Bridge to Health/Puente a la Salud: a pilot randomized trial to address diabetes self-management and social needs among high-risk patients

Abstract

Social needs contribute to persistent diabetes disparities; thus, it is imperative to address social needs to optimize diabetes management. The purpose of this study was to determine determine the feasibility and acceptability of health system-based social care versus social care + behavioral intervention to address social needs and improve diabetes self-management among patients with type 2 diabetes. Black/African American, Hispanic/Latino, and low-income White patients with recent hemoglobin A1C (A1C) ≥ 8%, and ≥1 social need were recruited from an integrated health system. Patients were randomized to one-of-two 6-month interventions: (a) navigation to resources (NAV) facilitated by a Patient Navigator; or (b) NAV + evidence-based nine-session diabetes self-management support (DSMS) program facilitated by a community health worker (CHW). A1C was extracted from the electronic health record. We successfully recruited 110 eligible patients (54 NAV; 56 NAV + DSMS). During the trial, 78% NAV and 80% NAV + DSMS participants successfully connected to a navigator; 84% NAV + DSMS connected to a CHW. At 6-month follow-up, 33% of NAV and 34% of NAV + DSMS participants had an A1C < 8%. Mean reduction in A1C was clinically significant in NAV (−0.65%) and NAV + DSMS (−0.72%). By follow-up, 89% of NAV and 87% of NAV + DSMS were successfully connected to resources to address at least one need. Findings suggest that it is feasible to implement a health system-based social care intervention, separately or in combination, with a behavioral intervention to improve diabetes management among a high-risk, socially complex patient population. A larger, pragmatic trial is needed to test the comparative effectiveness of each approach on diabetes-related outcomes.

eDECIDE a web-based problem-solving interventions for diabetes self-management: Protocol for a pilot clinical trial

“…The higher disease burden and lower adherence to self-management among African Americans with diabetes calls for innovative approaches to improve self-management behaviors [ 15 ]. Problem solving is a reliable tool for the behavior change necessary to improve self-management [ 20 ], The problem-solving approach has utility because it is a technique delivered to help patients identify their problems, learn skills to solve them, and implement solutions for particular challenges or obstacles in their disease self-management [ 28 , 35 , 36 ]. Therefore, this new modality of DECIDE known as eDECIDE has promise.…”

“…Less is known about efficacious approaches for delivering problem-solving skills training with new technology in a more self-directed format. Delivery modalities including self-study materials, in-person group sessions, and in-person individual sessions have been tested with DECIDE and found to increase self-management knowledge, problem-solving skills, and behaviors [ 20 ] Home and phone visit modalities have also been utilized for delivery of DECIDE within health system care models [ 20 ]. The proposed work will test the efficacy of translating the proven DECIDE diabetes problem-solving program into a web-based format.…”