC: 64.0 to 80.4%) , LDL & lt; 100 mg/dL (MAC: 75.7 to 84.9%; UC: 72.6 to 82.4%) , SBP & lt; 140 mm/Hg (MAC: 75.0 to 86.9%; UC: 80.2 to 86.4%) . When outcomes were analyzed continuously using multi-level modeling, both MAC and UC demonstrated statistically significant improvements on all clinical outcomes; however, the rate of improvement was largely equivalent across groups (time-by-group ps & gt; .05) . Due to the pragmatic nature of this trial, there was marked variation (by design) in intervention duration and intensity across participants, and in clinical and sociodemographic characteristics of participants across health systems. Additional analyses examining under what conditions and/or for whom the MAC intervention may prove more/less effective will be presented. Disclosure A.L.Fortmann: Consultant; Ascensia Diabetes Care, Employee; Dexcom, Inc. A.Philis-tsimikas: Advisory Panel; Bayer AG, Novo Nordisk, Research Support; Lilly Diabetes, National Institute of Diabetes and Digestive and Kidney Diseases, Novo Nordisk, Viking Therapeutics. T.Clark: None. S.R.Spierling bagsic: None. H.Sandoval: None. K.L.Savin: None. S.Roesch: None. L.Gallo: None. Funding NIH/NIDDK 1R18DK104250
    Type of Medium: Online Resource
    ISSN: 0012-1797
    URL: Article
    DOI: 10.2337/db22-493-P
    Language: English
    Publisher: American Diabetes Association
    Publication Date: 2022
    detail.hit.zdb_id: 1501252-9
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    Online Resource
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