Diabetes Disparities: Texting to Extend Treatment (DD-TXT)
Study Details
Study Description
Brief Summary
One way to help Veterans improve their diabetes control is through the use of technology to help provide information, motivation, and reminders necessary to support diabetes self-management. The study will seek input from diverse groups of Veterans living with diabetes to help develop DD-TXT, a new customizable, interactive texting intervention that allows Veterans to choose what kinds of diabetes self-management support they need, and when. This diabetes support will be provided to Veterans through "Annie", a new VA texting system for self-management support. Patients will be randomized to receive DD-TXT or an education-only texting intervention called DSE that is based on a diabetes skills workbook in order to test the comparative effectiveness of DD-TXT.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
N/A |
Detailed Description
Type 2 Diabetes is a common, complex health condition which can result in many serious and costly health complications if not treated and controlled properly. One in four Veterans are diagnosed with Type 2 Diabetes. Vulnerable Veterans, such as minority, low-income, or rural Veterans, and Veterans with comorbid mental health diagnoses, are disproportionately affected and are less likely to have their diabetes under control. The goal of this study, using a randomized comparative effectiveness design, is to test the comparative effectiveness of an interactive, tailored self-management texting protocol (DD-TXT), versus a traditional education-only intervention (DSE) in a sample of Veterans with uncontrolled diabetes.
The investigators will recruit from Veterans age 18 years and above who are actively receiving care at the study sites (as determined by upcoming scheduled appointment) who have uncontrolled glucose (HbA1c >= 8.0% for at least 50% of the most recent 6 months). Participants who meet these conditions and enroll in the study will be randomized to one of two groups. Those randomized to the intervention group will receive text messages from the DD-TXT protocol for 6 months, and those in the comparison group will receive text messages from DSE, a diabetes skills education-only texting protocol, for 6 months. The primary outcome will be HbA1c percent time in control. Secondary outcomes include self-reported adherence to diabetes self-care recommendations (SCI-R), diabetes self-efficacy, diabetes distress, LDL, and blood pressure control. The investigators hypothesize that DD-TXT will result in better proximal health outcomes and diabetes self-management behaviors vs an education-only protocol (DSE).
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: DD-TXT Participants in this group will be signed up for an interactive, tailored self-management texting protocol (DD-TXT). The DD-TXT protocol will consist of: Core Messaging: Customizable core modules on medication management, blood sugar and blood pressure monitoring, preventive care, problem solving, appointment reminders, administrative messages; and Optional Messaging: A library of patient-selected modules (e.g. nutrition, physical activity, weight management, emotional coping, goal setting) designed to motivate and educate. |
Behavioral: Intervention 1- DD-TXT
Participants in this group will be signed up for an interactive, tailored self-management texting protocol (DD-TXT). The DD-TXT protocol will consist of: Core Messaging: Customizable core modules on medication management, blood sugar and blood pressure monitoring, preventive care, problem solving, appointment reminders, administrative messages; and Optional Messaging: A library of patient-selected modules (e.g. nutrition, physical activity, weight management, emotional coping, goal setting) designed to motivate and educate.
|
| Active Comparator: DSE The comparison condition will be signed up for a one-way education-only protocol called Diabetes Skilled Education-Only (DSE). DSE contains only one-way educational content consisting only of content from the VA educational workbook entitled "Self-Care Skills for the Person with Diabetes", which was created in alignment with VA/DoD diabetes guidelines and is recommended for patients as part of usual care. Everyone in the DSE arm will receive the same daily text messages taken verbatim or almost verbatim from the content of the workbook but shortened to fit the 160-character limit of a text message. There will be no customizable or interactive content for the DSE arm. |
Behavioral: Comparison - DSE
The comparison condition will be signed up for a one-way education-only protocol called Diabetes Skilled Education-Only (DSE). DSE contains only one-way educational content consisting only of content from the VA educational workbook entitled "Self-Care Skills for the Person with Diabetes", which was created in alignment with VA/DoD diabetes guidelines and is recommended for patients as part of usual care. Everyone in the DSE arm will receive the same daily text messages taken verbatim or almost verbatim from workbook content but shortened to fit the 160-character limit of a text message (See Appendix 3 for sample messages from workbook). There will be no customizable or interactive content for the DSE arm.
|
Outcome Measures
Primary Outcome Measures
- HbA1c percent time in control [6 month follow up]
The investigators will examine the changes in HbA1c percent time in control. These data will be calculated using HbA1c measures pulled from the electronic medical record data.
Secondary Outcome Measures
- self-reported adherence to diabetes self-care recommendations (SCI-R) [6 month follow up]
Secondary outcomes include self-reported adherence to diabetes self-care recommendations (SCI-R). These will be collected from the patient via a questionnaire conducted over the phone.
- LDL [6 month follow up]
Secondary outcomes include LDL. These data will be pulled from the electronic medical record data.
- self-reported diabetes self-efficacy [6 month follow up]
Secondary outcomes include self-reported adherence to diabetes self-efficacy. These will be collected from the patient via a questionnaire conducted over the phone.
- self-reported diabetes distress [6 month follow up]
Secondary outcomes include self-reported diabetes distress. These will be collected from the patient via a questionnaire conducted over the phone.
- blood pressure control [6 month follow up]
Secondary outcomes include blood pressure control. These data will be pulled from the electronic medical record data.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
Veterans
-
active VHA patients with type 2 diabetes
-
have had at least 4 VA outpatient encounters in the previous year
-
have a future appointment scheduled, and not be hospitalized or institutionalized or have participated in Aim 1 DD-TXT development
-
must have access to their own or a cohabiting family member's cell phone or smartphone for participation. --must be willing and able to text, not have any visual impairment that would prevent them from reading or replying to text messages, and must be cognitively capable of consent to participate.
-
must also have HbA1c lab data (2+ values) for the 12 months prior to RCT recruitment.
-
must have inadequate glycemic control for at least 50% of the 6 months before enrollment.
Exclusion Criteria:
-Non-Veterans
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | North Florida/South Georgia Veterans Health System, Gainesville, FL | Gainesville | Florida | United States | 32608 |
| 2 | Jesse Brown VA Medical Center, Chicago, IL | Chicago | Illinois | United States | 60612 |
| 3 | VA Bedford HealthCare System, Bedford, MA | Bedford | Massachusetts | United States | 01730 |
Sponsors and Collaborators
- VA Office of Research and Development
Investigators
- Principal Investigator: Stephanie L Shimada, PhD, VA Bedford HealthCare System, Bedford, MA
Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- IIR 17-087